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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE:
AGENDA ITEMNUMBER: — 4t-C. __
CF Cycle for Life
Special Event Permit Application FILE NUMBER:
Cystic Fibrosis Foundation
COMMITTEE AGENDA DATE: May 19, 2025
COUNCIL AGENDA DATE: May 19, 2025
STAFF REVIEW: Kelley Chrisse, AICP, CEcD SIGNATURE bes a Ur Ae
ITEM SUMMARY:
The Cystic Fibrosis Foundation is seeking approval for their CF Cycle for Life bike ride scheduled for
Saturday, September 27 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, Business & Community Relations, 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:
This item is being presented to the Public Affairs Committee for consideration prior to the City Council
meeting.

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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
4. Completed and signed Special Event Application
a Intent to Meet Insurance Requirements
0 Section 1 — General information
o Section 2 — Narrative
a Section 3 — Permits
o Section 4 — Site Plan and/or Route Map
o Section 5 — Task List and Due Dates
o Section 6 — Hold Harmless Agreement
. 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
0 Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979)
eebAhhheeAdeRNteReRekiheeeeheAae ROReORAteNeHE LARA A THA AARe SELENE REAEAEEN AKA OE HA EREEEERAERROSEOREEEHERORREEEROERES®
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Received: A! Fee Paid: $.
Receipt # Check #
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. PW Park Dist. CDD
o Background checks completed by Police Dept. Date
o 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 fumish 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 fumish 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, Mea Schoo char , representing Quah C Floasis Tondobin
(pri ime 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.
diy las
signature) (date)
Cyclo For fe P2712
(name of event) (date of event)
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SECTION 1 —- GENERAL INFORMATION
Name of Event: Cycle for Life.
Type of Event:
O Parade Walk/Run/Bike O Camivals O Fireworks O Festival
O Other
Location of Event: Illinois Prairie Path - Elgin Branch
eee See iS he eco tae eT
Date(s) of Event: 9-27-2025 Hours of Event: 8:00amto2:00pm Est. Attendance: 75
Event Website: https://fundraise.cff.org/chicagocycleforlife
Purpose of event: A fully supported bike ride benefiting the Cystic Fibrosis Foundation that is starting at
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: Naomi Ishihara
200 N. LaSalle St, Suite 2300
Organizer address:
City/State/Zip: Chicago, iL 60601
Cell Phone EE E-mail: _nishinara@eft org
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1* Contact: _Naomi Ishihara Phone: [i
2" Contact:
Phone: 312-236-4491
Phone:
Is this an annual event? @ Yes © No ff Yes, provide next year's event date:
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 i third idi the Illinois Prairie Path. t '
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.
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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.ora 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 wsNo
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? 0 Yes wNo
!f 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? ao Yes sNo
if yes, you must submit a Raffie 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 No
'f 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:/Awww.dupagehealth.oratemporary-food-service for additional
information.
Are you requesting services from these departments?
QO Police 0 Fire District / Paramedics © Public Works
Specify services: We are requesting no services from any of your departments unless the City of
Chicago requires we use their police department for any needed crossing guards.
ir
Will you be utilizing any of the following services?
O Water Electric/Generator © Other
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SECTION 4 ~ SITE PLAN AND/OR ROUTE MAP
Please attach a separate sheet to illustrate the layout for your event.
#f 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?
B Yes No _Ifyes, 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 O No
if yes, please fill in the following information or submit a route map along with this application:
Street From To Dates Times
|
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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 t be completed by event organizer prior to notary signature.
Date of Special Event: 4 | (All
Tasks to be completed
Before Event
All items due to City unless noted Due Date
Submit “Intent to Meet Insurance Requirements” ; ; age
i : ; Prior to Prior to application
poverty ace with Special Event Permit application review rave
Submit Special Event Permit Application
| Submit Carnival Permit Application
Submit Fireworks Permit Application
Submit Temporary Liquor License Application
| Submit Building (Temporary Tent) Permit
Application
Submit Temporary Food Service Permit
Application(s)
| (OuPage County Health Dept. - 630-682-7979)
Submit Original Certificate of Insurance*
| Submit Raffle Registration Application
| Notify residents/businesses of special event
Post “No Firearms” signs at all public entrances
(See IL State Police requirements for standardized
sign in West Chicago's Special Events Policy)
Day of Event
*If this requirement is not met, the proposed event may be cancelled.
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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 attomeys 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 frec\ 2002S
slic Glomsis ;
Name of Organization
gnature ¢f Alithori
Execohue Direche/
Title
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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, including
compliance with the State of Illinois Firearm Concealed Carry Act.
*All applications must be signed and notarized.
ohn feo, Schne dar Y4inlas
( Name of Signatory) (Date)
ANOREA HENDERSON
Notary Public, State of tiltners
Commissian No. 898467
My Commission Expires July 23. 2027
(Notary Public)
: pri 22S .
Signed and swom to before me this l f day of
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
GAeadeneenadanenesHanncnnenenthenRetdERhthheahhOGHRteRenTEeeeneeAHAnhthAeeeAeeeeenssann eae eeee eens RLEHAENENSS EAA ASEREAEEAS
FOR OFFICE USE ONLY
AOeeneebenen Net eeAReARehPeOeAAREheRA Rh eeHAAeeHeE HA EAAORAENAERROARR EHEC ORE EAR ESD ARRER ARAN RE RARER EEE HEE AREER TEEOEERRCETEREE ERE
Based on the information which has been submitted and contingent upon approval of any necessary inspections
the day of the event, the request fora permit has been:
© Approved Permit No.
O Denied
Remarks:
nena
Authorized Signature
Title Date
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