HomeMy WebLinkAbout11-132MARCH 22, 2011 11 -132 RESOLUTION
(CARRIED 7 -0 LOST LAID OVER WITHDRAWN )
PURPOSE: APPROVAL OF SPECIAL EVENT / UW- OSHKOSH ADAPTED
PHYSICAL EDUCATION PROGRAM / UTILIZE MENOMINEE PARK
FOR FISHING HAS NO BOUNDARIES / MAY 21 & 22, 2011
INITIATED BY: CITY ADMINISTRATION
NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of
Oshkosh that approval is granted to the UW- Oshkosh Adapted Physical Education
Program (Chuck DeMunck) to utilize Menominee Park, on Saturday, May 21, 2011, from
6:00 a.m. to 5:00 p.m. and Sunday, May 22, 2011, from 6:00 a.m. to 12:00 noon, for their
fishing has no boundaries, 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
none
APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURICILD TO C /TY._
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CLERK
GENERAL EVENT INFORMATION FEB 2 3. Zpl
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Official Name of Special Event:
Start Date: 'N M '' . ' z- o t End Date:
Briefly describe your event. Be sure to include the purpose of the event and all
planned activities. ' '
L— V—_
EVENT
�SUN�
MON
TUE
WED
THUR
FRI , .Sl�Atzi
DATE
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SETUP TIME
$�y
START TIME
STOP TIME
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TEAR DOWN
/ CLEAN UP
1, c�
COMPLETED
Location of Event:,
IeC�v�t �.es �5 S4�►C.1....`�_ Mcr.10 M ► N�::..>C. �AC- \
Estimated Attendance (daily & total): ZG�
Booths: -6
Number of
A
Organization(s) Sponsoring Event:
(including addresses)
C o i.1 Za.�'. G�+J C� fl �- t�,,J nl �►�
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6
APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY
CLERK
Primary Contact:
Daytime Telephone: zr� - 3� �t - S '� z. o ` "� �` 4Q€ �.
Cell Phone: 4— .s - ['Za
Fax: 20 —
Emai
Address: gpcc) C�►L..G a._ �3�..� O
City: State: ws. Zip Code: 5" 4 q C 1
Secondary Contact:
Daytime Telephone:
Cell Phone:
e 2 t'4 L:z tC� �<-
Fax:
Emai Ec_2 Ec� Zl Cr r^.A Co t
Address:
City: _
State:
Zip Code:
Onsite Primary Contact: cy,"c —v .. My
Cell phone: 9 Zo - 7:3"1 Vt — S" 7'2..a
Fax: g 2 — iAz - 14 4 "1
Email: !�,_ TA-) C> c
Address: 8k=XQ ?4 -L, -a ._ 8W(J
City: G2644 wgn6" State: Zip Code: `S - L496 I
Onsite Secondary Contact:
Cell phone:
Fax:
Email: %''\
Address:
City:
State:
Zip Code:
NOTE Either the primary or secondary onsite contact must be present onsite at
all times during the event.
7
APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY
CLERK
SPECIAL EVENT CHECKLIST
(please check all boxes that apply)
Is vour event a:
❑ Festival / Music Concert
❑ Religious / Educational
• Rally / Memorial
• Street / Block Party
❑ Parade I 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
(No additional permits required)
p ent 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)
E'?
APPLICATION FOR SPECIAL EVENT PERMIT — TO BE RETURNED TO CITY
CLERK
Amplified Sound
cVAnimals included or allowed in event -- aNE
(animals must be licensed and have proof of vaccination)
❑ Cooking Equipment
(Fire Department approval required)
We have made arrangements for
O I-zestroom and hand washing facilities
Solid waste and recycling services
Yr Event insurance
Public safety & security / EMS services
❑ Electricity / Generators
Fire extinguishers
pe'Advertising with banners or signs
prinking water
rey water and grease removal
Bather contingencies
VLP Gas
❑ Tent Heating
Space Intentionally Left Blank
01
APPLICATION FOR SPECIAL EVENT PERMIT -
TO BE RETURNED TO CITY CLERK
Special Event Public Safety and Security Plan
Name of Event: S�.t�� �-�►A- t�1rs ��V N�a�. '' .S
Location of Event:
Date of Event: Z-k Zc:, \
Time the Event is to Open: O - 7 0 n
Sponsor of the Event: QVA-s
Estimated Attendance (daily and total): 25cO
Emergency Contact Information:
Name: G1 -S►�c ��.�y
Daytime Phone Number:
Cell Number: E — 3Z 5 - 7 Z. Q
Name:
Daytime Phone Number:
Cell Number:
Name:
Daytime Phone Number:
Cell Number:
Primary Location of Event Staff at Event Site: c>*A v %Z
Emergency Notification of the Public
10
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 Med ical Services
Name of Provider: ^ -4^J I,G
Contact Person /Telephone Number:
Location of Provider at Event Site: c- K1
Fire Protection
Name of Provider:
Contact Person / Telephone Number:
Location of Provider at Event Site:
Number of Fire Extinguishers:
Location of fire access roads:
Securit
Name of Provider: � #-�� �x L 1-.
Contact Person / Telephone Number:
Location of Provider at Event Site: oi-J �i >� 't Z-( 0 os , 00
Location of Missing Persons Station:
Event Parking Locations: t�r2 A+ t 12�� �-- � �l�M� Nir L= JZK
11
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?
S-cS
Who will determine if your event is canceled or held? Phone number:
gA,� ���Z Q,
Ck ,LSc. S 7 c� � — .2 �ZSJ ' �'
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 ,
12
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My Background: Currently Chairperson for Fishing Has No Boundaries- UW- Oshkosh Chapter.
Currently a Mamber of Wisconsin Technical Rescue Operational Team(WTROT)
Certified First Responder
Certified First Aid and CPR
Certified Search and Rescue Technician by the National Association for Search
and Rescue in area such as Confined Space, Collapsed Structures,ect.
Certified as Wilderness Technician
Was deployed to New Orleans during hurricane Katrina and to southern
Texas during hurricane Wilma
Completed FEMA courses:
Intro to the Incident Command System( ICS 100)
State Disaster Management ( IS- 00208)
Intro to Hazardous Materials (IS- 00005)
ICS for Single Resources and Initial Action Incidents (IS -200)
National Incident Management System ( IS -700)
National Response Plan (NRP) (IS -800)
Last year the Fishing Has No Boundaries- UW- OSHOSH Chapter had logistically, 85 'Special Needs"
participants( 10 in wheel chairs, 4 in Power wheel chairs, 5 meals over two days, 100 plus community voluntee
and 20 boats.
Incident Action Plan (ICP)on the water:
All boats will be equipped with two types of communication, a cell phone and a walkie talkie.
All boats will be equipped with a blaze orange flag on a 6 foot rod attached the stern.
All boats will be numbered with a 6 inch number attached to each side of the boat.
All boats will be safety inspected for PFD's , fire extinguish and valid boaters registration sticker.
At 0700 each day, there will be a meeting with boat captains to discuss emergency planning for that
day.
Each boats position will be plotted on a master chart and change of locations will be called into the
Incident Command Post ( ICP).
The fastest vessel will be designated as a "Stand by vessel" and will positioned in such a way as to
respond to emergencies . When respond to emergencies on the water, the "Stand By Vessel"
will respond with a boat captain, a medical first responder, trauma kit and one other personal..
The boat captains will decide the course of action for the vessel they are piloting. This is because the boat
captain are the most knowledgeable about this body of water and the unique situations that can arise at any give
moment.In case of emergencies, the boat captain my either decide to keep his vessel where it is, seek, safer anc
more protected waters or return the vessel to the Incident Command Post.
Incident Action Plan ( ICP) on land.
The Incident Commander ( here identified as the Chairperson of the event.). will direct volunteers and staff i
assist participates to a safer location, this might be, but not limited to the shelters reinforced kitchen area, if time
permits, to get people into the reinforced bathroom area located across the street.
Injuries:
The Medical First responder with have the authority assess, treat, triage and call for assistance and they will
have sole responsibility until re leaved by an equal or higher licensed personal.
the priorities will always be LIFE „LIMB, PROPERTY
Night Responsibilities:
From 2000 until 0500 the grounds of the event will be the responsibility of the Oshkosh Axillary Police.
1 /1 S/7n1 1 F-110 PM
APPLICATION FOR SPECIAL EVENT PERMIT
— TO BE RETURNED TO CITY CLERK
Other
Provide any other information that you feel should be considered
Yes No
c I have reviewed and have considered the Contingency Plan
information provided by the City of Oshkosh along with this
application (pages 11, 12)
I :yo I have reviewed and understand the City's Insurance
requirements for Special Events as described in this document
(pages 13, 14, and 15)
-,--O�A I am enclosing the event's Public Safety Site Plan (see page 9)
Z ti 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 t t I will promptly notify the City of Oshkosh of these
changes re proval of them.
/-- t 4 — 1 1
013 \4—:3A � 45M Date
(print name) (print title with organization)
13
SPECIAL EVENT
INDEMNIFICATION AND HOLD HARMLE AGREEMENT
(Medium and High Risk Events)
EVENT:
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.
In consideration for the City's approval of the Special Event, e d � _V N d
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.
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
(print name of organizer)
te)
(signature) (ti e)
(print name) (print title)
I -- I a- z,a t t
(date)
(signature) (title)
(print name) (print title)
17
Map of 44.022503,- 88.518556
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http: / /maps.yahoo. com/print ?mvt —s &ioride= us &tp = &sty &fcat = &fr...
When using any driving directions or map, it's a good idea to do a reality check and make sure the road still exists, watch
out for construction, and follow all traffic safety precautions. This is only to be used as an aid in planning,
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1/15/20117:53 PM