Loading...
HomeMy WebLinkAboutItem 8 Wild Adventure Race SEP Attachments LAKE ELMO Special Event Permit Application I. Title and Brief Description of Event �7( c (2, II. Applicant Information The applicant is responsible for answering all questions, including inquiries from media and citizens. Applicant: Gr z- ti Title: �C- Address: H Yo r3of' Si Business/Organization: C-i. (0r' "5/- 8 s- Daytime Phone: s� e i ` Mobile Phone: Emergency Phone: 111. Event Timetable A. requested day and date: B. Requested Hours of Operation, from N/p.m. to a.m.fip_mJ C. Setup beginning clay and date_�j,— 1 _, time D. Dismantle by day and date time a.m.,�rr� E. Anticipated number of participants: and spectators: iv. II IJUI U/II.G an event is covered.The Policv must also show evidence that the requested event is not excluded from insuranUe iiauiky. I - / 1 f o0.k w OU S--( d,- !J" L-7-r " v J' 1 u 7Z�� ems �. . LJ� I[� c�/� ? C,--'-( �<,�c�U .�.�r � G S y c•��.L �-+�►,� i n/$ v is/--�F /(,c..�.� C�.-�r ��--`a -./c� 1 IJ V. Check All Items that Apply to your Event 0 Use of a Public Facility (note facility): <, , Event participant and/or spectator parking areas (describe): 2"3 vt 1 ✓��i �; ��-- ❑ Entertainment or stage location (provide to-scale drawings); ❑ Construction or erection of temporary structures (may need permit: check with planning department); ❑ Trash containers (indicate# and locations): ; ❑ Portable toilet facilities (indicate # and locations): 0 First aid facilities (indicate who is providing): ❑ Parade and/or parade floats (may need permit); ❑ Fireworks and/or pyrotechnics site (may need permit, check with the fire department); ❑ Cooking facilities, open flame, or vehicle fuels (may need permit, check with fire department); ❑ Electricity (indicate source and plan): ❑ Other (please describe): V1. Food, Beverages, and/or Entertainment A. If your event includes music, live entertainment, sound amplification or any other noise impact, please describe, including the intended hours of the music, sound or noise. B. Will alcoholic beverages be served? Yes X No C. Name of liquor establishment: L) A- D. For service of alcohol outside a licensed premise, include a diagram showing the defined area of the alcohol concession service and attach a copy of your certificate of liquor liability insurance covering the limits or the alcohol service area. B. If the event is to occur at night, describe how you will light the event area in order to increase the safety of participants and spectators coming to and leaving the event: IX. Clean-up List ersons responsible for clean-up duties: X. Mitigation of Impacts on Others Describe how you intend to mitigate the impacts of the special event on businesses, churches, neighbors, motorists, and others: C F, IZ- P .� �._ c—� v a .J,r�c,� i�►v (o s- C�� Note: Any condition w ich causes adverse impacts may be cause to revoke the Special Events Permit Ll � � l Applicant Signature: 5��=, , (�—//� (��ti ^ Date of Application: rJr 4 Request for Special Event Permit What: Wild Adventure Race Sprint Series Race 1 When: Swhz I , `Z o 13 Where: Sun Fish Lake Park and Lake Elmo Park Reserve Time: 6:00 am to 4:00 pm (race competitors will be in the park from approximately 10:00 am to 2:00 pm) Description: An adventure race is a team sport that requires navigating a course with maps and a compass utilizing combinations of non-motorized disciplines - on foot, bike, and in boats (canoe, kayak, or raft). It is very similar to orienteering, which has been done at Sun Fish Lake Park in the past. In this particular event, which is designed for beginners, racers in teams of 2 will begin on bikes in Lake Elmo Park Reserve (LEPR). They will be looking for checkpoints along the way. Checkpoints are generally orange and white, lightweight orienteering flags (see image). Racers will also be doing a boat section in LEPR. These two , sections could take teams up to 2 hrs to complete, thus spreading out teams quite a bit. After the bike and boat sections teams will leave LEPR by the North Entrance, cross Hwy 5, and enter Sun Fish Lake Park. Teams will then drop their bikes with volunteers in a section of the parking lot or just off the lot, near the trailhead. Teams will then go on foot to look for more checkpoints, approximately 5-10 of them. Most teams should finish in under 1 hour. Once the section is complete, teams will retrieve their bikes and head back across Hwy 5 to the finish in LEPR. The whole course should take the average team 3 hours. There may be one or two volunteer vehicles, but other than that, the only space we will be occupying is an area with the bikes. This is very flexible. With the start and finish in LEPR, there will limited impact in Sun Fish Lake Park. The Minnesota Orienteering Club held a similar event in the park several years ago. We have permission from LEPR and we are coordinating the crossing of Hwy 5 with the Washington County Sheriffs Office and MnDOT. Max People: 200 competitors plus up to 10 volunteers. The competitors will be well spread out. We will not disturb regular park visitors any more than any other trail runner would. In fact, the comment we usually receive from park managers and staff is that visitors were not even aware an event was happening in the park. Sound Equipment: None Sanitary Facilities: None required, the competitors will be running on the trails for approximately 1 hour and then will head to LEPR. Security: We will have volunteers at the bike drop. Competitors will retrieve bikes after they have done the trail run and return to LEPR. Food Service: No food will be provided at Sun Fish Lake Park Fire Protection: Not applicable Clean Up Plan: Clean up will merely mean removing 5-10 orange and white orienteering flags that will have been placed along the trails, and making sure the parking lot is clear of any possible wrappers from "energy bars" consumed by the participants. This will take no more than one hour. Waiver: NA Insurance: We carry a $1 million insurance per occurrence and provide additional insured certificates for land owners/managers. Provided is an example from a previous race of an additional insured certificate for the City of Duluth. Safety: We will have EMTs on site. Miscellaneous: Parking will not be needed (except for a volunteer vehicle or two), but bikes will be dropped in a corner of the lot. Thank you for considering our request. Please direct any questions to Rick Odgers at 612.3 56.13 53 or via email at rickoC@wildadventurerace.com. ATE �`� 522/CERTIFICATE OF LIABILITY INSURANCE D/22//DD/YYYY) 2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Meg Carruthers McKay Insurance Agency, Inc. PH°A/CNE (641)842-2135 FAX, No:(641)628-2013 106 East Main Street AU pE ,mcarruthers@mckayinsagency.com P 0 BOX 151 INSURERS AFFORDING COVERAGE NAIC# Knoxville IA 50138 INSURERA-Lexin ton Insurance Company 19437 INSURED Silent Sports Association - AR Series INSURER B: Wild Adventure Race, LLC INSURERC. 8839 Tyler Street NE INSURERD: INSURER E: Blaine MN 55434 INSURER F COVERAGES CERTIFICATE NUMBER CL1252227 67 6 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. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MWDD/YYYV MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO HEN I FL) X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) S 100,000 A I CLAIMS-MADE rz OCCUR X 9472463 6/2/2012 6/3/2012 MED EXP(Any one person) $ Excluded X Includes Athletic PERSONAL&ADV INJURY S 1,000,000 Participants GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 71 POLICY PRO FX7 LOC S COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAR CLAIMS-MADE AGGREGATE S 1,000,000 DED RETENTION$ 9472463 6/2/2012 6/3l2012 $ WORKERS COMPENSATION WC Y/N STATU-'UM Ta OTH- AND EMPLOYERS'LIABILITY T ER ANY PROPRIETORlPAR7NERlEXECUTtVE❑ N/A E L.EACH ACCIDENT D $ OFFICEPJMEMBER EXCLUDE (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ -i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Spring Sprint 3-Hour Adventure Race: June 2, 2012. Certificate holder is an additional insured but only with respect to liability arising out of the operations of the above named insured. "This policy is issued, pursuant to Iowa Code section 515.147, by a nonadmitted company in Iowa and as such is not covered by the Iowa Insurance Guaranty Association," CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Washington County 1515 Keats Avenue N Lake Elmo, MN 55042 AUTHORIZED REPRESENTATIVE Scott Ziller/MEG ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN9025rgn1nnsi m Thm art-inn nnmm onri Innn nra ranicfararl mnr)rc of Ar'npn