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HomeMy WebLinkAbout11-31JANUARY 25, 2011 11 -31 RESOLUTION (CARRIED 7 -0 LOST LAID OVER WITHDRAWN ) PURPOSE: APPROVAL OF SPECIAL EVENT / SPECIAL OLYMPICS / UTILIZE MENOMINEE PARK FOR POLAR PLUNGE / FEBRUARY 18 -19, 2011 INITIATED BY: CITY ADMINISTRATION NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that approval is granted to Special Olympics Fox Valley Area (Nicci Sprangers) to utilize Menominee Park (Miller's Bay & Parking Lot), on Friday, February 18, 2011, from 8:00 a.m. to 10:00 p.m. and Saturday, February 19, 2011, from 8:00 a.m. to 6:00 p.m. for their Polar Plunge benefitting Special Olympics, in accordance with the municipal code and the attached application, with the following exceptions /conditions: BE IT FURTHER RESOLVED that as a condition of approval, the Event Organizer shall pay the City's actual costs for extraordinary services. Cost Estimates for Extraordinary Services Street Department -- Barricades ($1,095 preliminary estimate) Parks Department -- Plowing of one field within park for parking ($200 -$300 preliminary estimate) i�f v APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNEL7 - rO CITY I CLERK - OC T 0 4 2010 I GENERAL EVENT INFORMATION of Special Event: Start Date: End Date: a 1 14 I a c;l 1 12.: vo 2 vg f QLuri Jer_ All gr S ���� SaPc►aI n1 .mp,L - i=o 0011e, Qv . EVENT SUN MON TUE WED THUR FRI SAT DATE a 5 D 1 a s a SETUP TIME Q;.00-5 00 16! Lo -- o o 8:0o START TIME WOO I� aca✓ti, STOP TIME IO:a�f'�► y'ooP,� TEAR DOWN CLEAN UP o b ' � , COMPLETED Location of Event: NNI `S " - me yn 1 i Y1 e p \ y )< Estimated Attendance (daily &total): Number of Booths: 5- Organization(s) Sponsoring Event: r 1 DQ2 is l njw V)e-S iD \)GL\k,e ay -, ec; (including addresses) Briefly describe your event. Be sure to include the purpose of the event and all planned activities. APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Primary Contact: SO(- 0LQ- S Daytime Telephone: q ,)t, - 9 `3 i - I bb /y Cell Phone: 9a0 -1e, - a 31 D Fax: c (X -131 -?. I Email: n5�cnr,aer5la ��ecialdl.srn ©,cSw;sC enSin.orq Address: City: , fin I o n State: %-0 Z Zip Code: Secondary Contact: B r�� SC hold es Daytime Telephone: qan x'1 35� Cell Phone: Fax: Email: rg .i1�es, Ci . n h �►1. �,�►, uS Address: '-IaD .IcxcCC�,,� S�. City: ()Sh J � State: W Zip Code: SLl q b Onsite Primary Contact: �� cx sora,nae� Cell phone: qap - (,5q -a3 th Fax: Email: ec c�I aiy DicSl,.3�nSir► arcs .. - W421 _ Zip Code: Sy 9 1-5 Onsite Secondary Contact: R(San Sc..h►aNdf,5 Cell phone: Fax: Email: �seti . oS ®_ c► edsl,t�rsh. % ► �►� Address: yQ6 SCn S I- • City: c 5� State: , Zip Code: NOTE Either the primary or secondary onsite contact must be present onsite at all times during the event. APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK SPECIAL EVENT CHECKLIST (please check all boxes that apply) Is your event a: i4estival / Music Concert • Religious / Educational • Rally / Memorial ❑ Street / Block Party • Parade / Fun Run / Walk- a -Thon • March utilizing any Public Property • Public Assembly for Political Purpose ❑ Sport Tournament (Fishing, Soccer, etc.) ❑ Other Location of event: Park or other public property • Public street, sidewalk, alley, or right of way • Private property Will you have Alcoholic beverages (Additional permit required from City Clerk) Food & non - alcoholic beverages (Additional permit required from Health Dept.) ❑ Non -food related sales and /or display booths o additional permits required) Tent and /or Canopy (Additional permit required from Inspections Dept.) Digger's Hotline must be contacted minimum of 3 days before digging) Generator(s) and/or additional electrical facilities (Additional permit required from Inspections Dept.) • Fires or Candles (Additional permit required from Fire Dept.) • Fireworks (Additional permit required from Fire Dept.) • Activities in a park outside of normal operating hours (Waiver required from City Council) • Barricades (Approval from City Clerk's office if in right of way) APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK w Amplified Sound ❑ Animals included or allowed in event (animals must be licensed and have proof of vaccination) VCooking Equipment (Fire Department approval required) We have made arrangements for u�' Restroom and hand washing facilities VSolid waste and recycling services ZEvent insurance VPublic safety & security / EMS services � lectricity / Generators a fire extinguishers ,D dvertising with banners or signs rinking water &K Grey water and grease removal Vylleather contingencies X Gas nt Heating Space Intentionally Left Blank APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Special Event Public Safety and Security Plan Name of Event: 9b\A r 9k 1� inn a Location of Event: Date of Event: �2, - awl l Time the Event is to Open: Fcb 1 q �c��ru a� I O � �n, • P� �r� -� i 2' vo 3 � ao F.nd ' E Sponsor of the Event: Sam ,«► n �., s . V,,k�:a11 Estimated Attendance (daily and total): - 5f Emergency Contact Information: Name: W. Daytime Phone Number: Cell Number: 9aD- (��q- 93) A Name: 2�qV. 9 ri cLn Scan IriPs Daytime P one Number: - a ac - 3 k 5 7'-:� Cell Number: � Name: Oe. kz8 i e— -Jenn , W& Daytime Phone Number: qao- t4aC) SLI9 Cell Number: it Primary Location of Event Staff at Event Site: PnAnr `P1u0Q,< area can � Ce- Emergencv Notification of the Public The public will be notified of safety and /or security issues in the following manner: APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Emeraencv Medical Services Name of Provider: _. plus nAmpr - [ks l Res1- ��ti(Qrc Contact Person / Telephone Number: J k rwn 936- a3 I - - 790 Location of Provider at Event Site: i nS,o1Q, main +en+ ,)e w� kl se�uo �+rsl-aic� Fire Protection Name of Provider: nr1P� 1, uwyo W S C' -jwbA� A -Q51�. _ 'rO — ^ i nspec {i drls Contact Person / Telephone Number: Location of Provider at Event Site: Number of Fire Extinguishers: \tJW lx- ,a-- oC -qw p 1"kifts cks rf � L� 061 V . ,r Location of fire access roads: bas oavi,�Q reSEue- vev\MeS Security Name of Provider: d:SynVy)sh Pak i ce— . 1 Acw i S torsi Contact Person / Telephone Number: RcLA "arrls S ao - 936 EA Location of Provider at Event Site: Auii 1mar Comma. &G+ Location of Missing Persons Station: A"x \ arm Ppm Qre Event Parking Locations: 1 r-;.RAd s 1 omked Oh n or th P-v-\d eA 1' -m ers — f��e E cl CX �-cu5 G 2 APPLICATION FOR SPECIAL EVENT PERMIT— TO BE RETURNED TO CITY CLERK Severe Weather Contingency Shelter Locations: Have you confirmed that the locations will be open and available? Who will determine if your event is canceled or held? Phone number: Public Safety Site Plan Provide a schematic drawing of the event site location. The drawing must be legible and drawn to scale. The public safety plan must include the following items if they will be provided, or if they are required. 1. Location of booths, stages, and event structures 2. Location of first aid stations 3. Location of information / ticket booths 4. Boundaries of the event 5. Location of fences 6. Location of exits and gates (gates must be numbered) 7. Location of Fire extinguishers 8. Location of severe weather shelters 9. Location of Fire / EMS access road 10. Location of security staff 11. Location of emergency contact event personnel 12. Location of assembly area and approximate occupant amounts 13. Location of event parking 14. Location of barricades 15. Location of generators 16. Location of temporary roadways APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY CLERK Other Provide any other information that you feel should be considered Yes No V V I have reviewed and have considered the Contingency Plan information provided by the City of Oshkosh along with this application (pages 11, 12) I have reviewed and understand the City's Insurance requirements for Special Events as described in this document (pages 13, 14, and 15) am enclosing the event's Public Safety Site Plan (see page 9) I am enclosing other information that I believe is necessary or helpful to describe the planned event SIGNATURE I am allowed to sign this application on behalf of the event sponsor. The information contained in this application for a Special Event permit is true, correct, and complete to the best of my knowledge. If there are any changes to the Special Event, I agree that I will promptly notify the City of Oshkosh of these changes and request approval of them. .:��t SOAD-M IR1I(c1 to Date (print name) Orint title with organization) Application for Special Event Permit and Additional Permits or Licenses for Event - For Staff Applicant — Use Only — Type of License or Check box for each License or Permit applicable to Enter Permit your event. Submit this form together with your amount of completed Applications and Fee to the Office of Fee, if the City Clerk. re uired Special Event Permit Park Shelter Please check this box if a shelter reservation will be Reservation required. Application If a shelter reservation is required for your event, you must make that reservation directly through the Parks Department office. Temporary Please check this box if there will be food or Restaurant Permit beverages, other than prepackaged items, sold or % :1L0.1%'\ use, served at your event. b s -L��t ti Temporary Restaurants will be inspected and licensed on site during the Event. mQ�� o "� A list of vendors must be provided to the Health Services Division at least one week prior to the Event. Temporary Class "B" Retailers License d (Acct. No. 100- 0050- 4322 -00000 Temporary Use pa., v\e,2d- S ?oKQ t Ucrttne- (3V - 0"'A ' Permit e ^ . kb 1 3i %� g0n +6 11otdi ems;��is (Acct. No. 100- �n ��t p ar K do nt.r reed t� Verm% ' 0740 - 4334 -00000 Fireworks and Burning Permit Acct. No. -- Total Fee $ SPECIAL EVENT INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (Medium and High Risk Events) EVENT: E 96m p, ORGANIZER The event organizer agrees that it, and not the City, will be solely responsible for all incidents related to the event. This responsibility of the organizer to the City includes but is not limited to the actions of the event organizer, its officers, employees, agents, and volunteers, along with event vendors, contractors, subcontractors, participants, and visitors, except as may result from the sole negligence or willful misconduct of the City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. Inconsideration for the City's approval of the Special Event, 4)Q Pr\ay (u P . . the organizer of this event agrees to indemnify and hold harmless the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers, from for, and against and agrees to defend the same from and against, any and all suits, claims, grievances, damages, costs, expenses, judgments and/or liabilities, including costs of defense and reasonable attorneys fees, and further agrees to pay any settlement entered into or on behalf of, or judgment entered against, the foregoing individuals and/or entities, except as may result from the sole negligence or willful misconduct of the City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. The event organizer shall abide by the City's insurance requirements for the event, including the addition of the City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers as additional insured's for the event. The individual(s) signing this agreement has the authority to enter into this agreement on behalf of the organizer(s) of the Special Event. EVENT ORGANIZER (prinfiiamA of organizer) J (date) (date) �X-t C�i l,✓y Cd/Yl C L Lx- Di rec fGr C n (signature) -� (title) aV,? I of tlnoo (signature) (title) i C cringer S - p ree b c-F ;x fop,Yi rd (pridt nam (print title) (print name) (print title) M a F FA LLI U y J C o o Y Q LLD X c � V c U L iz v►' o> a 0 Rl N 0I C H d a W R �..► o u 00r y a y w = C 0 m I I I V C L W yr W of C W m o 0 N