5.e) Special Event Premit, Meister's Bar and Grill-Wrestling Event Meeting Date: 3/15/2011
Agenda Item: � �
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City Council Agenda Report
City of Scandia
14727 209`h St. North
Scandia, MN 55073 (651) 433-2274
Action Requested: Approve a Special Event Permit for Meister's Third Annual Wrestling
Event to be held on May 21, 2011.
Deadline/ Timeline: N/A
Background: • Meister's Bar and Grill will be holding a Wrestling event on May
21, 2011. They have applied for a Special Event Permit under the
provisions of Ordinance No. 115 which governs outdoor
gatherings of at least 100 people.
• The application indicates that the entertainment will be the same
as in 2010. The wrestling event will be from 5 p.m. to 8 p.m. and
a band will play from 8 p.m. to 12 p.m. The event will use sound
amplification. The ordinance allows no more than four amplified
events at one location in any one calendar year. This would be
Meister's second amplified event in 2011. (There is no limit on
the number of non-amplified events.)
� There will be a $5 cover charge. They expect attendance of 200 to
400 people. The wrestling promoter will provide bouncers and
Meister's will hire 2 sheriffls deputies between 9 a.m. and 1 a.m.
for security.
• Multiple trash receptacles will be provided; sanitary facilities will
consist of 6 to 8 portable toilets. There will be no food or
beverage service outside.
• Parking will occur on site, available street parking and the back
parking lot which is owned by the City. The City of Scandia is
named as an additional insured on the Liability policy because of
the use of City property for parking.
• It appears that all ordinance requirements have been met.
Recommendation: Staff recommends that the following conditions be attached to the
permit (the same conditions were applied to the permit last year:)
1. The event shall be held as described in the application received
on February 24, 2011.
2. Any vendors present on the site shall possess sales and use tax
permit if required by Minnesota law.
3. Any signs or banners shall comply with the Scandia
Development Code.
Page 1 of 2
03/10/11
Attachments/ • Special Event Permit Application
Materials provided: . Release and Indemnification Agreement
• Certificate of Liability Insurance
Contact(s): Scot Taylor, Meister's Bar and Grill
763 433-5230
Prepared by: Anne Hurlburt, Administrator
(Meister's 2011 Wrestling Event)
Page 2 of 2
03/10/11
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- CITY OF SCANDIA
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14727 209'h Street North
Scandia,Minnesota 55073
(651)433-22�4 �1��o�1a�.ci.scandia.nan.us
Special Event Permit Application
INSTRDCTIONS: Fill out this form completely,sign it and include all required attachments. If additional space is
needed,attach additional sheets. Submit to the City of Scandia at least 30 days prior to the date of the event with the$25.00
permit fee. You will be notified at the time of application of the date for City Council consideration of the request.
`\ 1. Name, purpose and description of event: I!
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Location address: i � ��t��l t\ l �' •
Date(s): �
Event starting Time: ,� ��� �� Event ending time:
Set-up start date and time: �. `(J P �C;� ��� \ `
Dismantle by- date and time: �
Anticipated number of participants and/or spectators: � -' •�� �
If there is a fee or donation required as a condition of
attendance, please describe:
2. Attach sketch or site plan showing the location of the following as applicable:
route(beginning/end, direction of travel, _ food concession areas (cooking, serving,
traf�ic control points) consumption)
_ ticketing/registration/entry locations _ alcoholic beverage concession area
_ entertainment or stage locations _ other concession areas
_ portable toilet facilities ! size and location of any tents or structures
_ fencing locations _ trash/recycling receptacle area
_ parking areas for participants/spectators _ fireworks or pyrotechnics site
_ sign locations _ first aid facilities
_ speaker(sound amplification) locations _ other as may be applicable
City of Scandia, Special Event Permit Application, Page 1 of 7
3. Applicant information:
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Name: � Title: ��,�''����''_1�
Address: � i,
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Phone: �� � ���—��� Cell: �� � — j
E-Mail: �-- t
Affiliation/organization: � < <
Are you an authorized applicant for this organization? Yes� No
Will this person have authority to cancel or modify event plans? Yes� No
Will this person be present at the event and in charge of the event
at all times? Yes�No
If no, provide contact information for person who will be the
responsible party on the day of this event
Name: Title:
Address:
Phone: Cell:
E-Mail:
4. Entertainment:
Describe entertainment plans. If there will be music, sound amplification or any other noise impact,
please describe including the intended hours.
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5. Sanitation/potable water:
Describe the toilet and hand washing faciiities present on the site (type,number& location)as well as
tem orary/portable facilities to be�rovided. Describe the source of potable (drinking) water.
� �
City ofScandia,Special Event PermitApplication, Page 2 of 7
6. Parking and traffic control:
Describe the location and number of parking spaces available. Describe arrangements that have been
ade for traffic control.
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7. Emergency/medicat services:
Describe measures that will be taken to ensure emergency vehicle access(police, fire, ambulance)to
the event area.
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8. Security/crowd management:
Describe your proposed procedures and staffing for the event operations and crowd control.
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9. Trash/recycling, event clean-up:
Describe the number,type and location of trash/recycling containers to be provided. What provisions
have been made for clean-up of the site and sunounding area after the event?
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Name of trash/recycling hauler: ,�T �(�� ��
10. Lighting:
Describe any temporary or permanent lighting that will be ded for the event.
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City of Scandia, Special Event Permit Application, Page 3 of 7
11.Temporary structures or construction.
Describe any tents, canopies, enclosures, stages, platforms, scaffolding, risers,bleachers, fences, and
any other type of temporary structure or construction for the event. Event sponsor is responsible to
obtain any building or electrical permits that may be required for such construction.
� �
12.Advertising and promotion.
Describe how this event will be advertised and promoted. Describe any signs(size,type, location.)
All signs must comply with Scandia Development Code Chapter 2 Section 9.13 including a permit if
re uired. � �
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13. l�o�se:
Describe expected type,duration and timing of any noise sources. Describe measures to be taken to
ensure complia ce with city noise ordinance(Ordinance No. 65.)
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14.Fireworks or pyrotechnics:
Will any fireworks or pyrotechnics be used at the event? Yes No
If yes, describe in detail. Fire Department approval will be required.
City of Scandia, Special Event Permit Application, Page 4 of 7
15. Food and beverages:
Will alcoholic beverages be served? Ye No
If yes, describe the type of beverages and the status of the liquor license:
Will food andlor non-alcoholic beverages be served? Yes o
If yes, describe what will be served and any plans for cooking food in the event a ea, including fuel
source to be used:
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Has a license been obtained from the Washington County
Department of Health and Environment? (please attach) Yes No
16. Other concessions:
Describe what vendors or concessionaires you will allow at the event, and how you intend to regulate
and monitor their activities.
17. Gambling:
Will there be any gambling(raffles,pull-tabs,bingo, etc.) at the
event? Yes N
If yes, a lawful gambling permit will be required as provided by state law and Scandia Ordinance No.
100. Describe the gambling activity and the status of the gambling permit.
18. Workers compensation compliance:
In accordance with Minnesota Statutes all applicants for license and permits to operate a business in
Minnesota must submit acceptable evidence of compliance with workers' compensation insurance
requirements. Please complete the certificate of compliance and attach to this application.
City of Scandia,Special Event Permit Application, Page S of 7
19. Indemnification:
Ordinance No. 119 requires that a special event permit holder shall agree to defend, indemnify and
hold the City, its officers and employees harmless from any liability, claim, damages, costs,judgments,
or expenses, including attorney's fees, resulting directly or indirectly from an act or omission
including, without limitation, professional errors and omissions of event promoter, its agents,
employees, arising out of or by any reason of the conduct of the activity authorized by such permit and
against all loss caused in any way by reason of the failure of the event promoter to fully perform all
obligations under this ordinance. Please complete the release and inde»tnification agreement and
attach to this application.
20. Insurance
As a condition of the granting of a permit for a special event conducted on public property or public
streets or parking lots, the permit holder shall provide to the City a public liability insurance policy
naming the CiTy as an additional insured entity with limits of not less than one million dollars per
occurrence. Please attach the certificate of insurance to this application.
THE MINNESOTA DATA PRACTICES ACT requires that we inform you of your rights about the private
data we are requesting on this form. Private data is available to you, but not to the public. We are rec�uesting
this data to determine your eligibility for a permit from the City of Scandia. Providing the data may disclose
information that could cause your application to be denied. You are not legally required to provide the data;
however, refusing to supply the data may cause your permit to not be processed. Your residence address and
telephone number will be considered public data unless you reguest this information to be private and provide
an alternative address and telephone number. Please si�n b�lakv-to indicate that you have read this notice:
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Signature: Date: '
I reguest that my residence address and telephone number be considered private data.
My alternative address and telephone number are as follows:
Address: ����� �L,t�!�� Telephone: �l i���U
Acknowledgement/Signature:
I hereby acknowledge receipt of a copy of this application form and Ordinance No. 119,Establishing Rules and
Regulations for Special Events,and agree to abide by the ordinance and any other conditions that the City of
Scandia may place upon issuance of this permit.
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Signature: - Date: �, �-�
City of Scandia, Special Event Permit Application, Page 6 of 7
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-sPEc�a� EVEn�� sPan�saR-
RELEi4SE AND INDEMINIFlCATION AGREEMENT
ClTY OF SCANDiA, MtNNESOTA
THIS IS A RELEASE OF LIABILITY INDEMNIFICATION AGREEMENT. SPECIAL
EVENT PERMIT HOLDER MUST READ CAREFULLY BEFORE SIGNING.
In consideration for being permitted to engage in the following special event activities in Scandia:
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Special Event Permit Holder hereby acknowledges, represents, and agrees as follows:
A. We understand that the above described activities are or may be dangerous and do or may
involve risks of injury, loss,or damage to us and/or third parties. We further
acknowledge that such risks may include but not be limited to bodily injury,personal
injury, sickness, disease, death, and property loss or damage, arising from the following
circumstances, among others:
(Special Events Permit Aolder initials here) 1
B. If required by this paragraph,we agree to require each participant in our special event to
execute a RELEASE AND INDEMNIFICATION AGREEMENT for ourselves and
for the City of Scandia,on a form approved by the city.
Participant Release and Indemnification required?YES_NO„��
(Special Events Permit Holder initials here) �4 ►
C. We agree to procure, keep in force, and pay for special event insurance coverage, from an
insurer acceptable to the City of Scandia, for the duration of the ahove described
activities.
(Special Events Permit Holder initials here) --�' ; '
1
D. By signing this RELEASE AND INDEMNIFICATION AGREEMENT,we hereby
expressly assume all such risks of injury, loss, or damage to us or any related third party,
arising out of or in any way related to the above described activities,whether or not
caused by the act, omission, negligence,or other fault of the City of Scandia, its officers,
its employees, or by any other cause.
(Special Events Permit Holder Initials here)
E. By signing this RELEASE AND INDEMNIFICATION AGREEMENT,we further
hereby exempt,release and discharge the City of Scandia, its officers,and its employees,
from any and all claims, demands, and actions for such injury, loss, or damage to us or to
any third party,arising out of or in any way related to the above described activities,
whether or not caused by the act, omission,negligence, or other fault of the City of
Scandia its officers, its employees, or by any other cause.
(Speciai Events Permit Holder Initials here)
F. We further agree to defend, indemnify and hold harmless the City of Scandia, its officers,
employees, insurers, and self insurance pool, from and against all liability, claims, and
demands, court costs and attorneys fees, including those arising from any third party
claim asserted against the city, its officers, employees, insurers or self insurance pool,on
account of injury, loss or damage, including without limitation claims arising from bodily
injury, personal injury, sickness, disease, death, property damage or loss,or any other
loss of any kind whatsoever, which arise out of or are in any way related to the above
described activities,whether or not caused by our act,omission,negligence, or other fault
of the City of Scandia, its officers, its employees, or by any other cause.
(Special Events Permit Holder Initials here) �-
G. By signing this RELEASE AND INDENINIFICATION AGREEMENT,we hereby
acknowledge and agree that said Agreement extends to all acts, omissions,negligence, or
other fault of the City of Scandia, its officers, and/or its employees, and that said
Agreement is intended to be as broad and inclusive as is permitted by the laws of the
State of Minnesota.If any portion thereof is held invalid, it is further agreed that the
balance shall, notwithstanding, continue in full legal force and effect.
(Special Events Holder IniHals here) �
H. We understand and agree that this RELEASE AND INDEMNIFICATION
AGREEMENT shall be governed by the laws of the State of Minnesota and that
jurisdiction and venue for any suit or cause of action under this agreement shall lie in the
courts.
(Special Events Permit Holder Initials here) \�t
I. This RELEASE AND INDEMNIFICATION AGREEMENT shall be effective as of
the date or dates of the applicable special event, shall continue in full force until our
responsibilities hereunder are fully discharged, and shall be binding upon us,our
successors,representatives, heirs, executors, assigns, and transferees. �--�
(Special Events Permit Holder Initials here �� �
)
2
IN WITNESS THEREOF, THIS RELEASE AND INDEMN�ICATION AGREEMENT is
executed by the special events permit holder, acting by and through the undersigned,who represents
that he or she is properly authorized to bind the Special Events Permit Holder hereto.
PRINTED NAME OF SPECIAL EVENTS PERMIT HOLDER:
� ,
PRINTED NAME AND TITLE OF PERSON SIGNING ON BEHALF OF SPECIAL EVENTS
PERNIIT HOLDER:
Name � 4 '
Title �
,��'�_���__
Signature_��"
Date cJ�
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, DATE�MM/DD/YYYY)
ACORO� CERTIFICATE OF LIABILITY INSURANCE
�'" oz/24/zoii
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 11PON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BEIOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIYED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of auch endorsement�s).
PRODUGER � A T $116Q, JOA71II E
NAME:
Security State Agency PHONE 651 433-5753 � No; 651-433-3205
21190 Ozark Avenue North qpRE ;
P. O. Box 190
Scandia, NII�T 55073 INSURER�S)AFFORDINGCOVERAGE NAICN
iNSurtER n: 12AM A7UTUAL INSURANCE
INSURED 651-762-8083 651-433-5230 1NSURERB:
MEISTER�S BAR AND GRILL, INC� INSURERC:
14808 OAKHILL RD N `
SCANDIA, MN 55073 INSURERD:
INSURER E:
INSURER i:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT TNE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�ITR� TYPE OF INSURANCE ADDL U pOl1CY NUMBER ��pDY EFF �'PO�� UMRS
GENERAL LIABILITY EACM OGCURRENCE S 1�000�000
�1 X COMMERCUILGENERALLWBILITY CP174140.00 12/28/2010 12/2B/2011 pREMISES Eaocpurance S
CWMS-MADE a OCCUR MED EXP(My one pereon) 3 5�0 0 0
PERSONAL 8 ADV INJURY S 1,O O O,O O O
GENERALAGGREGATE S 2,000,000
GEML AGGREGATE LIMIT APPLtES PER: PRODUGT5-COMP/OP AGG S 2,O 00,000
POLICY PR� LOC S
'AUTOMOBILE LIA&LITY COMBINED SINGLE LIM T
''� Ee accident S
ANV AUTO BODILV INJURV(Per peraon) S
ALL OWNED scHEDULEO BODILY INJURY(Per accident) S
AUTOS AUTOS
NON-OWNED PROPERTY DA�AAGE
HIRE�AUTOS AUTOS _(Per accidentl s .__--.—
S
UMBRELU,LIAB OCCUR EACH OCCURRENCE S
EXCESS IJAB CUIMS,MppE AGGREGATE S `
DED RETENTION i S
WORKERS COMVENSA710N WC STATU- OTH-
AND EMPLOYERS LIABILITY Y/N "--�'�"�-`—
ANYPROafttE70wPM7NER�E7cECUTNE � N�A E.I.EACHACCIDENT j
OFFICERIMEMBER EXCLUDED7 --
(M�ndatory In NH) E.L.pISEASE-FA EMPlOYEE E
MYo s,tleaaibe urwer � — . �.—- .
DESCRIPTION OF OPERATIONS Celav i E.L.OISEASE-POUCV LMAR i
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DESCRIPTION OF OPERATONS I LOCATOHS/VEHICLES(Attach ACORD 101,Adtlition�l Remarks Schsdula,tt more space k raqWrW)
INCLUDING TH6 CITY OF SCANDIA AS ADDITIONAL INSURED WITH RESPECT TO EVENTS SPONSORED BY MEISTER'S BAR AND
GRILL USING THE CITY'S PARKING LOT LOCATED ADJACENT TO MEISTER'S BAR AND GRILL ON 4/24/11, 5/21/11,
9/9/11 AND 9/10/11
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF RE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN
CZTY OF SCANDIA ACCORDA�t��WITH THE POLICY pROVISIONS.
14727 209TH STREET r �
SCANDIA� MN SS073 AUTHOR�DREPR E�VfATVE ���
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.'� f OO 7988-2010 ACORD RPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are regi�d marks of ACORD