2013 special event permit application - Chicago Park District

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Thank you for completing your Special Event Permit Application. Before yousubmit your application to the Chicago Park District, please make sure that thefollowing steps have been completed:Have you?Signed and dated your application?Attached your event site map? (A route map must also be included for Athletic Level events.)Provided all documents and information as requested throughout the application?Included the $35 non-refundable application fee? (If your application is submitted/received less than30 days for Picnic, Commemorative and Promotion Level Permits or 45 days for Athletic, Corporate andFestivals/Concerts Level Permits prior to your event, a late fee may apply. Refer to Fees and Fee Deadlineson page 8.)Submit your completed Special Event Permit Application to the Department ofRevenue or any of the Regional Offices below by fax, mail or you may bring yourapplication to any Regional Office. Please do not email. All applications will becoordinated through the Department of Revenue.DEPT. OF REVENUEAdministration Office541 N. Fairbanks Ct., 4th FloorChicago, IL 60611Phone: (312) 742-5369Fax: (312) 742-6038TTY: (312) 747-2001NORTH REGIONNorth Region OfficeAttn: Permits6601 N. Western Ave.Chicago, IL 60645Phone: (773) 262-8658CENTRAL REGIONCentral Region OfficeAttn: Permits100 N. Central Park Ave.Chicago, IL 60624Phone: (312) 746-5962SOUTH REGIONSouth Region OfficeAttn: Permits3344 W. 71st St.Chicago, IL 60629Phone: (312) 747-7661FORM 1001 Rev 1/12Select photography by Chicago Park District Photojournalistprinted on recycled paper
ADDENDUM A: INSURANCE CERTIFICATE AND ENDORSEMENTPlease refer to the insurance requirements listed on page 6 of this application and below. We suggest that you provide your insurancebroker/agent with a copy of these requirements and request that they provide Certificates of Insurance complete with copies of allrequired Endorsements. Forward documents to the Department of Revenue via e-mail, fax or mail. Your permit will not be issuedwithout these documents.Applicants must submit two documents to satisfy insurance requirements.NOTE: “Chicago Park District, and members of the Chicago Park District Board of Commissioners, and the officers, agents, andemployees of the Chicago Park District, individually and collectively” must be listed as an additional insured.1. “Certificate of Insurance in the amount of $1,000,000.00 worth of General Liability coverage, including coverage for real andpersonal business property damage while the permit applicant is in possession of or occupying Chicago Park District property.This policy shall name the Chicago Park District as additional insured on a primary, non-contributory basis and must be submittedfor the event and the date(s) of all preparation for such event occurring on Chicago Park District property.• Cancellation Language: The Certificate of Insurance MUST provide 30 days notice of cancellation, except 10 days noticefor non-payment of premium.• Please reference EVENT NAME on insurance certificate, if applicable.2. Endorsement issued under their General Liability policy of insurance, including coverage for property damage while property isoccupied by the permittee, for the event that reflects that the Chicago Park District is an additional insured for the event.• Endorsement must include reference to the Policy Number and the Insured as they appear on the Certificate• Additional Covered Party: Name of Person or Organization: Chicago Park District, and members of the Chicago ParkDistrict Board, and the officers, agents, and employees of the Chicago Park District, individually and collectively.• Primary Insurance: The Endorsement must state that coverage afforded by this endorsement shall apply as Primary.Other insurance maintained by the Chicago Park District shall be excess only and not contributing with the insurance providedunder this policy.• If the Endorsement is not received 48 hours prior to the event, a permit may not be issued.• A sample Endorsement (Exhibit A-1) can be found on page 24.*NOTE: If your insurance company will not write an Endorsement due to the way the policy is written, please contact the ChicagoPark District Risk Management Office at (312) 742-4622. The Chicago Park District maintains the right to modify, delete, alter or changethese requirements.Applicants assume all responsibility for and hereby agree to indemnify and hold harmless the Chicago ParkDistrict, its Board of Commissioners, officers, agents and employees against any losses, damages, liabilities,actions suits, proceedings, costs or expenses that the Chicago Park District may incur or sustain or forwhich it may become liable (including, but not limited to, personal and bodily injury to, or death of, personsor damage to property) resulting from, arising out of or in any way relating to the event. The obligation toindemnify and hold harmless the Chicago Park District, its Board of Commissioners, officers, agents andemployees will survive the termination or expiration of the Permit.Your permit will not be issued if both the Certificate of Insurance and the Endorsement have not beenreceived.Certificate holder may be listed on certificate as:Chicago Park DistrictAttn: Department of Revenue541 N. Fairbanks Ct., 4th FloorChicago Park District 2013 Special Event Permit Application Package 23
Page 1 and 2: 2013SPECIAL EVENTPERMIT APPLICATION
Page 3 and 4: Dear Patron,Thank you for choosing
Page 6 and 7: (Permit Application Process continu
Page 8 and 9: (Event Rules and Regulations contin
Page 10 and 11: TYPE OF SPECIAL EVENTPERMITS(Refer
Page 12 and 13: 2013 SPECIAL EVENT PERMIT APPLICATI
Page 14 and 15: EVENT FEATURESAll event features ar
Page 16 and 17: VEHICLES (Athletic, Corporate, Comm
Page 18 and 19: ADVERTISING AND MARKETINGPlease not
Page 20 and 21: SECURITY PLAN AND MEDICAL SERVICESD
Page 24 and 25: ADDENDUM A: INSURANCE CERTIFICATE A
Page 26 and 27: ADDENDUM C: LIQUOR ACKNOWLEDGEMENT
Page 28 and 29: ADDENDUM E: GREEN EVENT GUIDELINEST
Page 30 and 31: ADDENDUM F: ACCESSIBILITY GUIDELINE
Page 32: ADDENDUM H: HELPFUL CONTACT INFORMA

2013 special event permit application - Chicago Park District

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