===== PDF PAGE 4 ===== [Extraction: OCR (rendered-page OCR)] CITY OF WEST CHICAGO PUBLIC AFFAIRS COMMITTEE AGENDA ITEM SUMMARY ITEM TITLE: AGENDA ITEM NUMBER: AL Spooky Trail West Chicago Park District FILE NUMBER: COMMITTEE AGENDA DATE: August 19, 2024 COUNCIL AGENDA DATE: STAFF REVIEW: Tom Dabareiner SIGNATURE__¢ LE APPROVED BY CITY ADMINISTRATOR: Michael Guttman SIGNATURE ITEM SUMMARY: West Chicago Park District is requesting a police car in the parking lot outside of the trail start/end at the Spooky Trail taking place October 24 — 26. 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. ACTIONS PROPOSED: Recommend approval of police assistance at the event, contingent upon submittal and approval of required insurance documentation. COMMITTEE RECOMMENDATION: ===== PDF PAGE 5 ===== [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 is due to the City of West Chicago a minimum of ninety (90) days prior to the event if it requires closure of public streets or use of public parking lots. The 90-day time period allows sufficient time to evaluate the request and provide a recommendation to the City Council for its consideration. Note: Prior to review of the Special Events Permit Application, all applicants must submit the Intent to Meet Insurance Requirements form (page 2). Submittal Checklist 1. Completed and signed Special Event Application a Intent to Meet Insurance Requirements a Section 1 — General Information a Section 2 — Narrative a Section 3 — Permits a Section 4 — Site Plan and/or Route Map a Section 5 — Task List and Due Dates a Section 6 — Hoid 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 a Temporary Liquor License Application — requires separate application a Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979) AERA IIIT ES ITI TOIT AI EAN IAEA AA NSO AEST S SAAS ARIA AAI IAAI ISAS IONE AAA AA ARR AAA AAO AAA Received: Fee Paid: $ Receipt # Check # Event Acknowledgement Form returned by: Police Dept. Fire Dist. PW Park Dist. c Background checks completed by Police Dept. Date co DuPage Co. Health Department notified Date co Certificate of Insurance received and approved Date Page 1 of 8 ===== PDF PAGE 6 ===== [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. I, ore Ditech , representing West Chicagek ok District (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 Chicag —_ 7/pley (date) Q Oot. 24-20 2o2y (name of event) (date of event) Page 2 of 8 ===== PDF PAGE 7 ===== [Extraction: OCR (rendered-page OCR)] SECTION 1 —- GENERAL INFORMATION Name of Event: > pools | rai | Type of Event: O Parade O Walk/Run/Bike O Carnivals O Fireworks O Festival Other Location of Event: Reed - “Keppler (er; » Y Date(s) of Event ‘Op ofas, efatours of Event: ins ial 010: BOpp Fst. Attendance: ZOO-_ Event Website: Purpose of event: Haunted l Teil Name of Sponsoring Organization(s): Lest Chicage ‘Park Distttet Organization's Legal Status (i.e. NFP, Partnership, Corporation): Govwernmer y+ Contact person from sponsoring organization: LowedA Organizer address: ZO\ City/State/Zip: Cell Phone} Emergency contact information (provide mobile numbers for on-site coordinators during even 1* Contact: \s : 2” Contact: Prone: Is this an annual event? Slyes O No If Yes, provide next year’s event date: ( r+ i 23- 26, 2024 If the event is a recurring event, please state any problems and/or incidents that have occurred in past years, such as noise or bd a parking complaints. “YeeragesS uring Score. Geers. What, if anything, are you doing to rectify the problem(s)? < . 5 . ‘ + \ 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 8 ===== [Extraction: OCR (rendered-page OCR)] SECTION 3 —- PERMITS Will your event include a carnival? o Yes \A No If yes, you must submit a Carnival it 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? 0 Yes jo No If yes, you must submit a Building Permit Application thirty (30) days prior to the event. Please visit www.westchicago.org under Forms or contact the City of West Chicago at (630) 293-2200 ext. 131 for an application. 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 or contact the City of West Chicago at (630) 293-2200 ext. 135 for an application. Are you holding a raffle at yourevent? o Yes 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 \4 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? o Yes {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? Police O Fire District / Paramedics © Public Works Will you be utilizing any of the following services? O Water \f ElectriciGenerator O Other Page 4 of 8 ===== PDF PAGE 9 ===== [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 ¥ No If yes, please fill in the following information or submit a route map alon§ With this application: Street From To Dates Times Page 5 of 8 ===== PDF PAGE 10 ===== [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” Prior to Prior to applicati . . ; . pplication Document (included with Special Event Permit application review review Application, pg.2) 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 . 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 11 ===== [Extraction: OCR (rendered-page OCR)] SECTION 6 —- WAIVER AND HOLD HARMLESS AGREEMENT In consideration of the name of organization) and its Members, employees, volunteers or guests, beihg allow to participate ind a Te. il , (the Activity) the undersigned hereby recognizes, acknowledges and assumes any and ail risk pertaining to (name of organization) participation in the Activity. To the fullest extent permitted by law, th ; (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 shugkrame 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 tue (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, te Zedatlldcageslach Dadhuat (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 th ‘stn Agreed this K day of rater 2024 ‘ iow Name of Organization > (name of organization). Sig nature of Authorized Person Page 7 of 8 ===== PDF PAGE 12 ===== [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. Meo 7 /a/24 (Print Name of Signatory) (Date) 4 ICIALS E Notary Public, State of Illinois My Commission Expires February 06, 2027 ublic) Signed and sworn to before me this Fs ra day of