===== PDF PAGE 8 =====

ITEM TITLE:
FIT4FALL SK
Special Event Permit Application
Healthy West Chicago
CITY OF WEST CHICAGO
PUBLIC AFFAIRS COMMITTEE
AGENDA ITEM SUMMARY
AGENDA ITEM NUMBER: _4.:..:.·=B:...... __
COMMITTEE AGENDA DATE: August 17, 2026
COUNCIL AGENDA DATE: August 17, 2026
STAFF REVIEW: Kelley Chrisse, AICP, CEcD
ITEM SUMMARY:
Healthy West Chicago is seeking approval for a 5K Run scheduled for Saturday, September 19, 2026
from 6:00 a.m. - 11 :00 a.m. with an estimate of 300 attendees. All proceeds from this event will be used
to support Healthy West Chicago programming and sustainability.
Set-up is scheduled to begin at 6:00 a.m. The race begins at 8:00 a.m. The event clean up is expected to
end at approximately 11 :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.

===== PDF PAGE 9 =====

Page 1 of 8
City of West Chicago
SPECIAL EVENT PERMIT APPLICATION
THIS FORM MUST BE COMPLETED IN FULL & SUBMITTED
90 DAYS PRIOR TO THE EVENT
Submittal Checklist
1. 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 –
$125 (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)
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).
PERMIT NO.  _______________
********************************************************************************************************************
FOR OFFICE USE ONLY
********************************************************************************************************************
Received: ____________________________
Fee Paid: $____________________
Receipt # _____________________________
Check #______________________
Event Acknowledgement Form returned by:
Police Dept. _________ Fire Dist. __________ PW _________ Park Dist. _________ CDD _________
□Background checks completed by Police Dept.
Date ____________________
□DuPage Co. Health Department notified
Date ____________________
□Certificate of Insurance received and approved
Date ____________________

===== PDF PAGE 10 =====

*** 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 $1 mil per occurrence and general aggregate no less than
$2mil for contractors/vendors.
2. *ttPLEASE 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 201 0 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, Sara Phalen
, representing Healthy West Chicago / People Made Visible
(print 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)
West Chicago Fit4Fall SK
(name of event)
Page 2 of 8
07/09/2026
(date)
09/19/2026
(date of event)

===== PDF PAGE 11 =====

Page 3 of 8
SECTION 1 – GENERAL INFORMATION
Name of Event: ______________________________________________________________
Type of Event:
□Parade    □ Walk/Run/Bike   □ Carnivals   □ Fireworks   □ Festival
□Other ____________________________________________________________________
Location of Event: _________________________________________________
Date(s) of Event: ____________Hours of Event: _______to_______ Est. Attendance: _______
Event Website: _______________________________________________________________
Purpose of event: _____________________________________________________________
____________________________________________________________________________
Name of Sponsoring Organization(s): ______________________________________________
Organization’s Legal Status (i.e. NFP, Partnership, Corporation): ________________________
Contact person from sponsoring organization: _______________________________________
Organizer address: ____________________________________________________________
City/State/Zip: __________________________________________
Cell Phone:
 E-mail: ___________________________________________
Emergency contact information (provide mobile numbers for on-site coordinators during event):
1st Contact:  _________________________________________ Phone:

2nd Contact: _________________________________________ Phone:

Is this an annual event? □ Yes   □ 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.
__________________________________________________________________________
__________________________________________________________________________
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.
West Chicago Fit4Fall 5K
Reed-Keppler Park and associated parking lots as permitted by Park District.
6am
11am
300
activity for the community and fundraiser for wellness activities
Healthy West Chicago / People Made Visible
People Made Visible, Inc.
Sara Phalen
103 W. Washington St.
West Chicago
sara@healthywestchicago.org
Sara Phalen
Susanne Schnell
9/18/2027
09/19/2026
N/A
https://raceroster.com/events/2026/138620/west-chicago-fit4fall-5k
X
X

===== PDF PAGE 12 =====

Page 4 of 8
SECTION 3 – PERMITS
Will your event include a carnival?
□Yes   □ No
If yes, you must submit a Carnival Permit Application ninety (90) days prior to the event.
Please visit www.westchicago.org 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?
□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 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 for an application.
Are you holding a raffle at your event?
□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?
□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?
□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     □ Fire District / Paramedics    □ Public Works
Specify services: _________________________________________________________________
_______________________________________________________________________________
Will you be utilizing any of the following services?
□Water     □ Electric/Generator     □ Other _____________________________________________
X
X
X
X
X
X
X

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Page 5 of 8
SECTION 4 – SITE PLAN AND/OR ROUTE MAP
Please attach a separate sheet to illustrate the layout for your event.
Are you requesting the use of any City-owned property, i.e. City streets, parking lots, or sidewalks?
□Yes   □ No     If yes, please indicate the property that you are requesting to use.
_________________________________________________________________________________________
_________________________________________________________________________________________
Would you like to request the closing of City streets?
□Yes   □ No
If yes, please fill in the following information or submit a route map along with this application:
Street
From
To
Dates
Times
______________________ ________________ ________________ ___________ __________
______________________ ________________ ________________ ___________ __________
______________________ ________________ ________________ ___________ __________
______________________ ________________ ________________ ___________ __________
______________________ ________________ ________________ ___________ __________
______________________ ________________ ________________ ___________ __________
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
Turtle Splash parking lot will be use for participant parking. Rolling closure at Yale St. and National St.,
sidewalks for the race route and youth 1mile.
X
X

===== PDF PAGE 14 =====

Page 6 of 8
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
(All items due to City unless noted)
Days Due
Before Event
Due Date
Submit “Intent to Meet Insurance Requirements”
Document (included with Special Event Permit
Application, pg.2)
Prior to
application review
Prior to application
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
Application
30 days
Submit Temporary Food Service Permit
Application(s)
(DuPage County Health Dept. – 630-682-7979)
30 days
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
sign in West Chicago’s Special Events Policy)
N/A
Day of Event
*If this requirement is not met, the proposed event may be cancelled.

===== PDF PAGE 15 =====

Page 7 of 8
SECTION 6 – WAIVER AND HOLD HARMLESS AGREEMENT
In consideration of the ____________________________ (name of organization) and its Members,
employees, volunteers or guests, being allow to participate in __________________, (the Activity) the
undersigned hereby recognizes, acknowledges and assumes any and all risk pertaining to
__________________________ (name of organization) participation in the Activity.
To the fullest extent permitted by law, the _____________________________ (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  ________________________ (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
__________________________ (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 ______________________________ (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 ______________________________(name of organization).
Agreed this _______ day of ______________, 20____
_______________________________________
Name of Organization
_______________________________________
Print Name of Authorized Person
_____________________________________
Signature of Authorized Person
_____________________________________
Title
Healthy West Chicago / People Made Visible
Fit4Fall 5K
Healthy West Chicago / People Made Visible
Healthy West Chicago / People Made Visible
Healthy West Chicago / People Made Visible
Healthy West Chicago / People Made Visible
Healthy West Chicago / People Made Visible
Healthy West Chicago / People Made Visible
9
26
July
Healthy West Chicago / People Made Visible
Sara Phalen
Executive Director

===== PDF PAGE 16 =====

Event Overview:
Fit4Fall 5K
Special Event Proposal:
Saturday September 19, 2026
The Fit4Fall SK will be sponsored by Healthy West Chicago in collaboration with Educare West
DuPage, with the support of Race Time Inc. This event will take place on Saturday, September
19, 2026 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 will coordinate the event day activities with Race Time Inc., Healthy West
Chicago Volunteer Committee, and West Chicago Park District.
General Information:
Main Contacts:
Sara Phalen
People Made Visible
Email: sara@healthywestchicago.org
Phone:
Susanne Schnell, susanne@healthywestchicago.org
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 SK Run/Walk Adult (18 and older): $22.85
•
SK Run/Walk Student ( 17 and under) $17.51
•
Resident SK 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.

===== PDF PAGE 17 =====

•
Families running the SK with 4 or more people will receive $5 off the total.
•
All proceeds from the event will be used to continue with Healthy West Chicago
programing and sustainability.
Main Event Schedule:
6:00 AM Staff & Volunteer Set-Up
7:00 AM Registration Opens
7:30 AM Registration Closes
8:00 AM SK Walk/Run starts
8:45 AM (or when last SK participant crosses finish line) I 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 5k Course Organizer:
Organizer: Race Time Finish Line Management & Timing Company
Website: http://www.racetime.info
Contact: Julie Pearson
Email: racetime2 l@hotmail.com
Awards Participants Receive:
SK Walk/Run: Trophies will be distributed to one overall male and one overall female winner.
5k Walk/Run Participants Receive:
• Short sleeved SK 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 11th 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.

===== PDF PAGE 18 =====

Race day pictures by professional photographer.
Water: water stations at Start/Finish and near mile markers I 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 thunderstonns, 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 infonned decisions regarding event safety.
Website & Registration Structure:
Participants will register using Race Time lnc.'s online platform.
Electronic signature of liability "Waiver & Release" will be required. A volunteer sign-up option
will also be available.

===== PDF PAGE 19 =====

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===== PDF PAGE 20 =====

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.
Healthy West Chicago / People Made Visible
Sara Phalen
7/9/2026
-------------
(Name of Organization)
(Print Name of Signatory)
(Date}
By I:'- a...a..c&S?1 ~
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(Authorize'&-signatory)
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SION EXPIRES 02/08/2027
Signed and sworn to before me this
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After submitting all forms, your application will be revi~ 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
....................................................................................................................................................
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:
D Approved
Permit No. ____ _
Authorized Signature
Title
Date
Page 8 of 8
D Denied
Remarks:
.....