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5.j) Fat Cat Permit ApplicationCANDI 1 14727 200Street North Scandia, Minnesota 55o73 (651) 433-1274 wwwAman0ammus Special Event Permit Application e�W'� d D APR 2 3 2015 S. 00 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 Scandis at least 30 days prior to the date of the event with the $23.00 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: Location address: t Date(s): le, Event starting Time: Event ending time: r A� {gyp Set-up start date and tone: �Tct Dismantle by- date and time: Anticipated number of participants and/or spectators`: �. If there is a fee or donation required as a condition ofoaf �n attendance, please describe: P 2. Attach sketch or site plan showingthe location of the following gas applicable - route (beginning/ end, direction of travel, _ food concession areas (coo` ing se g '01A.0 traffic control points) consumption) ticketing/ regisft ion/ 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 Scandko, Special Event Permit Application, Page I of 7 3. Applicant information: Name: Address: Phone: E -Mail: ,�► r _ SAA 51 Cell: Affiliation/ organization: Are you an authorized applicant for this 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: ' A e2 n qep—v\ f C he rn Title: Address: Phone: E -Mail: Yesy No Yes_ No Yes ✓ No. LDn � JT .5 3474D � M-� BI- ��-O 4. Entertainment: Describe entertainment plans. if there will be music, sound amplification or any other noise impact, please describe including the int n ' ded hours. I X>r\ c; ?cx F, r 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 Scan&; Special Event Permit Application, Page 2 of 7 6. Parking and traffic control: Describe the location and number of parking spaces available. 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. N { vs,ea r ail e_-%jer4 _ 8. Security/ crowd management: Describe your pro osed pro(cedures and staffing for the event operations and crovyd control. (� 00 1) < .7 f� � 1af` f� Vl V- P as C`<� 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: I t 10. Lighting: Describe any temporary or permanent lighting that will be added for the event. k' k -f n` i tr-- /__'\ , - 11 City of Scandia, Special Event Permit Application, Page 3 of 7 D� It. Temporary struetures or constrachao. 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. _ - 1 -3 b n nne-rc. OR rpr 0%. N x 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.) NQ hot 1 14. Fireworks or pyrotechnics: Will any fireworks or pyrotechnics be used at the event? Yes No I, -'- If yes, describe in detail. Fire Department approval will be required. City of Sc=&a, Special Event Permit Application, Page 4 of 7 r 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? Yeses 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_ No 16. Other concessions: Describe what vendors or concessionaires you will allow at the event, and how you intend to regulate anti mnnitnr thair art;v;tiPc -t ta /( �- 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 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 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 inwy 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 dAtity 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 eligibilityfor 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:f'/ / I request that Bence address and telephone number be considered private data. My alternative address and telephone number are as follows Address: Ac. Telephone: -'�2-3 3 -- y i�:�L� �f�✓ S�7 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: g City of Scandia, Special Event Permit Application, Page 6 of 7 Untitled project 3/10/15, 7:32 PM © Mapbox © OpenStreetMap Improve this map https://a.tiles.mapbox.com/v4/abrunfelt.h9alhag9/attribution,zoo... iwiYS16ljJQZWhFOTAifQ.d3YvrcfTgIVU6UbcWxn2Ag#13/45.2275/-92.7937 Page 1 of 1 di I thu L eo m d 6�p Q iF Saint oix Fat Cat iathlvn July 11 2015 Liability Waiver RELEASE, HOLD HARMLESS, AND COVENANT NOT TO SUE I the undersigned agree to release, hold harmless, and covenant not to sue Saint Croix Fat Cat Triathlon, Scandia Marine Lions Club, the cities of Scandia and Marine on St Croix Minnesota, and their employees, agents, assigns, or any volunteer, participant or spectator in the Saint Croix Fat Cat Triathlon for any claim of ordinary negligence arising out of the my participation in the Saint Croix Fat Cat Triathlon. I understand that this release, hold harmless, and covenant not to sue is limited to claims for ordinary negligence and in no way shall be construed to release claims for conduct that constitutes greater than ordinary negligence, conduct that constitutes reckless or grossly negligent conduct, or willful, wanton or intentional acts. I grant full permission to any and all of the entities listed in the first paragraph above to use my name, likeness and voice, as well as any photographs, videotape, and any other record of this event in which I may appear for any legitimate purpose including any broadcast of the event, the reuse in any media of these images or voice, and in advertising and promotion. Signature Printed name and address: Date I am also signing this Waiver of Liability as a parent or guardian on behalf of the following persons (printed names) who are under the age of 18 and participating in the Triathlon: March 18, 2015 Special Event Permit Scandia -- 2015 Fat Cat Triathlon Requirements/recommendations addendum 1. Traffic volunteer and water station at Oxboro/Park trail 2. Traffic/parking volunteer at Old Marine trail/O'Hara's field Lions Park- Posted "No Parking" 3. Traffic volunteer and Wash .Co. Sherriff at Olinda Crossing 4. Bike direction of loops in clockwise motion 5. Registration Fri at CC and Sat morning at Lion's Park 6. Extra parking O'Hara's field 7. Small temporary signs along routes 8. Promotional banner at Lion's park and various locals with Lions comm. signs 9. Loudspeaker 10 a.m. - 6 p.m. 2015 10. Food and beverages 10 a.m. 6 p.m. 11. Food at C.C. Friday evening. 12. Water volunteers and one boat on river 13. Trash bins at Log House and Lions Park 14. EMT/Scandia fire notified