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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDAITEMNUMBER: — ‘tA.
Homecoming - Fireworks Display
Wheaton Academy FILE NUMBER:
October 4, 2019
COMMITTEE AGENDA DATE: July 22, 2019
COUNCIL AGENDA DATE:
STAFF REVIEW: Tom Dabareiner SIGNATURE__ 4 Gs __—
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
ITEM SUMMARY:
Wheaton Academy is requesting permission for its Homecoming event on Friday, October 4, 2019 which
includes a fireworks display at 9:45 p.m. Residents in the surrounding neighborhoods will be notified by
Wheaton Academy of the date and time of the fireworks display in advance of the event.
The Special Event Permit Application 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.
A Fireworks Permit will be secured through the West Chicago Fire Protection District.
ACTIONS PROPOSED:
Recommend event for approval as proposed, contingent upon receipt of an approved Fireworks Permit
from the West Chicago Fire Protection District.
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.
Fak D © ahs mn seer anct at mes men wn ere we ad
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
a Section 1 — General Information
o Section 2 — Narrative
a Section 3 — Permits
a 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)
a Carnival Permit Application - $50 per employee
o Fireworks Permit Application —
$125 (Check made payable to the West Chicago Fire Protection District)
a Building Permit Application (temporary tents — see min. requirements) - $75
a Raffle Registration Application — requires separate application
o Temporary Liquor License Application — requires separate application
0 Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979)
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reason — FOR OFFICE USE ONLY.
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Received: aK Of\ | Fee Paid: $V LK
Receipt# NI/A check# N/A
Event pina rm returned by: iS.
Police Dept.” Vi Fire Dist. VV PW. Ye WA Comm. Dev.
a Background checks completed by Police Dept. Date
a 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.
L, ames \y olde OP , representing W he actoa Acaseay
(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
rz: => wilknot be reviewed -uniil this:document has been signed and returned to the City of: ~----- ~~~
West Chicago.
Sl ta Seles
Lome COoMmnAag IO-Y4-15
(name of event) (date of event)
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SECTION 1 — GENERAL INFORMATION
Name of Event: Wheaton Acadenny Home CO ming
Type of Event:
O Parade O Walk/Run/Bike O Carnivals -54Fireworks O Festival
O Other
Location of Event: Wh eataa Acader V.
Date(s) of Event: 1Q-4-\G - —Hours of Event: 5S to \l Est. Attendance: .6.d0_.
1O=4=19_- Spe tol pra _
Event Website:_ Wheaton cacacle rny Ore
Purpose of event: Ana nal Wome coming ( 2 { glorat (wa\
Name of Sponsoring Organization(s): Whee ten A cade mf
Organization's Legal Status (i.e. NFP, Partnership, Corporation):
Contact person from sponsoring organization: Uames Heo ltea p
Organizer address: 144] \C\ ngs bragle Ce
City/State/Zip: Ly )h Patan, — Phone:_Gol’ 7
Cell Phone: 630 X7¥-QgYF_ E-mail: _\wo Hrap © wheatsnr ACALLMY -O6G
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1* Contact: Wass Hockert+ Phone: (630 -°G2-509G
2" Contact: Steve [Karlson Phone: 63 — I267475—
Is this an annual event? ZAYes C1 No If Yes, provide next year’s event date:_)d - 3+ 4
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.
KJ OAQ_
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.
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Your word is a lamp to my feet... .
Psalm 119:105
May 10, 2019
Dear West Chicago Council,
On October 4, 2019, Wheaton Academy will be hosting their annual homecoming soccer game.
Each year we invite our alumni and families to return to the school for a dinner, program, and
soccer game. The evening will conclude with a fireworks display provided by Five Alarm
Fireworks.
We will have our own concession stand open as well. The community is invited to enjoy the
fireworks show also.
We have been hosting the event for many years now. The city has been very gracious in
allowing us this great opportunity. Please grant us the permits once again to hold our
celebration.
Thank you,
James K. Holtrop
(ome Kk to Step
Director of Special Events
Wheaton Academy 900 Prince Crossing Road West Chicago, IL 60185-5136 630-562-7500 630-231-0842 fax

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SECTION 3 — PERMITS
Will your event include a carnival? o Yes «No
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 temporary tent in excess of 400 sq. ft. in area with side curtains
or 700 sq. ft. in area without side curtains? Yes 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? yYes o No
If yes, you must submit a Fireworks Permit Application to the West Chicago Fire Protection
District 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. For questions
related to the Fireworks Permit Application, please contact the West Chicago Fire Protection
District at (630) 231-2123.
Are you holding a raffle at your event? o Yes PXNo
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 No
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? % Yes oNo We Nave, ovr OWN Concession stond.
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.
Are you requesting services from.these.departments? . wa en
O Police 4Fire District / Paramedics Public Works
Specify services: Ete feo Diet tke Wotkch € hve
f eR OFICS
Will you be utilizing any of the following services?
O Water OC Electric/Generator 0 Other No
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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?
YAYes O No Ifyes, please indicate the property that you are requesting to use.
Some Cars cul Pack on the Steroctk
Would you like to request the closing of City streets? O Yes JANo
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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CONCESSION STAND
Socrere aan
Aer 25°46" — go WALL
teen
PROPERTY UNES SHOW Keay
PER BOUNDARY SURVEY
‘BY OTHERS NDARY -

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N tx Neal Cl i] le 4 4c r
40: pe. VK \e fal +O
Dear Resident: veils, PUrchg
{ i om 4 x Gk dl PING 4 rv
The Wheaton Academy Homecoming Committee would like to
inform you that, weather permitting, on Friday, October 4, at
~~ S45 pit, there will be a fireworks show adjacent to the ~
Hawthorne entrance road on the Wheaton Academy grounds as
part of our homecoming celebration. The Fireworks Permit has
been granted by the West Chicago Fire Protection Dept., and the
Special Events Permit has been issued by the City of West
Chicago office. If you have any questions, please call WA at 562-
7544, We hope you enjoy the display!
James Holtrop
Director of Special Events

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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 signaiure.
Date of Special Event:
‘~~~ Bue Date) >
(See IL State Police requirements for standardized
sign in West Chicago’s Special Events Policy)
Tasks to be completed Days Due
~—~"(Air items due to City uniess noted) ~~ | BeforeEvent—
Submit “Intent to Meet Insurance Requirements” : F on
: f ; , Prior to Prior to application
Document (included with Special Event Permit sags : :
Application, pg.2) application review review
Submit Special Event Permit Application 90 days 5 . 0-14
Submit Carnival Permit Application 90 days WW / A
Submit Fireworks Permit Application 30 days q -U- 1G
Submit Temporary Liquor License Application 30 days N { A
Submit Building (Temporary Tent) Permit
oo 30 days “1G
Application g -~YU-\Y
Submit Temporary Food Service Permit
Application(s) 30 days q _Y-\ q
(DuPage County Health Dept. — 630-682-7979)
Submit Original Certificate of Insurance* 21 days* G -(4- \%
Submit Raffle Registration Application 14 days 4-20 =\4
Notify residents/businesses of special event 14 days i -tO —\4
Post “No Firearms” signs at all public entrances
N/A Day of Event
*lf this requirement is not met, the proposed event may be cancelied.
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SECTION 6 —- WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the AU heater Acasemy (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in Womecad Pies, (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
dhe aton Ac arem M (name of organization) participation in the Activity.
To the fullest extent permitted by law, the ve) hsaton A Ci adem ot (name of organization)
~ héreby agreés to defend, indemnify and hold harmiess 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 Luh Cate AN Cadem Uname 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
Loheaten Axe ad evs (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 iow heaton Acad Niza wi (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 Uhe aton Axe adcem ¥ (name of organization).
Agreed this JO day of Moy ,20.1G
\ Mineaten Arcachon
Name of Organization
Steven QL. \Consow)
Print Name of Authorized 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.
Whea-son Jeachern7 Kelly Elizabeth Tiemens 05/10/7017
(Name of WD, ¢Lin Y" (Print Name of Signatory) (Date)
Ly Maal Ah Mine ? Kelly Senna iene ‘
> Notary Public State of Illinois
= Commission Expires 12/07/2021 ¢
(Notary Public)
Signed and sworn to before me this [Oth day of M M4 , 20. 19
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
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FOR OFFICE USE ONLY
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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. nia a
sriostaeee ae O Denied = ~~ =
Remarks:
Authorized Signature
Title Date
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CC:
Historical Preservation Commission
Tuesday, July 23, 2019
6:00 p.m.
West Chicago City Hall, 475 Main Street
Council Chambers
AGENDA __
Call to Order, Roll Call and Establishment of a Quorum
Certificate of Appropriateness Review
A. C.O.A. 19-08 — 207 Main Street — Rincon Latino, Inc. — Flat Roof
Replacement and Awning
B. C.O.A. 19-09 — 111-115 Galena Street — Jersey Hurst, LLC — Replacement of
Garage Doors, Windows, and Doors
C. C.0.A. 19-10 — 136 West Washington Street — 136 W Washington LLC —
Parking Lot Repair, Replacement of Awning, Stairs, and Doors
D. C.O.A. 19-11 —351 East Washington Street — Schlegel Residence — Roof
Shingle Replacement
E. C.0.A. 19-12 —317 East Washington Street —- Bantsch Residence — Porch
Repair
Preliminary Review
Historic District/Landmark Update
Approval of Minutes
A. June 25, 2019
Other Business
Adjournment
Mayor
City Council
Historical Preservation Commission Members
Michael Guttman, City Administrator
Tom Dabareiner, Community Development Director
John Sterrett, City Planner
Sara Phalen, City Museum Director
News Media