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Public Safety & Welfare Committee

Regular Meeting

Verona, WI · August 26, 2019

AgendaMinutes

Minutes

CITY OF VERONA PUBLIC SAFETY AND WELFARE COMMITTEE AUGUST 26, 2019 VERONA CITY HALL MINUTES 1. Call to order: Heather Reekie called the meeting to order at 6:00 p.m. 2. Roll Call: Heather Reekie and Katie Kohl were present. Also present: Police Chief Bernie Coughlin, Sergeant Jesse Christensen, and City Clerk Ellen Clark. 3. Approval of Minutes: Motion by Kohl, seconded by Reekie, to approve the minutes from the August 12, 2019 Public Safety and Welfare Committee meeting. Motion carried 2-0. 4. Public Comment: There was no public comment. 6:02 p.m. - Evan Touchett is now present. 5. Discussion and Possible Action Re: A Special Event Permit application from Simeon Alder for the Madison 56ers Soccer Club Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 7 a.m. – 10 p.m. The Madison 56ers Soccer Club will be holding its 31st annual Fall Invitational at Reddan Soccer Park. Tents for merchandise sales and beer, as well as four food carts, will be on the grounds. One police officer is scheduled to be stationed on Cross Country Road from 9:30 a.m. – 3:30 p.m. Motion by Reekie, seconded by Kohl, to recommend to the Common Council to approve a Special Event Permit for the Madison 56ers Soccer Club Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 7 a.m. – 10 p.m. Motion carried 3-0. 6. Discussion and Possible Action Re: An Application for a Temporary Class “B” Beer License from the Madison 56ers Soccer Club for the Fall Invitational on Saturday, September 6, 2019 - Sunday, September 8, 2019 at Reddan Soccer Park, 6874 Cross Country Road, from 4 p.m. – 9 p.m., Simeon Alder, Agent. The club will be getting the beer from the Grumpy Troll Brewery, which has a wholesaler’s license. The beer tent area will be fenced, with one in/out point. IDs will be checked by 56ers Club volunteers, and an officer is scheduled to be on site from 4:00 p.m. – 9:00 p.m. Touchett asked if there is any measurement of how often, and to what degree, officers have had to step in at local events because of an alcohol related incident. Christensen replied if there is reason to believe that the Police Department should have more staff on hand, or for a longer period of time, they will make sure that happens. They try to gauge the peak event times, and have more personnel available at that time. The department counts on the organizations to police themselves, as well. Coughlin stated it’s much easier today than it was several years ago. There doesn’t seem to be as much drinking as there used to be. To date, there probably has not been a significant incident at an event. Motion by Reekie, seconded by Kohl, to recommend to the Common Council to approve a Temporary Class “B” Beer License from Madison 56ers Soccer Club for the Fall Invitational on Saturday, September 7, 2019 only, at Reddan Soccer Park, 6874 Cross Country Road, from 4 p.m. – 9 p.m., Simeon Alder, Agent, contingent upon completion of a background check of Club officers by the police department. Motion carried 3-0. 7. Discussion and Possible Action Re: A Special Event Permit application from Sandy Wolf for the Opportunity 34 Foundation’s Ride for Opportunity on Saturday, September 14, 2019 from 7 a.m. – 5 p.m. This is a charity bike ride for the Opportunity 34 Foundation. The ride will begin and end at Community Park. Foundation volunteers will be stationed throughout the course, which will be marked with taped arrows. No police assistance is required for this event. Motion by Reekie, seconded by Touchett, to recommend to the Common Council to approve a Special Event Permit for the Opportunity 34 Foundation’s Ride for Opportunity on Saturday, September 14, 2019 from 7 a.m. – 5 p.m. Motion carried 3-0. 8. Discussion and Possible Action Re: An Application for a Temporary Class “B” Beer License from the Opportunity 34 Foundation for the Ride for Opportunity on Saturday, September 14, 2019 at Community Park, 531 E. Verona Avenue, from 10 a.m. – 3 p.m., Sandy Wolf, Agent. The Foundation will be serving beer to event participants at the end of the route at Community Park. The pavilion will be fenced, and alcohol service and consumption will be restricted to that area. One officer will be scheduled from 12 p.m. – 3 p.m. Motion by Reekie, seconded by Kohl, to recommend to the Common Council to approve a Temporary Class “B” Beer License from the Opportunity 34 Foundation for the Ride for Opportunity on Saturday, September 14, 2019 at Community Park, 531 E. Verona Avenue, from 10 a.m. – 3 p.m., Sandy Wolf, Agent. Motion carried 3-0. 9. Discussion and Possible Action Re: A Special Event Permit application from Lyndsay Andrea, Sugar Creek PTO, for the Sugar Creek Fun Run on Saturday, September 28, 2019 from 6 a.m. – 11 a.m. This is the fifth year for this fundraising event for the Sugar Creek Elementary School PTO. The course begins and ends at Sugar Creek Elementary School. Two police department staff will be on hand for traffic control, which will be billed to the PTO. The race starts at 9:00 a.m. An updated route was submitted due to the construction taking place on West End Circle. This route is safer than the old route. Motion by Reekie, seconded by Kohl, to approve a Special Event Permit for the Sugar Creek Fun Run on Saturday, September 28, 2019 from 6 a.m. – 11 a.m., contingent upon the City receiving proof of approval from the DNR for use of the Military Ridge Bike Trail. Motion carried 3-0. 10. Discussion and Possible Action Re: An application for a Special Event Permit from Emily Peterson for the Arthritis Foundation of Wisconsin’s Jingle Bell Run on Saturday, December 14, 2019, from 7:30 a.m. – 1:30 p.m. The event has two routes: a 5K run and a 1- mile walk. Event coordinators will be on site from 6 a.m. – 2 p.m. The race starts at 10:00 a.m. Three officers will be assigned to the event. No Parking signs will be posted, and a resident notification form will be mailed to residents along the route approximately 10 days in advance of the event. Motion by Reekie, seconded by Kohl, to approve a Special Event Permit for the Arthritis Foundation of Wisconsin’s Jingle Bell Run on Saturday, December 14, 2019, from 7:30 a.m. – 1:30 p.m. Motion carried 3-0. 1. Adjournment: Motion by Reekie, seconded by Touchett, to adjourn at 6:31 p.m. Motion carried 3-0. Ellen Clark, City Clerk

Agenda

City Of Verona PUBLIC SAFETY AND WELFARE COMMITTEE MONDAY, AUGUST 26, 2019 AT 6:00 P.M. COUNCIL CHAMBERS VERONA CITY CENTER 111 LINCOLN STREET, VERONA, WI 53593 AGENDA 1. Call to order 2. Roll Call 3. Approval of Minutes from the August 12, 2019 Public Safety and Welfare Committee meeting 4. Public Comment 5. Discussion and Possible Action Re: A Special Event Permit application from Simeon Alder for the Madison 56ers Soccer Club Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 7 a.m. – 10 p.m. 6. Discussion and Possible Action Re: An Application for a Temporary Class “B” Beer License from Madison 56ers Soccer Club for the Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 4:00 p.m. – 9:00 p.m. at Reddan Soccer Park, 6874 Cross Country Road, Simeon Alder, Agent 7. Discussion and Possible Action Re: A Special Event Permit application from Sandy Wolf for the Opportunity 34 Foundation’s Ride for Opportunity on Saturday, September 14, 2019 from 7 a.m. – 5 p.m. 8. Discussion and Possible Action Re: An Application for a Temporary Class “B” Beer License from the Opportunity 34 Foundation for the Ride for Opportunity on Saturday, September 14, 2019 from 10:00 a.m. – 3:00 p.m. at Community Park, 531 E. Verona Avenue, Sandy Wolf, Agent 9. Discussion and Possible Action Re: A Special Event Permit application from Lyndsay Andrea, Sugar Creek PTO, for the Sugar Creek Fun Run on Saturday, September 28, 2019 from 6 a.m. – 11 a.m. 10. Discussion and Possible Action Re: An application for a Special Event Permit from Emily Peterson for the Arthritis Foundation of Wisconsin’s Jingle Bell Run on Saturday, December 14, 2019, from 7:30 a.m. – 1:30 p.m. 11. Adjournment Heather Reekie, Chairperson POSTED: Verona City Hall Verona Public Library Miller & Sons Market City Web Page at: www.ci.verona.wi.us IF YOU NEED AN INTERPRETER, MATERIALS IN ALTERNATIVE FORMATS OR OTHER ACCOMODATION TO ACCESS THE MEETING, PLEASE CONTACT THE CITY CLERK AT 608-845-6495 AT LEAST 48 HOURS PRECEDING THE MEETING. EVERY REASONABLE EFFORT WILL BE MADE TO ACCOMMODATE YOUR REQUEST. PUBLIC SAFETY & WELFARE COMMITTEE - 2019-08-26 1. Discussion and Possible Action Re: A Special Event Permit application from Simeon Alder for the Madison 56ers Soccer Club Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 7 a.m. – 10 p.m. The Madison 56ers Soccer Club will hold its 31st annual Fall Invitational at Reddan Soccer Park in Verona, Wisconsin. There will be two to three 10x10 tents for merchandise sales and a beer tent. Four food carts will be on the grounds, as well. One police officer will be stationed on Cross Country from 9:30am –3:30pm, which will be billed to the 56er’s, and the last game is scheduled for 7:45 p.m. on Saturday. Motion: To recommend to the Common Council to approve the Madison 56ers Soccer Club Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 7 a.m. – 10 p.m.. 2. Discussion and Possible Action Re: An Application for a Temporary Class “B” Beer License from Madison 56ers Soccer Club for the Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 at Reddan Soccer Park, 6874 Cross Country Road, Simeon Alder, Agent They will be getting the beer from Grumpy Troll who has a wholesaler’s license, and will be selling the beer to the 56'ers and serving the alcohol. Service will be in plastic cups, the area will be fenced with a single layer, one in/out point, ID’s checked by 56ers club volunteers, and an officer will be on site from 4:00 p.m. – 9:00 p.m., which the 56ers will be billed for. Motion: To recommend to the Common Council to approve the Temporary Class “B” Beer License for Madison 56ers Soccer Club Fall Invitational on Friday, September 6, 2019 - Sunday, September 8, 2019 from 4 p.m. – 9 p.m. 3. Discussion and Possible Action Re: A Special Event Permit application from Sandy Wolf for the Opportunity 34 Foundation’s Ride for Opportunity on Saturday, September 14, 2019 from 7 a.m. – 5 p.m. The charity bike ride is at Verona’s Community Park. They do not require any police assistance. Participants will follow the rules of the road. Staggered start time at 9:00 a.m. from Ice Arena to Enterprise Dr. They will have volunteers wear bright color or vests at Enterprise Dr and throughout the course. DJ with speakers will be at Community Park. Route will have taped arrows. Motion: To recommend to the Common Council to approve the Opportunity 34 Foundation’s Ride for Opportunity on Saturday, September 14, 2019 from 7 a.m. – 5 p.m. 4. Discussion and Possible Action Re: An Application for a Temporary Class “B” Beer License from the Opportunity 34 Foundation for the Ride for Opportunity on Saturday, September 14, 2019 from 10:00 a.m. – 3:00 p.m. at Community Park, 531 E. Verona Avenue, Sandy Wolf, Agent The event applicants would like to serve/give away beer at the conclusion of the bike ride. It is recommended that the pavilion at Festival Park be fenced and that alcohol service and consumption is restricted to this area. It is recommended that one officer be present at the time the ride is scheduled to conclude, 12:00 p.m., and remain present until at least 3:00 p.m. Motion: To recommend to the Common Council to approve the Temporary Class “B” Beer License for Opportunity 34 Foundation for the Ride for Opportunity on Saturday, September 14, 2019 from 10 a.m. – 3 p.m. 5. Discussion and Possible Action Re: A Special Event Permit Application from Lyndsay Andrea, Sugar Creek PTO, for the Sugar Creek Fun Run on Saturday, September 28, 2019 from 6 a.m. – 11 a.m. This is the fourth year for this fundraising event for the Sugar Creek Elementary School PTO. The course begins and ends at Sugar Creek Elementary School. Two police department staff will be on hand for traffic control which will be billed to the PTO. Race starts at 9:00 a.m. A separate route was submitted later due to the construction taking place on West End Cir. Motion: To approve a special event permit for the Sugar Creek Fun Run on Saturday, September 28, 2019 from 6 a.m. – 11 p.m. contingent upon the City receiving proof of approval from the DNR for use of the Military Ridge Bike Trail 6. Discussion and Possible Action Re: An application for a Special Event Permit from Emily Peterson for the Arthritis Foundation of Wisconsin’s Jingle Bell Run on Saturday, December 14, 2019, from 7:30 a.m. – 1:30 p.m. The Jingle Bell Run is a fundraiser for the Arthritis Foundation. This is the sixth year for the event in Verona. The event has two routes: a 5K run and a 1-mile walk. Event coordinators will be on site from 6 a.m. – 2 p.m. Race starts at 10:00 a.m. Three officers will be assigned to the event. No Parking signs will be posted, and a resident notification form will be mailed to residents along the route approximately 10 days in advance of the event. Motion: To approve a special event permit for the Arthritis Foundation of Wisconsin’s Jingle Bell Run on Saturday, December 14, 2019, from 7:30 a.m. – 1:30 p.m. CITY OF VERONA PUBLIC SAFETY AND WELFARE COMMITTEE AUGUST 12, 2019 VERONA CITY HALL MINUTES 1. Call to order: Heather Reekie called the meeting to order at 6:00 p.m. 2. Roll Call: Heather Reekie, Katie Kohl and Evan Touchett were present. Also present: Police Sergeant Jesse Christensen, and City Clerk Ellen Clark. 3. Approval of Minutes: Motion by Touchett, seconded by Kohl, to approve the minutes from the July 8, 2019 Public Safety and Welfare Committee meeting. Motion carried 3-0. 4. Public Comment: There was no public comment. 5. Discussion and Possible Action Re: A Special Event Permit application from Ryan Richards for the World Triathlon Corporation’s Ironman Triathlon on Sunday, September 8, 2019 from 7:30 a.m. – 4:30 p.m. Christensen stated this is a solid event every year. This is the 18th year for the event. The Ironman event brings several thousand participants and spectators to the City. All police officers are assigned to this event to assist with traffic and road crossings. New construction on CTH M between Whalen Road and Locust Street was a topic of concern regarding bringing the bikes off of Whalen, up Main Street, and then onto Locust Street. Christensen and Richards walked that area, and developed a route that they believe is the safest for all involved. It will require the bikers to cross South Main Street diagonally from north to south, then follow South Main Street on the south side to Locust Drive. There will be a hard shut down on Locust Street to Bruce Street. Touchett asked if there will be advance communication to the participants to let them know that there are areas in this section of the route that may be harder to navigate. Christensen replied a meeting will be held the evening before the event to communicate any course changes for the year. Maps of the course will be available for participants, as well. Costs for police department presence will be reimbursed by the applicant. Motion by Touchett, seconded by Kohl, to approve a Special Event Permit application from Ryan Richards for the World Triathlon Corporation’s Ironman Triathlon on Sunday, September 8, 2019 from 7:30 a.m. – 4:30 p.m. Motion carried 3-0. 6. Discussion and Possible Action Re: A Special Event Permit application from Rita Mortenson, Verona Area High School (VAHS), for the VAHS Homecoming Parade on Friday, October 4, 2019 from 4:00 p.m. – 5:15 p.m. The route and time for the parade have not changed from last year. The parade begins at the K-Wing parking lot of the high school, travels south on CTH M, west on Verona Avenue, and north on Westlawn Avenue back to the high school parking lot. Motion by Kohl, seconded by Touchett, to approve a Special Event Permit application from Rita Mortenson, Verona Area High School (VAHS), for the VAHS Homecoming Parade on Friday, October 4, 2018 from 4:00 p.m. – 5:15 p.m. Motion carried 3-0. 7. Adjournment: Motion by Reekie, seconded by Touchett, to adjourn at 6:18 p.m. Motion carried 3-0. Ellen Clark, City Clerk APPLICANT INFORMATION Name: sI H First eo t1 v. M.I. last Phone: '111- f )0 - S-8 70\ Address: l q I 'f MADI Sot-I W! 5"'.;111 Driver License#: Email: tor.o,·��tlil(l.1td1°(((tor@ MA41.Sc)� ,b,t(S. or.5 s-- AGENCY/ORGANIZATION INFORMATION Name: M ltD Is� t-1 ')6 ER! So (C �� I?> Phone: ( ,o �) 8'3 I'" 2 Address: I 5'"5" S � A-lAH � 12 D 1< � a uH wr 5""3 5'7 � c If this is a non-profit organization, please provide your EIN number for verification: EVENT INFORMATION fi1AJJI KD H ,i ERJ Name of Event: f.4:U INV I IATI Ot:l A:I Type of event Yo IATH S-t>(C; Jl Event date(s): �/ C - � /(1/2.0 14 - ID P r1 Event time(s): ] .+.., Set up Start Time:�,/, ./ I 'I' . l ] AJA. Tear Down End Time: � le�I J ('1 . lo PM EVENT (ONTACTS PLEASE LIST NAMES LOCATIONS AND CELL PHONE NUMBERS OF ON-SITE EVENT CONTACT PERSONS I NAME Driver License# LOCATION AT EVENT TIME ON-SITE CELL PHONE as shown on ID (Ex: Race Start, Supply (Ex: 10 a.m. to Tent etc.) 2p.m.) itPPAtf F1rLO 7 A-"1 - IO t' r--1 ti 11-15'"1 - S-37'1 Sl'1S:11'f .P ALDER A If3 ' - ld''t7- 2.Z't? _,.,,_ Hc>�SE �A�tl .J w FI I \i"P,. "'',O•Qf 01 ��, -, ,,-01 " ,, r,u�->7 r-, l..J j) !t /;2 Date:.��� a=-+-<s...J.-_ CITY OF VERONA CR#:________ Account#: 100-44910 APPLICATION FOR A SPECIAL EVENT/NEIGHBORHOOD EVENT PERMIT For Parades, Runs, Walks, Bicycle Events, Triathlons, Festivals, Neighborhood Events, etc. •All required application materials must be submitted at least 45 days prior to the event. Failure to meet this requirement may result In the denial of the application pursuant to Section 7-7-1{h) of the City of Verona Code of Ordinances* Application Fee: $150.00 + any additional fees Non-Profit Organization: $50.00 + any additional fees REQUIRED INFORMATION Please include the following information/materials regarding the event with your application: � A copy of the applicant's Driver's License Route map and description and/or map of event layout � :� Certificate of Insurance - at least 30 days prior to event APPLICANT INFORMATION Phone: fnQ8--44-4-2CJ .. }-0 Address: ,55-f �51:: la N.D \�A ) lA3r 53�) Driver License#: DOB: 2 �2.LJ-t,'Z) Email: ±swo\t.:SaJ �g:n"'�·L (O'()"\ AGENCY/ORGANIZATION .INFORMATION Name: OpPad:uo:-ty 3<-1, 4Pun·wJ<ao f'fi Phone:._...,.p{ �.......... _.;� __;� ::..;..;;;. ;;_-_q )f.....:. ...;..:....i '7___ Address: 5 <Rb (a;J- V .:ew fd If this is a non-profit organization, please provide your EIN number for verification: fu - 38 w13S4 EVENT INFORMATION Name of Event: (<;di to( O�o;� Type of event___.fu ' '-'\\R .._, .......__y , rJ.,,�---- ........., Event date(s): J.p\.. I'-}, WI C( Eventtime(s):.___ /l ------- �-'-A l'Y> Set up Start Time: ___J :Affi ....._.....,_'-'-------- Tear Down End Time: :S ptn (Appllcatlon Continues on Reverse) Last updated Date:._______ Initials:______ EVENT CONTACTS PLEASE LIST NAMES, LOCATIONS AND CELL PHONE NUMBERS OF ON-SITE EVENT CONTACT PERSONS NAME DOB LOCATION AT EVENT TIME ON-SITE CELL PHONE as shown on ID (Ex: Race Start, Supply (Ex: 10 a.m. to Tent etc.) 2p.m.) 8..-2J·l- C- s-, ,�- APPLICATION PROCEDURES 1. Application and all required materials shall be submitted to the City Clerk a minimum of 45 days prior to the event. (Section 7-7-l(h) of the City of Verona Code of Ordinances) 2. Upon verification of the application the City Clerk shall submit the application to the Police Chief for further review. 3. The applicant will be contacted by the Police Department Staff to review event route and the need for on- site police officers or City staff at the event. 4. The applicant is subject to a background check. 5. All police traffic control/city staff time incurred shall be billed to the applicant upon the completion of the event. 6. The applicant may be required to attend a Public Safety and Welfare Committee meeting and/ora Common Council meeting at which the event application will be reviewed for approval. 7. Once the application is approved by the appropriate official(s) the permit will be issued. APPLICANT SIGNATURE PLEASE READ CAREFULLY BEFORE SIGNING I understand the application and event requirements and agree to adhere to all applicable federal, state, and municipal laws in addition to the requirements on the application. I agree to pay any invoices received from the City of Verona for staff time at the event within 30 days of the invoice date. I understand that failure to adhere to any application requirements or any federal, state or municipal laws involving the event will result in the denial of the application or immediate termination of the event. The violation of federal, state or municipal laws will be subject to applicable fines and penalties. " ,.. J�-19 �l1 Applicant Signatur� Date Once application ls approved, the permit will be issued to applicant via email. A copy of the permit must be available at event for conformation. Application for Temporary Class “B” / "Class B" Retailer’s License See Additional Information on reverse side. Contact the municipal clerk if you have questions. FEE $ 38.00 Application Date: 08/06/2019 Town Village ✔ City of VERONA County of DANE The named organization applies for: (check appropriate box(es).) ✔ A Temporary Class "B" license to sell fermented malt beverages at picnics or similar gatherings under s. 125.26(6), Wis. Stats. A Temporary "Class B" license to sell wine at picnics or similar gatherings under s. 125.51(10), Wis. Stats. at the premises described below during a special event beginning 09/14/2019 and ending 09/14/2019 and agrees to comply with all laws, resolutions, ordinances and regulations (state, federal or local) affecting the sale of fermented malt beverages and/or wine if the license is granted. 1. Organization (check appropriate box)  ✔ Bona fide Club Church Lodge/Society Chamber of Commerce or similar Civic or Trade Organization Veteran's Organization Fair Association (a) Name OPORTUNITY 34 FOUNDATION (b) Address 566 EAST VIEW RD, VERONA, WI 53593 (Street) ✔ City Town Village (c) Date organized 12/27/2017 (d) If corporation, give date of incorporation 12/29/2017 (e) If the named organization is not required to hold a Wisconsin seller's permit pursuant to s. 77.54 (7m), Wis. Stats., check this box: ✔ (f) Names and addresses of all officers: President KRISTIN KELLERMAN 566 EAST VIEW RD, VERONA, WI 53593 Vice President BRIAN KELLERMAN 566 EAST VIEW RD, VERONA, WI 53593 Secretary TIM CHATMAN 6573 WINDING WAY, DEFOREST, WI 53532 Treasurer KARIN VICTERSON 349 MEDINAH RD, OREGON, WI 53575 (g) Name and address of manager or person in charge of affair: SANDY WOLF 551 HARVEST LN VERONA, WI 53593 2. Location of Premises Where Beer and/or Wine Will Be Sold, Served, Consumed, or Stored, and Areas Where Alcohol Beverage Records Will be Stored: (a) Street number 531 E VERONA AVE, VERONA, WI 53593 (b) Lot Block (c) Do premises occupy all or part of building? COMMUNITY SHELTER WILL BE USED (d) If part of building, describe fully all premises covered under this application, which floor or floors, or room or rooms, license is to cover: A SMALL PORTION OF THE COMMUNITY SHELTER 3. Name of Event (a) List name of the event RIDE FOR OPPERTUNITY (b) Dates of event 09/14/2019 DECLARATION The Officer(s) of the organization, individually and together, declare under penalties of law that the information provided in this applica- tion is true and correct to the best of their knowledge and belief. (Name of Organization) Officer Officer (Signature/date) (Signature/date) Officer Officer (Signature/date) (Signature/date) Date Filed with Clerk Date Reported to Council or Board Date Granted by Council License No. AT-315 (R. 6-16) Wisconsin Department of Revenue CITY OF VERONA Account#: 100-44910 APPLICATION FOR A SPECIAL EVENT/NEIGHBORHOOD EVENT PERMIT For Parades, Runs, Walks, Bicycle Events, Triathlons, Festivals, Neighborhood Events, etc. *All required application materials must be submitted at least 45 days prior to the event. Failure to meet this requirement may result in the denial of the application pursuant to Section 7-7-l(h) of the City of Verona Code of Ordinances* Application Fee: $150.00 + any additional fees Non-Profit Organization: $50.00 + any additional fees REQUIRED INFORMATION Please include the following information/materials regarding the event with your application: D A copy of the applicant's Driver's License D Route map and description and/or map of event layout D Certificate of Insurance - at least 30 days prior to event APPLICANT INFORMATION Name: \--'jYla&ly..,\ '{<.. \(,. -AndY-lt-C:, Phone: (oOS- "Z. \ 1-etoci·i F� M.I. Last Address: L\'2S \j\J-t:,S.tt I d '3,e t'o.x\<V'f°=j , '\feX"C1Y'\a... \Nl G3S4·� Driver license#: . tD/to/BD DOB:---'-------- AGENCY/ORGANIZATION INFORMATION Name: S�ClX Cxee� t::Lc,\'Y)�Y <j &>nod PTO Phone:.___________ Address: tf·2.D 0h1..,0rc)J 9.:\rG.eJ:, \/exoY)CL�\cl\ S3SCj? If this is a non-profit organization, please provide your EIN number for verification: 21 ... 1L\BB°IG3 EVENT INFORMATION Name of Event: S�ax C'<ce\:'.. nm Qu.n Type of event � K run IY"CA. l K.. /-'-\°I_,_________ Event date(s):._O\...!.J/'--1-�....... Event time(s): Che c¥ iY\ Baro I l<'.4.c-e a.t q a..\'Y1 _________ Set up Start Time:._l.P'---·.O_O_a..-_m ....:.:..I � Tear Down End Time:· I �=------- �00 (:1. yY'I (Application Continues on Reverse) Last updated Date: ______ Initials:______ MEMBER CERTIFICATE OF INSURANCE 8/21/19 Thank you for purchasing your insurance from AIM. This is your Member Certificate and should be kept with your permanent records. Insured #: WI11371 NAMED INSURED MEMBER: Named Insured & Mailing Address PRODUCER NAME Sugar Creek PTO Education Support Purchasing Group AIM Association Insurance Attn: Josh Rodriguez or Current Officer c/o AIM Management, Inc. 420 Church St. P.O. Box 674051 PO Box 674051 Dallas TX, 75267-4051 Dallas TX, 75267-4051 Verona, WI 53593 Company / Coverage Policy # Effective Dates Deductible Limits of Insurance Tudor Insurance Company / CPG1132808 4/26/19 - 4/26/20 $0 Each Occurrence $1,000,000 Commercial General Liability General Aggregate $2,000,000 Products - COMP/OPS - Subject Included to General Aggregate Personal & Advertising Injury $1,000,000 Fire Damage (any one fire) $50,000 Tudor Insurance Company / CPG1132808 4/26/19 - 4/26/20 $0 Any One Person $25,000 Extended Medical Payments Tudor Insurance Company / CPG1132809 4/26/19 - 4/26/20 $ 1,500 Aggregate $1,000,000 Professional Liability (Directors & Officers Liability) Retro-active Effective Date: 4/26/14 City of Verona is added as an Additional Insured to the General Liability policy only. Event: Sugar Creek Fun Run Date: 9/28/19 8AM - 1PM Certificate Holder: This member certificate, together with the common policy conditions, coverage part(s), coverage form(s), and endorsements, if any, complete the above numbered City of Verona policy. Copies of the Master Policies are available upon request or may be printed at 111 Lincoln Street www.aim-companies.com Verona, WI 53593 AUTHORIZED REPRESENTATIVE

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