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HomeMy WebLinkAbout17. 12-76FEBRUARY 28, 2012 12 -76 RESOLUTION (CARRIED 6 -0 LOST LAID OVER WITHDRAWN ) PURPOSE: APPROVAL OF SPECIAL EVENT/ DELTA SIGMA PHI FRATERNITY / UTILIZE CITY STREETS FOR THEIR OSHKOSH'S 2 nd ANNUAL 5K WALK SUICIDE AWARENESS /APRIL 28, 2012 INITIATED BY: CITY ADMINISTRATION NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that approval is granted to Delta Sigma Phi Fraternity (Bryan Stoffel) to utilize city streets: route — Oshkosh North High School on Smith Avenue, Wisconsin Street, W. New York Avenue, Algoma Boulevard, W. Murdock Avenue, Vinland Road, on Saturday, April 28, 2012, from 7:30 a.m. to 11:00 a.m., for their 5K Walk Suicide Awareness, 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 ($25 preliminary estimate) I . APPLICATION FOR SPECIAL EVENT PERMIT— TO BE RETURNED TO CITY CLERK GENERAL EVENT INFORMATION Official Name of Special Event: .9 Ao,nwAl '�K Suirl Start Date: ( 4 ` A T � _ End Date: EVENT SUN MON TUE WED THUR FRI SAT DATE SETUP TIME START TIME ?'30 cub STOP TIME 11., TEAR DOWN I CLEAN UP IAA COMPLETED Location of Event: 54• W 61, s ehoo l Estimated Attendance (daily & total): _ ',")00 - DU Number of Booths: Organization(s) Sponsoring Event: A_ 1 r_ _ '01 _ - P -I- (including addresses) 01- C)1LI t�3 1 1, 161 Briefly describe your event. Be sure to include the purpose of the event and all APPLICATION FOR SPECIAL EVENT PERMIT- TO BE RETURNED TO CITY CLERK Primary Contact: &jaff\ 0 Daytime Telephone: Cell Phone: 1 IS q $I - 0`73 - 1 Fax: (tune, Email: �7 0 edtA " 01) i Address: , n� 111j �ar � �cj* &� -4 7W City: a State: W 1 Zip Code: _ 5'1Q0 Secondary Contact:) m 2 Daytime Telephone: q,�() - j - `7q Me — Cell Phone: c P Fax: C70 Emai L&)&a rQ c-6( - e.r• n Address: City: L L State: W i Zip Code: Onsite Primary Contact: �mn St'ler Cell phone: qdO - 37q^ Mob — Fax: qgo - A35- 2n2 Email: WQS da( ems, n — Address: q City: 0-1 State: Zip Code: Onsite Secondary Contact: me) Cell phone: t5- - %1 7 Fax: 2. Email: �L 6 3 - 7c - o wo-A,e- LI - �- Address: l A k /� Gai " City: o State: L() 1 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: o Festival 1 Music Concert ❑ Religious I Educational ❑ Rally/ Memorial ❑ Street/ Block Party V" Parade 1 Fun Run 1 Walk- a -Thon (S14 w0kk * March utilizing any Public Property ❑ Public Assembly for Political Purpose ❑ Sport Tournament (Fishing, Soccer, etc.) ❑ Other Location of event: ❑ Park or other public property o� 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) • Tent and /or Canopy (Additional permit required from Inspections Dept.) (Digger's Hotline must be contacted minimum of 3 days before digging) Ea 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 �� p (Approval from City Clerk's office if in right of way) q� Tor WdRerS in q d "-Xj b a APPLICATION FOR SPECIAL EVENT PERMIT— TO BE RETURNED TO CITY CLERK N/ Amplified Sound b ao► ° v r w s�^ � � -A • Animals included or allowed in event (animals must be licensed and have proof of vaccination) • Cooking Equipment (Fire Department approval required) We have made arrangements for Restroom and hand washing facilities Solid waste and recycling services a Event insurance Public safety & security 1 EMS services V Electricity 1 Generators dFire extinguishers Advertising with banners or signs Drinking water Grey water and grease removal ,Aff ❑ Weather contingencies o LP Gas ❑ Tent Heating Space Intentionally Left Blank SPECIAL EVENT INDEMNIFICATION AND HOLD HARMLESS (Medium and High Risk Events) CITY LERK'' OFFICE EVENT: l� \i I�f 1\ �(}�U _� � O Ut l o l- 40c� rwp-55 WC 4, , ORGANIZER: 11C��'Cd. CiCYtl0. ��1 ��es dl� The event organizer agrees that it, and not the City, will be solely responsible for all incidents related to the event. This responsibility of tine 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, w z� !into " K Awi�l eo 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 tine 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 eventomanizer shall, abide 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 in ;sured'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 —)e K ,�-- (print name of organizer) 1 - I I W - 0 (date) (da }— �1 f�. �' - ck�u• l (signature) (title) (signature (title) vy \IQA (print name) (print title) —� (print na e) (print title) APPLICATION FOR SPECIAL EVENT PERMIT - TO BE RETURNED TO CITY CLERK Special Event Public Safety and Security Plan Name of Event: d SAS, ne 1 r St4)&, eS S WOK &t4d] Location of Event: ( } IWNI -N ? (ICU Wl I) Y Wn- tI�W Date of Event: "7 �t q! / (a Time the Event is to Open: PrYr\ Sponsor of the Event: S )94� Phi . � 601 rb� ftp2 Estimated Attendance (daily and total): I (M) Emergency Contact information: Name: _ h�-l. W l?. r Daytime Phone Number: 6 1 2,-0 ° ?2 -- ? - �l Cell Number: _ Name: 22 v k a y\ � -V,4+ -1 Daytime Phone Number: _f�= - - is " - MM Cell Number: Name: ,J - _ Daytime Nhone Number: 7,o _ e Cell Number: Primary Location of Event Staff at Event Site: l�S Emergency Notification of the Public O 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 Emergency Medical Services f to Name of Provider: ' Contact Person /Telephone Number: v Location of Provider at Event Site: Fire Protection Name of Provider: Contact Person 1 Telephone Number: Location of Provider at Event Site: Number of Fire Extinguishers: ,-A 4 1 1 Location of fire access roads: u Securit Name of Provider: Contact Person / Telephone Number: Location of Provider at Event Site: Location of Missing Persons Station: Event Parking Locations: 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 can��rreled 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 1 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 I 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 Q e W cic 13, 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 0 Yes No +� 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) -✓ I am enclosing the event's Public Safety Site Plan (see page 9) am enclosing other information that I believe is necessary or helpful to describe the planned event SIGNATURE 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 �7 Special Event, I agree that I will promptly notify the City of Oshkosh of these / changes and request approval of them. rL n & 'r Date (print name) (print title with organization) MASTER AGREEMENT BETWB N CITY OF OSHKOSH AND THE BOARD OF REGENTS OF THE UNIVERSITY OF WISCONSIN SYSTEM FOR SPECIAL EVENTS This Master Agreement is related to Special Events sponsored by the University, any department or division of the University or University recognized student group. The Board of Regents of the University of Wisconsin System (UW Oshkosh) shalt, within the confines of Wisconsin Law defend and hold harmless the City of Oshkosh, its members, its agents, employees and officers against any and all claims, demands, actions and causes of action and resulting liability, loss, damages, costs and expenses for injury to persons and damages to or loss of physical property to the extent caused directly or proximately by UW Oshkosh, its officers, employees and agents. Upon a written request, UW Oshkosh shall provide the City of Oshkosh a Certificate of Coverage as authorized by W1 ss. 893.82 and 895.46 of the Wisconsin Statutes. The individual(s) signing this agreement has the authority to enter into this master agreement on behalf of the City of Oshkosh and UW Oshkosh. Agreement will be considered ongoing beginning on October 1, 2011, CITY OF OSHKOSH (signature) l�. 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