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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDA ITEM NUMBER: 4A,
Homecoming - Fireworks Display
Wheaton Academy
October 8-9, 2021
FILE NUMBER:
COMMITTEE AGENDA DATE: July 26, 2021
COUNCIL AGENDA DATE:
SIGNATURE <
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
STAFF REVIEW: Tom Dabareiner
ITEM SUMMARY:
Wheaton Academy is requesting permission for its Homecoming event on Friday, October 8-9, 2021
which includes a fireworks display on Friday around 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.
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
o 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
0 Section 6 —- Hold Harmless Agreement
2. Completed and signed applications(s) for other permits(s) (See Section 3)
0 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)
EIS ISIISIISIISIIS ICICI ISI IAI I AIO IAT IA TO AIO TODAS OTT IIA IAAT II SI SSA SAN NSS AAI IAI AAA AS AISI SAAS I ANIA AISA I OA AAS OO SAI AA
FOR OFFICE USE ONLY
SSE IIIS IES aOR IO III EI ISI IIIT III IOI II III TIDUS ITA SOI SISTA AT IA a
Received: 2/23) 2o2\ Fee Paid: $
Receipt # Check #
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. PW Park Dist.
o Background checks completed by Police Dept. Date
o 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 ***
Musi 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. |f 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, Dames Ho te oe _ representing Whecrkan Academy
(print name of authorized pe 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.
O\anente Ic Ly oticn (o/a2jai
U/ signature) (date)
—Homecarniag, Oct 8-9, 205 \
(name of (date of event)
Page 2 of 8

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SECTION 1 —- GENERAL INFORMATION
Name of Event: Wheaton Academy Klomecarming
Type of Event:
O Parade O Walk/Run/Bike O Carnivals Fireworks O Festival
O Other 7.
Location of Event: MI h yy C assy Yaa\v
Date(s) of Event: lof] ay. Hours of Event: __Y patio Lf pm. Est. Attendance: 760
Event Website:
Purpose of event: —Plame coming Ne eked
Name of Sponsoring Organization(s):
Organization's Legal Status (i.e. NFP, Partnership, Corporation):
Contact person from sponsoring raiereel Tevnec Ha kere
Organizer address: Zz 19 Gal |< LAs broale Ct
City/State/Zip: Weealen, \c Ook Phone: 630 2 2 Bd F
Cell Phone: E-mail: Sno Pirup -@ Uuth eactyn 0.6 dan? ore
Emergency contact mye f (provide mobile numbers for on-site coordinators during event):
1° Contact: Phone: Gs 67- y! lb -6 427
2" Contact: oe ori He ocleeLé, Phone: (230-192 .50g -
Is this an annual event? Yes O No If Yes, provide next year's event date: Oct. 9- 1d
If the eventis a recurring event, please state any problems and/or incidents that have occurred in past
years, such as noise or neighborhood parking complaints.
ONE
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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A) WHEATON ACADEMY
June 22, 2021
Dear West Chicago Council,
On Oct. 8-9, 2021, Wheaton Academy will be holding their annual Homecoming Weekend.
Alumni from many states and countries will be on campus to celebrate another year of the
school. We will have a soccer game and a dinner for alumni.
As in the past we would like to have a fireworks display on Oct. 8, to add to the celebration. The
city has been very gracious in allowing us fireworks many times in the past. Five Alarm
Fireworks has provided the show for the past 8 years and we will have them once again. Please
grant us the tent, firework, and special event permits once again to make this year special.
Thank you,
James K. Holtrop
Orne IC bbe FE
Director of Special Events
900 Prince Crossing Road | West Chicago, IL 60185
P. 630.562.7500 | F. 630.562.2823
wheatonacademy.org

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SECTION 3 - PERMITS a
Will your event include a carnival? 0 Yes vyito
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 sa. ft. in area with side curtains
or 700 sq. ft. in area without side curtains? yg Yes o No
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. co s -
Will your event include a fireworks display? Yes oNo
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 yourevent? o Yes XfNo
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 \4No
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? XK Yes o No
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. We herve % CON CeSSiINStoad
Are you requesting services from these departments?
O Police Oi Fire District / Paramedics © Public Works
Specify services: No
Will you be utilizing any of the following services?
O Water O Electric/Generator O Other
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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?
O Yes 5ANo If yes, please indicate the property that you are requesting to use.
Would you like to request the closing of City streets? O Yes JKNo
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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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) Before Event Due Date
Submit “Intent to Meet Insurance Requirements” Pri F Pe
: f . . rior to Prior to application
Document (included with Special Event Permit ats . H
Application, pg.2) application review review
Submit Special Event Permit Application 90 days
Submit Carnival Permit Application 90 days
Submit Fireworks Permit Application 30 days
Submit Temporary Liquor License Application 30 days
Submit Building (Temporary Tent) Permit
vo 30 days
Application
Submit Temporary Food Service Permit
Application(s) 30 days
(DuPage County Health Dept. — 630-682-7979)
Submit Original Certificate of Insurance* 21 days*
Submit Raffle Registration Application 14 days
Notify residents/businesses of special event 14 days
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 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 AVA) he xe iat rcadecnt (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in FTOAO fa.W! , (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
\Wwheatm Be ademy (name of organization) participation in the Activity.
To the fullest extent permitted by law, the Lhe atan A cade ANE (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 ofall 2 enon Arcade myzame of
organization) participation in the Activity, or which may in anywise result therefore, except that arising out
WWhee legal cause of the City of West Chicago, its agents or employees. The
eo” Academy (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 Utheaton A iq Odeo (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 UWheelen Accodum \._(name of organization).
Wheaten Academy
SVames Ke Hobe
Print Name of Authorized Person
Pls
d 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.
WS neatsa Arcadenn mln ion _Robuts lay
(Name of Organization) (Pris Name of Signatory) Date)
‘ Angela Lynn Roberts
(Authoriz Signatory) Notary Public State of Illinois
My Commission Expires 10/25/2021
(Notary Public)
Signed and sworn to before me this 23 day of June 20Al
_ 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
SITIOS TODS IIIT III TT TIT TT TOTO TOT ITT TOOT I TOT ICTR TCE TOTO ITT TOO TOT III TOTD ET ITT OST OCI IOI TOIT A IIA ATOR TSI AR TIE A Fett
FERRIED ODIO IOIIIAISIIIIIISIEIIOIOIIOSI IIIT UIUIIISIIOIIIDISIISI IOC IIASA ISIS IIIS IDI III TAI IGS HNN anninnier
Based on the information which has been submitted and contingent upon approval of any necessary inspections
the day of the evént, the request for a permit has been: °
0 Denied
Remarks:
O Approved Permit No.
Authorized Signature
Title Date
Page 8 of 8

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Dear Resident:
The Wheaton Academy Homecoming Committee would like to
inform you that, weather permitting, on Friday, Oct. 8, at 9:45
p.m., 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 630-562-
7500. We hope -you enjoy the display!
James Holtrop
Director of Special Events

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City of West Chicago
Community Development Department
475 Main Street, West Chicago, IL 60185
Phone: (630) 293-2200 x 131 / FAX: (630) 293-1257
APPLICATION FOR PLAN EXAMINATION
& BUILDING PERMIT
Permit Number:
Date Received: / /
Permit Fee: $
Approved:
Homeowner’s Association?
Goo Prince. Crossinc, Ra
(Project Address) (Subdivision)
(Zoning) (Lot Number) (P.LN.)
Wheaton Acad ecay (o%-56Aa-1500
(Property Owner) (Phone)
mt) e5-{, Chiago, Ic a
[06 Prince. Crossing [Ce
(Street Address) (City, State Zip) Golgs
acres Holtrop “Le Q-75CR
(Name of Applicant) (Phone and FAX)
\90t_ [ca ng shor onle Gb (wheaton Jc mm (no \troep& Wheaton w
(Address® 8° H 8 8 BB BB BR B FERRIC nlf ddscss) ACHdemy dra
(General Contractor) (Address) (Phone)
(Electrical Contractor) (Address) (Phone)
(Plumber) (Address) (Phone)
(Roofer) (Address) (Phone)
WORK TO BE DONE: ee [| Gikatio TYPE OF STRUCTURE:
Addition to existing building New building Single family (detached)
Remodel Siding Townhouse
Driveway (new or repair) Electric (only) Commercial
Plumbing (only) Water meter (replacement) | Industrial
Water meter (lawn sprinkler) _[] Shed CL] Other:
Building Plan
_ PX Other: “Tent SUBMITTING WITH APPLICATION: []_ Survey
AO KOO Nosile Walle
ESTIMATED TOTAL COST OF PROJECT: $
STATEMENT OF APPLICANT:
I hereby certify that the above statements are true and accurate, agree to comply with the provisions of the
Ordinances of the City of West Chicago, affirm that the proposed work is authorized by the owner of record, and
that I have been authorized by the owner to make this application as his/her agent.
waaial
Aon We g “sone : 1S a ° Hiroe (Date)
(Print Name)

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—_—_—_—— Farmingdale, New York 7 1735-3628 Lisa
: z mi am? Tal. +4 (631) 283-8944 Fax +t ;
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Tested For: Julla Llaw, Unit A, 12!
Plato Chemical Ce., Lid,
10 Cheung Yee Street
_Lai Chi Kok Kowloon, Hong Kong
F Cheung Lung ind. Bldg. Kay Test:
Tek: O14 852 237 00332 Ext:
Fax: O11 8$2 22700377
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TEST PERFORMED: California Fire Marshal Title 19: section 1237 (2roposed Revision 8/9/93) Fire
}Resistance; smai1 Scale Test - EXTERIOR MATERIALS QUALIFICATION
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Registration Number
F-12110
LETLIFICALE OF ‘biding Kesistance
Date of Shipment
ISSUED BY 95/20/10
Ao
EVANSVILLE, INDIANA 477235
MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN
This is to certify that the materials described have been flame-retardant treated (or are inherently foninfammable) and
were supplied tg:
NITE LITE SIGNS BALLOONS INC
DBA AWESOME AMUSEM
ENTS CO __
Certification is hereby made that:
The articles described on this Certificate have been treated with a flame-retardant approved
hemical and that the application of said chemical was done in confor mance with Califomia Fire
Marshall Code. All fabric has been tested and passes NEPA 701, CPA! 84,
ie}
303000 (3)
Description of item certified:
iCENTURY FRAME TOP 20WX20 WHITE
VINYL. TRIVANTAGES BLOCKOUT
Flame Retardant Process Used Will Not Be Removed By
Washing Ant Effective For The Life Of The Faoric
_ _TRMANTAGE Taz ESV E- Men pee re earners ee ee 7 ae -
enw Raime OF Applicator of Flame Resistant Finish Ate
Signed: f “A Ce
T 6 ~
ANSHOR INDUSTRIES Inc

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At) Armour Building
27) Science & Technology
Visitors, please use Door 1 of the Academic Building and Center
heck-in at the front desk. 3) Library
see reverse side for classroom locations within the
; igs. @ Academic Building
5 ] Academy Hall
WHEATON AGADEMY
9) Warrior Dome
© Heritage Field House
@ Fine Arts Center