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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDA ITEM NUMBER: +t. C.
Stations of the Cross
St. Andrew Lutheran Church FILE NUMBER:
COMMITTEE AGENDA DATE: January 28, 2019
COUNCIL AGENDA DATE:
STAFF REVIEW: Tom Dabareiner SIGNATURE A oe a
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
ITEM SUMMARY:
St. Andrew Lutheran Church is seeking approval for their annual Stations of the Cross religious event
scheduled for Friday, April 19, 2019 from 12:00 p.m. — 1:00 p.m. with an estimate of 150 attendees.
The Church has requested use of City streets for a procession and Police services for assistance with
traffic control and a rolling street closure.
Members of the Church will gather at the corner of Easton Avenue before the procession begins at 12:00
p.m. The procession will walk East on Main Street, turn North onto Prince Crossing, cross Geneva Road,
and end at the Church.
The Special Event Permit Application, which includes the requests of the City, has been reviewed and
approved by staff from the Police, Public Works, and Community Development Departments as well as
the West Chicago Fire Protection District. The Special Event Permit Application is attached, which
includes the procession route map.
ACTIONS PROPOSED:
Recommend event for approval as proposed, contingent upon submittal and approval of required
insurance documentation.
COMMITTEE RECOMMENDATION:

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City of West Chicago
THIS FORM MUST BE COMPLETED IN FULL & SUBMITTED
90 DAYS PRIOR TO THE EVENT
PERMIT NO.
Special Event Permit Application
The Special Event Application is due to the City of West Chicago a minimum of ninety (90)
days prior to the event if it requires closure of public streets or use of public parking lots.
The 90-day time period allows sufficient time to evaluate the request and provide a
recommendation to the City Council for its consideration.
Note: Prior to review of the Special Events Permit Application, all applicants must
submit the Intent to Meet Insurance Requirements form (page 2).
-———_——
Submittal Checklist
1. Completed and signed Special Event Application |
a Intent to Meet Insurance Requirements
0 Section 1 — General Information
a Section 2 — Narrative
0 Section 3 — Permits
a Section 4 — Site Plan and/or Route Map
0 Section 5 — Task List and Due Dates
a Section 6 — Hold Harmless Agreement
2. Completed and signed applications(s) for other permits(s) (See Section 3)
a Carnival Permit Application - $50 per employee
a Fireworks Permit Application —
$125 (Check made payable to the West Chicago Fire Protection District)
a Building Permit Application (temporary tents — see min. requirements) - $50
a Raffle Registration Application — requires separate application
© Temporary Liquor License Application — requires separate application
a Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979) |
FEI III III II III I IIIA IIA IIIA A TIA IOI IOI OI I II AI IAI INIA AAI IAAI AAAI IANA ONT NAA NOAA ARONA OANA AANA OOO OIA ONO
FOR OFFICE USE ONLY
FEI IIIT III IIIA TTA IIIS TISAI IAS ITS IIIS IAI S AA IASI ISA IA IAAI ISA INI IAI TIA ISI IIIS ISIS IIIS HII IIIT IAT
Received: _\ /\6/\ { Fee Paid: $ Ww 7A
Receipt # NM LEN Check # MY A
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. PW Park Dist.
P ears checks completed by Police Dept. Date N / f
“DuPage Co, Health Department notified Date N / ;
a Certificate of Insurance received and approved Date
Page 1 of &

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** INTENT TO MEET INSURANCE REQUIREMENTS ***
Must be returned prior to application review by City staff
Prior to the issuance of a Special Event Permit, all organizations must
present a certificate of insurance meeting the criteria listed below:
1. Required limits per IRMA are $1mil per occurrence and general aggregate no less than
$2mil for contractors/vendors.
2, *“PLEASE NOTE: Under the box labeled “Description of
operations/locations/vehicles/exclusions added by endorsement/special provisions”, the
following language must appear:
“The City of West Chicago, its officials, agents, employees, and volunteers is/are named
additionally insured. The additional insured is covered as respect to liability arising out of any
work or activities performed on behalf of (company involved) for (event) (date, times (if
applicable), location) No endorsements or additional forms modify or limit coverage provided
to additional insured. Coverage provided to additional insured is primary as it relates to
(event)’.
3. Vendors shall furnish the additional insured endorsement (consult insurance professional;
examples include but are not limited to forms CG 2010 or CG 2026) to support the certificate
of insurance. The endorsement shall also name “The City of West Chicago, its officials,
agents, employees, and volunteers’ as primary and non-contributory.
4. If applicable, vendor shall furnish the City with evidence of Worker's Compensation
coverage with statutory limits.
5. The insurance provider will need to submit the Certificate of Insurance and supporting
endorsement form preferably via email to specialevents@westchicago.org or fax
(630-293-1257) to be considered an original document.
I, Mayen VA2QU0E2 , representing St Kacicew) Lotheran Chucch
(print name of authorized person) (organization)
have contacted the appropriate insurance provider and acknowledge that the above
insurance criteria can be met. | understand that the Special Event Permit Application
will not be reviewed until this document has been signed and returned to the City of
West Chicago.
Nop leg hehe
Waa Ceucis | Stohons af the Crass Y Lig lig
(date of event)
(name of event)
Page 2 of &

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SECTION 1 —- GENERAL INFORMATION
Name of Event: >) toon . Ane Cras
Type of Event:
O Parade /Walk/Run/Bike O Carnivals O Fireworks C Festival
O Other
Location of Event: _ MIQin Street Gack Prince Ceces oa
Date(s) of Event: gfialia Hours of Event: Jaq _ to lem Est. Attendance: 150
Event Website:
Purpose of event: Religsars event
Name of Sponsoring Organization(s): ¢ Ceud CO :
Organization's Legal Status (i.e. NFP, Partnership, Rarporation): NE i
Contact person from sponsoring organization: raey Ebene
Organizer address: |S hi_Fringe Crossing R
City/State/Zip: Phone:_G@3Q-d3\-378 |
Cell Phone: -mail: wio-ly \oloa\ . 4
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1" Contact: _ “Pastor Toss Elbengr Phone: $964 ~ (250 - ASOF
2™ Contact: Phone:
Is this an annual event? ron O No If Yes, provide next year’s event date: “ | 10 tate: 4ho]an 20
If the event is a recurring event, please state any problems and/or incidents that have occurred in past
years, such as noise or neighborhood parking complaints.
What, if anything, are you doing to rectify the problem(s)?
SECTION 2 — NARRATIVE
On a separate sheet, provide a detailed description of the overall event. The narrative will serve as
the special event proposal to City Council.
Page 3 of 8

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Stations of the Cross, or Via Crucis
On Good Friday, Apa\ (4, 20\4 12-1pm there will be a re-enactment of
Jesus Christ's cross stations, also known as "Via Crucis." The re-enactment
will be performed by members of St. Andrew Lutheran Church.
The Via Crucis begins on Easton Avenue and Main Street and finishes at St.
Andrew Lutheran Church with a brief service.
We invite all members of the congregation and the Community of West Chicago
to come and experience the journey that our Savior, Jesus Christ, lived through.
Via Crucis
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SECTION 3 — PERMITS
a Yes No
Will your event include a carnival?
If yes, you must submit a Carnival Permit Application ninety (90) days prior to the event.
Please visit www.westchicago.org under Forms or contact the City of West Chicago at (630)
293-2200 ext. 135 for an application.
Does your event include the use of a no ee in excess of 400 sq. ft. in area with side curtains
or 700 sq. ft. in area without side curtains? es oNo
If yes, you must submit a Building Permit Application thirty (30) days prior to the event.
Please visit www.westchicago.org under Forms or contact the City of West Chicago at (630)
293-2200 ext. 131 for an application.
Will your event include a fireworks display? 0 Yes wo
If yes, you must submit a Fireworks Permit Application thirty (30) days prior to the event.
Please visit www.westchicago.org under Forms or contact the City of West Chicago at (630)
293-2200 ext. 135 for an application.
Are you holding a raffle at your event? o Yes wo
If yes, you must submit a Raffle Registration Application fourteen (14) days prior to the
event. Not all applicants will qualify for a license. Please visit www.westchicago.org under
Forms or contact the City of West Chicago at (630) 293-2200 ext.170 for an application.
Will you be applying for a Temporary Liquor License? 0 Yes who
If yes, you must submit a Temporary Liquor License Application thirty (30) days prior to the
event. To qualify for a Class D license, the applicant must be a local organization or group
providing beer and/or wine at a picnic, carnival or similar function. A Class D license shall be
authorized on a day-to-day basis but not for more than seven (7) consecutive days. Please
contact the City of West Chicago at (630) 293-2200 ext. 170 for an application.
Will you be serving food at your event? o Yes oNo
If yes, you may be required to submit a Temporary Food Service Permit Application thirty
(30) days prior to the event. Please contact the DuPage County Health Department at (630)
682-7979 or visit http:/www.dupagehealth.org/temporary-food-service for additional
information.
Arevyou requesting services from these departments?
dee 0 Fire District / Paramedics © Public Works
Specify services: Win ree: \ CT
Will you be utilizing any of the following services?
O Water Electric/Generator /Other None
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SECTION 4 — SITE PLAN AND/OR ROUTE MAP
Please attach a separate sheet to illustrate the layout for your event.
If applicable, the following must be included:
Location of garbage receptacles (G) Location and number of barricades (B)
Location of toilets (T) Location of fire lane (FL)
Location of hand washing sinks (HWS) Location of fire extinguishers (FE)
Location of retail vendors (RV) Public entrances and exits (PE)
Location of food vendors (FV) Location of “No Firearms” signage (NF)
Location of first aid (FA) Location of sound stages and amplified sound (S)
Location of residential streets surrounding event
Are you requesting the use of any City-owned property, i.e. City streets, parking lots, or sidewalks?
eas O No _ If yes, please indicate the property that you are requesting to use.
__ Maia Street aad Pance Cerssing. Reads,
Would you like to request the closing of City streets? O Yes oh,
If yes, please fill in the following information or submit a route map along with this application:
Street From To Dates Times
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SECTION 5 — PLANNING WORKSHEET AND REQUIRED TASK DUE DATES*
Use this form to determine the date each of these tasks needs to be completed. For tasks that do not apply,
please mark "N/A" in the Due Date column. If the Due Date falls on a weekend or holiday, the Due Date
becomes the next normal business day. However, this does not affect the other Due Dates, as they are only
dependent on the date of the special event.
Note: This section must be completed by event organizer prior to notary signature.
Date of Special Event: bal | 1G | 19
Tasks to be completed Days Due |
(All items due to City unless noted) Before Event Due Date
Submit “Intent to Meet Insurance Requirements” ‘ ass haath
Document (included with Special Event Permit appl fi to A Prior to application
Application, pg.2) pplication review review
it Special Event Permit Applicati | ff (- q
Submit Special Event Permit Application 90 days [ | | /
Submit Carnival Permit Application 90 days IN / A
| Submit Fireworks Permit Application 30 days A
Submit Temporary Liquor License Application 30 days iA
| Submit Building (Temporary Tent) Permit P
a 30 days NI
Application } / A
Submit Temporary Food Service Permit |
Application(s) 30 days N / 4
| (DuPage County Health Dept. — 630-682-7979) | at
Submit Original Certificate of Insurance” 21 days* z / 24 / (A
— :
| Submit Raffle Registration Application 14 days N / AN
Notify residents/businesses of special event 14 days Y S ti (4
Post “No Firearms” signs at all public entrances
(See IL State Police requirements for standardized N/A Day of Event
sign in West Chicago’s Special Events Polic' ba VA) 4 /
“lf this reguirement is not met, the proposed event may be cancelled.
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SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the Si Aerie Lutheran Choc (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in Stok Of Ve Cross (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
Sk Aacites Loteran Chueh (name of organization) participation in the Activity.
To the fullest extent permitted by law, the Ob. Anrinnd | othemn Church (name of organization)
hereby agrees to defend, indemnify and hold harmless the City of West Chicago, its officials, agents and
employees, against all injuries, deaths, loss, damages, claims, suits, liabilities, judgments, cost and
expenses (including attorneys fees), which may in anywise accrue against the City of West Chicago, its
Officials, agents and employees, arising in consequence of Sk Anam Lothema Church (name of
organization) participation in the Activity, or which may in anywise result therefore, except that arising out
of the sole legal cause of the City of West Chicago, its agents or employees. The
a> a urCh (name of organization) shall, at its own expense, appear, defend and
pay all charges of attorneys and all costs and other expenses arising therefore or incurred in connections
therewith, and, if any judgment shall be rendered against the City of West Chicago, its officials, agents
and employees, in any such action, the Gp. (ed Lokhe Chu (name of organization) at
its own expense, satisfy and discharge the same.
The invalidity or unenforceability of any of the provisions hereof shall not affect the validity or
enforceability of the remainder of this Agreement.
The undersigned represents it has full authority to execute this Waiver and Hold Harmless Agreement on
behalf of the St Andi. Lithyfon Chucch (name of organization).
Agreed this _\ th day of “San vary , 201%
, re) e 1
Name of Organization
“Posior Tosh Eloenec
Print Name of Authorized Person
Signatyfe of (lec Person
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The Organization and the authorized signatory below agree to inform the City of West Chicago of any
changes in the application at least thirty (30) days prior to the event. Please note: Final approval of
this event is pending satisfactory completion of Certificate of Insurance requirements.
Signatory agrees to abide by all requirements of the Special Events Policy, including
compliance with the State of Illinois Firearm Concealed Carry Act.
*All applications must be signed and notarized.
Andre b St, Andrew Lutdeonn Cured. doshua D Eb D Ebener 4
et ° (a (Print Name of Se bet )
Co Signatory)
DENNIS CASTILLO
Official Seal
Notary Public — State of Illinois a
My Commission Expires Nov 6, 2021 (Notary Public)
day of ma ahuar y , 20 La :
After submitting all forms, your application will be reviewed by City staff. All departments that will be
involved in providing services or permits for the event will be notified. Please do not assume that all
aspects of the event will be approved. You may be asked to make some changes to your plan
based on the availability of services or scheduling of other events.
The City of West Chicago reserves the right to cancel any event at any time for reasons deemed
necessary by the City Council and/or City Administrator.
Deliver all completed items to:
City of West Chicago
Attn: Community Development — Special Events
475 Main Street
West Chicago, IL 60185
Signed and sworn to before me this
FEI III III OT TI OTA II III IT IA I I IAI ITT TOT IS AISA AAS AS ISAS SAAS I IN IA OI OI AOA SOSA SA SAO OOOO AION ORO OOOO TOOTS A A A
FOR OFFICE USE ONLY
FEI III III IR TIA III III TT IIIT III III AAT AS AIA SATA TAO TAI TIO II OS OTT IORI OOO OAT ON IOI OTITIS IOI A I
Based on the information which has been submitted and contingent upon approval of any necessary inspections
the day of the event, the request for a permit has been:
O Approved Permit No.
re O Denied
Remarks:
Authorized Signature
Title Date i
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