===== PDF PAGE 4 ===== [Extraction: embedded PDF text] CITY OF WEST CHICAGO PUBLIC AFFAIRS COMMITTEE AGENDA ITEM SUMMARY ITEM TITLE: AGENDA ITEM NUMBER: 4.A. CF Cycle for Life Special Event Permit Application COMMITTEE AGENDA DATE: May 18, 2026 Cystic Fibrosis Foundation COUNCIL AGENDA DATE: May 18, 2026 STAFF REVIEW: Kelley Chrisse, AICP, CEcD SIGNATURE ITEM SUMMARY: The Cystic Fibrosis Foundation is seeking approval for their CF Cycle for Life bike ride scheduled for Saturday, September 26 from 8: 00 a. m. — 2: 00 p. m. with an estimate of 100 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 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: embedded PDF text] 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 Completed and signed Special Event Application Intent to Meet Insurance Requirements Section 1 — General Information Section 2 — Narrative Section 3 — Permits Section 4 — Site Plan and/ or Route Map Section 5 — Task List and Due Dates Section 6 — Hold Harmless Agreement 2. Completed and signed applications( s) for other permits( s) ( See Section 3) Carnival Permit Application - $ 50 per employee Fireworks Permit Application — 425 ( Check made payable to the West Chicago Fire Protection District) Building Permit Application ( temporary tents — see min. requirements) - $ 50 Raffle Registration Application — requires separate application Temporary Liquor License Application — requires separate application Temporary Food Service Permit ( DuPage Co. Health Dept. 630- 682- 7979) FOR OFFICE USE ONLY Received: Fee Paid: $ Receipt # Check # Event Acknowledgement Form returned by: Police Dept. Fire Dist. PW Park Dist. Background checks completed by Police Dept. Date DuPage Co. Health Department notified Date Certificate of Insurance received and approved Date Page 1 of 8 ===== PDF PAGE 6 ===== [Extraction: embedded PDF text] 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. clli 1 I, " v1G I de C_ i roS. S f' G r - , representing 4",-4; pMt name of authorized person) ( organization) have contacted the appropriate insurance provider and acknowledge that the above insurance criteria can be met. I 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) q/ 2 t1,2 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: 2026 CFF byele for Life Type of Event: O Parade &.Walk/Run/Bike O Carnivals O Fireworks C Festival O Other Location of Event: Stards in St Carles ancl ridden a leap on ik pole, Date(s) of Event: Gb (26 Hours of Event: au. _ to Apm __ Est. Attendance: (OO Event Website: _ +, ‘se CFF. o9: Ai l she 2026 Purpose of event: Foul ree conch brie, Aware hess fov tlhe Leedic Fibrosis Seundelon Name of Sponsoring Organization(s): Cystic Ehosis Lovuolal ena Organization's Legal Status (i.e. NFP, Partnership, Corporation): NEP Contact person from sponsoring organization: Aolreu Prsel. * Organizer address:_200 4/ LaSalle St $e 2300 City/State/Zip: mia a bobo! Phone: $72- 265 -(0o> Cell Phone: E-mail: apaseh @ More Emergency contact information (provide mobile numbers for on-site coordinators during event): 1* Contact: Auchreu feel. Phone: 2" Contact: Carel, fuans Phone: Is this an annual event? &. Yes O No If Yes, provide next year's event date: F/ 2 /. 27 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)? Ae problenns. 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: embedded PDF text] SECTION 3 — PERMITS Will your event include a carnival? Yes XNo Ifyes, 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? a Yes ) k No ifyes, 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? 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? Yes Ifyes, 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? c Yes $, 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 ) L --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 dcrpagehealth orgItemporary-food-service for additional information. Are you requesting services from these departments? Police Fire District/ Paramedics Public Works Specify services: / UOk-r— Will you be utilizing any of the following services? I, Water Electric/ Generator Other / r/64t_- Page 4 of 8 ===== PDF PAGE 9 ===== [Extraction: embedded PDF text] SECTION 4 — SITE PLAN AND/ OR ROUTE MAP Please attach a separate sheet to illustrate the layout for your event. ff 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? bd Yes No If yes, please indicate the property that you are requesting to use. N. Cr/ S /' jj h i /' iG G Would you like to request the closing of City streets? Yes 7; -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: embedded PDF text] 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: ' 712C2C 1Z 4 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 application Document ( included with Special Event Permit application review review Application, . 2 Submit Special Event Permit Application 90 days b Z G/ zb 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 r FI Submit Temporary Food Service Permit 30 daysApplication( s) v ,, //A DuPa e County Health Dept. — 630- 682- 7979) zSubmit Original Certificate of Insurance* 21 days* ylq /; Submit Raffle Registration Application 14 days NO Notify residents/ businesses of special event 14 days a 126 Post " No Firearms" signs at all public entrances N/ A Day of Event See IL State Police requirements for standardized sign in West Chicago' s Special Events Polic If this requirement is not met. the proposecl event may be cancelled. Page 6 of 8 ===== PDF PAGE 11 ===== [Extraction: embedded PDF text] SECTION 6 — WAIVER AND HOLD HARMLESS AGREEMENT ir 10 n( name of organization) and its Members, In consideration of the 44'CJ;-. br6sS lrelz- employees, volunteers or guests, being allow to participate in= 46rr ., l< c, ( the Activity) the undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to r% name of organization) participation in the Activity. y 4AC.SIL fe low-, ( VA ( name of organization)To the fullest extent permitted by law, thef iC 4; L2?s& Lwd-4' 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 SI - 605: s f-, dname 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 hrr i l r / lam" a;& ( name of organization) shall, at its own expense, appear, defend and 1:Ls,' / 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 ros; 5 a,' a, ( name of organization) at C-and employees, in any such action, the 6Lt1- ' R ' 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 y5 l" as: S a< a. 4 ;.,F ( name of organization). 20Agreed this K day of l , Cask -c' vb sa \ s Name of Organization ,, / R" C Print Nah7d of Au,;! ignatur c Authorized Person Vp- 6X'ecv,' D i toGv Title Page 7 of 8 ===== PDF PAGE 12 ===== [Extraction: embedded PDF text] he 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. c1she RcygS`tS % ndom Nle khntifty 0 I5 2024F Name of Organization) ( Print Name of Signatory) ( Date) By rized Signatory) ANDREA NENDER50N Notary Public, State of Illinois r - Commission No. 89846' My Com— ssion Expires July 23. 2027 Notary P blic) Sigsned and worn to before me this 1J day of AM 20 ' 1-( P 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 i* t}** X***} X* fi*** t#*##** X** i###****##t**k**# t###**#*## ti#;*fi****####* kkX# it* t#*kk* i* t##R***** kt#**#*#******#****###* t#**#** i#* FOR OFFICE USE ONLY 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: Approved Permit No. Denied Remarks: Authorized Signature Title Date Page 8 of 8