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Fire Prevention Contractor Application (PRINT ONLY)
Please PRINT this form and submit it to Sun City Fire Administration Building, 18602 N. 99th Ave. Sun City, AZ 85373. Please include all necessary Certifications and Payment. ($75 Application fee)
Part One
Company Information
*
Corporation
LLC
Sole Proprietor
LLP
General Partnership
Company Name
*
DBA
*
Responsible Person
*
First
Last
Responsible Person Certification
Business Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Same as Business Address
Mailing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Phone
*
Cell Phone
Email
*
Website / URL
Part Two
Business Certification
License Class
*
A
A-12
A-17
C-4
CR-11
C-11
C-16
CR-16
C-37
CR-37
C-39
CR-39
C-67
CR-67
C-74
C-77
CR-80
Central Station UL
Central Station FM
GROL
IKECA
KA
R-11
R-16
R-37
OTHER
License Number
*
Exp. Date
*
License Class
A
A-12
A-17
C-4
CR-11
C-11
C-16
CR-16
C-37
CR-37
C-39
CR-39
C-67
CR-67
C-74
C-77
CR-80
Central Station UL
Central Station FM
GROL
IKECA
KA
R-11
R-16
R-37
OTHER
License Number
Exp. Date
License Class
A
A-12
A-17
C-4
CR-11
C-11
C-16
CR-16
C-37
CR-37
C-39
CR-39
C-67
CR-67
C-74
C-77
CR-80
Central Station UL
Central Station FM
GROL
IKECA
KA
R-11
R-16
R-37
OTHER
License Number
Exp. Date
Part Three
Services and Systems
Alternative Fire Suppression System (i.e. Foam, Wet & Dry Chem, Halon, CO2, etc.
Yes
No
Alternative Fire Suppression Services Provided
Installation
Inspections
Service/Repair
Emergency Responder Radio Coverage System/BDA
Yes
No
Emergency Responder Radio Coverage/BDA Services Provided
Installation
Inspections
Service/Repair
Site Surveys
Carbon Dioxide (CO2) System Detection and Monitoring
Yes
No
Carbon Dioxide (CO2) Services Provided
Installation
Service
Fire Alarm Monitoring – Central Station
Yes
No
Central Station Certification Number
Fire Alarm Systems
Yes
No
Fire Alarm Services Provided
Installation
Service
Fire Sprinklers – Commercial
Yes
No
Fire Sprinklers – Commercial Services Provided
Installation
Service
Fire Sprinklers – Residential
Yes
No
Fire Sprinklers – Residential Services Provided
Installation
Service
Fire Extinguishers
Yes
No
Fire Extinguisher Services Provided
Installation
Service
Underground Fire Lines
Yes
No
Underground Fire Lines Services Provided
Installation & Retrofit
Decomissioning
Interior Lining
Tightness Testing
Cathodic Protection Testing
ADEQ Certification Number
Does your organization perform work in buildings owned and/or operated by Sun City Fire Department or Youngtown?
Yes
No
Part Four
I (we) hereby make application for a permit to provide the products and/services described above, pursuant to The International Fire and Building Code, (IFC and IBC). I (we) agree to service, install and/or repair fire protection equipment in accordance with the applicable provisions of the International Fire Code and the appropriate standards of the National Fire Protection Association. I (we) further understand that issuance of approval does not constitute recommendation of my (our) company by the Sun City Fire and Medical Department and I (we) agree not to use such permit in said manner.
Name
*
First
Last
Title
*
Date / Time
*
Please attach all necessary certifications and license(s)
Copies of Contractor’s License*
FCC Licenses (GROL) and Training Certificates
Central Station Certification (UL or FM)
ADEQ UST Service Provider Certification
Tax and License Certificate (Current year)*
Current Product and Liability Insurance* (naming SCFD as a Certificate Holder)
Written Statement (see below)*
Application Fee*
* Required
Written Statement
Provide a written statement, on company letterhead and signed by a responsible party of the company, that states the following (cut and paste); [INSERT COMPANY NAME], agrees that persons involved in the design, installation, modification, or inspection of any Fire Protection Equipment within the Sun City Fire District shall be certified for the stated discipline or receive direct supervision by a certified individual.
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