CITY OF RIALTO
SANTA CAN
SPECIAL EVENT PERMIT Community Services Department
Attention: Jessica Perez
APPLICATION Office: 214 North Palm Ave. Rialto, CA 92376 Phone (909) 820-8036 Email: [email protected]
www.youmnaito.com
GENERAL INFORMATION
Name of Event:
BlAckontreBlock NS Juneteentri
Film Festivnt
Dranian Name Tomorrowş Worlel 3 Never Stop Grindiy
Applicant Name: ,
(05)855-7382
Mailing Address
1441 NCifford Are RAtto CA brick antheback miss el
05782 Ogal
DATE(5)/TIME(S) INFORMATION
Date(s) of Activity From Hours of Operation From
6| 19/23 16|19/23 6pm to 10pm
Set up Date(s) From: Set-up Timela) Freim:
(619/23 " 6|19/23 4pm * Lopm
Tear-down Time(s) From.
Tear down Datel From 6o|19/23 " 6/19/23 10pm 1pm
DESCRIPTION OF EVENT
Describe Planned Activities:
Recurriy Event In Honor of Juneteentn Celebratin
Afrivan American Culture 3 Hentge Free to the pubr
Opens Basketball genes 3 Falmudors
EVENT DETAILS
Estimated Atrendance: 100 Estimated No. of Staff / Volunteers 10 Will any fees be charger?
If so, what fees will be charge and who will the proceeds berefit? Will fees be collected on site? Yes / No
Alcoholit beverage sales/on-site consumption: _ Yes / No Elecincal (prowided by applicant): _ Yes/ No if yes, attach copy of ABC Permit if yes, type
at is the responsiblity of the Event Organizer to ensure that all Temporary Foad Facility Vendors at the event camply with load safety and sanitary requirements enforced by the San Wernarding County division of Environmental Health Services. All vendors seling food must have a City of Rialto business license Will food be served on sile Yes.
If yes, attach copy of the San Bernardino County Temparary Event Health Permit All verdees selling products must have a Cry of Rialto business license Adetional fees will asly. Wilt there be any dems for sale at this event?/ Yas For firewerks or pyrotechnic an additional applitation must be processed with the City of Rialte Fire Department a minimum of 90 days prior to your event.
Additional fees may apply. Are you requesting approval to provide a fireworks show at the event? Yes Na Will additienal porabie restroams be brought to the event site?. - Yes No IVES, please provide the folawing information Portable Restroom Company Name: Phone Number: Number of Restrooms: ADA:
Clean up of the event area immediately following the event, including trash removal from the site is the responsibility of the applicant. Burrter Waste Industries disposal has an exclusive franchise with the city and must be used for all trash hulling Will you require any trash containers or recycling bins? _ _Yes / _Na fare rods elsa te aral are you reces i arrested be coed or that even city pole pare required for evenes with alcohol or large crowds. Additional fees apply. Are you requesting any aublic streets be ciosed for this event/actvity? _ IE YES, entify the streets/blacks and indicate the times the closure is requested A traffic control plan may be required for events which recuire barricades or traffic control signage. An approved traffic control plan will be required prior to impierenting any Closures. Plan should specify pedestrian management traffic signal modifications, etc. Additionally, a message sign may be recuired, please list your traffic control pian if applicabie:
Are you raçuesting wehicies be permitted to load/unload on city streets?__ Yes No If YES. please indicate the location and times loading and unloading wil occur. if City staff assistance is requested, the applicant wil be charged additical fees to cover cost incurred by the City Will city staff be recuested? — Yes If YES, please explain
IN THE SPACE PROVIDED BELDW PLEASE DESCRIBE THE PROPOSED ROUTE FOR PARADES, RUNS, WALKS, ETC. A DETAILED MAP OF THE EVENT SITE OR ROUTE MUST SE INCLUDED WITH THIS APPLICATION IF TRAFFIC CONTROL OR PARKING ARE SIGNIFICANT I5SUES
EVENT SITE OR ROUTE MAP
A map of the event site is required, please draw your map in the space provided below or attach your map to the application upan submittal. Site Plan- should Include:
north arrow and drawing to scele, dimensions and shape of the lot, location and name of abutting streets and alleys, Ication of nearest off-site structures on the site. placement/locations af tents/canopies, Identification of the uses) within tents/canopies, interior seating plan within tents and method of seating, location, composition and height of all existing and proposed walls and/or fences, lacation of driveways showing all pints of ingress/egress to the site and event, parking layout showing accessible parking spaces and path of travel from the pubic right-of-way to the proposed event, location on site landscaping if enisting, location of restroom facilties. any equipment, storage, generator, any other materials associated with the event, location of refuse enclosures, and placement/location of temporary signage see Atache
FERGUSSON PARK
2395 W Sunrise Dr, Rialto, CA 92377
0-oe
W Sunrise Dr
WSunrise Dr W Sunrise Dr W Sunrise Dr W Sunrise Dr W Sunrised Seating for
Basketball
Movie Screen Spectators
Seating for Movie Spectators
RR
Riao
Food Vendors
Fergusson
Parki
BE
Shelters & Amenities
1—close proximity to parking lot; easily access playground area 2—adiacent to playground area
3—close to softball fields, bar-b que pit, close to restrooms RR= restrooms
PROPERTY OWNER AUTHORIZATION (for nan-City facilities only) D Property Owner D Agent (A letter of autharization is required to be submitted along with signature below) Title:
Name (Pleaso Print):
Phone:
Malling Address:
Date
Signature Authoriting this Application
SUMMARY OF REGULATIONS FOR SPECIAL EVENT PERMITS
GENERAL INFORMATION:
No person or entity shall operate, maintain, conduct, advertise, or provide admission for any temporary special event within the City of Rialto without possessing a permit for each such temporary special event. Applications must be submitted at least 90 days prior to the event date and at least 120 days prior for those seeking a street closure or requesting alcohol, to insure proper processing and scheduling. All special event costs will be the responsibility of the applicant/requesting organization.
SUBMITTAL REQUIREMIENTS CHECKLIST:
D Site Plan
O Obtain City of Rialto Business License at least 30 days prior to the event, it applicable • Copy of Facility Reservation application/Authorization Letter, if applicable D Copy of County Health Permit at least 2 weeks prior to the event, if applicable • Copy of Rialto Fire Department operational permit, if applicable • Copy of ABC License, if applicable
• Copy of security contract and potable restroom purchase order, if applicable • Copy of certificate of liability insurance at least 30 days prior to the event INSURANCE REQUIREMENTS: Before a Special Event Permit is Issued, a certificate of insurance must be submitted 30 days prior to the date of the event. Subject to approval by the City Manager and City Attorney, the following may be requirements of your event/organization:
• Minimum $1,000,000 General Liability Limit with the City named as additional insured. The endorsement page is required with the following: The City of Rialto, its directors, officials, employees, agents, and volunteers shall be named as additional insureds.
• Minimum $1,000,000 General Automobile Liability
• Minimum $1,000,000 Worker's Compensation (if the organization has paid staff) • Minimum limits of coverage may change depending on event Insurance Certificate On File • Insurance Certificate Not Available Insurance Certificate Attached
Expiration Date:
Insurance Company:
ADDITIONAL FEES AND REQUIRMENTS MAY APPLY (i.e. street closures, City personnel fees, facility and park shelter rental, etc.) SECURITY AND PORTABLE RESTROOMS; In the event that a carnival/street fair and/or alcohol service will be included in the event, an alcohol garden and security plan will need to be submitted along with a security contract and/or public safety staffing plan for review by the Police Department. Portable restrooms are required when estimated attendance exceeds what the host facility's restrooms can accommodate. If applying for a carnival, a separate Application for Carnival, Circuses, Etc. must be filled with the Building & Planning Department
REVIEW PROCESS: Once the application Is submitted to the Community Services Department, the application will be reviewed. If the application is complete the applicant will be scheduled to present his/her appications to the Special Events Planning Team for review. City staff will route the application and all other associated documents to all applicable departments who will review the application and site plan. Once the Department review is complete, Staff will determine if the permit can be approved and will coordinate the processing and responses from other City departments and will contact the applicant regarding status. If the event is approved, a letter will be written for the approval which will contain conditions under which the event will be permitted to operate.
A copy of this approval letter and event conditions must be kept on site for the duration of the event.
By signing below, agree to indemnify, hold harmless, and defend the City and its officials, employees, and agents, against ali claims, liabilities, and losses arising from activities connected with or undertaken pursuent to the Permil. The City Is not labie for any business loss, property loss, or other damage that may result from the use of the Permig or suspenufon or revocation of the Permit Date 330/23
Name: W _Signature:
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 638170936636983761
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED)
Alliant Insurance Services, Inc. in conjunction with City of Rialto Apex Insurance Services
P. O. Box 6450
Vewport Beach, CA 92658
icense No: OC 36861
NAMED INSURED (EVENT HOLDER): EVENT INFORMATION:
Vickie Davis TYPE: Exhibitions / Exhibits (Outside)
1441 N Clifford Ave 06/19/2023
Rialto, CA 92376 OCATION: 2395 W Sunrise Dr, Rialto, CA 9237 Liquor Liability Yes• No O
**Liquor Liability after 12 am ends before 2 am •
This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions of such policy(ies) unless amended as described in Special Conditions.
INSURANCE CARRIER: Evanston Insurance Company
MASTER POLICY NUMBER: MKLV7PBC001381
MASTER POLICY DATES: EFFECTIVE: January 01, 2023 EXPIRATION: January 01, 2024 COMMERCIAL GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: VONF Aggregate Limit $2,000,000
Products & Completed Operations 1,000,000 SPECIAL CONDITIONS:
Personal & Advertising Injury 1,000,000
Each Occurrence Limit 1,000,000 the Master play do not ap tached 10 Damage To Premises Rented To You (Any One Premises) 100,000 Certificate Of Insurance:
Medical Payments (Any One Person) 5,000
Liquor Liability (If purchased) 1,000,000
Optional Limits Purchased
• $1,000,000/$3,000,000
• $2,000,000/$2,000,000
Property Damage (If purchased)
No Property Damage Coverage
The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event.
OTHER ADDITIONAL INSUREDS
CANCELLATION: Should the above described policy be cancelled before the expiration dare thereof, notice wil be delivered in accordance with the policy.
Peng Albees
AUTHORIZED REPRESENTATIVE:
DATE ISSUED: 04/14/2023
City of Rialto Special Events Application Department Routing Sheet BOTB juneteenth jam
DEPARTMENT & CONTACT STATUS
SIGNATURE COMMENT
BUILDING Approved
[email protected] Denied •
(909) 820-2505
BUSINESS LICENSE Approved
ALL VENDORS
[email protected] Denied
(909) 820-2517 NEED BUSLIC
CITY CLERK Approved
[email protected] Denied
(909) 820-2519
COMMUNITY DEVELOPMENT Approved
[email protected] не О
Denied
(909) 820-8070
FIRE Approved
[email protected] Denied
(909) 820-2501
POLICE Approved
[email protected] Denied
(909) 820-2578
PUBLIC WORKS Approved
[email protected] Denied
(909) 820-2602
RISK MANAGEMENT Approved
[email protected] Denied •
(909) 820-2540 Sylua D.
SPECIAL EVENTS PROGRAMMER Approved
[email protected] Denied
(909) 820-8036
WASTE MANAGEMENT Approved
[email protected] Denied Amy Crow Trach 1 Necyal
(909) 421-7222 avatable to cherkdet
SAN BERNARDINO COUNTY Approved
Environmental Health Services Denied
[email protected] Jule Food vendors need
800) 442-2283 health permits
FINAL EVENT APPROVAL:
Approved
Denied
Parks, Recreation, and Community Services Director Date Approved
Denied City Manager
Date
For internal Use
• Reviewed • Committee Meeting Date:
• Department Routing • Permit
Comments: • Approval Letter
Updated 3/2/2023
4 City of Rialto Special Events Application Department Routing Sheet BoTB: juneteentn sam
DEPARTMENT & CONTACT STATUS SIGNATURE COMMENT
BUILDING Approved anners require penn
ampleted sign
[email protected] Denied
application 4 feel.
(909) 820-2505
BUSINESS LICENSE Approved ALL VENDORS
[email protected] Denied NEED BUSLIC
(909) 820-2517
CITY CLERK Approved
[email protected] Denied
(909) 820-2519
COMMUNITY DEVELOPMENT Approved
[email protected] Denied
(909) 820-8070
FIRE Approved
[email protected] Denied
(909) 820-2501
POLICE Approved
[email protected] Denied
(909) 820-2578
PUBLIC WORKS Approved
[email protected] Denied Ofro
(909) 820-2602
RISK MANAGEMENT Approved
[email protected] Denied
(909) 820-2540
SPECIAL EVENTS PROGRAMMER Approved $200 Refundable Damage [email protected] Denied seller Fees
(909) 820-8036 $132.80
WASTE MANAGEMENT Approved Trash & Recyale
[email protected] Denied Amy Crow ontainers are
ivaiable tor checkoul
(909) 421-7222
SAN BERNARDINO COUNTY Approved
Environmental Health Services Denied
yul Next pluge.
[email protected]
(800) 442-2283
FINAL EVENT APPROYAL: 4/25/23
Approved
Denied Parks, Recreatior ind Community Serkices Director Date 4/25/23
Approved
Denied City Manager Date
For internal Use
• Reviewed • Committee Meeting Date: • Department Routing • Permit • Approval Letter Comments:
Updated 3/2/2023
AN, RECRA, C'its af
eSTr 199 RIALTO
150i lou Arena. Rule CA423%
40434
Date: April 25, 2023
To: Vickie Davis
From: Jessica Perez, Recreation Programmer
Re: Summary of Requirements for Juneteenth Jam
The following is the timeline and requirements for the upcoming Juneteenth Jam to be held in the City of Rialto, on Monday, June 19, 2023, at Fergusson Park, 2345 W.
Sunrise Dr., Rialto, CA 92377.
Timeline
Task 1 Due Date
Insurance Certificate Due. Completed
Contact Waste Management for Trash and Recycle containers. 06/15/2023 Please email acrow @rialtoca.gov to schedule pick up time.
Park shelter deposit and fees need to be paid for Shelters 1 & 2 at 06/09/2023 the Parks, Recreation & Community Services office by 5:00 p.m.
The total shelter rental fee for the day is $132.80 not including the $100 refundable damage deposit.
Provide complete list of vendors serving food, or utilizing propane, 06/15/2023 fire extinguishers will be required.
Any changes to your event as described in your Special Event 06/12/2023 Permit Application needs to be requested vla email to
[email protected] no later than 10:00 a.m.
Email final vendors list, including information, food and 6/15/2023 merchandise vendors to Special Events Programmer and
Business Licensing at iperez @rialloca.gov & [email protected] no later than 10:00 a.m. All vendors $5 day business license fees must be paid.
ADDITIONAL PERMITS REQUIRED:
1. Copy of Approved San Bernardino County Environmental Health Services (TFF) permit.
CONDITIONS OF EVENI
1. All amplified sound will not be directed towards business, or homes.
2. Promoter is responsible for all clean up in the park and stage area.
IENTS
• Tents and canopies must adhere to the Rialto Fire Department Tent Requirements and conditions.
• No more than 7-10'10' tents together followed by a 12-foot break. • Adhere to San Bernardino County Environmental Health Services guidelines. • No Smoking in tents/canopies/park.
• Tents/Canopies are to be adequately anchored to withstand weather (wind).
Tents cannot be staked into the grass.
• Generators are to be separated from tents/canopies and buildings by a minimumof 20 feet
MISCELLANEOUS
• All electrical wiring must comply with California Electrical Codes. • Vehicles are not allowed to drive up into the park or in the grass. • Must adhere to all park and shelter use rules. - CHAPTER 2.45 • Violation of any provision of this chapter shall be punishable as an infraction, and the imposition of a fine of one hundred fifty dollars. - CHAPTER 2,45,060
• Requesting changes to your Special Event Permit Application does not guarantee approval for the change. All approved changes will be provided via email from [email protected]
I have read and understood the timeline and requirements governing this special event 1 agree to abide by these rules and regufations. Failure to abide by these rules and regulation, City, State, Federal and County laws, rules, or regulations will forfeit the damage deposit for this event and may result in fines, or having your event shut down 14 (Signature)
Vickie Davis
Black on The Block