===== PDF PAGE 9 ===== [Extraction: OCR (rendered-page OCR)] CITY OF WEST CHICAGO PUBLIC AFFAIRS COMMITTEE AGENDA ITEM SUMMARY ITEM TITLE: AGENDA ITEM NUMBER: “A. CF Cycle for Life Special Event Permit Application Cystic Fibrosis Foundation FILE NUMBER: COMMITTEE AGENDA DATE: August 21, 2023 COUNCIL AGENDA DATE: SIGNATURE & > y, - APPROVED BY CITY ADMINISTRATOR: Michael Guttman SIGNATURE STAFF REVIEW: Tom Dabareiner ITEM SUMMARY: The Cystic Fibrosis Foundation is seeking approval for their CF Cycle for Life bike ride scheduled for Saturday, September 23, 2023 from 8:00 a.m. — 2:00 p.m. with an estimate of 75 attendees. They will be starting at Pollyanna in St Charles with routes utilizing the IL Prairie Path throughout DuPage County. The estimated time that the riders will be in the West Chicago area is between 11:00 and 1:00pm. 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 Park District and Fire Protection District. The Special Event Permit Application is attached, which includes the course maps. ACTIONS PROPOSED: Recommend event for approval as proposed, contingent upon submittal and approval of required insurance documentation. COMMITTEE RECOMMENDATION: ===== PDF PAGE 10 ===== [Extraction: OCR (rendered-page OCR)] City of West Chicago ai SPECIAL EVENT PERMIT APPLICATION wg THIS FORM MUST BE COMPLETED IN FULL & SUBMITTED 90 DAYS PRIOR TO THE EVENT PERMIT NO. Special Event Permit Application The Special Event Application must be submitted 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 and/or city personnel. The 90-day time period allows sufficient time to evaluate the request and provide a recommendation to the City Council for its consideration. For any late submittals (applications submitted less than 90 days prior to the event), a $50 late fee must be paid with the application. Further, the applicant runs the risk of their Special Event request being denied. 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 o 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 co Temporary Liquor License Application — requires separate application a Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979) FEI III IO III III OITA TOTTI IIIT OI I IO TTI I II TOI I III ITI IOI II IIIT IS ITI II II TOI II IOI AI IIASA IIT RATA I ION FOR OFFICE USE ONLY HRA RARER RRR AREER IRIE BRIERE RIERA RIS IAAI AAI IIIA II AIA IAI AIIAI AAI III II AISI AI AIA AIPA AAAI AIO AAI IA AIA IIA AI II Received: {jz Fee Paid: $ Receipt # Check # Event Acknowledgement Form returned by: Police Dept.__K _ Fire Dist._ Pw__Xparper_X _-cpp_X a Background checks completed by Police Dept. Date a DuPage Co. Health Department notified Date = a Certificate of Insurance received and approved Date 8] \o | (Zo) Page 1 of 8 ===== PDF PAGE 11 ===== [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 IML-RMA 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, Meg Schneider , representing Cystic Fibrosis Foundation (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. (signature) (date) CF Cycle for Life 9/23/23 (name of event) (date of event) Page 2 of 8 ===== PDF PAGE 12 ===== [Extraction: OCR (rendered-page OCR)] SECTION 1 —- GENERAL INFORMATION Name of Event: _Cycle for Life Type of Event: O Parade [& Walk/Run/Bike O Carnivals O Fireworks O Festival 0 Other __A bike ride utilizing the Illinois Prairie Path requiring no street closures Location of Event: _ Illinois Prairie Path-Elgin Branch Date(s) of Event: 09.23.23 Hours of Event: 8:00 AM to 2:00 PM Est. Attendance: 75 Event Website: https://fightcf.cff.org/site/TR/Cycle/45_Greater_Illinois_Chicago?pg=entry&fr_id=9961 A fully supported bike ride benefitting the Cystic Fibrosis Foundation that is starting at Pur pose of event: Pollyanna in St. Charles with routes utilizing the IL Prairie Path throughout DuPage Co. Name of Sponsoring Organization(s): Cystic Fibrosis Foundation Organization's Legal Status (i.e. NFP, Partnership, Corporation): _Nonprofit Organization Contact person from sponsoring organization: _Katie Page Organizer address: _ 150 N Michigan Ave Suite 1550 City/State/Zip: _ Chicago, IL 60601 Phone: 872-265-1010 Cell Phone: _872-265-1010 E-mail: kreardon@eff.org Emergency contact information (provide mobile numbers for on-site coordinators during event): 1* Contact: _ Katie Page Phone: 872-265-1010 2" Contact: _ Stephanie Meyer Phone: _872-265-1005 Is this an annual event? Kl Yes O No If Yes, provide next year’s event date: 9/21/24 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. This is our first year riding on the Illinois Prairie Path, however, at our previous location there have been no problems or incidents that have occurred 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 & ===== PDF PAGE 13 ===== [Extraction: OCR (rendered-page OCR)] SECTION 3 - PERMITS Will your event include a carnival? o Yes No If yes, you must submit a Carnival Permit Application ninety (90) days prior to the event. Please visit www.westchicago.org under Forms 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 No If yes, you must submit a Building Permit Application thirty (30) days prior to the event. Please visit www.westchicago.org under Forms for an application. Will your event include a fireworks display? o Yes No If yes, you must submit a Fireworks Permit Application thirty (30) days prior to the event. Please visit www.westchicago.org under Forms for an application. Are you holding a raffle at your event? o Yes No 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 jt No If yes, you must submit a Temporary Liquor License Application thirty (30) days prior to the event. To qualify for a Class D license, the applicant must be a local organization or group providing beer and/or wine at a picnic, carnival or similar function. A Class D license shall be authorized on a day-to-day basis but not for more than seven (7) consecutive days. Please contact the City of West Chicago at (630) 293-2200 ext. 170 for an application. Will you be serving food at your event? a Yes x 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. Are you requesting services from these departments? O Police O Fire District / Paramedics O Public Works Specify services: We are requesting no services from any of your departments unless the City of West Chicago requires we use their police department for any needed crossing guards. Will you be utilizing any of the following services? No O Water 1 Electric/Generator O Other Page 4 of 8 ===== PDF PAGE 14 ===== [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? & Yes ONo _sIfyes, please indicate the property that you are requesting to use. Bike route is situated along the IL Prairie Path, going through West Chicago Would you like to request the closing of City streets? O Yes No 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 ===== PDF PAGE 15 ===== [Extraction: OCR (rendered-page OCR)] ie j e = 2 eect On) 9» OO | ss 4 Z53 Ga} Arthur, The Water Works fem Wing Park nd Se aaa . 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Community Hiah Schooi i Keyboard shoreuis | Map psi 2023 | Gasg' Google | Terms afuse Report a map error. ===== PDF PAGE 17 ===== [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: Tasks to be completed Days Due (All items due to City unless noted) Before Event Due Date Submit “Intent to Meet Insurance Requirements” F : + eat Document (included with Special Event Permit li wed Ke ie sid] seecaton 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 4 Submit Building (Temporary Tent) Permit aor 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. Page 6 of 8 ===== PDF PAGE 18 ===== [Extraction: OCR (rendered-page OCR)] SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT In consideration of the _Cystic Fibrosis Foundation (name of organization) and its Members, employees, volunteers or guests, being allow to participate in __CF Cycle for Life , (the Activity) the undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to Cystic Fibrosis Foundation __ (name of organization) participation in the Activity. To the fullest extent permitted by law, the CYStic Fibrosis Foundation (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 _Cystic Fibrosis Foundation _ (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 Cystic Fibrosis Foundation _ (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 ___ Cystic Fibrosis Foundation (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 _Cystic Fibrosis Foundation (name of organization). Agreed this day of , 20 Cystic Fibrosis Foundation Name of Organization Meg Schneider Print Name of Authorized Person Signature of Authorized Person Executive Director Title Page 7 of 8 ===== PDF PAGE 19 ===== [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. Cystic Fibrosis Foundation Me kin evclor 8 / S | 13 : ) Pint Name of Signatory) (Date Official Seal Notary Public - State of Itlinois My Commission Expires May 12, 2026 (Notary Public) Signed and swom to before me this__CS__day of August 20_ 22. 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 Se ER ARERR AHERERREREE RENE ER EHOEKERERORRAEREERERARRERERERERE RARER ERED OR TORRE EERE RERER ER ER AER RRAEERRERREERERERRERRORET ORE E NEES FOR OFFICE USE ONLY PReeeone ne eeenekenenheehe Aah eRe eARee area eA HEOEEEe AAA AhAREROAEEAEEHRAEREEEDAER EEE EREERLERER EERE NEERERERERDHER SRE AR EEC ER Based on the information which has been submitted and contingent upon approval of any necessary inspections the day of the event, the request for a permit has been: O Approved Permit No. - . O Denied Remarks: Authorized Signature Title Date Page 8 of 8