9.b) Special Event Permit, Meister's Bar and Grill Meeting Date: 3/16/2010
Agenda Item: ,�y � �
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City Council Agenda Report
City of Scandia
14727 209`h St. North
Scandia, MN 55073 (651)433-2274
Action Requested: Consider approving a Special Event Permit for Meister's Second
Annual Wrestling Event on May 22, 2010.
Deadline/Timeline: N/A
Background: . Meister's Bar and Grill will be holding a Wrestling event on May
22, 2010. Meister's Bar and Grill, located at 14808 Oakhill Road
North, has applied for a Special Event Permit; this permit is
reviewed under the provisions of Ordinance No. 115 which
became effective on September 17, 2009.
• Meister's Bar and Grill would set up an exterior wrestling ring, a
ring presenter with a small amplifier would announce the events
which will occur between 6 p.m. and 9 p.m. After the event, a
karaoke stage will play from 9 p.m. to 12 p.m. There will be a$5
cover charge and Meister's will supply 2 bouncers along with 4
security personnel from the wrestling company. Multiple trash
receptacles will be provided; sanitary facilities will consist of 4
portable toilets with hand sanitarizer provided outside of the bar
and the 2 interior bathrooms.
• 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.
• The Special Event Permit Application was submitted on February
19, 2010. Additional information was requested, and submitted on
March 3. It appears that all ordinance requirements have been
met.
• Staff contacted local utility companies to determine if there are
any utility projects scheduled that could impact the proposed
route, and found no conflicts.
Recommendation: Staff recommends that the following conditions be attached to the
permit:
1. The event shall be held as described in the application received
on February 19.
2. Event organizers shall request any utility locates that may be
required.
3. Any vendors present on the site shall possess a sales and use
Page 1 of 2
03/11/10
.
tax permit if required by Minnesota law.
4. Any signs or banners shall comply with the Scandia Sign code.
Attachments/ • Special Event Permit Application
Materials provided: . Washington County License to Operate
• Release and Indemnification Agreement
• Certificate of Liability Insurance
Contact(s): Scot Taylor, Meister's Bar and Grill
763 433-5230
Prepared by: Steve Thorp, Code Official
(Meister's 2010 Wrestling Event)
Page 2 of 2
03/11/]0
RECEIVED
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SC�D� CITY OF SCANDIA
14727 209`"Street North
Scandia,Minnesota 55073
(651)433-2274 www.ci.scandia.mn.us
Special Event Permit Application
INSTRUCTIONS: 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:
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Location address: � ���� �,�(� �� � `+ .
Date(s): ��� ���
Event starting Time: �r [}U Event endin time: r� , /�
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Set-up start date and time: ,�
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Dismantle by- date and time: ,�� Y � i
Anticipated number of participants and/or spectators: p��
If there is a fee or donation required as a condition of �
attendance, please describe: C('�
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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,
traffic 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
Ciry of Scandia, Special Event Permit Application,Page 1 of 7
6. Parking and traffic control:
Describe the location and number of parking spaces available. Describe arrangements that have been
made for traffic control. . �
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7. Emergency/ medical 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: I
Describe your propo ed 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 surrounding area after the event? _
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Name of trash/recycling hauler: +�(.,k�� }�'��C�C,(�(����
10. Lighting:
Describe any temporary or permanent lighting that will be added for the event.
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ry JScandta, Special Event Permit Apphcation, Page 3 oJ 7
3. Applicant information:
Name: �..� ` l �1 �C1� Title: �� "v v 1��
Address: � ` , � '
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Phone: _�,S � --�' .�-- �.�'� � Cell: U��— �f� ' � ��.,�
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Affiliation/organization: � � � � ( � ��,
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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? Ye�,/� 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 facilities present on the site (type, number& location) as well as
temporary/portable facilities to be provided. Describe the source of potable (drinking) water.
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Ciry of Scandia, Special Ei�ent Pe�•mit Application,Page 2 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.
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12. Adverdsing 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
required. /1
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13. Noise:
Describe expected type, duration and timing of any noise sources. Describe measures to be taken to
ensure compliance 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 N
If yes, describe in detail. Fire Department approval will be required.
Ciry of Scandia, Special Event Permit Application,Page 4 of 7
15. Food and beverages:
Will alcoholic beverages be served? YeSX No
If yes, describe the type of beverages and the status of the liquor license:
Will food and/or non-alcoholic beverages be served? Y No
If yes, describe what will be served and any plans for cooking food in the event area, including fuel
source to be use :
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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.
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17. Gambling:
Will there be any gambling(raffles, pull-tabs, bingo, etc.) at the
event? Yes Np�
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 tl�e ce�•tifi ate of co»zpliance a�zd attacli to tlzis applicatioiz.
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Ciry of Scandia, Special Event Pernait 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 indenznification agreement and
attach to tlzis 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 requesting
this data to determine your eligibiliry 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 request this information to be private and provide
an alternative address and telephone number. Please sign below to indicate that you have read this notice:
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Signature: �G-�v" Date: � � �
I request that my residence address and telephone number be considered private data.
My alternative address and telephone number are as follows.•
Address: I�C��.l� �L,�1 � � � �: / `�' Telephone: U.>l — �."���`.��J��
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: � k� /V'
Ciry of Scandia, Special Event Permit Application, Page 6 of 7
Special Event Permit Checklist
for o�ce use only
Event Name and Date
Application Form and Attachments PAI D
�� Signed application form
MAR - 3 2010
Sketch/site plan � � �
Sz� �
`,���,�- Workers Compensation Certificate of Compliance CITY OF SCANDIA
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•� Release and Indemnification Agreement
Certificate of Insurance
Other Permits/ Licenses as Applicable
Building Permit
Sign Permit
Liquor License
Lawful Gambling Permit
Washington County Dept. of Health and Environment (food)
Reviewed by:
Building and Code Enforcement Official
, Fire Department
Police/ Sheriffls Department
City Administrator
City Council Review/ Permit Issuance
Date application found to be complete
City Council Meeting Date
Approved Denied
Resolution No.:
Transmitted to applicant
City of Scandia, Special Event Pe�mit Applicatzon, Page 7 of 7
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Stlliwater MN 55082-0006
� Office: 651-430-6655 Facsimlle: 651-430-6730 'i
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Dated; October 26, 2009 �
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-SPECIAL EVENT SPONSOR-
RELEASE AND INDEMNIFICATION AGREEMENT
CITY OF SCANDIA, MINNESOTA
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 Holder initials here) �
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) -� '
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 above described
activities.
(Special Events Permit Holder initials here) �i�
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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) 1��
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.
(Special Events Permit Holder Initials here) � l I
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) 1
G. By signing this RELEASE AND INDEMNIFICATION 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 Initials 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) J ,
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) �ti I
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IN WITNESS THEREOF,THIS RELEASE AND INDEMNIFICATION 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:
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PRINTED NAME AND TITLE OF PERSON SIGNING ON BEHALF OF SPECIAL EVENTS
PERMIT HOLDER:
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Name� � ���;'��,;
Title (���A����
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Signature��i�
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Date
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�``c�� CERT(FICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY)
`� 03/03/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. 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 WAIVED, 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 such endorsement(s).
PRODUCER CONTACT
NAME: BllSE� JoAnn E
Security State Agency �°,q�,�"Na E��. G51-433-5753 ac,No1; 651-433-3205
21190 Ozark Avenue Uorth E-MAi� ---
,9DDRESS_;_
P. O. $OX 190 ptiO�UCER 10�2301i ` ` —'
Scandia, MN 55073 Cu�oMERION; _ __
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_______ INSURERL)AFFORDING COVERAGE NAIC#
INSURED INSURERA: RAM A'IUTUAL INSURANCE i
NEISTER'S BAR AND GRILL, INC, DBA INSURERB:
S. T. REALTY, LLC iNsuRER c;a '
14 8 0 8 OAK}II LI, RD N ----- --- -----
SCANDIA, MN 55073 iNSuaeRn: _ __A__ ____
INSURER E:
651-762-8083 65I-933-5230 INSURErtF:'
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD
INDtCATED. NOTWITHSTANDING ANY RE�UIREMENT, TERM OR COND�TION OF ANY CONTRAC7 OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANGE 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.
�NSR � v �----�-- ADDL SUBRI —TPOUCY EFF POUCY EXP � ---
LTR TYPE OF INSURANCE N � POUCY NUMBER MMIDD/YriY MMIDD/YVVV lIM1T5 ��
GENER4L�IABIUTY I �EACHOCCURRENCE S Z�OOO�OOC I
A X COb1h,tERCIALGENERALLfA81UTY II CP179190.00 �lz/2E/2o09 12/28/201o'�MAGE�ORENTFD -- —
� �PREMISES(Et+xcurrence_ S 100,00(
CIAtAAS-h1ADE � h I OCCUR I i �MED EXP(Any one persal) S _ 5,00 C
____ .__ I I PERSONAL 8 ADV INJURV S 1,OD O,0 0 C
I GENERAL AGGREGATE 5 2,O 00,O O C
�GEN'L AGGREGATE LIA71T APPLIES PER: � i �'' PRODUCTS-COA�1P/OP AG(3 S 2,0 00�OO(
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DESCRIP710N OF OPER,4710N5 I LOCn710N5 I VEHIClES (AHach ACORD 107,Additlonal Remarka Schedule,if more space Is requlred)
INC:LUDING THE CITY OF SCANDIA AS P.DDITIONAL INSURED WITH RESPECT TO TWO EVENTS SPONSORED BY MEISTER'S BAR
AhD GRILL USING THE CITY'S PARKING LOT LOCATED ADJACENT TO MEISTER'S BAR AND GRILL ON 5/22/2010 AI�TD TACO
DAZE ON 5/10/ZO10 AND 9/11/2010
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELIED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELiVERED IN
CITY OF SCF,NDIA ACCORDANCE WITH THE POLICY PROVISIONS.
14727 209TH STR�ET
SCAI':JIA� M'_� 55073 qUTHORI2EDREPRE�ENTATIVE
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