HomeMy WebLinkAbout6.1 Public Representation Budget and Event Funding DiscussionM+awn �'xyt�lts�=e
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Subject Public Representation Budget and Event Funding Discussion
Meeting September 10, 2024 - MEETING OF THE MOUNT PROSPECT
COMMITTEE OF THE WHOLE
Fiscal Impact
Dollar Amount
Budget Source
Category DISCUSSION ITEMS
Type Presentation
Information
The strategic planning of the Village includes a high priority item for Events Policy, Guidelines
and Process.
Background:
The Village created a Downtown TIF District Strategic Plan in 1997. The first plan objective
was, "Downtown should serve as a place for Village residents to congregate". This includes
outdoor dining, community events, formal and informal gathering spaces, and Village Hall and
other government facilities". A few years later, in 1999, the Block Party premiered as a
celebration of the reopening of Route 83 after it was closed for several weeks for repaving. It
was such a success that it became an annual event. Fall Fest followed in 2004. At the same
time, downtown Mount Prospect was going through its second wave of redevelopment.
Residences at Village Center and Shops & Lofts were under construction. More downtown
events were introduced throughout the years later, with Oktoberfest debuting in 2008, an Art
Show and Blues Fest also in 2008, Fridays on the Green Summer Concert Series in 2010 and
Irish Fest in 2012. Village departments, park districts, the library and non -for-profit
organizations also host a variety of events throughout the community every year.
In the past 20 years, as outdoor entertainment has increased in popularity, the quantity of
community events has increased in Mount Prospect and in other communities. Many new
events have launched and other events' scope have grown over time. The Blues Fest was a
one -day event in 2008 and 2009. It led the way for the creation of Fridays on the Green
concert series that launched in 2010 and now has multiple concert nights throughout the
summer.
The table below provides an overview of community events in a year hosted by the village,
supported by the village or other community events in town; however, the latter list is not all-
inclusive. The table also does not include the park districts, school districts, library or historical
society community events.
Village Hosted Event
Village Supported Event
Other Community Events
Downtown Block Party (2 days)
Oktoberfest/Fall Fest (2
56 Music Fix 156 Artisan Fix
34%
days - DMA)
(3 days)
Celebration of Cultures (1 day)
4th of July Festival (5 days -
New Year's Eve -Eve Family
Neutral
Lions)
Celebration (1 day - DMA)
4th of July Parade (1 day - SEC)
Movies on the Green (5
Derby De Mayo Pub Crawl
days - DMA)
(1 day - DMA)
Mental Health Matters (1 day)
Downtown Trick -or -Treat (1
Randhurst Village Fall Fest
day - DMA)
(1 day)
Fridays on the Green (6 days)
Bluesmobile Cruise Nights (20
Randhurst Village Street
days - Lions)
Fest (1 day)
PW Open House (1 day)
Farmers Market (22 days -
Lemons of Love 5k (1 day)
Lions)
FD Open House (1 day)
Boxwood Bash (1 day)
Disaster Preparedness Expo (1
day)
5-0 5K Run/Walk (1 day)
# day(s) = The number of day(s) is intended to help show
the number of events throughout a year. One day
National Night Out (1 day)
represents an event that may be one hour in length or
more on one particular day.
Tree Lighting / Christkindlmarket
(1 day)
SEC = Special Events Commission organizes the event.
DMA = Mount Prospect Downtown Merchants Association
Family Bike Ride (1 day - SEC)
organizes the event.
Lions = Mount Prospect Lions Club organizes the event.
Shining Stars Gala / Celestial
Celebration (1 day - SEC)
Mount Prospect's reputation for hosting great events is noted in the Village's 2020 Branding
Plan. Community events were mentioned frequently in focus group interviews leading to a key
Branding Concept: Mount Prospect Celebrates. The quality of Village Events receives
consistent positive reviews in the Village's community survey with at least 70% of respondents
reporting being satisfied or very satisfied. Respondents were asked to rate the quality of
Village Events on a 5 -point scale (Very Satisfied, Satisfied, Neutral, Dissatisfied, Don't Know)
and the table below summarizes the results, excluding the Don't Know responses:
2016
2020
2023
Very Satisfied
30%
34%
30%
Satisfied
44%
44%
48%
Neutral
23%
18%
20%
Dissatisfied 4% 3% 3
Interest in reviewing special events was prompted when the Village experienced cost savings
from the cancelation of community events during the COVID-19 pandemic in 2020. Staff was
tasked with identifying items in the budget where cost -savings could immediately be achieved
with the least amount of impact to core services during the pandemic. Included in one of the
Finance Department COVID-19 Impact memos, the Village had an overall budget of $540,966
for various community programs and events. The actual savings realized that year (from the
programming budget) was $444,366. There was also an increased interest in reintroducing
and expanding events once community events were back post -pandemic, which additionally
contributed to the need for a review of events.
In addition, it became apparent through the process of modernizing Chapters 10 and 11 of the
Village Code in April 2023 that there is a lack of clear, consistent or applicable regulations
related to community/special events. It seems like the past approach was to identify and
regulate each type of event separately. These code sections were added at various times,
most are outdated and scattered throughout the Village Code.
Village Events and Festival Enhancement Report:
Staff created a Village Events and Festival Enhancement Report to review existing conditions,
regulations, and policy recommendations. The report highlighted the Village's role in
community events, how the Village supports them, cost history of the Village, and other
communities' approaches to involvement (both managerial and financial) in their own events.
Discussion
Budgeting for Events:
Many of Mount Prospect's community events receive funding from the Village by way of the
annual budget process through direct funding. Events also receive support through the
contribution of staff time during regular working hours and overtime. Some community events
are Village hosted and others are Village supported. Village hosted events may be sorted into
two categories; hosted by a department(s) or by the Special Events Commission. The Public
Representation budget is where most of the Village's event expenditures are allocated, not
including overtime. Event overtime costs are tracked within each departments' overtime
budgets. The Public Representation budget consists of four divisions and two fund community
events.
• Mayor & Board of Trustees: Expenditures include part-time earnings for the Village
board, contractual services like the annual audit and strategic planning workshops, and
memberships to professional and regional organizations.
• Community Groups and Misc: Expenditures include funds allocated for the Memorial
Day Parade, Block Party, MP Historical Society, Fridays on the Green, Celebration of
Cultures, Celestial Celebrations, and Family Bike Ride.
• 4th of July and Civics Events: Expenditures include funds allocated for the July 4th
Parade, Oktoberfest, 4th of July Fireworks, Light Pole Banners, Parade/Block Party
Supplies and Sign Making Materials.
• Holiday Decorations: Expenditures include funds for holiday decorations and white
lights.
$232,250 is budgeted for community groups in 2024 and another $105,825 for 4th of July and
Civics Events, totaling $338,075 representing 48% of the total Public Representation budget.
Most communities have separate line items for the larger festivals, and the amount noted in
the Community Events and Festival Enhancement Report comparable data sourced directly
from the communities' budget documents. There are a few community engagement items
budgeted by the department responsible for conducting the specific event. For example, Public
Works and the Fire Department budget for their open houses in their department budgets and
not as part of the Public Representation budget.
It appears that our neighboring communities' special events 2024 budgeted expenditures a low
benchmark, would be around $100,000 in Buffalo Grove, not including overtime costs, with a
ceiling of $375,000 from Arlington Heights including overtime costs. The number of events and
their length impact the overall cost. Over the last 12 months, the Village has spent $348,287 in
non -personnel costs (e.g. tents, donations, programming) and $188,830 in overtime costs to
support events. The total spending for the year is $537,116. Various revenue sources for those
events provided an offset of $162,935. The trailing 12 months net expenditures on events total
$374,182. As recommended in the Village Events and Festival Enhancement Report, the
Finance Department has rolled out project accounting to track all events costs accurately.
Event Policy/Application Process:
A formal event policy with standardized application reviews will help keep the Village abreast
of new events and potential scope creep of existing events, allowing for better planning and
budgeting. Most events hosted start small, and over time grow into larger, more successful -
yet more demanding - community events. For example, the Block Party started as a one -day
event between 4 and 9 pm, and now it is a two-day event with a total of 19 hours of scheduled
entertainment. Events that require very little resources at one point could end up requiring
additional staff overtime, road closures, or have negative impacts on the surrounding residents
or businesses. This applies to events planned for public areas like Centennial Green or private
property like a business's parking lot.
Alternatives
Staff Recommendation
Staff recommends the Village Board discuss the funding of village -hosted and supported
events. In addition, the level of staff involvement in the planning/oversight of non -community
events. Staff recommends the current level of activities and funding.
Staff will present the financials from Village events and neighboring community events to
facilitate discussion.
After the Committee of the Whole discussion, staff will bring forward Village Code amendments
to establish the event application permit process. The event application permit process would
be for all events that would need Village involvement.
Attachments
1. Special Event Application Draft 7.24.24
2. Community Events and Festivals Report 10.17.23
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Village of Mount Prospect
SPECIAL EVENT APPLICATION PROCEDURE
1. Please complete and submit your application, no less than 90 days prior to a major special event and 30 days prior
to a minor special event, to:
COMMUNITY DEVELOPMENT DIRECTOR
VILLAGE OF MOUNT PROSPECT
50 S. EMERSON STREET
MOUNT PROSPECT, IL 60056
2. Completed applications will be forwarded to all necessary Village Departments for review and approval.
3. Any application(s) requiring the use or closure of Village Streets, the use of public infrastructure, or staff time
during the event will be forwarded to the Village Manager for final consideration.
4. The following documents will be required prior to issuance of a permit:
a. A completed Hold Harmless Agreement
b. A Certificate of Insurance naming the Village of Mount Prospect as an additional insured in the amount of
$1,000,000 per incident, aggregate of $2,000,000.
Should further information be necessary, or if an event requires Village services, you will be contacted by
the Community Development Department prior to the event.
d. A Surety Bond in the amount of $10,000 maybe required to guarantee cleanup and reimbursement for all
Village Services related to the Special Event. Determination is based on scope and location of the
proposed event. The Village's Community Development Director will notify the applicant if a surety bond
is required, and provide them with the Village's Surety Bond form.
Special Event Applications are reviewed in accordance with the standards and procedures set forth in Section
of the Village Code, which can be found at . Factors that will be considered include, without
limitation: impact on traffic; police and fire protection; noise; and public safety.
6. The Village reserves the right to charge the organizer for staff time associated with public safety and public work
resources used in preparation for or during the event. In addition, the organizer may be held responsible for the
costs associated with repairing any damage to public property that occurred because of the special event.
1
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Village of Mount Prospect
SPECIAL EVENT PERMIT APPLICATION
EVENT CATEGORIES
Date Application
Received:
Staff:
The Village has two special event categories; major special events and minor special events, which are defined below:
Major Special Event: Any event that includes closure of a Village street(s) and/or sidewalk(s), occurs more than one day,
has significant parking/traffic impact(s), and/or requires enhanced public safety and public works pre -planning and
assistance.
Minor Special Event: Any event that does not require the closure of a Village street(s) and/or sidewalk(s), and does not
require enhanced public safety or adversely impact parking or traffic.
The Village will determine the event category for a Special Event.
EVENT TYPE
EVENT INFORMATION
1. Name of Event:
2. Date(s) of Event:
3. Event Set-up begins:
Event Start time:
Major Special Event
Minor Special Event
Rain Date(s):
Event Dismantling ends:
Event End time:
4. Location of Event and, if applicable, Route *Please Attach Event Site Plan/Route Map*
5. Event Type (circle one): Festival/Fair Race/Walk/Bike Ride Concert/Parade
Other:
6. Event Description:
7. Estimated attendance: # of Event Monitors:
*The Pillage of Mount Prospect may require additional monitors at our discretion.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
ORGANIZATION INFORMATION
8. Sponsoring Organization:
❑ Non-profit (if yes, attach 501(c)(3) ❑ Private business ❑ Government/public entity
9. Address:
10. Business Phone:
CONTACT PERSON / EVENT MANAGER
*Please provide multiple copies of this page to include contact information for all "managers" who will be on-site the
day(s) of the event.
11. Name:
12. Phone:
13. Email:
14. Driver's License #:
15. Relation to above organization:
Cell Phone:
Date of Birth:
z
16. Has a similar perinit been granted by the Village or any other municipality in Illinois to the Event Manager and/or
the Applicant within the past two years?
YES NO
Has any Illinois municipality ever revoked, refused to issue or renew such a permit, either to the Event Manager
or the Applicant?
YES NO
17. Has the Event Manager and/or the Applicant ever been convicted of a felony?
YES NO
If yes, what was the nature of the offense and the punishment or penalty assessed?
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
3
State of Tllinois
SS.
County of Cook
The undersigned, being first duly sworn, an oath deposes and says that he/she has read the foregoing application and
knows the contents thereof, and that the matters and things therein contained are true to the best of his/her knowledge,
information, and belief.
SIGNATURE of Applicant Date
I AGREE THAT ALL ANTICIPATED VILLAGE EXPENSES IN CONNECTION WITH THIS
EVENT WILL BE PAID EITHER WITH REGARD TO HOURLY OVERTIME RATES OR
RENTAL RATES, UNLESS OTHERWISE APPROVED BY THE VILLAGE MANAGER.
SIGNATURE OF APPLICANT:
DATE:
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
SPECIAL EVENT HOLD HARMLESS AGREEMENT
(Applicant)
In consideration of the Village of Mount Prospect ("Village") granting a Special Event Permit to
to allow the
4
, operating at ("Applicant"),
Event" )% scheduled to occur on
between AM/PM and AM/PM, at
("Location" f , and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the Applicant
hereby agrees as follows:
Waiver and Release of Claims for
The Applicant shall, and does hereby, waive, release, and relinquish all claims of every kind, known and unknown, present
and future, that the Applicant may have against the Village and its officers, agents, servants, and employees, arising out of,
connected with or in any way related to the Event or the Applicant's participation therein or operation thereof, or as a
result of the condition, maintenance, and use of the public property involved in the Event.
Indemnity and Defense
The Applicant shall, and does hereby, indemnify, hold harmless, and defend the Village and its officers, agents, servants,
attorneys, and employees from and against any and all claims of every kind, known and unknown, present and future, that
the Applicant may have arising out of, connected with, or in any way related to the Event or the Applicant's participation
therein or operation thereof, or as a result of the condition, maintenance, and use of the public property involved in the
Event.
The Applicant has read and fully understands this document and executes it of the Applicant's own free will and without
any reservation whatsoever.
Dated this day of , 20
Applicant Signature
Applicant Name (printed)
Attest
'Any Not -for -Profit Special Event, or Commercial Special Event approved by the Village.
'If necessary, please attach additional information regarding the Location
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
5
REQUIREMENTS
Different events have varying requirements. Please check all relevant criteria for your event. if you check "yes" to any of
the following questions, please complete the referenced additional requirement(s). The Village reserves the right to
determine event requirements.
YES
NO
QUESTION
Are you requesting the closure of Village streets?
Are you requesting the use of Village sidewalks?
Are you requesting the use of other Village property?
(parking lots/garages, Centennial Green/Village Hall/Busse Pocket Park)
i yes, indicate location:
Does any portion of the event take place on private property?
If yes, and the applicant is not the property owner, please submit a letter of consent from the property
owner, or a copy of the agreement.
Are you hiring a private firm for traffic control and/or event security?
If no, how will traffic and pedestrian circulation be handled?
If yes, please read the section about police services on Page X.
The Tillage will determine if extra duty officers are required for the special event.
Will food, beverages, or merchandise be sold at the event?
If yes, please read section about short term merchants on Page X.
Provide Attachment C to your participating short term merchants.
Will tents be used at the event?
If so, please read the section on tents on Page X
Will electrical service, and/or generators be required for the event?
If yes, please read section on electrical service on Page X.
Temporary Signage? Types of signage include: event promotion, liquor restrictions, parking restrictions,
towing, and traffic detour.
If yes, please read and complete the Temporary Signage Application on Page X. Applicant must provide
# of signs and dimensions for each, sign text and graphics, how the signs will be secured, sign location
site map.
Are you requesting the use of electricity in Busse Pocket Park/on Centennial Green/Melas Park?
If yes, please note that service is limited to 15 amps per outlet; You must provide a list of equipment and
the amps to be plugged in and the locations) with your application.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
M
YES
NO
QUESTIONS
Will you be using speakers and sound amplification equipment?
Weekdays lam — 9pm, Weekends 9am — Ilpm, never on Holidays other than the 4"' of July.
Will portable toilets & handwashing stations be provided for the Event?
Ifyes, please provide the vendor's name and contact information.
Number of toilets: Number of hand wash sinks:
Provide the location(s) of sanitary facilities to be provided at the event on a site map.
Please note that all sanitary facilities must be removed immediately following the event.
The Village will provide final determination ifportable toilets/handwashing stations will be required.
Will liquor be served?
If yes, special rules and regulations govern the sale of alcohol at Special Events.
Read Page X for guidance.
Contact Executive Assistant to the Village Manager Doreen Jarosz, 847-818-5300 or
dj arosz@mountprospect. org
Are you holding a raffle at the event? A raffle involves selling tickets or chances and is restricted by State
law to non-profit organizations only. A prize drawing involves no purchase by participants, e.g. drop
business card in fishbowl.
If yes, a Raffle Permit is required. Raffle Permit Fee is $25. Complete Attachment F.
Are you requesting barricades? (Events on private property not eligible)
If yes:
Delivery location:
Name of contact person & phone number:
Date of delivery (set up will not be provided):
Read section on Page X.
Depending on number and type of barricade, you may be charged for these.
Will any other public works services be needed at the event? (Events on private property not eligible)
Read section on Page X.
Will garbage, recycling, and compost be produced as a result of this event?
If yes, applicant is responsible for event -related trash collection and removal.
Read section on Page X.
Will there be provisions for First Aid & Emergency Medical Services?
If yes, please provide plan.-
lan:At
Atminimum, Event Manager must have cellphone to dial 911.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
7
MUNICIPAL SERVICE REQUEST
POLICE
A minimum of one (1) extra -duty officer is required during all hours an event is open to the public at all Major Outdoor
Special Events.
Village staff review each application to determine the total number of extra duty officers recommended based on the scale
of the event, event criteria, if streets are closed, etc.
The applicant will be notified about the determination and scheduling.
For more information, please contact Investigative Commander Kanupke , 847-870-5656 or
ikanUDke(&,mOuntDrosnect.or,�i.
The information below is provided to help the applicant better plan and budgetfor this type of expense.
How many extra -duty officer(s) to be scheduled:
FIRE/EMS SERVICES
The Village may require the presence of MPFD/EMS staff presence during all hours an event is open to the public at all
Major Outdoor Special Events.
Village staff review each application to determine the total number of extra duty MPFD/EMS staff recommended based on
the scale of the event, event criteria, if streets are closed, etc.
The applicant will be notified about the determination and scheduling.
For more information, please contact Deputy Chief Tom Wang, 847-818-5334 or twang.( mountpro� ect.or«
The information below is provided to help the applicant better plan and budget for this type of expense.
How many extra -duty responder(s) to be scheduled:
PUBLIC WORKS SERVICES
Will you be requesting any resources from the Public Works Department?
Barricades:
Fencing:
Signs:
Other:
For more information, please contact , 847-XXX-XXXX or XXXXXX(a) ountprospect.org
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
Short Term Merchant
• A short term merchant is defined as a person or business selling food, beverages, or merchandise.
• The Event Manager is responsible for coordinating collection of all completed short term merchant application
forms and fees. A list of all participating vendors should be submitted to the Community Development
Department on a spreadsheet.
• All participating vendors must complete a Special Event Short Term Merchant Application (ATTACHMENT X)
• Local businesses that are registered with the Village of Mount Prospect must also complete all forms but will not
be charged a fee (typically $20 per day).
• All participating short term merchants, including local businesses, must sign the Event Inspection
Checklist (ATTACHMENT X)
• IMPORTANT —As mandated bylaw, all participating short term merchants are required to file paperwork
on gross sales with the State of Illinois, following conclusion of the event.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
Q
How many tents for the event?
The tent(s) is/are to be used:
How will tent(s) be secured?
Dimensions'?
as a shelter
Tent rental company and contact information:
Address / Phone:
TENTS
for cooking for dining entertainment
For tents larger than 100 -square -feet (or 10'x 10'), a Tent Permit is required. Please see Attachment C.
Tents, shelters, or any other kind of covering shall not be staked to any public road, parking lot, sidewalk, or right-of-
way. Offenders will be fined $500 per incident.
ELECTRICAL GENERATORS
Any event utilizing generators or temporary electrical is required to apply for and obtain an Electrical Permit firom the
Building and Inspection Services Division. All electrical work must be done by licensed electrical contractors. The work
will be inspected on-site by the Building Division prior to the event. It is recommended that your electrical contractor be
onsite during the inspection to address issues that may arise during the inspection.
Number of generators:
Generator Locations (attach site map):
Licensed Electrical Contractor Name:
Contractor's 24-hour phone:
Email:
Please see Attachment C for the Application form.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
TEMPORARY EVENT BANNERS & SIGN APPLICATION
Will you be displaying?
A -frame signs #
H -frame signs
Banners
Pole Signs
Dimensions
How will signage be secured?
Please attach a site map with signage location(s)
Please attach artwork/designs for A frame signage
Dimensions
How will signage be secured?
Please attach a site map with signage location(s)
Please attach artwork/designs for H frame signage
Dimensions
How will signage be secured?
Please attach a site map with signage location(s)
Please attach artmork/designs for temporary banner
Banner signs are limited to one 32-square-1oot banner a day for a
maximum of 14 days
# Dimensions
Dates signs will be displayed: From:
Signage must be removed after the event.
How will signage be secured?
Please attach a site map with signage location(s)
Please attach artwork/designs for pole signage
To:
(14 days max.)
10
Important Warning — it is illegal to install temporary signs on the public parkways (unless you're specifically instructed
to do a public alert about a race route which will impact residents). All illegal signage will be removed and disposed of
by Village staff.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
11
TEMPORARY SPECIAL EVENT LIQUOR PERMIT
A. Temporary Special Event liquor permits may be issued on a daily basis. No event permit can be issued for more
than five (5) consecutive days.
B. No more than twelve (12) such permit days shall be available to any one such organization during a year ten -n.
C. The permittee is responsible for securing any applicable State Permit. if the State Liquor Commission requires a
permit and it is not obtained, then the Village temporary permit shall be deemed void ab initio. It is the
responsibility of the permittee to determine whether or not a State permit is needed and issuance of a Village
Permit has no bearing on the issue of whether a State permit is required.
D. Liquor Liability insurance must be submitted with the Special Event application and the Village of Mount
Prospect named as the certificate holder. The insurance rider must specifically identify the location where the
event is being held and the coverage must coincide with the dates of the event.
E. The Liquor Commissioner may attach such conditions as are appropriate for the temporary event. A Bassett
Certified manager must be in attendance at all times of the event.
F. Cost is $25 per day.
REFUSE & RECYCLING REQUIREMENTS
The Applicant/Event Manager is responsible for providing refuse, recycling, and composting collection services for events
which generate waste that impacts the Fillage' receptacles.
For more information about temporary cans, dumpsters, and special pick-ups, contact
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
12
LIST OF ATTACHMENTS
Attachment A — Short Term Merchant Application
Attachment B — Event Checklist for Participating Short Term Merchants
Attachment C— Food Merchant Addendum
Attachment D — Tent / Generator Inspection Application
Attachment E — State of Illinois Special Event Liquor License
Attachment F— Special Event Liquor Permit
Attachment G— Raffle License Application
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
13
ATTACHMENT A: SHORT TERM MERCHANT APPLICATION
Annual license for vendors, peddlers, and itinerant merchants
1. Vendor Name/Names:
2. Date of Birth (attach copy of license or State ID):
3. Vendor Business Name:
4. Vendor Business Address:
5. Mailing Address if different from above:
6. Business Phone Number:
7. Business Email Address:
8. Nature and kind of business conducted (if selling food products, attach Temporary Food Event Application):
9. Location where goods are to be sold:
10. Illinois Sales Tax Number:
11. Please list all vehicles, including state and license plate number to be used in conjunction with this vendor permit:
12. Please list all addresses (other than permanent place of business) where the applicant conducted a transient
business within the last 6 months:
*Please attach a Certificate of Insurance naming the Tillage of Mount Prospect as an additional insured in the
sum of $I,000,000per incident, $2,000,000 aggregate*
The undersigned acknowledges and agrees that they are familiar with, have read and reviewed, and
understand, all laws and regulations applicable to this application and the requested license, including,
without limitation, the Village Code. The undersigned further agrees that the applicant complies with any
and all eligibility requirements for the requested license, and that the applicant will comply with all
applicable laws and regulations with respect to the requested license.
Dated this day of , 20
Vendor Signature
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
14
ATTACHMENT B: VENDOR CHECKLIST
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
15
ATTACHMENT C: FOOD VENDOR ADDENDUM
In addition to the information submitted with Attachments A and B, please submit the following (you do not have to
submit Health Permit, Business License, and food inspection report if your business operated within the Village of
Mount Prospect):
Most recent Health Permit and Business License from the community that your business operates in
Most recent food inspection report from the community that your business operates in
C Cottage Food License (if applicable)
C Certified Food Protection Manager (CFPM) certificate if preparing or serving open foods
Failure to maintain all potentially hazardous foods at proper temperature (less than 41 degrees or more than 135 degrees)
will result in their immediate disposal.
I agree to abide by the rules and regulations established for this event.
Owner's signature (Required)
Date
Please do not hesitate to contact the Environmental Health Division with any questions (847) 818-5292.
TEMPORARY FOOD OPERATOR MENU REQUIREMENTS
All potentially hazardous foods (including, but not limited to, most animal products, sliced melons, cooked starches) must
be stored at temperatures outside of the Danger Zone (41°F - 135°F). A calibrated thermometer is required to monitor
temperatures often at the event.
Indicate below all temperature control measures you will use to keep potentially hazardous foods either below 41 OF or
above 135°F. Specify how many units and sources of power (electric, generator, propane, freezer packs). Identify which
food items correspond to each category.
Cold Holding
Cooking
Hot Holding
L Refrigerator
L Oven
L Oven
C Refrigerated Truck
C Wok
C Steam Table
C Freezer
C Stove
C Gas Grill Oven
C Dry Ice
:1 Roaster Oven
:1 Stove
:1 Ice Chest
:] Fryer
:1 Chafing Dish
:1 Other
:1 Gas Grill
:1 Other
:1 Other
Note: STERNO is not acceptable as a
heating source
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
16
Food / Beverages
List all foods and beverages you will serve at the event. Only items listed will be approved for service. Any changes must
be approved by the Village of Mount Prospect before the event.
Food / Beverage Item Where Purchased — Source Preparation / Transportation / Holding Procedures
Example: Salad Mix Restaurant (Joe's Pizza) Prepared at restaurant, kept on ice and in refrigeration onsite
Example: Hamburger Retail Store (Walmart) Frozen meat, kept in reach in freezer
patties
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
17
Temporary Food Vendor Checklist
Use this list as a guide to assure you are prepared for the event and an inspection. Items on the list are required to be
onsite and set up prior to opening your booth to sales.
1. Check the amount of power that you will need to adequately operate all of your equipment and lighting (# of AMPS)
and verify with the event organizer that sufficient power is provided.
2. A rented portable toilet with hand sink is recommended for hand washing, but other methods can be used. You must
provide adequate amount of warm water, pump style hand soap, paper towels, and a catch bucket for wastewater.
3. A tent/overhead covering must be provided to protect food service areas. Grills/cooking equipment should not be
under the tent.
4. All food and non-food items must be stored 6" off the ground on pallets, tables, or dunnage racks.
5. Dish washing onsite is not required. Provide enough extra clean utensils to get through the duration of the event.
6. Provide sanitizer wipe buckets or spray bottles to keep tables clean and sanitized. Also, provide chemical test kits to
verify concentration.
7. Provide lidded garbage cans. Cardboard boxes are not approved.
8. Clean aprons, shirts, hats, and adequate hair restraints are required for all booth workers.
9. A food probe thermometer is required for all food handling tasks.
10. Single use disposable gloves are required for all food handling tasks.
11. Ground covering shall be made of concrete, wood, asphalt, duckboards, or platforms.
12. Dispensers for condiments (individual packets, pump dispensers, or squeeze bottles and lidded containers for
condiments such as onions, relish, etc.)
13. Eating utensils must be dispensed properly and organized to avoid hand contact. Individual sealed utensils are best.
14. Brooms, oil dry, etc. for booth cleanup at the end of the event.
15. Containers to transport, store, and remove used charcoal and fryer grease.
16. Water must be obtained from an approved source and be run through a food grade hose to your booth.
17. Mechanical refrigeration / freezers must be provided for cold holding potentially hazardous foods at a temperature
of 41 °F or below. Please contact the sanitarian to determine what foods are not permitted on ice.
18. Electric or propane fired equipment must be provided for hot holding potentially hazardous foods at 135°F or
above. STERNOS ARE NOT APPROVED OUTDOORS.
19. If you are transporting hot food, it must be reheated to 165°F rapidly, if it does not arrive at 135°F or above to the
event.
20. USE YOUR THERMOMETER TO CHECK FOOD TEMPERATURES OFTEN.
21. Leftover foods must be discarded at the end of each day and shall not be reserved during subsequent days of the
event.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
Temporary Hand Washing Set -Up
W1
Each temporary hand washing set-up for food service employees must be provided with:
A container of clean water with a free flowing spigot
A wastewater discard bucket
I Liquid, dispensed hand soap
❑ Paper towels
❑ Wastepaper basket
W:3
-ee Flowing
)igot
Soap
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
19
Booth Layout Information
Indicate all food service equipment, including mechanical cold and hot holding units, cooking equipment, hand washing
facilities, dish washing facilities, sneeze guards, sanitizer, potable water supply, garbage cans, racks or pallets for food and
single service storage, electrical source, gas cylinders, fire extinguishers, and insect fans.
SAMPLE
rront, customer service area
Service Table Condiments in
Squeeze Bottles
Utensil
Sink
Gas
Table or Grill
drainboard
For dishes
Trash Gas
Table Fryer
Soap Hand Ice & Cooler- Pallets for
Paper Sink Drinks refrigerated food Dry Storage
«Ne�s
PROVIDE DRAWING OF BOOTH IN BOX BELOW
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
20
Guidelines for Temporary Food Events and Farmers' Markets
• Limit foods to the least potentially hazardous, such as frankfurters and hamburgers, prepackaged chips, and snack
foods from approved sources. If other foods are to be served, contact your health inspector. Minimize onsite
preparation.
• Mechanical refrigeration is strongly recommended to be available for potentially hazardous foods. Ice coolers
must be approved by Health authority. Store cold foods at 41 degrees or lower. If foods are kept hot in a steam
table or by other means, they must be 135 degrees or higher. Foods must be transported and received onsite at the
proper temperatures.
• Protect foods by use of sneeze guards, display counters, tents, storage trucks, locking refrigerators, etc. Flooring
or hard surfaces are strongly recommended. All pre-packaged items must be properly labeled.
• Store cleaners, bleach, and other toxics away from the food preparation and food storage areas.
• Condiments must be served prepackaged or with hand pumps or squeeze bottles.
• Use bagged ice from an approved source. Use ice scoops for dispensing. Cover ice in ice storage bins.
• Don't eat or smoke in the food preparation area.
• Use aprons, hats, or effective hair restraints. Remove aprons when using restroom facilities.
• Provide hand -washing facilities: provide a jug or container of water with a tap, liquid hand soap, paper hand
towels, refuse container, and a bucket to catch wastewater. This inust be set up prior to any food preparation.
• Provide a sufficient number of lined garbage containers, preferably covered to minimize insect activity.
• Provide an approved method of utensil washing (wash, rinse, sanitize). Three large buckets with wash water,
rinse, and sanitizer are acceptable. Use test strips to check sanitizing agent.
• Use single service items only, such as plastic knives, forks, and spoons, paper napkins, paper plates, cups, etc.
• Wiping cloths must be stored in a sanitizing solution (�/z ounce of household bleach per gallon of water) and must
be used for wiping non-food contact surfaces of equipment. A separate bucket of bleach sanitizer must be used for
food contact surfaces of equipment and utensils.
• Provide an adequate number of restrooms conveniently located throughout the event area.
• Fans are recommended for flying insect control in areas where food is being cut, prepared, or assembled.
• Store food and food supplies off the ground or pavement.
• A food grade hose is required for all temporary potable water connections. Provide vacuum breakers on hose bibs
for water.
• Do not dispose of liquid waste on the ground. Capture waste and return to facility for proper disposal in a sink.
• Honey, maple syrup, apple cider, fruit and vegetable juices, and herb vinegars shall be made in an inspected
facility.
• Baked goods shall be prepared in an inspected facility. Potentially hazardous baked goods (i.e. cream or custard
filled items, egg -based or custard pies, etc.) shall be transported and held at or below 41 degrees at all times.
• Raw or milk cheeses may be sold if made in a licensed dairy plant and aged over 60 days.
• Meats and poultry must bear U. S.D.A. and/or the State of Illinois inspection label or stamp.
• Seafood must come from a verified source with a bill of lading.
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
21
ATTACHMENT D: Tent / Generator Inspection Application
A Tent Permit is REQUIRED if the tent is over 100 square feet.
Submission Requirements: Along with this completed application, please submit signed rental agreement, State business
license or registration, Certificate of flame resistance, liability insurance, and sketch of layout for tent.
Date:
Applicant Name(s):
Event Address:
Applicant's Phone:
Property Owner's Name(s):
Property Owner's Phone: _
Property Owner's Address:
Number of tents:
Contractor Signature:
Event Name:
Must schedule an inspection 24hrs prior to event
Event Date:
Applicant's Email:
Tents to be properly secured and certificate of flame resistance displayed.
Date:
GENERATORS: LICENSED ELECTRICIAN REQUIRED
Date: Event Address:
Contractor Name:
Contractor Address:
Contractor Phone:
Contractor Email:
Contractor's License Number:
Number of Generators:
Contractor Signature:
Must schedule an inspection 24 hours prior to the event:
• Grounding on the generator is required
• Extension cords required to have GFCI & covered
• Fire extinguisher required by the generator
a Avoid tripping hazards with the extension cords
• Provide a copy of the electrical license
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
zz
ATTACHMENT E: STATE OF ILLINOIS LIQUOR LICENSING
State liquor licensing information and applications can be found at the links provided below. A copy of the state -provided
liquor license must be provided prior to the event for liquor to be present.
APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE
(alt s://ilcc.nlitinois. pov/contentldam/soi/enlweblilcc/sitecollectciondocuments/s ecial use err°mnt. clG)
APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILER'S LIQUOR LICENSE (NOT-FOR-PROFIT)
(hant�citrrt��l4�rale,m.lw�ib/iflca;/s t��,ofl1��,tlonc�c�..... cnts/spccnafl cvcnt rctailcr ligaaor liccn5� nlpa.P-A)
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
23
ATTACHMENT F: SPECIAL EVENT LIQUOR PERMIT
Mourn Prospect
\,A/
VILLAGE OF MOUNT PROSPECT
SPECIAL EVENT LIQUOR PERMIT
(ALL INFORMATION ON THIS FORM MUST BE COMPLETED IN BLACK INK, PRINTED OR TYPED AND
RETURNED TO THE LIQUOR CONTROL COMMISSIONER'S OFFICE
Name:
Address:
Phone: Fax:
Website:
Type: ❑ Corporation ❑ Civic ❑ Religious ❑ Government ❑ Other:
Employer Identification Number (EIN)
or 501C3 Number
Business License Number:
Does your business have a Liquor License? ❑ Yes ❑ No If Yes, what is your license?
Name:
Address:
Work Phone:
Cell Phone:
Email:
Name:
Purpose:
Location:
Outdoors? ❑ Yes ❑ No
Type: ❑ Civic ❑ Library ❑ Village ❑ Daily Sampling ❑ Temporary Outdoor Entertainment ❑ Promotion
($0) ($0) ($0) ($25 per day) ($0) ($25 per day)
Start Date: Start Time:
End Date: End Time:
Type of Liquor Served: ❑ Beer ❑ Wine ❑ Spirits
Live or Amplified Music? ❑ Yes ❑ No
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
24
1. APPLICATION DATE: Permit applications MUST be submitted at least seven (7) calendar days prior to the date of the event.
2. INSURANCE: In addition to this application, you must also submit proof of Dram Shop or Host Liability Insurance for the event.
The insurance rider must specifically identify the location where the event is being held and the coverage must coincide with the
dates of the event. If the event is being hosted on a liquor licensee's premises, no proof of insurance is necessary.
3. PERMIT FEE: Make you check or money order payable to the VILLAGE OF MOUNT PROSPECT and attach it to this application.
4. STATE OF ILLINOIS SPECIAL EVENT PERMIT: If an applicant is applying for a Civic Permit, then they must obtain a State of
Illinois Special Event Permit after they obtain an approved Village of Mount Prospect Civic Permit.
1, the undersigned applicant or authorized agent thereof, have read this application and the statements are true, complete and correct.
The statements are made for the purpose of inducing the Village of Mount Prospect to issue a liquor permit for a specific event. 1
further understand that any misrepresentation or failure to notify the Liquor Control Commissioner of any fact requested in this
application or omission of any fact pertinent to this application shall constitute good cause for the Liquor Control Commissioner to deny
this permit application and/or to revoke any permit issued pursuant to this application.
Signature of Applicant/Authorized Agent Title/Position Date
OFFICIAL USE ONLY
Requirements
❑ APPROVED ❑ DENIED
❑ Insurance
❑ Fee
co
❑
O
z
Signature of Local Liquor Control Commissioner Local Liquor Control Commissioner Date
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY. APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
25
APPENDIX G: APPLICATION FOR NONPROFIT RAFFLE
VILLAGE OF MOUNT PROiSPECT
A,P,P,L,,IC,,A,T,l.O.N.,DAT E
1. APPLICANT
Name of Organization:
Address of Organizafion:�
City, State and ZIP code:
Business Phone:
Corporation Name (if appficable):
State and Date of incorporation:
Name and addresses of officers and directors of applicant if applicable):
Name Tithe Address
Name and addresses of all perso s with a proprietary, equitable or credit interest in the applicant if apphcable)�
Name
Address
Name raffle manager:
Address Town- Zip:
Gell Phone Number:
E -Mail :
Date during which raffle chances will be sold or issued From: to
Cost of each chance:
What is being raffled and approximate value: (Attach additional sheet if needed)
1,
2.
1
Areas which raffle chances will be sold or issued:
1.
2.
3.
Winning chance to be determined at the following location;
Address:
On the day of and the hour of
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
26
PLEASE PROVIDE THE FOLLOWING
F -OR UCEINSETO ISSUE OR SELL CHAINCIES UP TO 12 IDAYS
1. Appkation needs to be sul 14 days prior to the first sale of raffle chances,
2. Apl fee $25,00 made out to the Village otMount Prospect
3, Fidefity Bond of $1000,00 as required by SecA 1.3004l of the ViRage Code of Mount Prospect
4, Notarized signature or) sworn of of organization Officer or Member
5, Evidence of lie Organization not for profit status, Federal and State tax exempt certificate or acknoydedgernent,
FOt R MIME TO ISSUE OR SELL CHANCES UP TO, BUT NO MORE THAN 5,4 WEEKS
1.. Additional applicafion needs to be subrrflfted seven (7) days prior to the second found of tickets sold or the 121 day of sate
Z Appheabon fee $25,0.00 made omat to the Village otMount Prospect
2 l Bond of $5000,00 as regWred by Sec, 1 1.3004B.7 of the Village Code Of l Prospect
3 Notarized signature on sworn affidavit of Organization Officer or Member
4 Evidence of the Organizabon not for profit status, l and State tax exernot certificate or acknoMedgernent
AFFIDAVIT
State of [Illinois)
County of Cook) SS
The undersigned,
being dully sworn on oath, states that the above information is true and correct to the best of his/her knowledge and
tenet, the applicant is a not-for-profit organization, that has been in existence oontinuousi y for a period of 5 years
immediately to the submission of this application, that during that entire five year period it has had a bona fide
membership engaged In carrying out its objectives and, that it is not inefiglible for a l under section 3(5) of An, Act
to provide for licensing and regulating certain games of the State of Illinois as It may be amended from time to tune.
SUBSCRIBED and sworn to
Before me this day
Of
20 - Signature
Notary Public
(Notary Seal)
THIS APPLICATION FORM IS NOT YET FINALIZED; HOWEVER, IT IS BEING PROVIDED TO THE APPLICANT FOR USE IN
ADVANCE OF FINAL APPROVAL AS A COURTESY APPLICANT IS RESPONSIBLE FOR ALL REQUIREMENTS EVEN THOSE NOT
PRESENTLY LISTED IN THIS DRAFT
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