Fire Protection Contractor Application (Printable)

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 *

Company Name *

DBA *

Responsible Person *

First

Last

Responsible Person Certification

Business Address *

Address Line 1

Address Line 2

City

State

Zip Code

Same as Business Address

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Phone *

Cell Phone

Email *

Website / URL

Part Two

Business Certification

License Class *

License Number *

Exp. Date *

License Class

License Number

Exp. Date

License Class

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

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.