===== PDF PAGE 49 ===== [Extraction: OCR (rendered-page OCR)] CITY OF WEST CHICAGO PUBLIC AFFAIRS COMMITTEE AGENDA ITEM SUMMARY ITEM TITLE: AGENDA ITEM NUMBER: +. 6. West Chicago Railroad Days Western DuPage Chamber of Commerce FILE NUMBER: COMMITTEE AGENDA DATE: May 23, 2022 COUNCIL AGENDA DATE: STAFF REVIEW: Tom Dabareiner sonmunee ee call APPROVED BY CITY ADMINISTRATOR: Michael Guttman SIGNATURE ITEM SUMMARY: The Western DuPage Chamber of Commerce has submitted the attached Special Event Permit Application for West Chicago Railroad Days scheduled to take place Thursday, July 7 through Sunday, July 10, 2022 at Pioneer Park in accordance with the terms outlined in Resolution 22-R-0009. As in previous years, the event will include a carnival, food vendors, entertainment, beer garden, and merchant vendors. There will also be a parade and fireworks. The proposed plans will be reviewed by staff from the Police, Public Works, and Community Development Departments as well as the West Chicago Fire Protection District and Park District during the upcoming monthly coordination meetings. Proposed event components are contingent upon approval from the above noted staff, departments, and districts. ACTIONS PROPOSED: Recommend proposed event plans to proceed as outlined, contingent upon submittal and approval of required insurance documentation. COMMITTEE RECOMMENDATION: ===== PDF PAGE 50 ===== [Extraction: OCR (rendered-page OCR)] City of West Chicago Regt Nees Community Development Department Date Received: / / 475 Main Street, West Chicago, IL 60185 Phone: (630) 293-2200 x 131 / FAX: (630) 293-1257 APPLICATION FOR PLAN EXAMINATION | Approved: Permit Fee: $ & BUILDING PERMIT Homeowner’s Association? 429 W. FocesT Avenue, Wht Chuoie Preneer~ “Park (Project Address) (Subdivision) (Zoning) (Lot Number) (@.LN.) Vili Pack Disteet 630-231-9474 (Property Owner (Phone) 20) Ww. Natowal Street dest Chiage., I (0185 (Street Address) (City, State Zp) hiss, cof Chinmecee 620-221-3002 1,20 -221-2009 (Name of Applic (Phone and FAX) 30le Main St, besT- Chusge AL (6018 5 Team @ Wyestecatdupoge hamber.com (Address) (Email Address) (General Contractor) (Address) (Phone) (Electrical Contractor) (Address) (Phone) (Plumber) (Address) (Phone) (Roofer) (Address) (Phone) WORK TO BE DONE: []_ Patio TYPE OF STRUCTURE: []_ Addition to existing building L]_ New building |_ Single family (detached) | Remodel C1_ Siding (C1 Townhouse (1 Driveway (new or repair) L]_ Electric (only) |_ Commercial CL] Plumbing (only) [_]_ Water meter (replacement) LJ Industrial [-]_ Water meter (lawn sprinkler) []_ Shed TX¥]_ Other: Tewts | Other: Festua l SUBMITTING WITH APPLICATION: [ ] Survey Building Plan 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. IIE, baadaal Daud QD. Sabathne A IIS 12020 (Signaturé of Applicant) (Print Name) (Date) ===== PDF PAGE 51 ===== [Extraction: OCR (rendered-page OCR)] *** 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. Western DuPage Chamber of Commerce 306 Main St. : West Chicago, IL 60185 L Sabathne , representing (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. OE LZ 4fis[2022. (signature) / (date) esr shee ‘Kailpoad “De Duly Z-/0_, 202.2. (name of event) (date of event) Page 2 of 8 ===== PDF PAGE 52 ===== [Extraction: OCR (rendered-page OCR)] SECTION 1 — GENERAL INFORMATION Name of Event: 2 a oad Type of Event: ys Parade O Walk/Run/Bike rs) Carnivals pe Fireworks x Festival O Other Location of Event: ark otesT Aye. Date(s) of Event: Qaly 7-/6 22 Hours of Event: 47:00 to //ooPM_ Est. Attendance: 2S00mp Event Website: Westeradupage cham bee conn Purpose of event: l 4 : ‘ BY Cc Name of Sponsoring Organization(s): Ly t vf of Mel Chucega Elid che uw Dub, loge. asubet AO WHINETC Organization's Legal Status (i.e. NFP, Partnership, Corporation): Coe ep. SoICcG Contact person from sponsoring organization: __Dayid Sasathae Organizer address: 366 Jaw SheeT City/State/Zip: /y- /l Golgss Phone: £26 -23 [-3603 Cell Phone: E-mail: Zen @ ham Emergency contact information (provide mobile numbers for on-site coordinators during event): 1* Contact. Deri d Sadatha e Phone: 630 -G75-5.368 2" Contact: Mdaywe Lofton Se. Phone: G20-€85-9928 Is this an annual event? y) Yes No If Yes, provide next year's event date: /jvhwow A/ 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. Ale Aistocy of ceparted viecidealtS What, if anything, are you doing to rectify the problem(s)? lle Conbuive 10 axthupake Challesocs aud prepare fespouses to Safely Aaudle Hem. 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 ===== PDF PAGE 53 ===== [Extraction: OCR (rendered-page OCR)] SECTION 3 — PERMITS Will your event include a carnival? Yes aNo If yes, you must submit a Carhival 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 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? x 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? aYes No If yes, you must submit a Raffle Registrdtion 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? Yes aNo 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? Patel 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:/Avww.dupagehealth.org/temporary-food-service for additional information. Are you requesting services from these departments? i Police 0 Fire District / Paramedics 5) Public Works Specify services: Phase see Service reguesT feocm Will you be utilizing any of the following services? pi Water ) Electric/Generator O Other Page 4 of 8 ===== PDF PAGE 54 ===== [Extraction: OCR (rendered-page OCR)] 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? WW Yes O1No iIfyes, please indicate the property that you are requesting to use. Foeudes See attached map foc foute ¢ Temmylecary Ceolbag) Closures ve Would you like to request the closing of City streets? i Yes O No Ww If yes, please fill in the following information or submit a route map along with this application: Qo! Street From To Dates Times Dagaltons Nationa | Wash tug faed 2tof Z2_ —_f06 Pm La Sheng ton Tegaltons _Achoec u LIS Pm _Arboc Washington Kiptonrel 4 1.26 Pm Ao Festwal site Closures tonless cegucsted by West Cheap fplec oc fire Page 5 of 8 ===== PDF PAGE 55 ===== [Extraction: OCR (rendered-page OCR)] 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: ely 7-/0_, 2022 Tasks to be completed Days Due (All items due to City unless noted) Before Event Due Date Submit “Intent to Meet Insurance Requirements” : : i neti Document (included with Special Event Permit ork bi ole ai Eres ee Application, pg.2) PP Submit Special Event Permit Application 90 days 4 /7 Submit Carnival Permit Application 90 days 4/7 Submit Fireworks Permit Application 30 days al Submit Temporary Liquor License Application 30 days as Submit Building (Temporary Tent) Permit , . 30 days Application b /? Submit Temporary Food Service Permit , Application(s) 30 days (DuPage County Health Dept. - 630-682-7979) t/ v Submit Original Certificate of Insurance* 21 days* ul) y Submit Raffle Registration Application 14 days N y Ip Notify residents/businesses of special event 14 days bi 7D ( 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. Page 6 of 8 ===== PDF PAGE 56 ===== [Extraction: OCR (rendered-page OCR)] SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT Western DuPage Chamber of Commerce In consideration of the (name of organization) and its Members, employees, volunteers or guests, being allow to participate in _ West Chicago Railroad Days, (the Activity) the undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to West DuP: *. . oe 4 ie Aan Sstern DuPage Chamber of Commerce (name of organization) participation in the Activity. We To the fullest extent permitted by law, thee TamberofCommerce (ame 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 Wester DuPage Chamber of Commerce (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 Western DuPage Chamber ofCommerce (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 Western DuPage Chamber of Commerce (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 wi sas behalf of the estern DuPage Chamber of Commerce (name of organization). Agreed this, /5 dayof Aneel 20.22 Western DuPage Chamber of Commerce Name of Organization —_Dasid Y Sahathwe Print Name of Authorized Person ignature df Authorized Person PresidewT L CEO Title Page 7 of 8 ===== PDF PAGE 57 ===== [Extraction: OCR (rendered-page OCR)] 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. Sa, \ ~ > . 2 af : | i LSA on ‘| | ay, Deree \ ‘, \ a es c on ° } Nw | a oe 3 ( \s 88 Reuaree | SOUTHS. MAL r i ; ft we : Lis. €3 {= | of 3 = _& F . { | ; | bg 9 op FP py 8 Ke | | i 3 S j 3 ; is ves Vote - 5 ec - Vl Za a z lomgognes e 89 Ek 2 O* lox20 see ; 4\o Ea at ca ces 4 Powe 2 FRom Viexoes | | | — | ===== PDF PAGE 68 ===== [Extraction: OCR (rendered-page OCR)] SELLER / SERVER CERTIFICATION Trainee Name: David J Sabathne School Name: Certificate #: 000020299524 360training.com dba Learn2Serve Date of Completion: 04/04/2022 I, certify that the above named person Mplsies Uisetarevicesinesessaiy, successfully completed an approved pigeon + har r se alco: 0 Learn2Serve Seller/Server course. : : This is your temporary certificate of completion. You will receive your official card in the mail. Please forward all questions to support@360training.com. ===== PDF PAGE 69 ===== [Extraction: OCR (rendered-page OCR)] ‘Western DuPage 2022 RAILROAD DAYS EXHIBITOR. APPLICATION RAILROAD DAYS APPLICATION & AGREEMENT Chamber of Commerce The Western DuPage Chamber of Commerce as a manager of the 2022 West Chicago Railroad Days Festival and Exhibitor/Vendor agree to the terms and conditions of the agreement. The - Exhibitor/Vendor shall sell only the products specified and approved in this agreement at Pioneer Park during the 2022 Railroad Days event. Date & Times of the Railroad Days 2022 festival are as follows: Thursday, July 7, 2022 4:30 pm - 10:00 pm Friday, July 8, 2022 4:30 pm - 11:00 pm Saturday, July 9, 2022 Noon - 11:00 pm Sunday, July 10, 2022 2:30 pm - 10:00 pm ARTICLE 1: Exhibitor/Vendor: Contact and Product Information Company Name: Contact: Phone: ( ) Fax ( ) Street Address: City: State: Zip: E-mail(s): Description of products/items that will be distributed (including prices, if applicable): (if you need more space to write down additional items, please use the additional page section on application.) 1) $ 2) $ 3) $ 4) $ 5) $ 6) $ 7) $ 8) $ 9) $ 10) $ 11) $ 12) $ 13) $ 14) $ A) Food and/or Beverage Sales: the sale of food and/or beverages is limited to Approved Food Vendors. No Exhibitor or Vendor may sell any food or beverage without the prior written consent of the Western DuPage Chamber of Commerce and 2022 Railroad Days Committee. No Exceptions! ===== PDF PAGE 70 ===== [Extraction: OCR (rendered-page OCR)] Electrical Requirements: « This section must be complete and accurate. In order to ensure that all Exhibitors/Vendors have enough electricity, we must have all of your information. Any application that is not completed will not be accepted. NOTE: No changes will be allowed the day of the event, only requested electrical requirements would be supplied. - Vendors are solely responsible for their own heavy-duty extension cords (#123-prong conductor). « Vendor will be provided one 110 outlet; additional 110 outlets will be charged at $50 each. - List each electrical need individually. If necessary, please use the reverse side for any additional needs. A) Types of application (Need) Qty. Volts Watts Amps Outletneed 1) ___— E_] 110 outtet 2) Additional Outlets needed (see fees) 3) B) Total number of outlets needed: (REQUIRED): ARTICLE II — Rules & Compliance 1) This application must be completed and received by the Western DuPage Chamber of Commerce, not later than Wednesday, June 22nd _at 12:00 Noon and shall not be in effect until accepted by the Western DuPage Chamber of Commerce. 2) Please send your application to: Western DuPage Chamber of Commerce 306 Main Street West Chicago, IL 60185 Email: team@westerndupagechamber.com 3) This agreement must be submitted along with the following: a) All Fees (per attached fee schedule). b) See Attached Insurance requirements! 4) Vendor must remain open from the beginning of the event until the end of the event each day. 5) Vendor site must be kept clean and garbage discarded properly. 6) Vendors must supply their own sign with their name and prices on it. ===== PDF PAGE 71 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE Ill - Agreement The Western DuPage Chamber of Commerce reserves the absolute right to terminate the Agreement in the event the vendor sells or attempts to sell any product or service other than those specified in Article | or breaches any of the terms and conditions contained in Article II or the rules and regulations for Railroad Days 2022 Exhibitor/Vendor Agreement. In the event the Western DuPage Chamber of Commerce terminates this agreement, the Exhibitor/Vendor shall immediately forfeit the security deposit and all fees paid, cease any activities at Railroad Days 2022 and remove all equipment, personnel and other property from Pioneer Park. [ | | have read and understand the above agreement. Exhibitor/Vendor: (Please Print Company Name) Signature: x Date: (Staff Use Only) Accepted by: Date: Please keep a copy of the completed application for your records. VENDOR INDEMNITY AGREEMENT: As a part of your participation in Railroad Days 2022, the below vendor hereby agrees to indemnify and hold harmless the City of West Chicago, its officials, employees, agents and volunteers who are listed as additional insured. the Western DuPage Chamber of Commerce, West Chicago Park District and the West Chicago Fire Protection District against any and all claims, suits, cost, damages and expenses at Railroad Days 2022 they may sustain by reason of any acts of omission by the below vendor and/or employees, associates, affiliates and/or partners of the below vendor. The below vendor agrees to pay any judgment or settlement resulting from such suit, demean or claim, and to pay all reasonable attorney fees incurred by the City of West Chicago, the Western DuPage Chamber of Commerce, West Chicago Park District, or the West Chicago Fire Protection District in defending against such suit, demean or claim. In the event of any dispute between the vendor, the City of West Chicago, the Western DuPage Chamber of Commerce, West Chicago Park District, and the West Chicago Fire Protection District concerning the terms of this indemnity agreement, it is hereby understood and agreed that the proper venue for litigating any such dispute is DuPage County, Illinois. Company Name (printed): Signature Name (printed): Date: Signature: x Date: Street Address: City: State: ss Zip Code: Phone: ( ) (Staff Use Only) ACCEPTED BY: DATE (Western DuPage Chamber of Commerce Only) ===== PDF PAGE 72 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE IV - Payment The following Fees Apply to all Vendors participating in the 2022 Railroad Days festival on July 7-10, 2022. Exhibitor Booth Rental: R@Q ss... eines otvspcenye sted tite cosetea datenas cova tbesasastes $ 395.00 Electricity: (One 110 Outlet provided) Additional 110-outlet x$50.00ea. $9.00 SUBTOTAL $ 395.00 Western DuPage Chamber Members & West Chicago Business Discount None $100 discount if applicable LESS ¢ 0.00 TOTAL AMOUNT ¢ 395.00 MAKE CHECKS PAYABLE TO: WESTERN DUPAGE CHAMBER OF COMMERCE Mailing address: Westem DuPage Chamber of Commerce 306 Main Street, West Chicago, IL 60185 Phone: 630-231-3003 Email: team@westerndupagechamber.com No checks will be accepted without a completed vendor agreement and no vendor is considered to have been accepted as a participant in the 2022 Railroad Days event until receiving an Approval email from the 2022 Railroad Days Committee of the Western DuPage Chamber of Commerce. Credit Card: Enter the complete credit card number: Expiration Date: CVS (#): Payment Amount: $ 399.00 Billing Address for Credit Card: Street: City: State: Zip Code: | authorize Western DuPage Chamber of Commerce to charge the above credit card for the amount noted above. Cardholder Name (printed): Date: Cardholder Signature: Once credit card is processed for payment, we immediately destroy the original application and any digital copies. For our vendor's security, no portion will be retained for our records. ===== PDF PAGE 73 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE V - Insurance Requirements 2022 West Chicago Railroad Days Insurance Additional Insured: Endorsement Requirement The City of West Chicago, as the Major Sponsor of the 2022 Railroad Days Festival requires that the following statement appear on all certificates of insurance: Additional Insured: The City of West Chicago, West Chicago Park District, West Chicago Fire Protection District, Western DuPage Chamber of Commerce, its officials, employees, agents and volunteers. *See sample of an acceptable certificate below. Please provide this information to your insurance carrier to avoid any potential problems that would result in an unacceptable certificate being submitted and the rejection of your participation in this community event. Additional Comments: Checklist: [| Products/Items Identified with Pricing [] Electrical Requirements Added Sin Email Button | [] Certificate of Insurance Submitted [| Vendor & Indemnity Agreement Signed Vendors will be notified on the acceptance/rejection of application and items by email. Approved terms will be outlined in email as well as setup times, parking information/permits,& procedures. If you submitted your application and have not heard back from the Western DuPage Chamber of Commerce, please contact our office at 630-231-3003 or email us at Team@WesternDuPageChamber.com ===== PDF PAGE 74 ===== [Extraction: OCR (rendered-page OCR)] ACORD, CERTIFICATE OF LIABILITY INSURANCE ea [racoucen THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ‘Your insurance Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Yout Name and Address INSURER B: INSURER C INSURER 0: | | INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FOLIC HUBBER POLICY EFFECTIVE | POLICY EXPIRATION GENERAL LIABILITY \ EACH OCCURRENCE $ 1,000,000 rx] DAME YRENTED Aj X | COMMERCIAL GENERAL LiaBiLiTy | Polley Number 6 Ce RENE s _ 100,000 ___| claims mane | X | occur MEQ EXP (Any one person} | S 5,000 ; 1 | pa PERSONAL s 1,000,000 | i s 3,000,000 | GENL AGGREGATE LIMIT APPLIES PER s 3,000,000 poucy| | 58% [ |t0c | | auromosie Liasiury A | ANY AUTO. 1,000,000 ALL OWNED AUTOS SCHEOULEO ' HIRED AUTOS BODILY INJURY $ | NON-OWNED (Per accident) 7 a |e PROPERTY DAMAGE s (Per accident) | 1 _GARAGE LIABILITY AUTO ONLY-EA ACCIDENT |S i GAR ANY AUTO OTHER THAN EAace | s i AUTO ONLY AGG |§ EXCESS/UMBRELLA LIABILITY aa/ aa EACH OCCURRENCE s 2,000,000 mm, mm, A occur [| ciamsmane | Pavey Number vad/yy ey AGGREGATE s 2,000,000 1 | 4 ~ TT . L_] oeouctiee $ RETENTION s $ | WORKERS COMPENSATION AND Feat names LX [erties | |SE| 5 |) ERPLOveRS ABIITY. mm/dd/yy mm/dd/yy 3 | EL. EACH ACCIDENT $s 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ' £ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE} $ 500,000 yes. desenbe und = Si ECIAL PROVISIONS, below E.L. DISEASE - POLICY LIMIT | $ $00,000 OTHER i QESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Additional Insured: The City of West Chicago, West Chicago Park District. West Chicago Fire Protection District, Western DuPage Chamber of ‘Commerce, Its officials, employees, agents and volunteers. L CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Western DuPage Chamber of Commerce 306 Main Stoet Wost Chicage, IL 60185 ACORD 25 (2001/08) © ACORD CORPORATION 1988 ===== PDF PAGE 75 ===== [Extraction: OCR (rendered-page OCR)] ‘Western DuPage 2022 RAILROAD DAYS FOOD VENDOR APPLICATION £ ie P RAILROAD DAYS APPLICATION & AGREEMENT — -— Wes cng, 2022 eD | - 0 = ; | — 2 Chamber of Commerce The Western DuPage Chamber of Commerce as a manager of the 2022 West Chicago Railroad /| Days Festival and Food Vendor agree to the terms and conditions of the agreement. The Food Vendor shall sell only the products specified and approved in this agreement at Pioneer Park during the 2022 Railroad Days event. Date & Times of the Railroad Days 2022 festival are as follows: Thursday, July 7, 2022 4:30 pm - 10:00 pm Friday, July 8, 2022 4:30 pm - 11:00 pm Saturday, July 9, 2022 Noon - 11:00 pm Sunday, July 10, 2022 2:30 pm - 10:00 pm ARTICLE 1: Food Vendor: Company/Product Information & Electrical Requirements Company Name: Contact: Phone: ( ) Fax ( ) Street Address: City: State: Zip: E-mail(s): Description of products/items that will be sold (including prices if applicable): (If you need more space to write down additional items, please use the additional page section on application.) 1) $ 2) $ 3) $ 4) $ 5) $ 6) $ 7) $ 8) $ 9) $ 10) $ 11) $ 12) $ 13) $ 14) $ 15) $ 16) $ ===== PDF PAGE 76 ===== [Extraction: OCR (rendered-page OCR)] Beverage Sales: SOFT DRINKS OR WATER MAY BE SOLD BY ANY FOOD VENDOR during Railroad Days Festival 2022. NO GLASS CONTAINERS. Vendor may provide any other non-alcoholic beverage, i.e. lemonade, ice tea etc. In any size and price, as long as it is not in a glass container. A) Will you provide soda? [_ ]yes [ial No B) Will you provide other beverages? [_ ]ves | No Specify: C) Will you require 20-Ib bags of ice? [ ] Yes [ ] No Qty: X $7.50 each. Ice must be reserved & paid for with this application! Vendors will be notified on the acceptance/rejection of application and food items by email. Approved food items will be outlined in email as well as setup times, parking information/ permits, & procedures. If you submitted your application and have not heard back from the Western DuPage Chamber of Commerce, please contact our office at 630-231-3003 or email us at Team@WesternDuPageChamber.com Electrical Requirements: e This section must be complete and accurate. In order to ensure that all Food Vendors have enough electricity, we must have all of your information. Your application will not be accepted unless it is complete. e Nochanges will be allowed the day of the event, only requested electrical requirements will be supplied. e Vendors are solely responsible for their own heavy-duty extension cords (#123-prong conductor). e Vendor will be provided one 110 outlet; additional 110 outlets will be charged at $50 each. e Vendors who need 220 outlets will be charged $150.00 per 220 outlet. e Please list each electrical need individually. If necessary, use the additional page for any additional needs. Direct Connect Available on-site only, call for quote! A) Types of application (Need) Qty. Volts Watts Amps Outlet Type (220 or 110) 1) ee ee ey ee et Ei (ef ee apo a a Ee ee he. “eee gy) oe eC Tess ie 4) ey LJ1t0 [J 220 5) ——eses—sS—essssssSCEtt10 ss J 220 B) Total number of outlets needed: (REQUIRED): C) Total number of 20 Amp circuits needed: (REQUIRED): ===== PDF PAGE 77 ===== [Extraction: OCR (rendered-page OCR)] Parking, RV, Trailers & Other Storage Units: D) On-Site trailers, motor homes, RV, or other storage units must register and pay for space and electric service prior to arrival. Parking of these units is not allowed anywhere on park property without the expressed written consent of the Western DuPage Chamber of Commerce. 1) Parking of self-contained units (no water or electric hook-up) $100.00. 2) Parking of storage, RV or other unit (needing water) $125.00. 3) *Electric service to RV or another temporary unit. $175.00. (*) most RV & or storage units can operate on 110 or 220 volts with a standard plug. If direct connect or special power or plug is required, every attempt will be made to accommodate but there are no guarantees that the necessary hook-up will be available. No refunds will be provided so please make sure you are prepared to provide these at time of installation by our generator contractor. They will not return to hookup power after they have left the Site. . Example: RV requiring 220 volt electric & 1) [] Yes, | need Parking for None @ $100.00 perunit=$0.00 eter 4-days vibe $300.00 2) [ ] Yes, | need Parking & Water for None @ $125.00 per unit= $ 0.00 ($125.00 + $175.00) 3) [ ] Yes, | need Additional Electric for None @ $175.00 per unit= $ 0.00 GrandTotal=$0.00 ARTICLE I! - Rules & Compliance 1. This application must be completed and received by the Western DuPage Chamber of Commerce, not later than Friday, June 17th at 12:00 Noon and shall not be in effect until accepted by the Western DuPage Chamber of Commerce. 2. Please send your application to: Western DuPage Chamber of Commerce 306 Main Street, West Chicago, IL 60185 Email: team@westerndupagechamber.com 3. This agreement must be submitted along with the following: a) All Fees (per attached fee schedule). b) See Attached Insurance requirements! 4. Vendor must remain open from the beginning of the event until the end of the event each day. 5. Vendor site must be kept clean, and garbage discarded properly. Discarded food shall not be left on site after event. Cleaning up fees will be billed to vendor and vendor may be refused future participation in Railroad Days festivals. 6. Vendors must supply their own sign with their name and prices (if applicable) on it. 7. Vendor is solely responsible for compliance with the DuPage County Health Department regulations. This year's Railroad Days Health inspector is: (click the logo to visit website.) Contact: Rick Johnson Main Phone: (630) 682-7400 Cell: (630) 541-7181 Email: rohnson@dupagehealth.org ===== PDF PAGE 78 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE Ill - Agreement The Western DuPage Chamber of Commerce reserves the absolute right to terminate the Agreement in the event the vendor sells or attempts to sell any product or service other than those specified in Article | or breaches any of the terms and conditions contained in Article II or the rules and regulations for Railroad Days 2022 Exhibitor/Vendor Agreement. In the event the Western DuPage Chamber of Commerce terminates this agreement, the Exhibitor/Vendor shall immediately forfeit the security deposit and all fees paid, cease any activities at Railroad Days 2022 and remove all equipment, personnel and other property from Pioneer Park. [] | have read and understand the above agreement. Exhibitor/Vendor: (Please Print Company Name) Signature: Date: (Staff Use Only) Accepted by: Date: Please keep a copy of the completed application for your records. VENDOR INDEMNITY AGREEMENT: As a part of your participation in Railroad Days 2022 the below vendor hereby agrees to indemnify and hold harmless the City of West Chicago, its officials, employees, agents and volunteers who are listed as additional insured; the Western DuPage Chamber of Commerce, West Chicago Park District and the West Chicago Fire Protection District against any and all claims, suits, cost, damages and expenses at Railroad Days 2022 they may sustain by reason of any acts of omission by the below vendor and/or employees, associates, affiliates and/or partners of the below vendor. The below vendor agrees to pay any judgment or settlement resulting from such suit, demean or claim, and to pay all reasonable attorney fees incurred by the City of West Chicago, the Western DuPage Chamber of Commerce, West Chicago Park District or the West Chicago Fire Protection District in defending against such suit, demean or claim. In the event of any dispute between the vendor, the City of West Chicago, the Western DuPage Chamber of Commerce, West Chicago Park District, and the West Chicago Fire Protection District concerning the terms of this indemnity agreement, it is hereby understood and agreed that the proper venue for litigating any such dispute is DuPage County, Illinois. Company Name (printed): Signature Name (printed): Date: Signature: Date: Street Address: City: State: Zip Code: (Staff Use Only) Accepted by: DATE: (Western DuPage Chamber of Commerce Only) ===== PDF PAGE 79 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE IV — Insurance Requirements 2022 West Chicago Railroad Days Insurance Additional Insured: Endorsement Requirement The City of West Chicago, as the Major Sponsor of the 2022 Railroad Days Festival requires that the following statement appear on all certificates of insurance: Additional Insured: The City of West Chicago, West Chicago Park District, West Chicago Fire Protection District, Western DuPage Chamber of Commerce, its officials, employees, agents and volunteers. *See sample of an acceptable certificate below. Please provide this information to your insurance carrier to avoid any potential problems that would result in an unacceptable certificate being submitted and the rejection of your participation. Additional Comments: Checklist: [ ] Foods & Beverages Listed with Prices. [ ] Electrical & On-Site Needs Requested. [__] Contacted the DuPage County Health Department. Save Button [| Certificate of Insurance Submitted. Print Button | Vendor & Indemnity Agreements Signed. Email Button [| Meal Ticket Agreement Signed. (optional) ===== PDF PAGE 80 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE V - Payment Payments must be made in full before the first operation day of Railroad Days, starting Thursday, July 7th, 2022. Please contact Chamber staff if you have any questions regarding payments at 630-231-3003. Food Booth Rental: 12x12 Booth Space ..........eccecseecceeceeeeeeeeees $ 995.00 On-Site Trailers, RV, or other Storage Unit(s) $0.00 Electricity: (Two 110 Outlet provided) Additional 110-outlet x$50.00ea. $ 9-00 Additional 220-outlet x $150.00ea. $ 9-00 20 Lbs. Bags of Ice x $7.50ea. $ 9.00 SUBTOTAL $ 995-00 Western DuPage Chamber Members & West Chicago Business Discount None $100 discount if applicable LESS g 0.00 AMOUNT $ 995.00 MAKE CHECKS PAYABLE TO: WESTERN DUPAGE CHAMBER OF COMMERCE Mailing address: | Western DuPage Chamber of Commerce 306 Main Street, West Chicago, IL 60185 Phone: 630-231-3003 Fax: 630-231-3009 No checks will be accepted without a completed vendor agreement and no vendor is considered to have been accepted as a participant in the 2022 Railroad Days event until receiving an Approval email from the 2022 Railroad Days Committee of the Western DuPage Chamber of Commerce. Credit Card: Enter the complete credit card number: Expiration Date: CVS (#): Payment Amount: $ 995.00 Billing Address for Credit Card: Street: City: State: Zip Code: CL] | authorize Western DuPage Chamber of Commerce to charge the above credit card for the amount noted above. Cardholder Name (printed): Date: Cardholder Signature: Once credit card is processed for payment, we immediately destroy the original application and any digital copies. For our vendor's security, no Portion will be retained for our records. ===== PDF PAGE 81 ===== [Extraction: OCR (rendered-page OCR)] Checklist VI - Food Vendor Meal Ticket Agreement Meal ticket reimbursement program is designed to ensure food vendors who provide food to Police Officers, Fire Department, EMT Personnel, Volunteers, or Special Guests are properly reimbursed for the meals. The Western DuPage Chamber of Commerce manages these meal tickets (example below); and will have our signatures/Initials on the opposite side for security purposes. Your Responsibilities: Each meal ticket will be honored at $6.00 per ticket for anyone who wishes to exchange their ticket at your booth for a complete meal. in exchange we ask you to provide a complete meal for each ticket; drink (optional), main food item, and side item. For example. (hotdog, and bag of chips or equivalent). Please indicate what food items you are willing to provide in exchange for a meal ticket. Please provide two options. a) All items in the meal options must be given to the meal ticket holder. b) All meal vouchers must be submitted for reimbursement by Sunday, July 10 at 9 PM to staff. c) Verify that there are signatures/initials in the following area (without the initials & stamp, the ticket is not valid and NO reimbursement will be made). OurResponsibilities: We will provide meal tickets (example below) to our Police Officers, Fire Department, EMT Personnel, volunteers or special guests. Our staff will place a meal ticket examples at your booth to ensure that meal ticket recipients see you're a participant in the program. (a) We create a menu for volunteers, officers, guest, & staff; listing all participants and what is offered. Notes: 1. No substitutions allowed. 2. [tems purchased other than meal options must be paid for by employee, Police, Fire Dept., Volunteer or Guest. Option #1 (Example Only) Option #2 (Example Only) Drink: None Drink: Coke Products Main Item: 2 (Beef, Pork, or Chicken) Tacos Main Item: Hot Dog Side Item: Spanish Rice Side Item: Chips. Option #1 Option #2 Drink: Drink: Main Item: Main Item: Side Item: Side Item: As a Railroad Days food vendor, | have read and understand the terms of this agreement. By signing below | agree to the terms of this agreement and will honor meal tickets during the hours of operations. Signature: Date: (front) (back with initials/signature) ADULT $2.50 om i Ss Nese of Commerce os 308 ae ye0tes ===== PDF PAGE 82 ===== [Extraction: OCR (rendered-page OCR)] ACORD, CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Your Insurance Company INSURERS AFFORDING COVERAGE NAIC # INSUREO INSURER A: | Your Namo and Address INSURER B: | wsurer Cc INSURER D- INSURER E- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS. INSR AOD tea POLICY EFFECTIVE | POLICY EXPIRATION | _GENERAL LIABILITY EACH OCCURRENCE 21,009,000 A X | COMMERCIAL GENERAL LIABILITY | Polley Number 9 Eee re ees) | 100,000 {|__| CLAIMS MaDe [x] OccuR *AEO EXP (Any one person} 5,900 PERSONAL J 1,0 00 | 7 GENERAL AC 3,000,000 GEN AGGREGATE LIMIT APPLIES PER : PRODUCTS - 3,000,000 r POLICY (el Seer im Loc | AUTOMOBILE LIABILITY . FS SOMBINEO SIN AB AUTO b ; n va a accent 1,000, 000 ALL OWNEO AUTOS SCHEDULED |__| HIRED aur ! (NON-OWNED | BODILY INJURY | (Per accident) PROPERTY DAMAGE $ (Par accident) a | | AUTO ONLY-EAACCIDENT | GARAGE LIABILITY : $s |__| ANY AUTO : OTHER THAN Eaacc | s | AUTO ONLY acc |§ [ | EXCESSIUMBRELLA LIABILITY ad/ ad, EACH OCCURRENCE s 2,000,000 be mm, mm, A |__| occur claims Mang | Pury Number Vad/yy Vy AGGREGATE s 2,000,000 I | ou s | H DEDUCTIBLE |__| Retention 5 j Vic STATU- OTH. WORKERS COMPENSATION AND ‘ORY LIMITS {Se — 8B pe OG asa mm/dd/yy mm/dd/yy 3} | EL EACH ACCIDENT s 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE _ _—— won se OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE] $ 500,000 | ILyes, describe und — oe si Has PROVISIONS below | E.L. DISEASE - POLICY LIMIT | $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS Additional Insured: The City of West Chicago, West Chicago Park District, West Chicago Fire Protection District, Western DuPage Chamber of ‘Commerce, Its officials, employees, agents and volunteers. CERTIFICATE HOLDER CANCELLATION ‘SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30 DAYS WRITTEN Wostern DuPage Chamber of Commerce 306 Main Stroet West Chicago. It 60195 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988 ===== PDF PAGE 83 ===== [Extraction: OCR (rendered-page OCR)] ‘Western DuPage 2022 RAILROAD DAYS NON-PROFIT APPLICATION | 4 Tuly 5, F | RAILROAD DAYS APPLICATION & AGREEMENT [— Werci®»20a2 5 | - Chamber of Commerce PE oe TP eeameseOO, at \ The Western DuPage Chamber of Commerce as a manager of the 2022 West Chicago Railroad 7 | Days Festival and Exhibitor/Vendor agree to the terms and conditions of the agreement. The A Exhibitor/Vendor shall sell only the products specified and approved in this agreement at Pioneer Park during the 2022 Railroad Days event. Date & Times of the Railroad Days 2022 festival are as follows: Thursday, July 7, 2022 4:30 pm -10:00 pm Friday,July 8, 2022 4:30 pm -11:00 pm Saturday,July 9, 2022 Noon - 11:00 pm Sunday,July 10, 2022 2:30 pm -10:00 pm ARTICLE 1: Exhibitor/Vendor: Contact and Product Information Company Name: Contact: Phone: ( ) Fax(__) Street Address: City: State: Zip: E-mail(s): Description of products/items that will be distributed (including prices, if applicable): (If you need more space to write down additional items, please use the additional page section on application.) 1) $ 2) $ 3) $ 4) $ 5) $ 6) $ 7) $ 8) $ 9) $ 10) $ 11) $ 12) $ 13) $ 14) $ 8) Food and/or Beverage Sales: the sale of food and/or beverages is limited to Approved Food Vendors. No Exhibitor or Vendor may sell any food or beverage without the prior written consent of the Western DuPage Chamber of Commerce and 2022 Railroad Days Committee. No Exceptions! ===== PDF PAGE 84 ===== [Extraction: OCR (rendered-page OCR)] Electrical Requirements: « This section must be complete and accurate. In order to ensure that all Exhibitors/Vendors have enough electricity, we must have all of your information. Any application that is not completed will not be accepted. NOTE: No changes will be allowed the day of the event, only requested electrical requirements would be supplied. « Vendors are solely responsible for their own heavy-duty extension cords (#123-prong conductor). - Vendor will be provided one 110 outlet; additional 110 outlets will be charged at $50 each. - List each electrical need individually. If necessary, please use the reverse side for any additional needs. A) Types of application (Need) Qty. Volts Watts Amps Outlet needed 1) ie [ | 10 Outlet 2) ja a ee ecians) 3) B) Total number of outlets needed: (REQUIRED): ARTICLE II — Rules & Compliance 1) This application must be completed and received by the Western DuPage Chamber of Commerce, not later than Wednesday, June 22nd at 12:00 Noon and shall not be in effect until accepted by the Western DuPage Chamber of Commerce. 2) Please send your application to: Western DuPage Chamber of Commerce 306 Main Street West Chicago, IL 60185 Email: team@westerndupagechamber.com. 3) This agreement must be submitted along with the following: a) All Fees (per attached fee schedule). b) See Attached Insurance requirements! 4) Vendor must remain open from the beginning of the event until the end of the event each day. 5) Vendor site must be kept clean and garbage discarded properly. 6) Vendors must supply their own sign with their name and prices (if applicable) on it. ===== PDF PAGE 85 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE Ill - Agreement The Western DuPage Chamber of Commerce reserves the absolute right to terminate the Agreement in the event the vendor sells or attempts to sell any product or service other than those specified in Article | or breaches any of the terms and conditions contained in Article II or the rules and regulations for Railroad Days 2022 Exhibitor/Vendor Agreement. In the event the Western DuPage Chamber of Commerce terminates this agreement, the Exhibitor/Vendor shall immediately forfeit the security deposit and all fees paid, cease any activities at Railroad Days 2022 and remove all equipment, personnel and other property from Pioneer Park. [] | have read and understand the above agreement. Exhibitor/Vendor: (Please Print Company Name) Signature: x Date: (Staff Use Only) Accepted by: Date: Please keep a copy of the completed application for your records. VENDOR INDEMNITY AGREEMENT: As a part of your participation in Railroad Days 2022, the below vendor hereby agrees to indemnify and hold harmless the City of West Chicago, its officials, employees, agents and volunteers who are listed as additional insured; the Western DuPage Chamber of Commerce, West Chicago Park District and the West Chicago Fire Protection District against any and all claims, suits, cost, damages and expenses at Railroad Days 2022 they may sustain by reason of any acts of omission by the below vendor and/or employees, associates, affiliates and/or partners of the below vendor. The below vendor agrees to pay any judgment or settlement resulting from such suit, demean or claim, and to pay all reasonable attorney fees incurred by the City of West Chicago, the Western DuPage Chamber of Commerce, West Chicago Park District or the West Chicago Fire Protection District in defending against such suit, demean or claim. In the event of any dispute between the vendor, the City of West Chicago, the Western DuPage Chamber of Commerce, West Chicago Park District, and the West Chicago Fire Protection District concerning the terms of this indemnity agreement, it is hereby understood and agreed that the proper venue for litigating any such dispute is DuPage County, Illinois. Company Name (printed): Signature Name (printed): Date: Signature: x Date: Street Address: City: State: ss Zip Code: Phone: ( ) (Staff Use Only) ACCEPTED BY: DATE. (Western DuPage Chamber of Commerce Only) ===== PDF PAGE 86 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE IV - Payment The following Fees Apply to all Not-for-Profit Vendors participating in the 2022 Railroad Days festival on July 7-10, 2022. Non-for-Profit Booth: Electricity: (One 110 Outlet provided) Additional 110-outlet x$50.00ea. ¢ 9.00 SUBTOTAL § 150.00 TOTAL AMOUNT ¢ 150.00 MAKE CHECKS PAYABLE TO: WESTERN DUPAGE CHAMBER OF COMMERCE Mailing address: | Western DuPage Chamber of Commerce 306 Main Street, West Chicago, IL 60185 Phone: 630-231-3003 No checks will be accepted without a completed vendor agreement and no vendor is considered to have been accepted as a participant in the 2022 Railroad Days event until receiving an Approval email from the 2022 Railroad Days Committee of the Western DuPage Chamber of Commerce. Enter the complete credit card number: Expiration Date: CVS (#): Payment Amount: $ 159-00 Billing Address for Credit Card: Street: City: State: Zip Code: L] | authorize Western DuPage Chamber of Commerce to charge the above credit card for the amount noted above. Cardholder Name (printed): Date: Cardholder Signature: Once credit card is processed for payment, we immediately destroy the original application and any digital copies. For our vendor's security, no portion will be retained for our records. ===== PDF PAGE 87 ===== [Extraction: OCR (rendered-page OCR)] ARTICLE V — Insurance Requirements 2022 West Chicago Railroad Days Insurance Additional Insured: Endorsement Requirement The City of West Chicago, as the Major Sponsor of the 2022 Railroad Days Festival requires that the following statement appear on all certificates of insurance: Additional Insured: The City of West Chicago, West Chicago Park District, West Chicago Fire Protection District, Western DuPage Chamber of Commerce, its officials, employees, agents and volunteers. *See sample of an acceptable certificate below. Please provide this information to your insurance carrier to avoid any potential problems that would result in an unacceptable certificate being submitted and the rejection of your participation in this community event. Additional Comments: Checklist: [| Products Identified & Priced [ ] Electrical Requirements Addressed Save Button [| Certificate of Insurance Submitted [| Vendor & Indemnity Agreement Signed — Vendors will be notified on the acceptance/rejection of application and items by email. Approved terms will be outlined in email as well as setup times, parking information/permits,& procedures. If you submitted your application and have not heard back from the Western DuPage Chamber of Commerce, please contact our office at 630-231-3003 or email us at Team@WesternDuPageChamber.com ===== PDF PAGE 88 ===== [Extraction: OCR (rendered-page OCR)] ACORD, CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Your insurance Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # MeURED) INSURER A: Your Name and Address Rona INSURER ¢ a INSURER D. l INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS. INSR heey POLICY NUMBER POLICY EFFECTIVE | POLICY EXPIRATION | | GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 x | mm/dd, mm/dd, + DAMAGE YO" ie A | X | COMMERCIAL GENERAL LiasiLiTy | Polley Number vad/yvy ue CASES ee ce) s 100,000 jie CLAIMS MADE [x] occur Sean 5,000 s 1,000,000 | 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER J c 3,000,000 POLICY ica mire F AUTOMOBILE LIABILITY 1,000,000 A ANY AUTO ALL OWNED AUTOS | SCHEOULED Ay HIRED AUTOS BODILY INJURY NON-OWNED (Per accident) a ee Ne Rai. PROPERTY DAMAGE 5 | (Per accident) GARAGE LIABILITY ; AUTO ONLY -EAACGIDENT | § | : ANY AUTO OTHER THAN _EAACC | $ | AUTO ONLY acc |s EXCESS/UMBRELLA LIABILITY ed, yea/ EACH OCCURRENCE { s 2,060,000 Policy mm, mm, A occur CLAIMS MADE aad vy wy AGGREGATE $2,000,000 7 , _—— |s_ eee} DEDUCTIBLE $ |_| Retention _s ! d We STATU- OTH WORKERS COMPENSATION AND Poncy Namier |x Ligavits | [SR _ p.,,| SRPLRYESS, DARLIN mm/dd/yy mm/dd/yy 3 | EL. EACH ACCIDENT ls 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE {i OFFICER/MEMBER EXCLUDED? E.L_ DISEASE - EA EMPLOYEE) $ 500,000 tyes. nd a aap SPECIAL PROVISIONS bolaw [eu oisease -Poucy umit | s $00,000 OTHER i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Additional Insured: The City of West Chicago, West Chicago Park District, West Chicago Fire Protection District, Western DuPage Chamber of ‘Commerce, Its officials, employees, agents and volunteers. CERTIFICATE HOLDER CANCELLATION ‘SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _30 DAYS WRITTEN Western OuPage Chamber of Commerce 306 Main Stroet West Chicago, It 6018S NOTICE TO THE CERTIFICATE HOLOER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) © ACORD CORPORATION 1988 ===== PDF PAGE 89 ===== [Extraction: OCR (rendered-page OCR)] City of West Chicago CARNIVAL PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL BY CARNIVAL BUSINESS OWNER & SUBMITTED 90 DAYS PRIOR TO THE EVENT NOTE: A Special Event Permit Application shall be completed by the event City of West Chicago coordinator in addition to the Camival Permit Application and submitted to the City of 475 Main Street West Chicago 90 days prior to the event. The form is available for download at West Chicago, IL 60185 www. westchicago.org/forms. (630) 293-2200 Applicant is: Corporation Partnership Individual Legal Name of Business: Fantasy Amusement Company Inc. Business Phone: 847-259-9090 Business Fax: NIA Address of Business: 629 N. Forrest Ave. Arlington Heights, IL 60004 Applicant's Name: William Johnson Title. President Applicant's Address: 629 N. Forrest Ave. Arlington Heights, IL 60004 Applicant's Phone: 847-259-9090 Applicant's Cell Phone: 847-271-9089 Applicant's Email Address: fac9090@comcast.net Location/address where carnival will be operated: Pioneer Park 479 Forest Ave. Dates of camival operation: Start July 7, 2022 Close July 10, 2022 SANDRA ROTHSTEIN OFFICIAL SEAL Sey Re Rubl ent Minois Oey Comm mel Sa Expires October 08, 2022 Signed and sworn to before me this 28th day of March , 20.22 “All employees, including those operating rides, games, amusement or food or beverage stalls, MUST submit to fingerprint background checks to be completed 21 days prior to the event. Contact the West Chicago Police Department at (630) 293-2222 to schedule fingerprinting. FEO EEO TUITE OTE TIO TOIT I IIE ICCC UIIE EOS IOIOUIIEEEA SIDES IIE IIS TITEIO TOU TOEIOTIOTI IOS UU HETIOOSIOOECNER ICT inti FOR OFFICE USE ONLY Sahalahedehshelelelalehatalahelealatelehaladeialeialedehsiaieiabatelabeleliilelsieiaioh iebelebbisilebibeiabiaaiisininiaddteiddiddiddeolddiddadddddichddionicrdenadacee eee eee ete Based on the information which has been submitted, the request for a permit has been: O Approved © Denied Notes: Authorized Signature — Police Dept. Representative Date Number of fingerprint background checks completed: Print Name Authorized Signature - Community Dev. Representative Date Print Name