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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDA ITEM NUMBER: acer
FIT4FALL 5K
Special Event Permit Application
Healthy West Chicago & City of West Chicago
FILE NUMBER:
COMMITTEE AGENDA DATE: June 3, 2024
COUNCIL AGENDA DATE:
sionature_S—
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
STAFF REVIEW: Tom Dabareiner
ITEM SUMMARY:
Healthy West Chicago & The City of West Chicago are seeking approval for a 5K Run scheduled for
Saturday, September 21, 2024 from 6:00 a.m. — 10:00 a.m. with an estimate of 300 attendees. Alll
proceeds from this event will be used to support Healthy West Chicago programming and sustainability.
Set-up is scheduled to begin at 6:00 a.m. The race begins at 7:30 a.m. The event is expected to end at
approximately 10:00 a.m.
Event organizers have requested use of the public walkway along Yale Street as well as National Street
east of Yale Street for the race route.
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 map.
ACTIONS PROPOSED:
Recommend event for approval as proposed, contingent upon submittal and approval of required
insurance documentation.
COMMITTEE RECOMMENDATION:

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City of West Chicago
SPECIAL EVENT PERMIT APPLICATION
THIS FORM MUST BE COMPLETED IN FULL & SUBMITTED
90 DAYS PRIOR TO THE EVENT
PERMIT NO.
Special Event Permit Application
The Special Event Application 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
a ||
1. Completed and signed Special Event Application |
a Intent to Meet Insurance Requirements
a Section 1 — General Information
ao Section 2 — Narrative
a Section 3 — Permits
0 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
c 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)
EI IIIT III III ITI TTT IO TR TOOT IO OCI TI TOATIUTTTII OT SAI TORO II ACIS ATA AAAS AA IIT OS SSAA IAAI AAI A etek
FOR OFFICE USE ONLY
JERI III IOC IIIT TOC IOI OTTO TICS TI OTIS IOI I OCI TABI TAI IT AIA SOI OS UII ARITA TIAA AA A Tb tb tk
Received:__4/ 24 [24 : Fee Paid: $
Receipt # Check #
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. PW Park Dist. CDD
0 Background checks completed by Police Dept. Date
oc DuPage Co. Health Department notified Date
o Certificate of Insurance received and approved Date
Page 1 of 8

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*** INTENT TO MEET INSURANCE REQUIREMENTS ***
Must be returned prior to application review by City staff
Prior to the issuance of a Special Event Permit, all organizations must
present a certificate of insurance meeting the criteria listed below:
1. Required limits per 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.
1, Carly Smitherman . fepresenting Healthy West Chicago
(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.
hbaup LBORY
Lo signature (date)
Fit4Fall 5K Saturday, September 26, 2024
(name of event) (date of event)
Page 2 of 8

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SECTION 1 — GENERAL INFORMATION
Name of Event: Fit4Fall 5K
Type of Event:
O Parade @ Walk/Run/Bike O Carnivals 0 Fireworks O Festival
O Other
Location of Event: _Reed-Keppler Park, 129 W National St, West Chicago, IL
Date(s) of Event: _9.21.2024 Hours of Event: 6:00 am to 10:00 am Est. Attendance: 225
Event Website: https://raceroster.com/events/2024/87943/west-chicago-fit4fall-5k
Purpose of event: _Community engagement
Name of Sponsoring Organization(s): Healthy West Chicago and City of West Chicago
Organization's Legal Status (ie. NFP, Partnership, Corporation): NFP and Goverment Agency
Contact person from sponsoring organization: Nicolette Stefan and Sara Phaten
Organizer address: 475 Main Street
City/State/Zip: West Chicago, IL_60185 Phone: 630.293.2200, ext. 176
Cell Phone: / E-mail: _info@healthywestchicago.org or nstefan@westchicagao.org
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1" Contact: Nicolette Stefan Phone: 630.293.2200, ext. 176
2™ Contact: Sara Phalen Phone: cEraox
Is this an annual event? @ Yes O No If Yes, provide next year's event date: 9.20.2025
If the event is a recurring event, please state any problems and/or incidents that have occurred in past
years, such as noise or neighborhood parking complaints.
No problems or incidents last year.
What, if anything, are you doing to rectify the problem(s)?
N/A
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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SECTION 3 — PERMITS
Will your event include a carnival? oYes aNo
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 aNo
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 aNo
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? oYes aNo
If yes, you must submit a Raffle Registration Application fourteen (1 4) days prior to the
event. Not all applicants will qualify for a license. Please visit www. westchicago.org under
Forms or contact the City of West Chicago at (630) 293-2200 ext.170 for an application.
Will you be applying for a Temporary Liquor License? o Yes aNo
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? Yes 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 http:/www.dupagehealth.org/temporary-food-service for additional
information.
Are you requesting services from these departments?
O Police Fire District / Paramedics © Public Works
Specify services: None
Will you be utilizing any of the following services? No
O Water OC Electric/Generator Other
Page 4 of 8

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Fit4Fall 5K
Special Event Proposal:
Saturday September 21, 2024
Event Overview:
The Fit4Fall 5K will be sponsored by Healthy West Chicago and the City of West Chicago, with
the support of Race Time Inc. This event will take place on Saturday, September 21, 2024 at
Reed-Keppler Park, West Chicago with the race beginning at 7:30 a.m. This event will attract
participants from West Chicago and surrounding communities. The event will include features
such as a race t-shirt, 5K race medals, food truck offering free waffle with unlimited toppings,
swag bags, and wellness vendors.
Race Time Inc. is offering their services at a discounted rate. The Healthy West Chicago's
Program Administrator and City of West Chicago’s Event Coordinator will coordinate the event
day activities with Race Time Inc., Healthy West Chicago Volunteer Committee, and West
Chicago Park District.
General Information:
Main Contacts:
Carly Smitherman
Healthy West Chicago
Email: info@healthywestchicago.org
HWC Phone: (630) 230-6370
Nicolette Stefan
City of West Chicago Special Events Coordinator
Email: nstefan@westchicago.org
Phone: 630.293.2200, ext. 176
Proposed Course:
USATF course Run to Remember on the Illinois Prairie Path. Proposed map of racecourse
submitted with permit application. Course length: 3.1 miles.
Registration & Fee Structure:
e 5K Run/Walk Adult (18 and older): $35.00
e 5K Run/Walk Student (17 and under) $15.00
e 1 Mile Youth Run (10 and under) $5.00

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e Early Registration Discount: $5 off.
e West Chicago Staff Discount for West Chicago City, Park District, and school staff: $10
off.
e Families running the 5K with 4 or more people will receive $5 off the total.
e All proceeds from the event will be used to continue with Healthy West Chicago
programing and sustainability.
Main Event Schedule:
6:00 AM Staff & Volunteer Set-Up
6:30 AM Registration Opens
7:00 AM Registration Closes
7:30 AM 5K Walk/Run starts
8:30 AM (or when last 5K participant crosses finish line) 1 Mile Youth Run starts
9:20 AM Awards Announced/Distributed
9:40 AM Site Clean Up Begins
10:00 AM Site Clean Up Ends
Race Timing and 5k Course Organizer:
Organizer: Race Time Finish Line Management & Timing Company
Website: http://www.racetime.info
Contact: Julie Pearson
Email: racetime21@hotmail.com
Awards Participants Receive:
5K Walk/Run: Trophies will be distributed to one overall male and one overall female winner.
5k Walk/Run Participants Receive:
* Short sleeved 5K t-shirt
* Official Chip time
¢ Finisher medal
1 Mile Youth Run: All participants will receive a finisher ribbon.
All Event Attendees Receive the Following:
Participants that register by September 6" will receive a free waffle with unlimited toppings from
All Belgium Food Truck. Waffles for purchase will be available for bystanders, 1k, or those that
register after September 6.
The first 100 registered receive a swag bag filled with giveaways.

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Pre and post stretching provided by Athletico Physical Therapy.
Music and announcer at the Start/Finish.
Race day pictures by professional photographer.
Water: water stations at Start/Finish and near mile markers 1 and 2 along the course.
First-aid tents will be located at Start/Finish and near mile marker 2 near the turnaround.
Cancelation:
The event will only be canceled in the event of extreme weather conditions that pose a threat to
safety. This includes severe thunderstorms, lightning, high winds, or any other weather
conditions deemed hazardous by event organizers.
Utilization of Thor-Guard System: To assess the potential risk of lightning strikes and severe
weather, we rely on the West Chicago’s Park District Thor-Guard system. This state-of-the-art
integrated lightning prediction and warning system provides real-time data and alerts, enabling
us to make informed decisions regarding event safety.
Website & Registration Structure:
Participants will register using Race Time Inc.'s online platform.
Electronic signature of liability "Waiver & Release" will be required. A volunteer sign-up option
will also be available.

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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 of toilets (T)
Location of hand washing sinks (HWS)
Location of retail vendors (RV)
Location of food vendors (FV)
Location of first aid (FA)
Location and number of barricades (B)
Location of fire lane (FL)
Location of fire extinguishers (FE)
Public entrances and exits (PE)
Location of “No Firearms” signage (NF)
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 O1No _ifyes, please indicate the property that you are requesting to use.
Reed-Keppler Park and associated parking lots as permitted by Park District.
Turtle Splash parking lot will be use for participant parking. Rolling closure at Yale St. and National St.
Would you like to request the closing of City streets?
@ Yes O No
If yes, please fill in the following information or submit a route map along with this application:
Street From To Dates Times
Park District Wiggly Field and Zone 250 parking lots 9.21.2024 6:00-10:00 am
Yale St. Use of public walkway along Yale St. (5k) 9.21.2024 7:30-7:40 am
National St. National St. east of Yale St. for race route. (5K) 9.21.2024 7:30-7:40 am
Yale St. Use of public walkway along Yale St. (1 Mile Youth Run) 9.21.2024 8:30-8:50 am
National St. National St. east of Yale St. for race route. (1 Mile Youth Run) 9.21.2024 8:30-8:50 am
Page 5 of 8

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Fo ranuuneLe asa _
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+ ¥' Distance Marcers— Unics
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Beaton, Teathic
Bicycle Paths
Notional St.
ig
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Vester Dr
rand Labe Med,
6
West Chicago
Prairie County
Forest Preserve
Water: water stations at Start/Finish, and at the turnaround, near mile marker 2, and mile marker 3 along the course.
First-aid tents will be located at Start/Finish, between mile marker 1 and 2 (off MacQueen Dr) and a first aid kit will be at the turn around.
Support

===== PDF PAGE 49 =====
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USA Track & Field RRCA
j Road Running Technical Council recognized by
Nox 7
USA, Measurement Certificate
Name of the course Run to Remember _ Distance 5 km
Location (state) Illinois (city) West Chicago
Type of course: road race [XJ calibration [[] track Oo Configuration: Out and Back
Type of surface: paved 23 % dirt % gravel 77 % grass % track %
Elevation (meters above sea level) Start 234 Finish 234 Highest 240 Lowest. —-228
Straight line distance between start & finish Same Point Drop 0 m/km Separation 0 %
Measured by (name, address, phone & _ Winston Rasmussen a
Race contact (name, address, phone & e-mail) __Robbi Peterson, West Chicago Police Dept, 325 Spencer
West Chicago, IL 60185 (630) - RPeterson@West Chicago.org
Measuring Methods: _ bicycle steel tape [] electronic distance meter
Number of measurements of entire course: 2 Date(s) when course measured: April 14, 2015
Race date: April 19, 2015 Course certification effective date: April 45, 2015
Certification cade: 1L15011WR
Notice to Race Director: Use this Certification Code
in all public announcements relating to your race.
Be It Officially Noted That
Based on examination of data provided by the above named measurer, the course described above and
in the map attached is hereby certified as reasonably accurate in measurement according to the stan-
dards adopted by the Road Running Technical Council. If any changes are made to the course, this cer-
tification becomes void, and the course must then be recertified.
Verification of Course — In the event a National Open Record is set on this course, or at the discretion
of USA Track & Field, a verification remeasurement may be required to be performed by a member of
the Road Running Technical Council. If such a remeasurement shows the course to be short, then all
pending records will be rejected and the course certification will be cancelled.
This certification expires on December 31 in the year | 2025
AS NATIONALLY CERTIFIED BY:
Date: April 15, 2015

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Run to Remember
5 kilometers
West Chicago, Illinois
USATF Certification # 1L15011WR
Effective April 15, 2015 — Dec 31, 2025 NORTH
START: Mag nail, center of road, 68’ W of edge of gate post on N side of road (See detail) Map Not to Scale
1 MILE: North edge of gravel path, 147‘ W of 2 electrical tower W of RR tracks
Turnaround: Center of path, even with stop sign (21'6” E of center of round storm drain on Industrial Drive
2MILE: South edge of gravel path, 23’6” E of center of culvert
3 MILE: West edge of gravel path, 44’6” S of S end of parking fot
Finish: Same as the start
Measured by Winston Rasmussen April 14, 2015 (w.rasmussen@comeast.net)
Top
row
BLvd
“6
Ss
9
STorm = Endusteiac
Deore
2,880 MeTers
ZndasTrial Blvd.

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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 com pleted by event organizer prior to notary signature.
Date of Special Event:
Tasks to be completed Days Due
L _(All items due to City unless noted) Before Event Due Date
Submit “Intent to Meet Insurance Requirements” ; . _
; ; . - Prior to Prior to application
Document (included with Special Event Permit Rati : ;
Application, pg.2) application lil | 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
se 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

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LT
R: Registration Tent
FV/RV: Vendor Booths
T: Toilets
S/F: Start and Finish
FA: First Aid
FT: Food Truck

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SECTION 6 - WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the Healthy West Chicago (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in Fit4Fall 5K , (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
Healthy West Chicago (name of organization) participation in the Activity.
To the fullest extent permitted by law, the Healthy West Chicago (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 Healthy West Chicago (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
Healthy West Chicago (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 Healthy West Chicago (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 Healthy West Chicago (name of organization).
Agreed this_22(9_ day of Apri L. 20 AY
Healthy West Chicago
Name of Organization
Carly Smitherman
Program Administrator
Title
Page 7 of 8

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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, inctuding
compliance with the State of Illinois Firearm Concealed Carry Act.
*All applications must be signed and notarized.
duS an 4holy
(Print Name of Signatory) (Date)
Notary Public State of Minois
My Commission Expires 05/11/2025 (Notary Bublic)
Signed and swom to béfére Me +h : Pach Apr.) oat
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.
LAY S VICES
ization)
Official Seal
Jaclyn M Stem
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
ANTAWOSSONORASh ON ESGanELU nS seHEeheneeA eeaenyaNeENeeaUs shbbebnhehihhasbithenntntinttbae saneenentanaveensteasaesueconseraeaneres
FOR OFFICE USE ONLY
ARERR ENR EERNEA RARER SELTRETSR RENAL OOH ER EOE EREE AREER DEER EED TE EERE OR ELSES ERE DN ENRON ERR EERE hE End ObaR AiR RetaEo Ree eeeeens
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