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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDAITEMNUMBER: — “0. |
We Go Run
Leman Middle School FILE NUMBER:
COMMITTEE AGENDA DATE: January 28, 2019
COUNCIL AGENDA DATE:
SIGNATURE_ 7 & a
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
STAFF REVIEW: Tom Dabareiner
ITEM SUMMARY:
Leman Middle School is seeking approval for the 15" Annual WE GO Run, a combination of a 5K and
10K Run/Walk and a 1 Mile Fun Run scheduled for Sunday, May 5, 2019 from 5:00 a.m. — 11:00 a.m.
with an estimate of 350 attendees. This event is in intended to serve as a fundraiser in support of West
Chicago School District #33.
Leman Middle School has requested use of City streets for the course route and Police services for
assistance with traffic control and a rolling street closure.
Registration and set-up is scheduled for 4:30 a.m. The 5k and 10k races begin at 8:00 a.m. and the 1
Mile Fun Run begins at 9:45 a.m. The anticipated completion time for the races is 10:00 a.m. The entire
event is expected to end at approximately 10:30 a.m.
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 course 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
SPECIAL EVENT PERMIT APPLICATION
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
o Intent to Meet Insurance Requirements
a Section 1 — General Information
0 Section 2 — Narrative
a Section 3 — Permits
© Section 4 — Site Plan and/or Route Map
a 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)
© Carnival Permit Application - $50 per employee
a Fireworks Permit Application —
$125 (Check made payable to the West Chicago Fire Protection District)
0 Building Permit Application (temporary tents — see min. requirements) - $50
a Raffle Registration Application — requires separate application
a Temporary Liquor License Application — requires separate application
© Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979)
FEIT III ITI II III IIIT TIO III IOI TTT I OTT IAAT IA IAA OTA SOT IO A ITI OT OO SOO IS 8S SOS AOS AS OO TOROS OOO NAIA
FOR OFFICE USE ONLY
AIO ie RII III III III III III III III Ine HOI III te:
Received: __t / 7] / | q Fee Paid: $ WA
Receipte_ M/A Check #___. N// A
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. PW Park Dist.
7 Background checks completed by Police Dept. Date N /
0 DuPage Co. Health Department notified Date
a Certificate of Insurance received and approved Date
Page 1 of 8

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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.
Sieg Rea scra ropasoning WECc a
(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.
Cle! Cut ANG
(signature) (da ms
Ws. aie BUN
(name of event) (date! of event)
Page 2 of 8

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SECTION 1 — GENERAL INFORMATION
Name of Event: WE 6o kN
Type of Event:
O Parade IR Walk/Run/Bike O Carnivals O Fireworks C Festival
0 Other
*
Location of Event: i ‘ \\ OP\ B Chol
Date(s) of Event: ; Hours of Event: Damto Est. Attendance:L} 50 _
Event Website: WA? WED ICS =
Purpose of event:
_Ftendvaer & LOS Atay
Name of Sponsoring Organization(s): [ Raph uy | Vu dolla x Y. dain
Organization's Legal Status (i.e. NFP, Partnership, Corporation): Scar D Sua Cm
Contact person from sponsoring organization:
Organizer address:
am Ee Mer hone: (,39- “als O2aU
Cell Phone: 30920724 E-mail: Us Am EO WW A>
Emergency contact information (provide mobile numbers for on-site coorditators during eve
1* Contact: « WIE. Rea rea Phone: 620 5} ny 2364
2" Contact: Phone:
Is this an annual event? Yes C1 No If Yes, provide next year’s event date:
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.
Sn
What, if anything, are you doing to rectify the problem(s)?
A)
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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15th ANNUAL WE GO RUN
8:00 A.M., SUNDAY MAY 5, 2019
LEMAN MIDDLE SCHOOL
WEST CHICAGO, ILLINOIS
Introduction:
The WE GO RUN will once again be hosted at Leman Middle School, the largest school in
School District #33. This event allows us to promote positive health and wellness while raising
money for the athletic programs at Leman Middle School.
1) Police Services: We hope to get the same support that we have in previous years from
the West Chicago Police Department. We understand that we will not get street closures
but for the initial start of the race would need traffic held for approximately 10 minutes.
Police have also assisted in key busy intersections.
a) Last year we had 50+ volunteers on the race course route. We will have the
same, if not more this year. Volunteers on course will have cell phones to call 911
or the Race Director in case of emergency.
2) General Information:
a. Set up will start at 4:30AM at Leman Middle School and on the course.
b. First Race: 10K and 5K at 8:00AM, 1 Mile at 9:45, Kiddie Dash at 10:00
i. Completion time: approximately 10:30AM. Course closes at 10:00AM
ii. Anticipating 350 runners
c. Proposed map of race course submitted with permit application.
d. Course length: 6.2 miles and 3.1 miles
i. Race committee will mark with orange for 5K, green for 10Km and red for 1 mile
ii. Courses are USATF certified
e. Will only cancel in extreme weather. Will call city that morning to notify.
f. Have committe and volunteer vehicles along the course for emergencies.
g. Advertising will take place via posters and registration forms being put into the hands of
families that are part of School District #33. Also in area local businesses.
h. Certificate of Liability Insurance will be sent directly to City Hall to the attention of
Bethany Bayci.
i. Main Contact: Amy Wagner 630-926-0724
j. Race committee members will be distributing flyers along the course to village residents
one week prior to event notifying them that the race will take place. Flyer will be in English and
Spanish.
k. Parking will take place at Leman Middle School and Gary School.
|. The WE GO RUN is a fundraiser put on solely by volunteers. All proceeds go back to West
Chicago School District #33.

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SECTION 3 — PERMITS
Will your event include a carnival? Yes Kwo
If yes, you must submit a Carnival Pérmit 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.
or 700 sq. ft. in area without side curtains? 0 Yes te)
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.
Does your event include the use of a temporary tent Ron of 400 sq. ft. in area with side curtains
Will your event include a fireworks display? 0 Yes Ae
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
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 °
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? oe oNo
If yes, you may be required to subini#’'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.
Are you requesting services from these departments?
yee O Fire District / Paramedics © Public Works
Specify services: ass St Uo z= roc t Conty |
Will you be utilizing any of the following services?
0 Water O Electric/Generator O Other ( \wy2
Page 4 of 8

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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?
Kives O No _ If yes, please indicate the property that you are requesting to use.
OC
Would you like to request the closing of City streets? O Yes joe
If yes, please fill in the following information or submit a route map along with this application:
Street From To Dates Times
Page 5 of 8

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DOA course will be the Sara.
2018 WE GO SK Route (2 Loops for 10K)
Start: Hazel Street (by school sign)
East on Hazel
South on Bishop
West on Forest
North on Joliet
West on Brown
North on Wood
East on Geneva
South on Allen
East on Spencer
South on Barber
East on Blair
South on Gates
West on Brown
South on Joliet
East on Hazel
Finish: Same as start (by school sign)

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NestCnicago
Hiohchool
31
PioneerPark
HdleSchool

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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:
Tasks to be completed Days Due
(All items due to City unless noted) | _BeforeEvent Due Date
Submit “Intent to Meet Insurance Requirements” ; ; tact
Document (included with Special Event Permit _ bc sig Pe om
Application, pg.2) PP
Submit Special Event Permit Applicatton “"S 90 days \ i \T- a
| Submit Carnival Permit Application 90 days () lo.
Submit Fireworks Permit Application | 30 days ma
Submit Temporary Liquor License Application 30 days vad
Submit Building (Temporary Tent) Permit
30 days
Application Ne
Submit Temporary Food, Service Permit
Application(s) “. 30 days
| (DuPage County Health Dept. = 630-682-7979) _ : 12) | ” O<- |
Submit Original Certificate of Insurance* 21 days* feet ve ] 3-19
Submit Raffle Registration Application _ 14 days le
Notify residents/businesses of special event 14 days oY é. O- ) al
Post “No Firearms” signs at all public entrances
(See IL State Police requirements for standardized
sign in West Chicago's Special Events Policy)
N/A Day of Event
bs) tous
om «
*If this requirement is not met, the proposed event may be cancelled.
Page 6 of 8

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SECTION 6 - WAIVER AND HOLD HARMLESS AGREEMENT
. SS
In consideration of the Loner Ma dQ chive (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in Woe Go RON , (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
LY) fon (name of organization) participation in the Activity.
To the fullest extent permitted by law, the Lyy) S (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 Lins (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
Ly r"\ » (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 LimsS (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 Lv) S (name of organization).
Agreed this ier day of Jano 20 {A
Name of Organization
Pou Wa t
Print Name of Authoriz erson
Seer
Signature of Authozed Person
Poco Draestor
Title
Page 7 of 8

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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.
Lins Dowd WAG NEL q
(Name of Organization) (Print Name of Signatory) (Date)
sien
ed Signatory) ye ¢
arent see tf Dow
IE K JEI
NOTARY PUBLIC - sree
& _ MY COMMISSION EXPIRES:o4/28/0 thn (Notary Public)
PTA,
@ “sine: and sworn to before me | | ( 2 day of a a; / \/ J o_| 1
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
JFOIITISI IIIT IOI IOI IIE III TIO TOO TOIT TOTO TO TT ITT TI TTT TIT T IIT TATA T I TOT ATI OA SONS AIO A OO AA AAA SOSA SEAS SA ION OO ORI A A A I
FOR OFFICE USE ONLY
EIEIO TIO IT TTT TIT TTT IT TIT TTT ITO I AI I I JOO IIIA II TOA ASIA OT IA AI A AA I OAT AI SO TOO I IO A SOA I ONO AO SOAS ADI 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.
oP O Denied
Remarks:
Authorized Signature
Title Date
Page 8 of 8