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5.h Tour de Hugo Bike Ride Special Event PermitSCANDIA Staff Report Date of Meeting: July 16, 2019 To: City Council From: Brenda Eklund, Deputy Clerk Re: Special Event Permit for Tour de Hugo Community Bike Ride Background: City Ordinance No. 119 requires a Special Event Permit for any "outdoor gathering of at least 100 individuals whether on public or private property, assembled with a common purpose for a period of one hour or longer but may not exceed twelve hours in duration..." This includes races or bicycle events occurring on city streets. The City Council may place conditions on the approval of the permit that may pertain to any of the following: a) Location and hours during which the event may be held; b) Sanitation/availability of potable water; c) Security/crowd management; d) Parking and traffic issues; e) Emergency and medical services; f) Clean-up of premises and surrounding area/trash disposal; g) Insurance; h) Lighting; i) Fire service/safety; j) Temporary construction, barricades/fencing; k) Removal of advertising/promotional materials; 1) Noise levels; m) Alcohol consumption; n) Notification of residents or businesses; o) Any other conditions which the Council deems necessary. Issue: Should the Council approve a Special Event Permit for the Tour de Hugo Community Bike Ride scheduled for September 21, 2019? Proposal Details: The City of Hugo Parks Department is sponsoring the 91h Annual Tour de Hugo Community Bike Ride on September 21, 2019. The ride will start and finish at Hugo City Hall. Three years ago, a longer route was added that travels around Big Marine Lake by heading north on Manning Trail, then east on Mayberry Trail to 195th Street, then south on Olinda Trail on a route that will return back to Hugo. The organizer estimates that riders will be traveling through Scandia between 7:30am to 10:30am. All participants will be required to sign a waiver and wear helmets while riding. Washington County Public Works is reviewing an access permit for travel along the County roads. A map of the route is included with the application. No incidences related to the bike ride were reported in the last 3 years that this route has traveled through Scandia. The organizer has furnished a certificate of insurance naming the city as an additional insured. A copy of the Special Event Permit application is included in your packet. Fiscal Impact: None Options: 1) Approve the Special Event Permit with the following conditions: • The event shall be held as described in the application received on June 27, 2019 as provided by the conditions of approval. • As required, the route and traffic control shall be approved by the Washington County Sheriff's Department and a permit issued by the Washington County Public Works Department. • The 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 be reason of the failure of the event promoter to fully perform all obligations under Ordinance No. 119. 2) Do not approve the Special Event Permit Recommendation: Option 1. .i�4 SCANDIA 14 72 7 2091x' Street North Scandia, Minnesota 55073 (651) 433-2274 www.ci.scandia.mn.us PAID „ {�N 2.7+25 l i. CIT OF SGANDIA 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: 6 6ka, Location address: Date(s): Event starting Time: Set-up start date and time: 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: 1 13 r.+. Event ending time: 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 City of Scandia, Special Event Permit Application, Page I of 7 3. Applicant information: Name: Title: f la/k,� F7C14lid Address; ` .- Phone: I z( a --0 b 3 N a Cell: E -Mail: .ev r U C, 0111 Affiliation/ organization: 0 Are you an authorized applicant for pis organization? Will this person have authority to cancel or modify event plans? Will this person be present at the event and in charge of the event at all times? If no, provide contact information for person who will be the responsible party on the day of this event Name: v Title: Address: �1010 M A V Phone: E -Mail: Yes No Yes V, No Yes No Cell:01314 ........ 4. Entertainment: Describe entertainment plans. If there will be music, sound amplification or any other noise impact, please describe including the intended hours. ...��.......... _... — ............ .... ..... 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. City of Scandia, Special Event Permit Application, Page 2 of 7 6. Parking and traffic control: Describe the location and number of parking spaces available. made for traffic control. Describe arrangements that have been 7. Emergency/ medical services: Describe measures that will be taken to ensure emergency vehicle access (police, fire, ambulance) to the event area. 8. Security/ crowd management: Describe your proposed procedures and staffing for the event operations and crowd control- ontrol. LA- %li 9. 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? Name of trash/ recycling hauler: 10. Lighting: Describe any temporary or permanent lighting that will be added for the event. 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 required. 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.) 14. Fireworks or pyrotechnics: Will any fireworks or pyrotechnics be used at the event? Yes Nox— 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? Yes No If yes, describe the type of beverages and the status of the liquor license: Will food and/or non-alcoholic beverages be served? Yes No If yes, describe what will be served and any plans for cooking food in the event area, including fuel source to be used: Has a license been obtained from the Washington County Department of Health and Environment? (please attach) Yes Nox_ 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 No If yes, a lawful gambling permit will be required as provided by state law and Scandiar 'nance 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 5 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 indemnification 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 ofyour 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 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 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: Signature: Date: (� L) I request that my residence address and telephone nt ttber be considered private data. My alternative address and telephone number are as follows: Address: Telephone: 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. Signature: Date: City of Scandia, Special Event Permit Application, Page 6 of 7 Certificate of Compliance Minnesota Workers' Compensation Law PRINT IN INK or TYPE. Minnesota Statutes, Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business or engage in any activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Minnesota Statutes, Chapter 176. The required workers' compensation insurance information is the name of the insurance company, the policy number, and the dates of coverage, or the permit to self -insure. If the required information is not provided or is falsely stated, it shall result in a $2,000 penalty assessed against the applicant by the commissioner of the Department of Labor and Industry. A valid workers' compensation policy must be kept in effect at all times by employers as required by law BUSINESS NAME (Individual name only if no company name used) LICENSE OR PERMIT NO (if applicable) Ca b4, C) r— [ 0 DBA (doir0o business as name) (if piicable) ADDRESS (PO Box must include street a H (o& 9 F tr,6AecCAIA five.. N. I i (D /V)l'V YOUR LICENSE OR ERTIFICATE WILL NOT BEISSUED WITHOUT THE FOLLOWING INFORMATION. You must complete number 1, 2 or 3 below. NUMBER 1 COMPLETE THIS PORTION IF YOU ARE INSURED: INSURANCE COMPANY NAME (not the insurance agent) OF M N G+ fl, l;S �lIzA-s — WORKE ' COMPENSATION INSURANCE POLICY NO. I EFFECTIVE DATE I EXPIRATION DATE ZIP CoIJE I �co'4 9 oi$$ti -a 103lo1 /aoiti l03/o1/ao3?o NUMBER 2 COMPLETE THIS PORTION IF SELF-INSURED: ❑ 1 have attached a copy of the permit to self -insure. NUMBER 3 COMPLETE THIS PORTION IF EXEMPT: I am not required to have workers' compensation insurance coverage becaus— e; ❑ I have no employees. ❑ 1 have employees but they are not covered by the workers' compensation law. (See Minn. Stat. § 176.041 for a list of excluded employees.) Explain why your employees are not covered: ❑ Other. ALL APPLICANTS COMPLETE THIS PORTION: I certify that the information provided on this form is accurate and complete. If I am signing on behalf of a business, I certify that I am authorized to sign on behalf of the business. SIGNATURE (mandato F6J0PlAAne� I Dbla,9idL)i9 NOTE: If ydur Workers' Compenshilon policy is cancelled within the license or permit period, you must notify the agency who issued the license or permit by resubmitting this form. This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800.342.5354 (DIAL -DLI) Voice or TDD (651) 297-4198. MN LIC 04 (11108) CITYO-2 OP ID• Rill ,a►��Ez CERTIFICATE OF LIABILITY INSURANCE DAAA19ADDIYYYY) flFf9d1711'(4 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(les) must have ADDITIONAL INSURED provisions or 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 651-79T-t)7OOCQNTACT Beulke House Account Alliance Insurance Advisors N ME: 1=IiCNN 651-797-6700 FAX 651-735-0907 4782 Washington Square (A�C. Ha, Ext): AIC, No): _ White Bear Lake, MN 55110 c•MA+� aI a ante nsuranceadv SGIS.com Beulke House Accounts __ -5: .— - of MN Cities Ins 4669 WAerald Ave No ugo, N 35038 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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. ENSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP IDIYYM LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X CLAIMS -MADE OCCUR CMC10018918-3 03101/2019 03101/2020 DAMAGE TO RENTED a Included PREMIl�a-vcsv.[ .-.-..... MED EXP (Any one person) 2,500 ......... _ PERSONAL&ADV NJURY $ Included GEN'LAGGREGATE LIMIT APPLIES PER: POLICY C PRO- JECT D LOC GENERAL AGG GAIE $ 3,000'000 PRODUCTS - COMP/OP AGG $ OTHER: A AUTOMOBILE LIABILITY ICMC10018918-3 COMBINED SINGLE L1MM $ 2,000,000 BODILYII+IJURY Par. emon $ X ANY AUTO 03/01/2019 03/01/2020 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Peraccident �r ,1L AMAGE .�. AUTOS ONLY NONO ONLY A UMBRELLA LIAR OCCUR EACH OCCURRENCE X EXCESS LIAB X CLAIMS -MADE IMEL1001892-3 03/01/2019 03/01/2020 AGGREGATE 11000'000 DED 1 RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN.. ANY PROPRIEBER/PXCLUDE/EXECUTIVE JMandatory In ER EXCLUDED? j�. In and If If yes, describe under DESCRIPTION OF OPERATIO I N I A C1001889-3 0310112019 j ! 1 0310112020 X I PER OTH- ER - E, L. EACH ACCIDENT 1,500,000 E.L. DISEASE - EA EMPLOYE E.L DISEASE -POLICY LIMIT 1, 1,500,000 .1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Scandia 14727 209th St No Scandia, MN 55073 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 14 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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