9.b) Staff Report-Special Event Permit for Washington County Historical Society 5K c� ' ' �
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SCANDIA
Staff Renort
Date of Meeting: March 19, 2013
To: City Council
From: Kristina Handt, City Administrator
Re: Special Event Permit for Wash. Co Historical Society Sk
Agenda Item#: 9.b)
Background:
This is the first year for this event. Washington County Historical Society is seeking approval of
a special event permit to hold a Sk run on Saturday, May 4, 2013.
City Ordinance No. 119 requires a Special Event Permit for any"outdoor gathering of at least 100
individuals whether on public or private properry, assembled with a common purpose for a period of
one hour or longer but may not exceed twelve hours in duration... "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;
fl 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 Washington County Historical
Society Hay Lake Sk Run on May 4, 2013?
Proposal Details:
David Sandager with the Washington County Historical Society will be present at the meeting to
answer your questions about this event. The race will begin and end at the Hay Lake School
Museum. The route will go east on Old Marine Trail, north on Oxboro, west on 197`h St, south
on Orwell and west on Old Marine Trail back to the museum.
The organizer has signed the required release and indemnification agreement and 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 March 1, 2013
as provided by the conditions of approval.
2) Do not approve the Special Event Permit
Recommendation:
Option 1.
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Sca�zdin, 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
pennit fee. You will be notified at tl�e time of application of the date for City Council consideration of the request.
1. Name, purpose and description of event:
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- ►o t'a�sC d�wace l�j�s [�. Su��er�. -�-o� �.I+� L�as��„f.on Co4n�., y s{or;c.1 Soc;c�.ti
�I � K fun EL �JR�� Afo4n� �au � SAnd Ln�.�. %� S[an.� '�1 ��
Location address: K..� L,�I,,� Sc,L,..t 7']uft4M � I�OZD t45�' S�. 7'j T7..:.. rhs'L .f��oy�
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Date(s): Sa£LLrd�� T'IR� Y 2 0�3
Event starting Time: j0'� AtI Event ending time: �/�� PM
Set-up start date and time: GS/oy/Zo t'� ��oJ ��•��►,(
Dismantle by- date and time: p5/�y f2o�3 br �" PM
Anticipated number of participants and/or spectators: � /00
If there is a fee or donation required as a condition of
attendance, please describe: �zJr�
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,
raffic control points) consumption)
_ ticketing/registration/entry locations _ alcoholic beverage concession area
_ entertaimnent 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
3. Applicant information:
Name: �OI.V�� S Qndla, r Title: $:�c y"1 „ Gr
Address: (G$� /�S(,�a��. Avc. , S�,_ (�a�� y"1n SS/OY
Phone: �651� - Y 9(- GG 3 G ., WSl�-Y33-yo�y Cell: �5�� - yt! - GG 3 C
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E-Mail: �0.v;�. S Qn�a�r cr � A�a:l • C o�,
Affiliation/organization: �„�,�st,:.►.�e. Le �.�{.� H���o�;c•l Sac;a�.ti
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
lf no, provide contact information for person who will be the
responsible party on the day of this event ( Q.c� �)
Name: ��c�}. P� �.arso� Title: W�HS (�:r«bo�
Address: Po Qa x l b� S{;l( w s{ cr 7'1 Y�, SSpdZ
Phone: �651) - y39 �5 9 S� Cell: �GS!) -208- 5�3y
E-Mail: Qr�n�.. pe.tcr�on (� wc�,�rnn.. a�4
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
teinporary/portable facilities to be provided. Describe the source of potable(drinking) water.
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Ciry of Scandin, Special Event Pennit Application,Page 2 of 7 �
6. Parking and traffic control:
Describe the location and number of parking spaces available. Describe arrangements that have been
inade 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:
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 surrounding area after the event?
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Naine of trash/recycling hauler: l�JR3}c M...,...��{ �w S�:l� ...�}�r-
10. Lighting:
Describe any temporary or permanent lighting that will be added for the event.
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Ciry of Scandia, Special Event Pennit 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 far tl�e event. Event sponsor is responsible to
obtain any building or electrical permits that may be required for such construction.
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12. Advertising and promotion.
Describe how this event will be advertised and promoted. Describe any signs (size, type, location.)
All signs inust coinply with Scandia Development Code Chapter 2 Section 9.13 including a permit if
required.
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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 No X
If yes, describe in detaiL Fire Department approval will be required.
City of Scandia, Special Event Pennit Application,Page 4 of' 7
15. Food and beverages:
Will alcoholic beverages be served? Yes No X
If yes, describe the type of beverages and the status of the liquor license:
Will food and/or non-alcoholic beverages be served? Yes X No
If yes, describe what will be served and any plans for cooking food in the event area, including fuel
source to be used:
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Has a license been obtained fioin the Washington County
Departinent of Health and Environment? (please attach) Yes No X�O. w�
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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 X
If yes, a lawful gambling pernzit will be required as provided by state law ai�d Scandia Ordinance No.
100. Describe the gambling activity and the status of the gainbling pennit.
18. Workers compensation compliance:
In accordance with Minnesota Statutes all applicants for license and permits to operate a business in
Minnesota inust submit acceptable evidence of compliance with workers' compensation insurance
requirements. Please eorrzplete the certificate of co�nplia�zce and attach to this application.
City oJ�Scandia, Special Eve�it Perniit 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, iucluding attorney's fees, resultiug directly or indirectly from an act or oinissioil
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 pennit 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 coniplete the release and i��demnificr�tion agreement��2d
attach to this application.
20. Insurance
As a condition of the graiZting of a perniit for a special event conducted on public property or public
streets or parking lots, the pennit 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 insuralzce to tl�.is application.
.�- _
THE MINNESOTA DATA PRACTICES ACT requires that we inform yocr of�you��rights about the private
data we are requesting on this fornz. Private data is available to you, but not to the public. We are requesting
this data to cletermine your eligibility for n permit fronz the City of Scandia. Providing the data may disclose
info��mation that could cause your application to be denied. You are not legally reyuired to provide the data,-
however•, refusing to supply the data may cause your permit to not be processed. Yoi�r residence address and
telephone number will be considerecl public data unless you request this information to be private and provide
crn alternative address and telephone namzber. Please sign below to indicate that you have read this notice:
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Signatz�re: �� � Dute: 4 Z�12�Ldt3
I reguest that m residence c�dc� ess c�nd telephone nunlber be eonsiclered private data.
My alternative dress and t ephone nu�nber are as follows:
Adcb�ess: ��Gff'� �S�fs..� �•x. ��. Pa,.f �'7n Teleplxone: L J�� ' ���� - �, G.��
Ssjv�
Acknowledgement/Signature:
I hereby acknowledge receipt of a copy of this application fonn and Ordinance No. 1 19, 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: 0 2/zz/3
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Ciry of Scandia, Special Eve�zt Perniit Application,Pczge 6 of 7
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