2013 special event permit application - Chicago Park District

SECURITY PLAN AND MEDICAL SERVICESDepending on the size and activities of your proposed event, Park District Security may require the presence of security personnel. Event organizersare responsible for the actions and conduct of any and all persons and organizations (participants, spectators, sponsoring organization, its officers,employees or agents or any person under their control insofar as permitted by law) associated with the permitted event. Furthermore, the eventorganizer is responsible for and will bear all costs related to policing, cleaning and restoring the park upon conclusion of the event or activity and willreimburse the Park District for any such costs incurred by the Park District.SECURITY PLAN (Required for Picnic 4, Athletic 3-5, Corporate, and Festivals/Performances/12,001+ Permits)Have you made provisions for on-site security services? Please note that Park District Security may be available for your event. For moreinformation, contact the Department of Revenue (refer to contact information on page 5 of this application).(Please check NO or YES below. If YES, please provide the information requested below. Document(s) with this information may be attached.)NO YES 13 Please provide the information requested belowSECURITY COMPANYCONTACT NAMENUMBER OF SECURITY STAFF PER SHIFT PER DAY LICENSE NUMBER INSURANCE COMPANY NAMESTREET ADDRESSSUITECITY STATE ZIP CODEE-MAIL ADDRESSPHONE FAX EVENT DAY CELL13Additional Documentation Required: If you checked “YES” above, please provide a copy of the Security Company’s license and certificate of insuranceas required by the State of Illinois. Provide a detailed schedule indicating the number of security personnel per shift throughout each day of the event(including set-up, event and tear-down days) and contract. Document(s) with this information may be attached. Please note: all security plans must beapproved by the Park District Director of Security or designee. Additional information may be requested upon review of any and all security plans.MEDICAL SERVICES (Required for Athletic 3-5, Corporate, and Festivals/Performances/12,001+ Permits)Have you made provisions for on-site medical services?(Please check NO or YES below. If YES, please provide the information requested below. Document(s) with this information may be attached.)NO YES Please provide the information requested belowMEDICAL COMPANYCONTACT NAMESTREET ADDRESSSUITECITY STATE ZIP CODEE-MAIL ADDRESSPHONE FAX EVENT DAY CELLTYPE OF SPECIAL EVENT PERMITPlease consult the Fee Schedule on page 10 to determine which type of Special Event Permit is suitable for the event you are planning. Check theappropriate box below.PICNIC ATHLETIC CORPORATE COMMEMORATIVE OTHERLEVEL 1LEVEL 2LEVEL 3LEVEL TLEVEL 1LEVEL 2LEVEL 4LEVEL 5LEVEL 1LEVEL 2LEVEL 3LEVEL 1LEVEL 2LEVEL 3FESTIVALS/PERFORMANCES/12,001+PROMOTIONSLEVEL 4LEVEL 3LEVEL 4GREEN EVENT: If you are holding a Green Event and are seeking a 10% reduction in your permit rental fee, please check this box to theleft and refer to Addendum E for guidlines and information. This box may be checked in addition to the appropriate box above.(Athletic, Corporate, Festivals/Concerts and Picnic Level Permits Only)Chicago Park District 2013 Special Event Permit Application Package 20