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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDA ITEM NUMBER: HA.
Pro-Life March
St. Mary’s Parish FILE NUMBER:
COMMITTEE AGENDA DATE: November 25, 2019
COUNCIL AGENDA DATE:
STAFF REVIEW: Tom Dabareiner SIGNATURE >
APPROVED BY CITY ADMINISTRATOR:
SIGNATURE.
ITEM SUMMARY:
St. Mary’s Catholic Church is seeking approval for a Pro-Life March event scheduled for Sunday, January 19, 2020
from 2:15pm to 4:00pm.
St. Mary’s has requested Police support for a rolling street closure during the march which takes place along city
streets as outlined in the provided map.
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.
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
a Intent to Meet Insurance Requirements
a Section 1 — General Information
a 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
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
a Temporary Liquor License Application — requires separate application
a Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979)
FEISS SII IOS OSI III IT TI II III II TI II II IIIT ST TOSS SSI IS A IIS IORI AAS AI IO SS OSI BA SIS IS ASSO S ISOS ISI SIS SSI ISO II
FOR OFFICE USE ONLY
IX IDI IIIS IOS SSIS TO IIA IOI TI TIA TI II IIS IAS SAI II ASAI ISIS IS ISIS IO ISAS IISA SASHA ISAS I AI I
Received: 10 /18/\ & Fee Paid: $
Receipt # Check #
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. Pw cOo
a Background checks completed by Police Dept. Date
a DuPage Co. Health Department notified Date
o Certificate of Insurance received and approved Date
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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, Rev. David Lawrence , representing St. Mary's
(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.
Ye. OLA. lo/ax/r4
(signature) (date)
iy) fo- L €e M ae i a) Benatar 14 2020
(name of event) (date’of event)
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SECTION 1 — GENERAL INFORMATION
Name of Event: Pro-Life March
Type of Event:
O Parade @ Walk/Run/Bike O Carnivals O Fireworks Ci Festival
O Other
Location of Event; St. Mary's Parish
Date(s) of Event: 489. 19, 2020 Hours of Event: 2:15 Pmt 4:00 pm Est Attendance; 200
Event Website: Stmarywe.org
Purpose of event: Pray for the protection of life, from conception to natural death; pray for the fetus to get again
independent rights under the law of Illinois and the revoking of the Supreme Court law approving abort
Name of Sponsoring Organization(s); St. Mary's Catholic Church
Organization's Legal Status (i.e. NFP, Partnership, Corporation): NFP
Contact person from sponsoring organization: Rev. David Lawrence
Organizer address: 140 N. Oakwood Ave
City/State/Zip: West Chicago, IL 60185 Phone: 630-231-0013
Cell Phone: 830-640-3528 E-mail: father.david@stmarywc.org
Emergency contact information (provide mobile numbers for on-site coordinators during event):
4 Contact: St Yolanda Forero Phone: 630-877-5883
2" Contact: Sr. Rosanny Contreras Phone: 630-877-5782
Is this an annual event? @ Yes O No If Yes, provide next year's event date: January 2021
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.
No past problems on January 2018
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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Narrative for St. Mary’s Pro-Life March
St. Mary’s Pro-Life March is a peaceful and prayerful event organized to publicly
raise awareness of the dignity of all human life from conception to natural death.
We will also be offering prayers to Almighty God for the legal protection of all
human life. We will assemble outside of St. Mary’s Church and share testimonies
of the dignity of life. Then we will begin our prayers and singing as we process
through the streets of our neighborhood. The event will conclude at St. Mary’s
Church with prayers and blessings for all present.

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SECTION 3 - PERMITS
Will your event include a carnival? o Yes gNo
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? o Yes aNo
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? oc Yes aNo
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 aNo
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? o Yes aNo
/f 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? aYes zNo
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?
Police Fire District / Paramedics © Public Works
Specify services: Rolling closere for 1.7 miles aprox. (see next page). Estimated time 1+ hours
Will you be utilizing any of the following services?
O Water 1 Electric/Generator +O 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?
@ Yes O No If yes, please indicate the property that you are requesting to use.
City Streets
Would you like to request the closing of City streets? Yes O No
If yes, please fill in the following information or submit a route map along with this application:
Street From To Dates Times
Garden St. E. York Ave. E. Washington 2:35-2:40
E. Washington St. Garden St. Ingalton Ave. 2:40-2:45
Ingalton Ave. E. Washington St, _E. Grandlake Blvd. 2:45-2:55
E. Grandlake Blvd. Ingalton Ave. Arbor Ave. 2:55-
Arbor Ave. E. Grandlake Blvd. E. York Ave. —
E. York Ave. Elmwood Ave. Garden St. —
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Mineral
Holy Transfiguration
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West Chicago
City Museum
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Datos del mapa ©2019 = SCOprest_—-_. es
Main Park Ag

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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:
January 19, 2020
Tasks to be completed - Days Due
(All items due to City unless noted) BeforeEvent Due Date
Submit “Intent to Meet Insurance Requirements” ; : + ati
: f ; : Prior to Prior to application
Document (included with Special Event Permit 5 enti A . 4
Application, pg.2) application review review
Submit Special Event Permit Application 90 days \O j\7s/ \Q
Submit Carnival Permit Application 90 days NY / Lf
Submit Fireworks Permit Application 30 days N JA
é
Submit Temporary Liquor License Application 30 days J i; A
j Z
Submit Building (Temporary Tent) Permit
a 30 days 1 zy
Application N/A
Submit Temporary Food Service Permit
Application(s) 30 days | N / A
(DuPage County Health Dept. — 630-682-7979) |
Submit Original Certificate of Insurance* 21 days* | \U/2q JAA
Submit Raffle Registration Application 14 days N / A
Notify residents/businesses of special event 14 days | / s +4 ( a
Post “No Firearms” signs at all public entrances
(See IL State Police requirements for standardized NIA Day of Event
sign in West Chicago's Special Events Policy)
“If this requirement is not met, the proposed event may be cancelled.
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SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the St. Mary's Pro-Life March (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in St. Mary's Pro-Life March_, (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
St. Mary's Pro-Life March (name of organization) participation in the Activity.
To the fullest extent permitted by law, the St Mary's Pro-Life March (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 St. Mary's Pro-Life March (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
St. Mary's Pro-Life March (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 _ St. Mary's Church (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: Mary's (name of organization).
Agreed this 18 day of October , 202019
St. Mary's
Name of Organization
Rev. David Lawrence
Print Name of Authorized Person
Ge. SH xf —
Signature of Authorized Person
Pastor
Title
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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.
St. Mary's , Rev. David Lawrence
(Name of Organization (Print Name of Signatory) (Date)
)
» Jen DY Ze
é (Authotizéd Signatory)
OFFIC, Seay 3 oi
LAUR K JENSEN ALIAAL :
NOTARY PUBLIC STATE OF tasors (Notary Public)’
* COMMISSION EP RES.042821 :
Signed and SWORE Metis.’ Q8 day of OCT 2014.
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
FEI III IOI IITA TOIT III III IO IIT TIT II IOI OTA I IOS I TOSI IIA TOI I I SATII BARI I BOI I IOI IS ICIS IOI SII II SSAA AA A tek
FOR OFFICE USE ONLY
FOS III TOO IOI II IO IIT STI II OT TI III TT TI SIT ITO IA ITT SI TI I I AOS TI IS ORB OI ITI A II I IOI II A SOS SASS SASS SIS IT IR IAI Ah eb
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 Denied
Remarks:
O Approved Permit No.
Authorized Signature
Title Date
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