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CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
ITEM TITLE: AGENDA ITEM NUMBER: ub. D.
FIT4FALL 5K
Special Event Permit Application
Healthy West Chicago
FILE NUMBER:
COMMITTEE AGENDA DATE: July 21, 2025
COUNCIL AGENDA DATE: July 21, 2025
STAFF REVIEW: Kelley Chrisse, AICP, CEcD § SIGNATURE_|(Li4 Chur
ITEM SUMMARY:
Healthy West Chicago is seeking approval for a 5K Run scheduled for Saturday, September 20, 2025
from 6:30 a.m. — 10:00 a.m. with an estimate of 250 attendees. All proceeds from this event will be used
to support Healthy West Chicago programming and sustainability.
Set-up is scheduled to begin at 6:30 a.m. The race begins at 8:00 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, 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 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.

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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 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
© Section 1 — General Information
0 Section 2 — Narrative
0 Section 3 — Permits
c 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
0 Fireworks Permit Application —
$125 (Check made payable to the West Chicago Fire Protection District)
0 Building Permit Application (temporary tents — see min. requirements) - $50
0 Raffle Registration Application — requires separate application
o Temporary Liquor License Application — requires separate application
o Temporary Food Service Permit (DuPage Co. Health Dept. 630-682-7979)
PORTER EREEREEEEREREREREERREERNEREREEREHENEREREREEE EEA ER EAEREREREREE EER ERR ERERENEREEE ER ERE ER RRe RRR eRR eRe RED
estapsesToen ttt inacediossp ones MSDE iy AER STATS Pics SDsieelscvad soto
Received: (| 23 2s" Fee Paid: $
Receipt # — Check # -_
Event Acknowledgement Form returned by:
Police Dept. Fire Dist. PW Park Dist.
0 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 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, Sno Onolye representing Alias LD ask hi te Priv
(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.
(signature) (date)
_____West Chicago FitaFall5K 2025
(name of event) (date of event)
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SECTION 1 — GENERAL INFORMATION
Name of Event: West Chicago Fit4Fall 5K
Type of Event:
CO Parade CKWalk/Run/Bike 0 Carnivals O Fireworks O Festival
O Other
Location of Event: _Reed-Keppler Park and associated parking lots as permitted by Park District.
Date(s) of Event: 8/20/2025 Hours of Event: 6:30amto 10am _ Est. Attendance: 250
Event Website: https://raceroster.com/events/2025/103951/west-chicago-fit4fall-5k
Purpose of event: activity for the community and fundraiser for wellness activities
Name of Sponsoring Organization(s): Healthy West Chicago / People Made Visible Inc.
Organization's Legal Status (i.e. NFP, Partnership, Corporation): People Made Visible, Inc.
Contact person from sponsoring organization: Sara Phalen
Organizer address: 103 W. Washington St.
City/State/Zip: West Chicago, IL_60185 Phone,
Cell Phone: E-mail: peoplemadevisible@gmail.com
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1* Contact: Sara Phalen Phone:
2™ Contact: _Natalia Serrano Phone:
Is this an annual event? (¥ Yes O No If 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.
nla
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

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SECTION 3 - PERMITS
Will your event include a carnival? cc Yes 4 No
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 in excess of 400 sq. ft. in area with side curtains
or 700 sq. ft. in area without side curtains? Yes %% 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? 0 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 your event? 0c 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 %4No
lf 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-/Awww.dupagehealth.org/temporary-food-service for additional
information.
Are you requesting services from these departments?
O Police O Fire District / Paramedics 0 Public Works
Specify services:
Will you be utilizing any of the following services?
O Water XX 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.
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_yqu requesting the use of any City-owned property, i.e. City streets, parking lots, or sidewalks?
No If yes, please indicate the property that you are requesting to use.
iis Bend ale
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 along with this application:
Street From To Dates Times
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Fit4Fall 5K
Special Event Proposal:
Saturday September 20, 2025
Event Overview:
The Fit4Fall 5K will be sponsored by Healthy West Chicago and We Go Together, with the
support of Race Time Inc. This event will take place on Saturday, September 20, 2025 at
Reed-Keppler Park, West Chicago with the race beginning at 8:00 a.m. This event will attract
participants from West Chicago and surrounding communities. The event will include features
such as a race t-shirt, SK race medals, food offerings, swag bags, and wellness vendors.
Race Time Inc. is offering their services at a discounted rate. The Healthy West Chicago's
Program Director and We Go Together for Kid’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:
Natalia Serrano
Healthy West Chicago
Email: info‘ healthy westchicago.ory
HWC Phone
Sara Phalen
People Made Visible (HWC Fiscal Agent)
Email: peoplemadevisible@gmail.com
Phone:
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 (includes processing fees):
SK Run/Walk Adult (18 and older): $33.53
Resident 5K Run/Walk Adult (18 and older): $22.85
5K Run/Walk Student (17 and under) $17.51
Resident 5K Run/Walk Student (17 and under) $12.18
1 Mile Youth Run (10 and under) $6.84
Early Registration Discount: $5 off.
West Chicago Staff Discount for Park District, and school staff: $10 off.

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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:
6:30 AM Staff & Volunteer Set-Up
7:00 AM Registration Opens
7:30 AM Registration Closes
8:00 AM 5K Walk/Run starts
8:45 AM (or when last SK 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 Sk Course Organizer:
Organizer: Race Time Finish Line Management & Timing Company
Website: http://www.racetime.info
Contact: Julie Pearson
Email: racetime2 |@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 12" will receive a free food item provided by our partners
The Kitchen Table.
The first 75 registered receive a swag bag filled with giveaways.
Pre and post stretching provided by Athletico Physical Therapy.
Music and announcer at the Start/Finish.

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Race day pictures by professional photographer.
Water: water stations at Start/Finish and near mile markers | 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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Fores! 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.
wat

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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 completed by event organizer prior to notary signature.
Date of Special Event: Uy [ is
Tasks to be completed Days Due
(All items due to City unless noted) Before Event Due Date
Submit “Intent to Meet Insurance Requirements” ; " Roa
Document (included with Special Event Permit appli Le gS pe emaaah
Application, pg.2) pp
Submit Special Event Permit Application 90 days | © | 23
Submit Carnival Permit Application 90 days —
Submit Fireworks Permit Application 30 days _
Submit Temporary Liquor License Application 30 days a
Submit Building (Temporary Tent) Permit
Ae 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* S| 24
Submit Raffle Registration Application 14 days Zl
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.
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SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the _tealthy West Chicago / People Made Visible Intname of organization) and its Members,
employees, volunteers or guests, being allow to participate in _Fi'4Fall 5k , (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
Healthy West Chicago / PeoplarMdaeoWinihiaitagon) participation in the Activity.
To the fullest extent permitted by law, the _ea!thy West Chicago / People Made Visible In¢rname 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 _4WC/PMV (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
Ce (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 _"WC/PMV name of organization) at
ploy’ y
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 _"WC/PMv (name of organization).
Agreed this 23 day of _vune , 20_25
Healthy West Chicago / People Made Visible Inc.
Name of Organization
Sara Phalen
Print Name of Authorized Person
Signature of Authorized Person
Executive Director
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 lilinois Firearm Concealed Carry Act.
*All applications must be signed and notarized.
Sawn Chole dulos
(Print Name of Signatory) Date)
OFFICIAL SEAL
JULIA A FAVELA
NOTARY PUBLIC, STATE OF ILLINOIS
MY COMMISSION EXPIRES 02/08/2027
(Notary Public)
Signed and sworn to before me this ae day of Be AL ,20 AS.
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
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FOR OFFICE USE ONLY
RERAAAAAEARRER EAR EREAERA EAA AEREE RE SEL ARERAEH EATER AEA AREAAER EEO E ERE PURAAA EEA LAAT RAARAH AE ERORAAAEEHEHE ERE EAE EAE RRENe TET ee
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.
Authorized Signature
Title Date
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