LUKE AIR FORCE BASE_REDACTED.PDF

MARICOPA COUNTY BOARD OF SUPERVISORS
301 West Jefferson Street, 10th Floor, Phoenix, Arizona 85003
APPLICATION FOR FIREWORKS DISPLAY
Arizona Revised Statutes § 36-1603 requires every display shall be handled by a competent operator, and shall
be of a character and located, discharged and fired so that it will not be hazardous to property or endanger any
person. Before a permit is granted, the operator, location and handling of the display shall be approved by the
sheriff of the county. After a permit is granted, the sale, possession, use and distribution of fireworks for the
display shall be lawful for that purpose only. Permits are not transferable or assignable.
Further, A.R.S. § 36-1604 requires that the governing body shall require each applicant to provide a satisfactory
bond of not less than $500, or a copy of the certificate of liability insurance in a principal amount usually not less
than $1 million, conditioned upon payment of all damages which may be caused to persons or property by
reason of the display.
Complete the following application and submit to the Clerk of the Board of Supervisors, 301 W. Jefferson Street,
10" Floor, Phoenix, 85003 (602-506-3766) at least 30 days prior to the event date.
All applications must have the following documentation attached:
1. Proof of appropriate bond or insurance payable to Maricopa County.
2. Map of display area.
3. List of fireworks to be discharged. The Director of Display for the fireworks company is expected to be
licensed and/or trained by the City of Phoenix or have other verification of expertise.
4. Verification from local fire department that they were notified of event, date, location and time.
EVENT INFORMATION
Name/Organization: Luke Air Force Base
Name of Event: Independence Celebration Fireworks display
Event Address: Empty Field at 7510 N Dysart Rd - Glendale AZ
Date and Time of Event: July 1, 2021 @ 9pm
DISPLAY DIRECTOR (permit will be issued to the following)
Name: Ron Fuchs Phone: coXOXl
Business: — Fireworks Productions of Arizona Fax:
Address: Pe Email: a
SUBMIT APPLICATION AND REQUIRED DOCUMENTATION TO:
Maricopa County Clerk of the Board of Supervisors Email: ClerkBoard@mail.maricopa.gov
301 W. Jefferson Street, 10" Floor Fax: 602-506-6402
Phoenix, Arizona 85003
For questions, please call the Clerk of the Board of Supervisors at: 602-506-3766.

FIREWORKS DISPLAY SITE MAP
Indicate the following:
North direction Fire department access
oe
Distance from firing area to impact/fallout area Hydrants
PONS
Spectator location Distance to structures
Storage area a Overhead lines
(North)

FOR DEPARMENT USE ONLY:
SHERIFF’S OFFICE RECOMMENDATION
The State Fire Marshal or local fire chief has reviewed the site and fireworks described by the applicant and
found them to be satisfactory.
Sheriff's Office Signature Date
PERMIT FOR FIREWORKS DISPLAY
The above application having been filed pursuant to A.R.S. § 36-1603, together with other proper
documentation; permission is granted to the above-named applicant to conduct a fireworks display on the dates
set forth in the application. IN THE EVENT OF POSTPONEMENT OF SAID SHOW, the display will be given
not later than one (1) week from the date specified above.
Approved by the Maricopa County Board of Supervisors:
DATED this day of 20
Clerk of the Board, authorized signature

Location
Off-Site
Site
info@fireworksaz.com
Display
Access
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Helen ey Rie secured Size:
Te 480-948-0090
Shell
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210 Pressurized Extinguishers Maximum
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EXHIBIT A
LUKE AIR FORCE BASE
Thursday, July 1, 2021
20 Minute Display
(3 second pace)
Total Aerial Shells 596
Opening:
Your show begins with an impressive series of brilliantly-colored shells and powerful
booms with flashing light to excite and thrill the audience.
Your Opening: 14 - 3” shells, 4 - 5” shells, 2 — 6” shells w/ 7 - 3” Titanium Salutes
Aerial Display:
A large assortment of brilliantly-colored shells, including Chrysanthemums, Waves, Crowns,
Peonies, Strobes, Brocade Crowns, Diadems, and Crosseties in gorgeous Reds, Yellows,
Blues, Greens, Silvers, and Golds.
Your Aerial Display will contain a total of 468 Aerial shells.
3” - 108 Chinese Fancy’s & Specials
4” - 180 Chinese Fancy’s & Specials
4” - 36 Designer Specials
5”- 72 Chinese Fancy’s & Specials
5”- 18 Pattern Specialty Shells
6”- 36 Chinese Fancy’s & Specials
6”- 18 Pattern Specialty Shells
Grand Finale:
Your celebration will close in spectacular excitement as multiple styles of brilliantly-colored
shells, rocket skyward growing and glowing in breath-taking Blues, Golds, Greens, Silvers,
Yellows, Purples and Red.
Your Grande Finale consists of 101 Aerial shells:
Your Grande Finale: 56 - 3” shells, 32 - 4” shells, 6 — 6” shells w/ 7 - 3” Titanium Salutes
Designed for | uke Air Force Pase by: Fireworks Productions of Arizona

—=
®
DATE (MMIDDIYYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE
5/3/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER RONLACT Janet Nau
11225 SE 6th St., Suite 110 {Are Exi); (AIC, No}:
No
Bellevue WA 98004 | ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: T.H.E. Insurance Company 12866
16021)
EPA, LTD euRERB: Travelers Property Casualty Co of America 25674
Fireworks Productions of Arizona INSURER ¢ :
17034 S. 54th Street INSURER D :
Chandler AZ 85226
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1626176780 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL/SUBR POLICY EFF | POLICY EXP
LTR TYPE OF INSURANCE INSR| WvD POLICY NUMBER (MM/DDIVYYY) | (MM/DDIYYYY) LIMITS
A | GENERAL LIABILITY Y | y | CPP0i0586204 10/9/2020 10/9/2021 | EACH OCCURRENCE $ 1,000,000
X DAMAGE TO RENTED
| COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) _| $ 500,000
CLAIMS-MADE OCCUR MED EXP (Any one person) $ N/A
X | $2000 Deductible PERSONAL & ADVINJURY | $ 1,000,000
GENERAL AGGREGATE $ 10,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 2,000,000
* [pour aa :
sect
A | AUTOMOBILE LIABILITY CPP010586204 10/9/2020 10/9/2021 COMBINED BINED Si SINGLE LIMIT imi
faraccidents $1,000,000
ANY AUTO BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) | $
X X | NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (Per accident)
$
A UMBRELLA LIAB X | occur ELP001232904 40/9/2020 10/9/2021 | EACH OCCURRENCE $9,000,000
X | EXCESS LIAB CLAIMS-MADE AGGREGATE $9,000,000
DED | | RETENTION $ $ GL Only
B | WORKERS COMPENSATION 4K643590 40/9/2020 40/9/2021 |X | WC STATU- OTH-
AND EMPLOYERS’ LIABILITY TORY LIMITS ER
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? [] NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE] $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000
A_ | Auto Excess Liability - Occurrenc ELP001291102 10/9/2020 40/9/2021 Each Occurrence 4,000,000
Aggregate 4,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
The following are included as Additional Insured on General Liability as their interest may appear as respects operations performed by or on behalf of the
Named Insured, as required by written contract:
Date of Display; July 1, 2021
Location: Dysart and Northern Ave., Glendale, AZ
Additional Insured(s): NAFI and the United States; Luke Air Force Base; Community Center; State of Arizona; Maricopa County Board of Supervisors; City of
Glendale; Glendale Fire Department; Rural-Metro Fire Department; Miedema Produce, Inc. Waiver of Subrogation applies per form attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
56 Force Support Squadron
MWR NAFi
7383 N Litchfield Rd Ste 3090 AUTHORIZED REPRESENTATIVE
Luke AFB AZ 85309 Pe
seth ertonn an
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© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

DEPARTMENT OF THE AIR FORCE
AIR EDUCATION AND TRAINING COMMAND
28 Apr 2021
MEMORANDUM FOR KENDON VICTOR (Fireworks Production of Arizona)
FROM: 56 CES/CEF
SUBJECT: Fire Department Support for Fireworks Display
1. Luke AFB Fire and Emergency Services (FES) Flight will provide Fire Suppression/Medical
Support for the upcoming fireworks display at Dysart and Northern Avenue on | July 2021.
2. Luke FES will assume all responsibility for the safety of the fireworks production personnel,
residences, and spectators at the event. Luke FES will provide one Battalion Chief (Command
and Control) and one fire suppression apparatus (Structural Pumper) consisting of 5-6 personnel.
If required, additional fire department resources will be staged at Fire Station #1. In addition,
Rural Metro Fire Department will provide resources at the request of Luke AFB Fire Department
as needed.
3. If you have any questions please contact Mr. Kevin Cotton at (623) 856-7425.
COTTON.KEVIN.L.1124 Disitally signed by
COTTON.KEVIN.L.1124373642
373642 Date: 2021.04.30 07:15:33 -07'00'
KEVIN L. COTTON, GS-12, DAF
Deputy Fire Chief, 56 CES/CEF

FIRE DEPARTMENT
13 May 2021
To: Kendon Victor Fireworks Production of Arizona
From: Ryan Wick, Deputy Fire Marshal, RMFD
Sub: Fireworks for Luke Air Force Base
Thank you for submitting the required paperwork for the upcoming fireworks display at Dysart and
Northern Avenue, Glendale, AZ on July 1st, 2021. Luke AFB and Fireworks Production have written
permission from the landowner to conduct this display on said date and time.
Rural Metro Fire is not the “Authority Having Jurisdiction” for this area therefore we would not be the
issuing agency for a fireworks permit. Rural Metro Fire Department acknowledges that personnel from
Luke AFB will be obtaining all necessary paperwork and permits for this show and will also have the
appropriate emergency vehicles on site to provide fire protection and medical services if needed. We do
recommend contacting ADOT, Maricopa County Emergency Management and the Office of the State Fire
Marshal prior to this production taking place.
Rural Metro Fire Department acknowledges that Luke AFB personnel will assume all responsibility for the
safety of the fireworks production personnel, residences, and spectators at the event. Rural Metro Fire
Department acknowledges they will not have apparatus or personnel at the event but will provide such
resources at the request of Luke AFB Fire Department as needed. If there are any questions please feel
free to contact me directly.
Ryan Wick
Deputy Fire Marshal
Rural Metro Fire Department
Ryan.wick@gmr.net
602-677-4421
8465 N Pima Road | Scottsdale, AZ 85258 | 800.645.9413 | RuralMetroFire.com

( City of Phoenix
FIRE PERMIT
Fire Department
150 South 12th Street
To find out about Phoenix construction code adoption
news and to research your permits or projects, please Phoenix, Arizona 85034 POST THIS PERMIT ON JOB SITE
visit hitp:/Avww.phoenix.gov/PDD General Information (602)262-6771
Permit # | F702 1804205 | Issue Date 07-NOV-2018 Expires 16-DEC-2021
Permit Description RON J. FUCHS, COFF OUTDOOR/THEATRICAL FW
Project 18-3604
Address NOT FOUND Zoning
Description/Scope of Work: FIREWORKS/PYRO NEW CERT OF FITNESS CARD
PERMIT TO CONDUCT FIREWORKS SHOWS IN THE CITY OF PHOENIX:
OUTDOOR & THEATRICAL FIREWORKS CARD HOLDER:
Ron J. Fuchs
EMPLOYED BY:
Arizona
THIS PERMIT IS NOT TRANSFERABLE
Valuation: $0
Owner Information
Certificate ertificate o of
Name COFC
Occupancy Type:
Address
Contractor Information
Permit Issued By CMCC Entered By CMCC
Instructions and Comments
Inspections Required: FIRE-GEN
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