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: June 30, 2022 @ 9pm

DISPLAY DIRECTOR (permit will be issued to the following)

Name: Cody Welty Phone:

Business: _ Fireworks Productions of Arizona Fax:

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.

Indicate the following:

Pon >

North direction

FIREWORKS DISPLAY SITE MAP

Distance from firing area to impact/fallout area

Spectator location
Storage area

bee eI Ga

Fire department access
Hydrants

Distance to structures
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. INTHE 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

Legend
Cc] Desert Leasing LLC Property

| Luke AFB Land

™ ACCess

Fireworks Launch Area

LUKE AIR FORCE BASE #S&
DESERT LEASING LLC GLENDALE, ARIZONA SS

LUKE AFB
4TH OF JULY FIREWORKS 500 1,000 Feet
RIGHT OF ENTRY MAP

EXHIBIT A
LUKE AIR FORCE BASE

Thursday, June 30, 2022

15 - 20 Minute Display
(3 second pace)

Total Aerial Shells 499

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: 4 - 5” shells, 2 — 6” shells w/ 21 - 3” Titanium Salutes

Aerial Display:

A large assortment of brilliantly-colored shells, including Chrysanthemums, Waves, Crowns,
Peonies, Strobes, Brocade Crowns, Diadems, and Crossettes in gorgeous Reds, Yellows,
Blues, Greens, Silvers, and Golds.

Your Aerial Display will contain a total of 378 Aerial shells.

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 94 Aerial shells:
Your Grande Finale 35 - 3” shells, 32 - 4” shells, 6 - 6” shells w/ 21 - 3” Titanium Salutes

Designed: for [ uke Air Force Base by: Fireworks Productions of, “Arizona

DATE (MM/DDIYYYY)

——-_ °
ACORD CERTIFICATE OF LIABILITY INSURANCE = non

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 RRNES | Janet Nau
The Partners Group Ltd PHONE Te |
11225 SE 6th St., Suite 110 (A0G No. Ei ————______—L{AIG, No!
Bellevue WA 98004 ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: Everest Indemnity Insurance Co 10854
FPA LTD 16021) iwsuRER B : Everest Denali Insurance Company _ 16044
Fireworks Productions of Arizona insurer ¢ : AXIS Surplus Lines Insurance Company ___ | 26620
17034 S. 54th Street INSURER D: Travelers Property Casualty Co of America 25674
Chandler AZ 85226 INSURER E:

INSURER F :
COVERAGES CERTIFICATE NUMBER: 1650521801 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| Wvp POLICY NUMBER (MM/DDIYYYY) | (MMIDDIYYYY) LIMITS:
A | GENERAL LIABILITY Y ‘S18ML02344211 10/9/2021 10/9/2022 | EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
X_| COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) __| $500,000
| cLaims.MaDE occuR MED EXP (Any one person) __| $ N/A
PERSONAL & ADV INJURY _| $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 2,000,000
poticy | X | SRO: Loc $
B | AUTOMOBILE LIABILITY S18CA00258211 10/9/2021 torei2022 | COMBINED SINGLELIMIT Te o0 o00
X | any AUTO BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED ,
ace ASE en PROPERTY ORINGE
x PERTY
X | HiRED AUTOS AUTOS (Per accident) bd
$
c UMBRELLALIAB =| X | occur P00100069169701 40/9/2021 10/9/2022 | EACH OCCURRENCE $ 4,000,000
X_| EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000
veo |__| retentIONs $
D | WORKERS COMPENSATION 6R08411 70/9/2021 40/9/2022 |X | WCSTATU- OTH:
AND EMPLOYERS' LIABILITY YIN TORY Ls | ER
ANY PROPRIETOR/PARTNERVEXECUTIVE E.L. EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE| $ 1,000,000
Ifyes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000
A | General Liability & SIBEXO1790211 10/9/2021 10/9/2022 | Each Occurrence 5,000,000
Auto Excess over $4M Aggregate 5,000,000

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: June 30, 2022

Location of Display: 7510 N. Dysart Rd., Glendale, AZ

Additional Insured(s): 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.; Desert Leasing LLC..

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.

Luke Air Force Base - 56 Cons
14100 W. Eagle St.

Luke Air Force Base AZ 85309-1920

AUTHORIZED REPRESENTATIVE
wad

© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD

Cindy Herbel _

From: Kendon Victor

Sent: Monday, May 23, 2022 4:39 PM
To: Cindy Herbel

Subject: FW: Luke AFB-Fireworks

—-- Original Message-----

From: MORENO, KAYLEE D NF-03 USAF AETC 56 FSS/FSWC Poo
Sent: Monday, May 23, 2022 3:05 PM

To: Kendon Victor

Cc: ROMERO, JAELYN 2d Lt USAF AETC 56 FSS/FSW FY

Subject: RE: Luke AFB-Fireworks
Mr. Victor,

We have established that the land and all details from previous years are the same.

The company for the insurance paperwork is still Mia Dima Produce Inc. whom works with Dessert Leasing LLC. We will
have our base fire team in full support of your fire safety needs same as previous years and the fireworks will be
scheduled to launch around 2100-2130. Please let me know if any other questions come up and if you need anything
else from me at all. Thank you again for all of your time today and | look forward to hearing from you again soon.

KayLee Moreno NF-III
Community Commons

56th Force Support Squadron
Luke AFB, Arizona

DSN: 856-7152

Co

RURAL

FIRE DEPARTMENT

24 May 2022

To: Kendon Victor Fireworks Production of Arizona
From: Ryan Wick, Fire Marshal, Rural Metro Fire Department
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 30June2022. 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

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

G

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news and to research your permits or projects, please
visit hitp/Avww.phoenix.gov/PDD

City of Phoenix
Fire Department
150 South 12th Street

Phoenix, Arizona 85034
General Information (602)262-6771

FIRE PERMIT

_ POST THIS PERMIT ON JOB SITE

Permit# | F702 2008438

| Issue Date 19-FEB-2020

Permit Description CODY WELTY - PYROTECHNIC CERT OF FITNESS

Project 20-668

Expires 17-FEB-2023

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 FIREWORKS CARD HOLDER:

EMPLOYED BY:

FIREWORKS PRODUCTIONS OF ARIZONA, LTD.
17034 S. 54th Street

Chandler, AZ 85226

480-948-0090

Valuation: $0

Owner Information

Name
Address

Certificate of

Occupancy Type: COFC

Contractor Information

Instructions and Comments

Inspections Required: FIRE-GEN

Permit Issued By CMCC

Entered By CMCC

|

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