===== PDF PAGE 7 =====
[Extraction: OCR (rendered-page OCR)]
CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDAITEMNUMBER: — +2 |
Homecoming - Fireworks Display
Wheaton Academy FILE NUMBER:
COMMITTEE AGENDA DATE: September 18, 2023
COUNCIL AGENDA DATE: September 18, 2023
STAFF REVIEW: Tom Dabareiner SIGNATURE V2= y
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
ITEM SUMMARY:
Wheaton Academy is requesting permission for its Homecoming event on Friday, October 6, 2023, which
includes a fireworks display. 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:

===== PDF PAGE 8 =====
[Extraction: OCR (rendered-page OCR)]
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 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
0 Intent to Meet Insurance Requirements
a Section 1 — General Information
a Section 2 — Narrative
o Section 3 — Permits
o Section 4 — Site Plan and/or Route Map
0 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)
0 Carnival Permit Application - $50 per employee
a Fireworks Permit Application —
$125 (Check made payable to the West Chicago Fire Protection District)
0 Building Permit Application (temporary tents — see min. requirements) - $50
a Raffle Registration Application — requires separate application
6 Temporary Liquor License Application — requires separate application
o Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979)
FEISS IIE IOOITIITICITITIORIIITIEI IR IOCIOTOUOOEIAOT TOIT IAIN IIIT TA IIIT IRN TATTOOS SOS ASA A Ae
FOR OFFICE USE ONLY
Inn nnnenUEnnEnor nn nSini iin innmendiinE conn inning nnintintiiniit htinhinnsetnisineinnninainernannneenentzan
Received: 4 lle! 24 Loe Fee Paid:$ SO - 4 lle 23
. ~~ —
Receipt # Check #
Event Acknowledgement Form returned by:
Police Dept. f Fire Dist. PW / ~Park-Dist___-- CDD rA
0 Background checks completed by Police Dept. Date =
o DuPage Co. Health Department notified Date
0 Certificate of Insurance received and approved Date
Page 1 of 8

===== PDF PAGE 9 =====
[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, Dames May awa , representing Wheatsn Arc ad En
(print name of ailthorized| 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.
G-- 20a3
(signature) (date)
— Homecoain. 10 -6-a0a3
(name of event) (date of event)
Page 2 of 8

===== PDF PAGE 10 =====
[Extraction: OCR (rendered-page OCR)]
SECTION 1 - GENERAL INFORMATION
Name of Event: _\MJ heatan Ak caderny nee C anming
Type of Event:
O Parade O Walk/Run/Bike O Carnivals Fireworks O Festival
D Other
Location of Event: Too Pein oe Crossing (ca.
Date(s) of Event: 10) 2.3 Hours of Event: Sem to! |\0Opest. Attendance: _7d06
Event Website: Wwwheatoa Acadsem yore,
Purpose of event: C¢@\@bratse O1lurnni
Name of Sponsoring Organization(s): (As he aton Ata a 4on Y
Organization's Legal Status (i.e. NFP, Partnership, Corporation): Schoo )
Am es Vo Met ©
City/State/Zip: Phone Ee eed
Cell Phone E-mail: Na i-br ae QV whe atynacadys ANp og
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1* Contact: Sst wae Kar Is@n Phone: LY
2" Contact: S-++-#v e (swt Phone: iY
Is this an annual event? Yes O No If Yes, provide next year’s event date:
Contact person from sponsoring organization:
Organizer address:
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.
\yone
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

===== PDF PAGE 11 =====
[Extraction: OCR (rendered-page OCR)]
Sept 6, 2023
Dear West Chicago Council,
On Oct 5-7, 2023, 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 an alumni program, soccer game, and a dinner for the alumni.
Please grant us the special event permit and firework permit once again, to make this year
special.
Thank you so much,
James K. Holtro
irector of Special Events

===== PDF PAGE 12 =====
[Extraction: OCR (rendered-page OCR)]
SECTION 3 —- PERMITS
Will your event include a carnival? oc Yes \q 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? yYes oNo
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? WYes a 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? 0 Yes \g 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? AYes oNo
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 htto://www.dupagehealth.org/temporary-food-service for additional
information. \\re Wave OUT OWN CONCLS Sion Stand -
Are you requesting services from these departments?
KPolice Fire District / Paramedics 0 Public Works
Specify services: Fice 4 Cpt. a) moorwe ; newor es
Will you be utilizing any of the following services?
O Water O Electric/Generator O Other
Page 4 of 8

===== PDF PAGE 13 =====
[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?
O Yes No if yes, please indicate the property that you are requesting to use.
Would you like to request the closing of City streets? O Yes Xi 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 14 =====
[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” ; : + ati
i ; 7 . Prior to Prior to application
Document (included with Special Event Permit a H I
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
ee 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 15 =====
[Extraction: OCR (rendered-page OCR)]
SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the Whe ocken Arcadeary (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in a! GCnE¢ OMUAG, (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
VJ he oto A Cadeny (name of organization) participation in the Activity.
To the fullest extent permitted by law, the UU ) h eq tea Axc G dy raw {(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 attomeys fees), which may in anywise accrue against the City of West Chicago, its
Officials, agents and employees, arising in consequence of wh eatun A-cadenl me 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
@ (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 uh eedten Ace dem (4 _ (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 Wheatn Arcos. &m Y_(name of organization).
Agreed this __( Fhe day of _S tpt ‘ 20a?
Vth eaten Academy
Name of Organization
Sames C. Ho It+reg
Print Name of Authorized Person
Bignt ture of Authorized Person
aie oF Specal Enats
Page 7 of 8

===== PDF PAGE 16 =====
[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.
Ulheatin Aca df Dames Ke Lettre
On sir Name of Signatory) ¥ (Date)
(Name of ni
(Notary Pliblic)
Signed and sworn to before me this__ wt" day of —Sepiinler 2093
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 Efe
475 Main Street
West Chicago, IL 60185
taalehabaedalebelalatalahlabalalalalehdelebahbebabeeialelchiehddletebtet iiet titeh LALA LLL Lee COT ETE C EET TT TET RTT E TTT TOT TUTE TTT
FOR OFFICE USE ONLY
ilahalahaledalahaheleiehehehetalehebabalelabelelshehsialaietebaieiaheialolabinieloioiebeiedetetoebieia beta ek Ge ETT TTT TTT eT TTT
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:
q roved Permit No.
App O Denied
Remarks:
Authorized Signature
Title Date
Page 8 of 8