9 NCORPORATED 1
100th AND VERSARY
THE CITY OF PATTERSON
SPECIAL EVENT
PERMIT APPLICATION
RECREATION & COMMUNITY SERVICES
1033 W. LAS PALMAS AVENUE, PATTERSON, CA
SUMMARY OF EVENT
DESCRIPTION
Event Date 10/5/2024
Event Title Health & Resource Fair
Location NoRth park
Description
Event Category Athletic/Recreation _ Concert/Performance Circus / Carnival Exhibits/Misc. Farmer/Outdoor Market I Dance
• Festival/Celebration Private Event • Other:
Parade/Procession/March (not open to the public)
Number of Participants (units and floats): 200° Number of Spectators:
Anticipated Number of Attendance: Total # 200 Number Per Day
DATE/TIME
Setup Date 10/5|24 Time_ 7am Sat.
Day of Week
Event Starts Date 10/25|24 Time_ 9 am Day of Week
Event Ends Date 10/35/24 Time- 12pm Day of Week
Dismantle Date W15 | 21 Time_ 1pm Day of Week
Yes No
X Is this an annual event? How many years have you been holding this event? Inagame Is your event part of a larger marketing campaign (i.e. Back to School Block Party & Safety Fair, Apricot Fiesta, etc.)?
If yes, please list
PARK LOCATION • North Park Garza Park
VENURE • South Park Sports Complex
(Select one or more)
1 SUMMARY OF EVENT, continue
NEIGHBORHOOD [Z Northeastern Patterson (includes Downtown Patterson & Plaza Circle) REGION • Southwestern Patterson (includes T.W. Patterson Sports Complex) • Northwestern Patterson
• Southeastern Patterson
•All four regions
NEIGHBORHOOD REGION MAP
Northwestern Northeastern
Patterson Patterson Hech School C Patterson
Walmar: Supercerter O
Southwestern Southeastern
Patterson Patterson
* see Special Event Planning Guide with approved street closure for the Plaza Circle - under Street Closure Information on pages 5-7
2 APPLICANT AND HOST ORGANIZATION INFORMATION
A written communication from the Chief Officer of the Host Organization authorizing the applicant and/or professional event organizer to apply for this Special Event Permit on their behalf must be submitted with your permit application.
Host Organization Invest in me
Chief Officer of Host Organization
Applicant Name ERica ayala
E-mail Address [email protected]
Address: Street POBox 158
City PatteRsn State CA Zip 95343
Telephone: Day 209.204.4323 Evening_
Cell
Please list any professional event organizer, event service provider, or commercial fund-raiser hired by you that is authorized to work on your behalf to plan, produce and/or manage your event.
Applicant Name:
E-mail Address
Address: Street
City State _ Zip
Telephone: Day Evening Cell
ORGANIZATION STATUS/PROCEEDS/REPORTING
Yes No
• • Is the Host Organization a commercial entity?
• Is the Host Organization a bona fide tax exempt, nonprofit entity? If yes, you must attach to this application a copy
Are patron admission, entry or participant fees required? If yes please provide amounts:
Are vendor or other fees required?
If yes please provide amounts:
VENDORS
Yes No
• X Does your event include food vendors? If yes number of tents/canopies:
• Will any of the food vendors be cooking or heating food on-site? How many:
What methods will be used (check all that apply)? • Gas •Electric • Charcoal • Other What is your plan for disposing of grease, charcoal and/or waste water? * see Special Event Planning Guide for Vendor Requirements 3 VENDORS, continue
Yes No
[X Will items or services be sold at your event?
If yes, please describe or attach a complete list of vendors and include a sample of the vendor pass that will be used.
Will items or services sold at your event present unique liability issues (eg. body piercing, massage, animal rides, etc.)?
If yes, please describe or attach a complete list of vendors.
SITE PLAN/ROUTE MAP
Your event site plan/route map should be submitted in blueprint or CAD format and include but not be limited to:
An outline of the entire event venue including the names of all streets or areas that are part of the venue and the surrounding area. If the event involves a moving route of any kind, indicate the direction of travel and all street or lane closures.
The location of fencing, barriers and/or barricades. Indicate any removable fencing for emergency access.
The provision of minimum twenty foot (20) emergency access lanes throughout the event venue.
The location of first aid facilities and ambulances.
The location of all stages, platforms, scaffolding, bleachers, grandstands, canopies, tents, portable toilets, booths, beer gardens, cooking areas, trash containers and dumpsters, and other temporary structures.
A detail or close-up of the food booth and cooking area configuration including booth identification of all vendors cooking with flammable gases or barbecue grills Generator locations and/or source of electricity.
Placement of vehicles and/or trailers.
Exit locations for outdoor events that are fenced and/or locations within tents and tent structures.
Identification of all event components that meet accessibility standards.
Other related event components not listed above.
NARRATIVE
Please provide a narrative and timeline of your event. You may provide this information as an attachment if necessary.
Tum - 8am set of
9um Stupt time
1pm tears up end
Ipm - 2pm ciend up
Site may
I Carenco
N. Del pueRto
tables
Ba thoms - Ustlet
resune tisbre,
pluza cir
nobue vai
Las Palmas Ave
N. Del Puerto Farmers El Cirerlo
Nort Parte
Martest
SECURITY PLAN
Yes No
lave you hired a licensed professional security company to develop and manage your event's securit lan? If yes, you are required to provide a copy of the security company's valid Private Patrol Operator' License issued by the State of California.
Security Organization:
Address: Street
City State Zip
Telephone: Day Evening Cell
Private Patrol Operator License #
Please describe your security plan including crowd control, internal security or venue safety, or attach the plan to this application.
MEDICAL PLAN
Yes No
[X Have you hired a licensed professional emergency medical services provider to develop and manage your event's medical plan?
If yes, please list:
Medical Services Provider:
Address: Street
City State Zip
Telephone: Day Evening Cell
Please describe your medical plan including your communications plan, the number, certification levels (MD, RN, Paramedic, EMT) and types of resources that will be at your event and the manner in which they will be managed and deployed. Your plan should include hours of setup and dismantle of medical aid areas. You may attach the plan to this application if necessary.
5 ACCESSIBILITY PLAN
This checklist is intended to serve as a planning guideline and may not be inclusive of all City, County, State and Federal access requirements. You may attach more detailed information if necessary.
Yes No
Will there be a Clear Path of Travel throughout your event venue? Please describe Spread out, pryron map.
Have you developed a Disabled Parking and/or Transportation Plan (including the use of public trans- portation or shuttle services) for your event? Please describe N
Will a minimum of 10% of portable rest rooms at your event be accessible? Please describe Yes, If needed Sulinas purturoses
* Will all food, beverage and vending areas be accessible? Please describe N/A
Will all signage be provided in highly contrasting colors and placed so pedestrian flow will not obstruct its visibility? Please describe
Bonds w/ VIsIBLe Suznage
If an information center is provided at your event will customer service representatives be available to assist disabled individuals? Please describe _
If all areas of your event venue cannot be made accessible will maps or programs be made available to show the location of accessible rest rooms, parking, phones (if any), drinking fountains, and first aid stations? Please describe
N/N
PARKING AND SHUTTLE PLAN
Yes No
E Will your event involve the use of a parking and/or shuttle plan? If yes, please describe or provide an attachment of your plan
STREET CLOSURE INFORMATION
Yes No
Will your event involve street closures?
Name of streets) to be closed: (Attach additional pages as needed; or for moving events such as parades, runs, walks,marches, etc. indicate "see route" and attach the approved map.) plaza N. Del Puerto Plaza aN. El Circlulo 7am End Tpm
Street Name between Start Time
6 STREET CLOSURE INFORMATION, continue
Street Name and Start Time End Time
between
Street Name between and Start Time End Time
STREET OF EVENT CLOSURE •One Lane 1 Two Lane Half of Street • Full Street (Select one or more)
Closure Type: • Rolling Street Closure (street opens to normal traffic after participants pass) Hard Street Closure (street closed for an extended period of time and/or event equipment will be placed in street for duration of the event; no vehicle access / Yes, No
• Will your event requiring encroachment on City right-of-way or public facilities (park, sidewalks, facilities? **Please refer to Special Event Planning Guide page 16 and Best Management Practices (BMPs) that must be implemented during your event.
ENTERTAINMENT AND RELATED ACTIVITIES
Yes No
Are there any musical entertainment features related to your event? If yes, complete the following information or provide an attachment listing all bands/performers, type of music, sound check and performance schedule.
Number of Stages What are the dimensions?
If yes, please describe
Number of Performers/Bands
Performer/Band name and music type
Will sound checks be conducted prior to the event?
If yes, Start time Finish time
• Will sound amplification be used?
If yes, Start time 9am titana Finish time 12pm
Do you plan to have a patron dance component to either live or recorded music at your event? If yes, please describe
Please describe the sound equipment that will be used for your event DJ Will inflatables, hot air balloons or similar devices be used at your event? If yes, please describe
• Does your event include the use of fireworks, rockets, lasers, or other pyrotechnics? If yes, please describe
K Will your event include the use of any signs, banners, decorations, or special lighting? If yes, please describe
7 ALCOHOL
* see Special Event Planning Guide (pages 9-11) for Alcohol Management Plan Yes No
Does your event involve the use of alcoholic beverages? If yes, please check all that apply: •Beer Wine Distilled Spirits Explain your sales plan (ticket system, cash at service area, etc.):
Explain who will serve the alcohol (professional bartenders, volunteers, etc.):
Yes No
E • Is the event open to all ages?
Explain how IDs will be checked, wristbands applied and how you will monitor for underage drinking:
Yes No
Do you have an alcohol sponsor?
If yes, explain:
TENTS
Yes No
Will your event include tents or canopies for vendors? (Food and non-food vendors) Number of tents/ canopies: resure booth tenty-to P
If yes, indicate on the site map and explain_
8 TENT PERMIT APPLICATION
Location of tent:
Date of set-up: Date of take down:
Event Date(s): Start Time:
Event Sponsor:
Event Address:
City: State: Zip:
Sponsor Contact: Phone:
Rental Company:
Address:
City: State: Zip:
Rental Contact: Phone:
Brief Description of Event:
Estimated Attendance:
Applicant Signature: Date:
Tent Permit Fees are $159.00. A check made payable to the City of Patterson Fire Department shall be submitted with this application.
*Permits that require after hours inspection will be billed by invoice for the inspection. Normal inspection hours are Monday - Friday 8:00 am to 5:00 pm. 9 PORTABLE REST ROOMS
You are required to provide portable rest room facilities at your event, unless you can substantiate the sufficient availability of both ADA accessible and nonaccessible facilities in the immediate area of the event site which will be available to the public during your event.
Yes No
Do you plan to provide portable rest room facilities at your event? If yes: Total number of portable toilets.
Number of ADA accessible portable toilets.
If no: Please explain: Use public restrim accrecos so veterans PaRK
Rest Room Company Salinas Purtubles
Address: Street
City State _ Zip_ 93343
Telephone: Day L 78. 2230 Evening _ Cell
Equipment Setup: Date 105|24 Time_ Pickup: Date Time
SANITATION AND RECYCLING
8 Number of Trash Cans
Number of Trash Cans with Lids
Number of Dumpsters with Lids
(One for every increment of 400 people)
Number of Recycling Containers 2
Sanitation Company: tentative. Cop. wil pande.
Address: Street
City _ State _ Zip
Telephone: Day Evening Cell
Equipment Setup: Date Time Pickup: Date _ Time
Please describe your plan for cleanup and removal of recyclable goods, waste and garbage during and after your event.
cans will be planed in vanus locatin fur
usane. - Intative: Caty Will be ampany no?
pluking vl =
10 MITIGATION OF IMPACT
Yes No
• Have you meet with the residents, businesses, places of worship, schools and other entities that ma! ›e directly impacted by your event? * see Special Event Planning Guide for requirements If yes, please attach a complete list of these entities.
If no, please explain
NA
Do you have a sample of the notice that you propose to distribute two weeks prior to your event? * see Special Event Planning Guide for sample of the notice If yes, please attach.
If no, please explain MA
MARKETING AND PUBLIC RELATIONS
Yes No
• • Will this event be marketed, promoted, or advertised in any manner? If yes, please describe Socie medin
L Will there by live media coverage during the event?
If yes, please describe
& Will media vehicles be parked within the event venue? If yes, please describe safety plan
Do you plan to place signs or hang banners on City property? If yes, please describe Banner un fence entering community. 11 INSURANCE REQUIREMENTS
Name of Insurance Agency ACORD = HVB Internature Insurane Semes * see Special Event Planning Guide for insurance requirements Address: POBOx 3BID
Street
Sunta Burbroa State _ zip_ 93130
Sos.
Telephone: Day 879.9591 Evening Cell
Contact Name michele Sinupoli
Policy Number
Yes No
Have you submitted the Certificate of Insurance & Additional Endorsement? (Your permit will not be issued until both the Certificate of Insurance and Additional Endorsement have been received. ) If you do not have insurance, contact HUB International Insurance for Special Event coverage. For more information visit www.eventinsure.com
AFFIDAVIT OF APPLICANT
I have read the rules and regulations contained in this document and agree to abide by these rules and regulations. I am duly authorized by the Organization to submit this application on its behalf and agree to be financially responsible for any fees and costs that may be incurred by or on behalf of the event in the City of Patterson. I certify that the information that I have provided on this application is true and accurate to the best of my knowledge. If the event details change, I agree to submit a revised application or provide additional information in writing at least 30 days prior to the event.
Name (please print) Enca ayak
Signature
Date. 4/5/2024 "Driver License # P4977103
Additional Documentation Required: Please attach a current copy of your Driver's License or California ID to complete application.
12 Signed and dated your application?
Attached your event site plan?
Provided samples of communications that will be distributed to impacted residents, businesses, schools, places of worship and other entities? Attached your Certificate of Insurance and Additional Endorsement? Attached a copy of your IRS 501(C) tax exemption letter, if applicable? Submit your completed permit application to:
City of Patterson
Recreation & Community Services
1033 W. Las Palmas Ave.
Patterson, CA 95363
This information is available in alternative formats upon request Printed on Recycled Paper (REC 06/20)
Copyright ® City of Patterson
IRS Permit of the see.
In reply refer to: 0752453551
ATLANTA GA 39901-0001 Feb. 20, 2018 LTR 4168C
95-4116679 000000 00
00019256
BODC: TE
SOCIAL AND ENVIRONMENTAL
ENTREPRENEURS INC
23532 CALABASAS RD STE A
CALABASAS CA 91302-1333
15570
Employer ID Number: 95-4116679
Form 990 required: Yes
Dear Taxpayer:
This is in response to your request dated Feb. 08, 2018, regarding your tax-exempt status.
We issued you a determination letter in February 1988, recognizing yau as tax-exempt under Internal Revenue Code (IRC) Section 501(c) Our records also indicate you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Section 509(a) (2).
deduct contributions they make to you as brovided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522.
In the heading of this letter, we indicated whether you must file an annual information return. a return is required, you must file Form 990, 990-EZ, 990-N, or 990-PF by the 15th day of the fifth month after the end of your annual accounting period. IRC Section 6033(j) provides that, if you don't file a required annual information return or notice for three consecutive years, your exempt status will be automatically ravaked on the filing date of the third required return or notice.
For tax forms, instructions, and publications, visit www.irs.govor 1-800-TAX-FORM (1-800-829-3676).
questions, call 1-877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and Hawaii
0752453551
Feb. 20, 2018 LTR 4168C
95-4116679 000000 00
00019257
SOCIAL AND ENVIRONMENTAL
ENTREPRENEURS INC
23532 CALABASAS RD STE A
CALABASAS CA 91302-1333
Sincerely yours,
Teri • M. Johnson
Operations Manager, AM Ops. 3
SOCIAND-01 KPOWELL1
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDYY) 5/14/2024
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
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
PRODUCER License # 0757776 CONTACT Michele Sinopoli
tUB International Insurance Services Inc. EX: (805) 879-9591 (AC, No):
0 Box 3310
janta Barbara, CA 93130-3310 ADDRess: [email protected] INSURERS) AFFORDING COVERAGE NAIC #
INSURER A : Alliance of Nonprofits for insurance, Risk Retention Group (ANI) 10023 NSURED INSURER B : Berkshire Hathaway Homestate Insurance Company 20044 Social and Environmental Entrepreneurs INSURER C :
23564 Calabasas Rd., Ste 201 INSURER D:
Calabasas, CA 91302
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
TYPE OF INSURANCE
A X COMMERCIAL GENERAL LIABILITY 1,000,000
CLAIMS-MADE X OCCUR x 202320293 10/1/2023 10/1/2024 500,000 20,000
MED EXP (Any one person)
FERSONAL & ADV INJURY 1,000,000
GENERAL AGGREGATE 2,000,000
POLICY PRODUCTS - COMP/OP AGO 2,000,000
_iquor Lial 1,000,000
LOTHER:
A AUTOMOBILE LIABILITY OMBINED SINGLE LIM 1,000,000
a acciden
ANY AUTO 202320293 10/1/2023 10/1/2024 BODILY INJURY (Per person) AUTOS ONLY STOLEN EODILY INJURY (Per accident) $
X HUSS ONLY
A X UMBRELLA LAB X OCCUR 2,000,000
EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE 202320293UMB 10/1/2023 10/1/2024 2,000,000
AGGREGATE
DED RETENTIONS
B AND EMPLOYERS NABILIN * SEATUTE.
Y/N SOWC457897 7131/2023 7/31/2024 EL EACH ACCIDENT 1,000,000 N/ A 1,000,000
EL DISEASE - EA EMPLOYEE S
/es, describe und 1,000,000
SCRIPTION OF OPERATIONS belo EL DISEASE -POLICY LIMIT
A Sexual Misconduct 202320293 10/1/2023 10/1/2024 Per Occ/Aggregat 1,000,000 A Prof Liability 202320293 10/1/2023 10/1/2024 Per Occ $ 1M/Aggrgte 2,000,000 POSEI: TIVES OPERTIONS / LOCATIONS / VEHICLES (ACORO 101, Adational Romarks Schodule, may be atached it more space is require) e City of Patterson, It's officials agents and employees and volunteers as Additional Insured under the General Liability Policy, as required by writte ntract or agreement, per the form attached: CG 20 26 12 1
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Patterson ACCORDANCE WITH PAE POLICY PROVISIONS E WILL BE DELIVERED IN Special Event Services
1033 W. Las Palmas Avi
atterson, CA 95363 AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: 202320293 COMMERCIAL GENERAL LIABILITY
Named Insured: Social & Environmental Entrepreneurs SEE, Inc.* CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Iny person or organization that you are required to add as an additional insured on this policy, under a writte ontract or agreement currently in effect, or becoming effective during the term of this policy. The additiona insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance:
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" If coverage provided to the additional insured is caused, in whole or in part, by your acts or required by a contract or agreement, the most we omissions or the acts or omissions of those acting will pay on behalf of the additional insured is the on your behalf: amount of insurance:
1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or Or 2. Available under the applicable Limits of
2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less.
However: This endorsement shall not increase the
1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and
2. If coverage provided to the additional insured is
equired by a contract or agreement, the
surance afforded to such additional insure
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 26 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1
EST 2013
COMMUNITY
HEALTH & FAIR
RESOURCE
Join us for Health Services &
Prevention Programs, Community
Resources, Activities for Children
& Families, and more.
SATURDAY
OCTOBER 5
Time
9:00am-1:00pm
Location
North Park, Patterson
For More Information
linktr.ee/investinme
www.investinmeca.com
SORPORATED
LEST 12013
FERIA DE
SALUD Y COMUNIDAD
RECURSOS
Acompañanos para Servicios de Salud y
Programas de Prevención, Recursos
Comunitarios, Actividades para Niños &
Familias y mas.
SÁBADO
5 DE OCTUBRE
Horario
9:00am-1:00pm
Lugar
Parque Norte, Patterson
Para Más Información
linktr.ee/investinme
www.investinmeca.com