===== PDF PAGE 4 =====
[Extraction: OCR (rendered-page OCR)]
CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDA ITEM NUMBER: 4. A.
Stations of the Cross
St. Andrew Lutheran Church FILE NUMBER:
COMMITTEE AGENDA DATE: January 20, 2025
COUNCIL AGENDA DATE: = January 20, 2025
STAFF REVIEW: Kelley Chrisse, AICP, CEcD SIGNATURE. bat Chee
APPROVED BY CITY ADMINISTRATOR:
Michael Guttman SIGNATURE
ITEM SUMMARY:
St. Andrew Lutheran Church is seeking approval for their annual Stations of the Cross religious event
scheduled for Friday, April 18, 2025 from 12:00 p.m. — 1:00 p.m. with an estimate of 150 attendees.
The Church has requested use of City streets for a procession and Police services for assistance with
traffic control and a rolling street closure.
Members of the Church will gather at the corner of Easton Avenue before the procession begins at 12:00
p.m. The procession will walk East on Main Street, turn North onto Prince Crossing, cross Geneva Road,
and end at the Church.
The Special Event Permit Application, which includes the requests of the City, has been reviewed and
approved by staff from the Police, Public Works, Business & Community Relations, and Community
Development Departments as well as the West Chicago Fire Protection District. The Special Event Permit
Application is attached, which includes the procession route map.
ACTIONS PROPOSED:
Recommend event for approval as proposed, contingent upon submittal and approval of required
insurance documentation.
COMMITTEE RECOMMENDATION:
This item is being presented to the Public Affairs Committee for consideration prior to the City Council
meeting.

===== PDF PAGE 5 =====
[Extraction: OCR (rendered-page OCR)]
SEY
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
O Intent to Meet Insurance Requirements
0 Section 1 — General Information
a Section 2 — Narrative
a Section 3 — Permits
0 Section 4 — Site Plan and/or Route Map
a Section 5 — Task List and Due Dates
0 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
o 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
a Temporary Liquor License Application — requires separate application
| a Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979) |
SERARAERARRE HERE SERELEERERRERE ROHR EER ARE RERRERRE REE EERE EL ERR EEE EEEREREEREREEERE REDE EREEREREEERE EA RORERDEHOROREEE
FOR OFFICE USE ONLY
SARRRERRRRERAERERENRNERENKHEAEERERE EH GRELNEREARREEEEREREREAEEREREEEREAAAE EMEA EAEOREEEeAbeeeareeraereeenernean
Received: Fee Paid: $
Receipt # Check #
Event Acknowledgement Form retumed by:
Police Dept. Fire Dist. PW Park Dist.
0 Background checks completed by Police Dept. Date
a DuPage Co. Health Department notified Date
0 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, Nilouc AZGOEC , representing at Andee \ otheen Chere
(print fame 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.
ee =
(date)
‘ iS | OS
(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: ei Lathoas of ne Cross : =
Type of Event:
O Parade uf WakiRunteike O Carnivals O Fireworks O Festival
0 Other
Location of Event: _JV\cana Sieceet and Piace cropaing Ba.
Date(s) of Event: _4 | 16 | 2S __Hours of Event: _|Qoce to Apm Est, Attendance: {SO
Event Website:
Purpose of event:
‘
Wot <- eat
Name of Sponsoring Organization(s): S\ (\ndce ws Lulhecen Chqucch
Organization's Legal Status (i.e. NFP, Partnership, Corporation): NEP
Contact person from sponsoring organization: yey _ Wer Molina
Organizer address: DS NA Peance CcOSS\ng, Ra.
City/State/Zip: est Crago, TL (e1KS Phone: (630 -93\-318)
Cell — alhic eA StoascedoMnercn. net
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1* Contact: Pastor Wer Molina Phone:
2" Contact: __ Yr pice 10 Ponto Phone:
Is this an annual event? Yes 0 No If Yes, provide next year’s event date: 4 | Xd | Aw
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.
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 8 =====
[Extraction: OCR (rendered-page OCR)]
SECTION 3 - PERMITS A
Will your event include a carnival? 0 Yes lo
If yes, you must submit a Carnival 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 a aid of 400 sq. ft. in area with side curtains
or 700 sq. ft. in area without side curtains? o Yes wNo
if yes, you must submit a Bullding 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? 0 Yes wio
If yes, you must submit a Fireworks Permit Application thirty (30) days prior to the event.
~ "Please visit www.Westchicago.org undér 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? 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 whio
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? oc Yes he
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.
Arg you requesting services from these departments?
Police (O Fire District / Paramedics 0 Public Works
Specify services:
Will you be utilizing any of the following services?
O Water 1 Electric/Generator Other 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
Arg you requesting the use of any City-owned property, i.e. City streets, parking lots, or sidewalks?
Yes ONo _ Ifyes, please indicate the property that you are requesting to use.
Mera Sireek end Pcvace crassiec, BAL
Would you like to request the closing of City streets? 0 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 10 =====
[Extraction: OCR (rendered-page OCR)]
The Stations of the Cross
On Good Friday, April 18, 2025, at 12pm (noon), there will be a re-enactment of Jesus
Christ’s cross stations, also known as “Via Crucis.” The re-enactment will be performed -
by members of St. Andrew Lutheran Church.
The Via Crucis begins on Easton Ave. & Main St. and finish at St. Andrew Church with a
brief service.
We invite all members of the church and community of West Chicago to come and
experience the journey that our Savior, Jesus Christ, lived through.
Via Crucis
ood Ave 3 z = Oi
g ae ri
Wendall Ave F4 2 Pa
=
E Grand Lake Blvd Grand Lake Blvd — fe,
%
eal g "lene finish
Zz < Ave
@ < o AV
= 2 Highland 2
2 g Parroquia
Plymouth Ct 5 San Andrés
3
E Washington St de 3
Easton Park «
summit
Ave
z
Colford Ave 5
A ==> 5 :
Main St a ,
DOWNTOWN 8 2
WEST CHICAGO) «= -ASetg g :
ee Hillview Ave 2 g
SB cc
ESterling Ave 2 “eal
s LAKE
E Lawrence Ave
Dupag
2 Jetiln
2
a
2 Blair sy
IASTFO gz Pomeroy St is

===== PDF PAGE 11 =====
[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: 4 | | 6 a5
Tasks to be completed Days Due
_(All items due to City unless noted) Before Event Due Date
Submit “Intent to Meet Insurance Requirements” . ;
f . F Prior to Prior to application
Document bss with Special Event Perma _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 iF
— 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 NIA 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 12 =====
[Extraction: OCR (rendered-page OCR)]
SECTION 6 —- WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the Dt. Ordcous Loreen Chuth (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in Sto hon cE ANAC (OSS (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
De Arckew Linea Chw-ch (name of organization) participation in the Activity.
To the fullest extent permitted by law, the Sk Aevietus LoYnercn Chwth (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 Dy. Aodce> Lotheen-chyetiname 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
DWAndeevs Lite Church (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 > Andie Lumen Church (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 ra Ancien? \ vdhewn Ch veh (name of organization).
Agreedthis_ 1 day of
Se adtew Lo\nean Choc l
Name of Organization
Yev. Ney Moling _
int Name of Authorized Pe
nature of Authorized Person
“Vostor
Title
Page 7 of 8

===== PDF PAGE 13 =====
[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.
Sk Anckcew Lutheran Chyah Alex Molina 1/10 fas
(Name of Organization (Print Name of Signatory) (Date)
B
Option
MAYTE N BAUTISTA- ALMORA
Official Seal
“Notary Public= State of Illinois ~
My Commission Expires May 14, 2025 (Notary Public)
Lay of lan UC a 20S.
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.
Signed and sworn to before me this
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
RRR ARRERRERRERERAER EERE ERAEERER AREER ERERRRAEERRREREEHREAR EEE AERA RARER RE ERE RERERER ERA REREREENRAAEEREREEREEEAER ERAN ERE ER
FOR OFFICE USE ONLY
EIDE AISI III EI IIIS ISI IOI IIIT ITT IITA TIS TOAD ATA ITA II IIIA IITA IIASA SASSI ASIA ASIA ISIS SAIS SAIS ASN SS ASS
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:
Oo d Permit No.
Approve ‘ermit No Cl Denied
Remarks:
Authorized Signature
Title Date
Page 8 of 8