CITY OF SAN BERNARDINO
FEE WAIVER REQUEST/SPONSORSHIP FORM
PLEASE PRINT LEGIBLY
Date: 07.13.2026
[ ] Banner ($200.00) Install Date: ________________ Remove Date: _______________ Location: Sole Alley, 4th Street San Bernardino CA
BANNER TEXT: No need for banner
[ ] Filming Permit ($260.00)
[ ] Facility Rental $_________________ Which Facility? Date: ___________________________________________
Time: _ __________________________________________
(Begin) (End)
[ x ] Other-Special Event Permit: Proposed for the Future Green Leaders’ Summit Event for 300 people at Sole Alley for the Chicano Elegance Gala. The Applicant is asking for the waiver of the following fees:
• Special Event Fee: $1279.20
• Public Work Fee: $3052 .92
• Total $4,332.12
APPLICANT/ORGANIZATION INFORMATION
Name: Chicano Elegance and Arts Connection
Address: Sole Alley, 4th Street San Bernardino CA
Phone: 909.251.2860
INSTRUCTIONS FOR APPLICATION
All application must be accompanied by the following:
1. Type of Program/Event
2. Owner/Principals of the Organization
3. Name of the Organization
4. Address of the Organization
5. Clear statement of the total waiver/sponsorship
amount
6. Clear statement of departmental costs (requesting
organization is responsible for obtaining costs from
the appropriate City departments)
7. Proof of Organization Non -Profit/Tax Exempt Status
(example: tax letter stating 501(c)(3) status)
8. Description of the Event
9. Diagram/plot plan of the Event
10. Location f Banner
11. Number of San Bernardino residents benefited
(estimate) 300
07/10/26
Authorized for Submittal Date
OFFICE USE ONLY
Approval Checklist:
___ Type of Program/Event?
___ Owner/Principals of the Organization?
___ Name of the Organization?
___ Address of the Organization?
___ Clear Total?
___ Clear Department Costs?
___ Proof of Tax Status?
___ Description of the Event?
___ Diagram/plot plan of the Event?
___ Location f Banners?
___ Resident Benefit?
___ Total Cost Authorized?
Recommended for Approval:
______________________________________
Print Name Date
______________________________________
Signature Date
Approved:
______________________________________
City Manager Date
CITY OF SAN BERNARDINO
Community Development Department, Planning Division
Office: 201 North E Street, 3rd Floor
Mail: 290 North D Street
San Bernardino, CA 92401
Phone (909) 384-7272 ∙ Fax (909) 384-5155
Web address: www.sbcity.org
GENERAL INFORMATION *for City facilities a Facility Use Agreement Application is also required
Name of Event: Chicano Elegance Location of Activity (Address): Sole Alley, 4th Street San Bernardino CA 92 Organization Name: Chicano Elegance Foundation
Applicant Name: Freddy Calderon Telephone: (909) 333-9235 Mailing Address: 468 W 5th St Ste 218, San Bernardino, CA 92401 On-Site Contact Name: Freddy Calderon Telephone: (909) 333-9235 I declare, under penalty of perjury, that the information on this application is true and correct to the best of my knowledge. I further understand that knowingly providing any false information is cause for the immediate denial of a Special Event Permit or its suspension/revocation if one has been issued. I hereby state that I am aware that it is my responsibility to attempt to maintain order at said event, and will provide such personnel as may be required and approved by the City.
Signature of Applicant: Date Signed: 07/10/2026
DATE(S)/TIME(S) INFORMATION
Set-up Date(s): Sept. 26 2026 Time(s): 8:00am Tear-down Date(s): Sept 26th, 2026 Time(s): 10:00pm - 11:30pm Date(s) of Activity: From: Sept. 26 2026 5:00pm To: Sept. 26 2026 10:00pm Hours of Operation: 5:00pm - 10:00pm
Describe Planned Activities: Fashion runway of chicano fashion, musical performances, exhibit of visual arts includes car paint and body, Photo booth experience, and beer garden open. (See attached)
Expected Attendance: 300
Alcoholic beverage sales/on-site consumption: X Yes No If yes, attach copy of ABC Permit
Will food be prepared on site: X Yes No
If yes, attach copy of County Health Permit
Structures including vendor booths/tents (provided by applicant): X Yes No If yes, type: 0 * Tent 0 * Canopy 3 Booth Fence 4 Portable Toilets Bleachers 1 Stage Other:
Sound System (provided by applicant): X Yes No
If yes, type: Bull Horn Siren X Amplified Sound System Other:
Electrical (provided by applicant): Yes X No
If yes, type: Generator Temp. Power Pole Light String/Booth Lighting Pole Lighting/Flood Lights Rides/Generators Other:
X Property Owner ◻ Agent (A letter of authorization is required to be submitted along with signature below) Name (Please Print): David Friedman Title: Owner
Mailing Address: 395 N E St Ste 104, San Bernardino, CA 92401 Phone: (909) 486-2957 Signature Authorizing this Application: Date: july 10 2026 ◻ Approved By: ◻ Denied By:
Comments:
Permit Number: Application Date: Received By: Receipt No: Fee(s) Paid: Fee(s) Due:
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 San Bernardino without possessing a permit for each such temporary special event. Applications must be turned in 30 business days prior to the event but no sooner than 45 days before events occurance. A Special Event in the City of San Bernardino is defined as; group assemblies with more than 100 attendees and/or for a duration longer than three days, circuses, rodeos, and carnival (subject to compliance with Chapter 5.42 of the Municipal Code), Fairs, Festivals and concerts, when not held within premises designed to accommodate such events, such as auditoriums, stadiums, or other public assembly facilities. Food events (more than 3 trucks), and certified Farmers Markets.
Submittal Requirements Checklist:
Site Plan- should include; north arrow and drawing to scale, dimensions and shape of the lot, location and name of abutting streets and alleys, location of nearest off-site structures on the site, placement/locations of tents/canopies, identification of the use(s) 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, location 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 public right-of-way to the proposed event, location on site landscaping if existing, location of restroom facilities, any equipment, storage, generator, any other materials associated with the event, location of refuse enclosures, and placement/location of temporary signage.
Copy of Facility Reservation application/Authorization Letter, if applicable Copy of County Health Permit, if applicable
Copy of County Fire Department Permit
Copy of ABC License, if applicable
Copy of security contract and potable restroom purchase order, if applicable Copy of certificate of liability insurance
Insurance: Before a Special Event Permit is issued, a certificate of insurance must be submitted. The following may be requirements of your event/organization:
♦ Minimum $1,000,000 General Liability Limit ♦ On an additional insured endorsement the City, its elected officials, officers, and agents are to be named as additional insured
♦ Minimum $1,000,000 General Automobile
Liability
♦ Minimum $1,000,000 Worker’s Compensation ♦ Minimum limits of coverage may change depending on event X Insurance Certificate Attached Insurance Certificate On File Insurance Certificate Not Available Insurance Company: Expiration Date:
Additional fees may apply (i.e. street closures, Police Department Fees, City personnel fees, utilities, facility rental, etc.) Review Process: Once the application is submitted to the Community Development Department, a permit number will be issued. 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. 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.
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.
By signing below, I agree to indemnify, hold harmless, and defend the City and its officials, employees, and agents, against all claims, liabilities, and losses arising from activities connected with or undertaken pursuant to the Permit. The City is not liable for any business loss, property loss, or other damage that may result from the use of the Permit, or suspension or revocation of the Permit.
Name: Signature: Date:
Alejandro Gutierrez Chavez
07/10/2026
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
11384
Nonprofits' Insurance Alliance of California, Inc
A
A
42376
Technology Insurance Company, Inc.
B
AA1122000
Certain Underwriters at Lloyd's of London
C
7/8/2026
(951)694-0625
(951)719-3350
Phone:
Fax:
PSA Insurance Services
PO Box 720
Temecula, California 92593-0720
Arts Connection
PO BOX 1181
San Bernardino, CA 92402
✔
✔
✔
01-CP-0041910-01-04
1/14/2026
1/14/2027
1,000,000
500,000
20,000
1,000,000
2,000,000
2,000,000
✔
✔
01-CP-0041910-01-04
1/14/2026
1/14/2027
1,000,000
Y
TWC4640603
7/25/2025
7/25/2026
✔
1,000,000
1,000,000
1,000,000
Professional Liability
MPL504307226
Each Claim
Aggregate
1/14/2026
1/14/2027
2,000,000
2,000,000
The City of San Bernardino ET AL
Holder's Nature of Interest : Additional Insured
201 N E Street
San Bernardino, CA 92401
✔
Certificate Department
(951)694-0625
(951)719-3350
[email protected]
N
N
N
N
Certificate holder is named as additional insured when required by written per form CG 20 10 12 19 attached 31014
POLICY NUMBER: 01-CP-0041910-01-04 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED 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) Location(s) Of Covered Operations
Any person or organization that you are required to
add as an additional insured on this policy, under a
written contract or agreement currently in effect, or
becoming effective during the term of this policy.
The additional 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
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to provide
for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equipment
furnished in connection with such work, on the
project (other than service, maintenance or
repairs) to be performed by or on behalf of the
additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a principal
as a part of the same project.
C.With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1.Required by the contract or agreement; or
2.Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the applicable
limits of insurance.
E
Chicano Elegance Gala 2026
Event Schedule & Operational Overview
Event Date: September 26, 2026
Location: Sole Alley, 4th Street San Bernardino
Event Timeline
5:00 PM
Gates Open / Guest Check-In Begins
5:00–10:00 PM
Art Gallery, Interactive Artist Exhibits, Photo Booth Experience, and Beer Garden Open 5:30 PM
Opening Ceremony (Approx. 10 minutes)
5:40 PM
Thrifs Presentation (Approx. 10 minutes)
6:00–7:00 PM
Dinner Service
Throughout the Evening
DJ providing continuous music and event atmosphere
Throughout the Evening
Becky Lu serving as Master of Ceremonies (Host)
Throughout the Evening
Martin conducting on-site interviews with artists, designers, performers, sponsors, and guests for event media coverage
Live Performance Program
Performance Block Begins at 7:00 PM
1. Adelaide — 10 minutes
2. Face Vs It — 10 minutes
3. Yetzirah — 10 minutes
4. Jag — 10 minutes
Fashion Runway Showcase
Runway Begins at 9:00 PM
1. OG Family — 7 minutes
2. Gabriela — 7 minutes
3. Mexichic — 7 minutes
Closing Performance
9:30 PM – El Santo Golpe
Closing musical performance (approximately 30 minutes).
Event Activities (5:00 PM – 10:00 PM)
Curated art gallery exhibition
Interactive artist installations and displays
Professional photo booth experience
On-site media interviews conducted by Martin with artists, designers, performers, sponsors, and attendees Beer garden located inside Stronger Together – The Pulse Dinner service (6:00 PM–7:00 PM)
Live DJ entertainment throughout the evening
Master of Ceremonies providing event announcements and transitions This programming is designed to provide continuous engagement for attendees while performances and the fashion showcase occur on the main stage.