PermitPacket2016.pdf

31
DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 East Washington Street, 4th Floor Chicago • Illinois • 60602 City of Chicago Mayor Rahm Emanuel 2016 SPECIAL EVENTS PERMIT PACKAGE www.chicagoneighborhoodfestivals.us

Transcript of PermitPacket2016.pdf

Page 1: PermitPacket2016.pdf

DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 East Washington Street 4th Floor Chicago bull Illinois bull 60602

City of Chicago Mayor Rahm Emanuel

2016 SPECIAL EVENTS PERMIT PACKAGE

wwwchicagoneighborhoodfestivalsus

2016 APPLICATION CHECK LIST

Before you submit your special event application please make sure that the following steps have been completed

GENERAL APPLICATION (Must be completed in full amp submitted 45 calendar days prior to the date of your event) HAVE YOU

Completed all the necessary general information Signed and dated your application Attached a site plan Attached insurance Set up meeting or met with your local Alderman and Commander

Filled out the Art and Entertainment Survey For Athletic events have you filled out the online Chicago Department of Transportation (CDOT)

Athletic Application httpipicityofchicagoorg For Parades (that also include festivals) have you filled out the online Chicago Department

of Transportation (CDOT) Parade Application httpipicityofchicagoorg For events that require street closures have you filled out the online Chicago Department

of Transportation (CDOT) Event Application httpipicityofchicagoorg

FOOD APPLICATIONS (Must be completed in full amp submitted 20 calendar days prior to the date of your event) HAS THE VENDOR

Completely filled out their applications (including menu itemsingredients sources of purchase list of equipment amp cooking times amp temperatures)

Attached a copy of the restaurants most recent Health Department inspection (must be with in 6 months) If new inspection is needed call (312) 746-8030

Filled in their account number or if you do not have one have they attached completed Business Information Sheet

Attached a copycopies of their Summer Festival Food Vendor Sanitation Certificate(s) Please see Resource Guide for class schedule

Has the application been signed by the ownerofficer

MERCHANT APPLICATION (Must be completed in full amp submitted 10 calendar days prior to the date of your event) HAVE YOU

Listed the vendor information or attached a spreadsheet with information Entered a count of the total number of vendors Filled in your (the event organizer) account number or if you do not have one attached a completed Business

Information Sheet Has the application been signed by the ownerofficer

LIQUOR APPLICATION HAS THE VENDOR

Completely filled out the city and state applications (not for profits only need to fill out the state application) Attached a copy of your insurance Attached a detailed security plan Received approval from the local Alderman and Police Commander

Filled in account number Signed by ownerofficer - original signature

All for profit and non-profit liquor applicants must be in good standing with the State of Illinois - the status can be looked up at wwwcyberdriveillinoiscomdepartmentsbusiness_servicescorphtml

There can be no holds or city indebtedness to the City of Chicago on any of your accounts In order to check whether an account has any holds you may call (312) 74-GO BIZ

SUBMIT YOUR COMPLETED SPECIAL EVENT PERMIT APPLICATION TO THE DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E WASHINGTON ST 4TH FLOOR CHICAGO

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 1 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS FOR COMPLETING THE SPECIAL EVENT PERMIT APPLICATION

Careful completion of the form will help to avoid delays in processing It is important that you follow the instructions and provide clear and accurate information Submit all necessary documents with the application Please consult the Special Event Resource Guide for more detailed information

When you fill out this form bull do not use white-out on application or attachments bull type or use a pen with BLACK INK and print clearly bull do not write in the shaded areas

The following sections MUST be completed by the event coordinator for ALL events bull General Event Information bull Security Plan bull Site Plan bull IF THIS IS AN ATHLETIC EVENT You must provide a clear route map and written description of the route and

a copy of your athletic application that was submitted to Chicago Department of Transportation (CDOT) Room 905

Other than those sections mentioned above which must be completed for ALL events only complete those sections that pertain to your individual event

After submitting all forms your application will be reviewed by the departmentrsquos staff The application will be sent to all departments that will be involved in providing services or permits for the event You will be notified if the event has been approved Do not assume that all aspects of the event will be approved you may be asked to make some changes to your plan based on the availability of services and scheduling of other events Therefore you are encouraged NOT TO MAKE ANY OTHER ARRANGEMENTS FOR YOUR EVENT UNTIL APPROVAL FROM THE CITY HAS BEEN RECEIVED

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 2 of 17

Recvd by FOR OFFICE USE ONLY SELA

16 -Scanned by

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ALDERMAN ________________________________________ WARD_________________________ POLICE DISTRICT _____________________________

GENERAL EVENT INFORMATION Name of Event First time event Yes No

Exact Street Address of Event - NO GROVES OR INTERSECTIONS

Date(s) of Event Hours of Event Step-off time (For athletic events only)

to

Phone numberwebsite for publication Estimated attendance Last years actual attendance

Last years location Last years date

Describe the events community andor cultural benefit

Name of Sponsoring Organization Contact person from Sponsoring Organization

Sponsoring Organization Address City Zip

Federal Employee ID Number or Social Security Number if not a corporation

Name of Producing Agent (if applicable) Federal ID Number

Producing Agent Address City Zip

Name of OrganizerCoordinator Email

OrganizerCoordinator Address City Zip

Phone Number Cell Number FAX Number

Name of Emergency Contact Email

Address City Zip

7 day24 hours Phone Number Cell Number FAX Number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 3 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT PERMIT APPLICATION continued

Name of Carnival Company (if applicable) Federal Employee ID Number

The carnival operator must obtain an electrical permit and an elevator permit from the Department of Buildings

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

Are you serving food at your Event NO YES If yes how many vendors This includes if you are the only vendor selling or serving food If yes you must submit the Temporary Food License Application twenty (20) LPG (Liquefied Petroleum Gas) A licensed propane company is required days prior to your event You must obtain a temporary Food Vendor at all festivals when propane usage exceeds 100lbs per booth License for each food vendor

Are you serving beer and wine at your Event NO YES If yes how many vendors If yes you must submit the Special Event Liquor License Application twenty (10) days prior to your event You must obtain a liquor license for each booth that will be serving liquor

Are you selling retail merchandise at your Event NO YES If yes how many vendors If yes you must submit the Itinerant Merchant Application twenty (20) working days prior to your event You must obtain an Itinerant Merchant License for each vendor

Are you erecting a tent over 400 sq ft NO YES If yes a Tent Canopy amp Platform permit is required from the Department of Building Visit the following link

httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you erecting a stageplatform greater than NO YES If yes a Tent Canopy amp Platform permit is required from the 24 in height Department of Building Visit the following link httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you closing the street for your festival NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

Type III barricades and detour signs are required for all Event Street Closure If your street closure has metered parking you will incur meter fees

Is there a Divvy Bike Station located NO YES A copy of this application will be sent to CDOT (Chicago Department of within your street closure Transportation) Project Development Division

Is this an Athletic Event NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

If your course is on or crosses city streets andor sidewalks a CDOT Athletic Public Right of Way Permit needs to be submitted

Will the street closure be on a CTA bus route NO YES If yes include a mapplan for the routing of buses

If yes list CTA Bus Routes impacted by street closure

If yes list CTA Facilities Usage (ie terminals bus turnarounds)

Have you determined how area residents and NO YES If yes include a description of community outreach plan businesses will be notified of street closures parking restrictions

Has the event already been publicized NO YES If yes include a copy of flyermailing or description of efforts

Will live music be performed at the event NO YES If yes how many stages or performance areas for live music will there be

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 4 of 17

SECURITYSAFETY PLAN

Name of Event Date of Event

Name and Date of your event in previous year

Name of Private Security Company (If applicable)

Address City Zip Code

Phone Number Number of Private Security Personnel hired per shift

Describe procedure for carding minors (if applicable)

Describe procedure for preventing over-consumption of alcohol (if applicable)

Please describe a Disaster Plan that addresses emergencies specific to your event (must include a plan for weather related emergencies and cancellations)

Ambulance Provider Contact Name Contact Number

Comments or Special Instructions

If applying for a large scale event liquor license a separate security plan may be requested

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 5 of 17

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
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      242. AddressRow1
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      244. List of Vendors Name of VendorRow2
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      253. List of Vendors Name of VendorRow5
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      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
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      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
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      787. 4Group102 no live music Off
Page 2: PermitPacket2016.pdf

2016 APPLICATION CHECK LIST

Before you submit your special event application please make sure that the following steps have been completed

GENERAL APPLICATION (Must be completed in full amp submitted 45 calendar days prior to the date of your event) HAVE YOU

Completed all the necessary general information Signed and dated your application Attached a site plan Attached insurance Set up meeting or met with your local Alderman and Commander

Filled out the Art and Entertainment Survey For Athletic events have you filled out the online Chicago Department of Transportation (CDOT)

Athletic Application httpipicityofchicagoorg For Parades (that also include festivals) have you filled out the online Chicago Department

of Transportation (CDOT) Parade Application httpipicityofchicagoorg For events that require street closures have you filled out the online Chicago Department

of Transportation (CDOT) Event Application httpipicityofchicagoorg

FOOD APPLICATIONS (Must be completed in full amp submitted 20 calendar days prior to the date of your event) HAS THE VENDOR

Completely filled out their applications (including menu itemsingredients sources of purchase list of equipment amp cooking times amp temperatures)

Attached a copy of the restaurants most recent Health Department inspection (must be with in 6 months) If new inspection is needed call (312) 746-8030

Filled in their account number or if you do not have one have they attached completed Business Information Sheet

Attached a copycopies of their Summer Festival Food Vendor Sanitation Certificate(s) Please see Resource Guide for class schedule

Has the application been signed by the ownerofficer

MERCHANT APPLICATION (Must be completed in full amp submitted 10 calendar days prior to the date of your event) HAVE YOU

Listed the vendor information or attached a spreadsheet with information Entered a count of the total number of vendors Filled in your (the event organizer) account number or if you do not have one attached a completed Business

Information Sheet Has the application been signed by the ownerofficer

LIQUOR APPLICATION HAS THE VENDOR

Completely filled out the city and state applications (not for profits only need to fill out the state application) Attached a copy of your insurance Attached a detailed security plan Received approval from the local Alderman and Police Commander

Filled in account number Signed by ownerofficer - original signature

All for profit and non-profit liquor applicants must be in good standing with the State of Illinois - the status can be looked up at wwwcyberdriveillinoiscomdepartmentsbusiness_servicescorphtml

There can be no holds or city indebtedness to the City of Chicago on any of your accounts In order to check whether an account has any holds you may call (312) 74-GO BIZ

SUBMIT YOUR COMPLETED SPECIAL EVENT PERMIT APPLICATION TO THE DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E WASHINGTON ST 4TH FLOOR CHICAGO

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 1 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS FOR COMPLETING THE SPECIAL EVENT PERMIT APPLICATION

Careful completion of the form will help to avoid delays in processing It is important that you follow the instructions and provide clear and accurate information Submit all necessary documents with the application Please consult the Special Event Resource Guide for more detailed information

When you fill out this form bull do not use white-out on application or attachments bull type or use a pen with BLACK INK and print clearly bull do not write in the shaded areas

The following sections MUST be completed by the event coordinator for ALL events bull General Event Information bull Security Plan bull Site Plan bull IF THIS IS AN ATHLETIC EVENT You must provide a clear route map and written description of the route and

a copy of your athletic application that was submitted to Chicago Department of Transportation (CDOT) Room 905

Other than those sections mentioned above which must be completed for ALL events only complete those sections that pertain to your individual event

After submitting all forms your application will be reviewed by the departmentrsquos staff The application will be sent to all departments that will be involved in providing services or permits for the event You will be notified if the event has been approved Do not assume that all aspects of the event will be approved you may be asked to make some changes to your plan based on the availability of services and scheduling of other events Therefore you are encouraged NOT TO MAKE ANY OTHER ARRANGEMENTS FOR YOUR EVENT UNTIL APPROVAL FROM THE CITY HAS BEEN RECEIVED

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 2 of 17

Recvd by FOR OFFICE USE ONLY SELA

16 -Scanned by

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ALDERMAN ________________________________________ WARD_________________________ POLICE DISTRICT _____________________________

GENERAL EVENT INFORMATION Name of Event First time event Yes No

Exact Street Address of Event - NO GROVES OR INTERSECTIONS

Date(s) of Event Hours of Event Step-off time (For athletic events only)

to

Phone numberwebsite for publication Estimated attendance Last years actual attendance

Last years location Last years date

Describe the events community andor cultural benefit

Name of Sponsoring Organization Contact person from Sponsoring Organization

Sponsoring Organization Address City Zip

Federal Employee ID Number or Social Security Number if not a corporation

Name of Producing Agent (if applicable) Federal ID Number

Producing Agent Address City Zip

Name of OrganizerCoordinator Email

OrganizerCoordinator Address City Zip

Phone Number Cell Number FAX Number

Name of Emergency Contact Email

Address City Zip

7 day24 hours Phone Number Cell Number FAX Number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 3 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT PERMIT APPLICATION continued

Name of Carnival Company (if applicable) Federal Employee ID Number

The carnival operator must obtain an electrical permit and an elevator permit from the Department of Buildings

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

Are you serving food at your Event NO YES If yes how many vendors This includes if you are the only vendor selling or serving food If yes you must submit the Temporary Food License Application twenty (20) LPG (Liquefied Petroleum Gas) A licensed propane company is required days prior to your event You must obtain a temporary Food Vendor at all festivals when propane usage exceeds 100lbs per booth License for each food vendor

Are you serving beer and wine at your Event NO YES If yes how many vendors If yes you must submit the Special Event Liquor License Application twenty (10) days prior to your event You must obtain a liquor license for each booth that will be serving liquor

Are you selling retail merchandise at your Event NO YES If yes how many vendors If yes you must submit the Itinerant Merchant Application twenty (20) working days prior to your event You must obtain an Itinerant Merchant License for each vendor

Are you erecting a tent over 400 sq ft NO YES If yes a Tent Canopy amp Platform permit is required from the Department of Building Visit the following link

httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you erecting a stageplatform greater than NO YES If yes a Tent Canopy amp Platform permit is required from the 24 in height Department of Building Visit the following link httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you closing the street for your festival NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

Type III barricades and detour signs are required for all Event Street Closure If your street closure has metered parking you will incur meter fees

Is there a Divvy Bike Station located NO YES A copy of this application will be sent to CDOT (Chicago Department of within your street closure Transportation) Project Development Division

Is this an Athletic Event NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

If your course is on or crosses city streets andor sidewalks a CDOT Athletic Public Right of Way Permit needs to be submitted

Will the street closure be on a CTA bus route NO YES If yes include a mapplan for the routing of buses

If yes list CTA Bus Routes impacted by street closure

If yes list CTA Facilities Usage (ie terminals bus turnarounds)

Have you determined how area residents and NO YES If yes include a description of community outreach plan businesses will be notified of street closures parking restrictions

Has the event already been publicized NO YES If yes include a copy of flyermailing or description of efforts

Will live music be performed at the event NO YES If yes how many stages or performance areas for live music will there be

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 4 of 17

SECURITYSAFETY PLAN

Name of Event Date of Event

Name and Date of your event in previous year

Name of Private Security Company (If applicable)

Address City Zip Code

Phone Number Number of Private Security Personnel hired per shift

Describe procedure for carding minors (if applicable)

Describe procedure for preventing over-consumption of alcohol (if applicable)

Please describe a Disaster Plan that addresses emergencies specific to your event (must include a plan for weather related emergencies and cancellations)

Ambulance Provider Contact Name Contact Number

Comments or Special Instructions

If applying for a large scale event liquor license a separate security plan may be requested

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 5 of 17

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
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      461. Email Address
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      747. city
      748. state
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      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
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      772. 4Group102 cta Off
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      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
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      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 3: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS FOR COMPLETING THE SPECIAL EVENT PERMIT APPLICATION

Careful completion of the form will help to avoid delays in processing It is important that you follow the instructions and provide clear and accurate information Submit all necessary documents with the application Please consult the Special Event Resource Guide for more detailed information

When you fill out this form bull do not use white-out on application or attachments bull type or use a pen with BLACK INK and print clearly bull do not write in the shaded areas

The following sections MUST be completed by the event coordinator for ALL events bull General Event Information bull Security Plan bull Site Plan bull IF THIS IS AN ATHLETIC EVENT You must provide a clear route map and written description of the route and

a copy of your athletic application that was submitted to Chicago Department of Transportation (CDOT) Room 905

Other than those sections mentioned above which must be completed for ALL events only complete those sections that pertain to your individual event

After submitting all forms your application will be reviewed by the departmentrsquos staff The application will be sent to all departments that will be involved in providing services or permits for the event You will be notified if the event has been approved Do not assume that all aspects of the event will be approved you may be asked to make some changes to your plan based on the availability of services and scheduling of other events Therefore you are encouraged NOT TO MAKE ANY OTHER ARRANGEMENTS FOR YOUR EVENT UNTIL APPROVAL FROM THE CITY HAS BEEN RECEIVED

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 2 of 17

Recvd by FOR OFFICE USE ONLY SELA

16 -Scanned by

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ALDERMAN ________________________________________ WARD_________________________ POLICE DISTRICT _____________________________

GENERAL EVENT INFORMATION Name of Event First time event Yes No

Exact Street Address of Event - NO GROVES OR INTERSECTIONS

Date(s) of Event Hours of Event Step-off time (For athletic events only)

to

Phone numberwebsite for publication Estimated attendance Last years actual attendance

Last years location Last years date

Describe the events community andor cultural benefit

Name of Sponsoring Organization Contact person from Sponsoring Organization

Sponsoring Organization Address City Zip

Federal Employee ID Number or Social Security Number if not a corporation

Name of Producing Agent (if applicable) Federal ID Number

Producing Agent Address City Zip

Name of OrganizerCoordinator Email

OrganizerCoordinator Address City Zip

Phone Number Cell Number FAX Number

Name of Emergency Contact Email

Address City Zip

7 day24 hours Phone Number Cell Number FAX Number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 3 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT PERMIT APPLICATION continued

Name of Carnival Company (if applicable) Federal Employee ID Number

The carnival operator must obtain an electrical permit and an elevator permit from the Department of Buildings

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

Are you serving food at your Event NO YES If yes how many vendors This includes if you are the only vendor selling or serving food If yes you must submit the Temporary Food License Application twenty (20) LPG (Liquefied Petroleum Gas) A licensed propane company is required days prior to your event You must obtain a temporary Food Vendor at all festivals when propane usage exceeds 100lbs per booth License for each food vendor

Are you serving beer and wine at your Event NO YES If yes how many vendors If yes you must submit the Special Event Liquor License Application twenty (10) days prior to your event You must obtain a liquor license for each booth that will be serving liquor

Are you selling retail merchandise at your Event NO YES If yes how many vendors If yes you must submit the Itinerant Merchant Application twenty (20) working days prior to your event You must obtain an Itinerant Merchant License for each vendor

Are you erecting a tent over 400 sq ft NO YES If yes a Tent Canopy amp Platform permit is required from the Department of Building Visit the following link

httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you erecting a stageplatform greater than NO YES If yes a Tent Canopy amp Platform permit is required from the 24 in height Department of Building Visit the following link httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you closing the street for your festival NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

Type III barricades and detour signs are required for all Event Street Closure If your street closure has metered parking you will incur meter fees

Is there a Divvy Bike Station located NO YES A copy of this application will be sent to CDOT (Chicago Department of within your street closure Transportation) Project Development Division

Is this an Athletic Event NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

If your course is on or crosses city streets andor sidewalks a CDOT Athletic Public Right of Way Permit needs to be submitted

Will the street closure be on a CTA bus route NO YES If yes include a mapplan for the routing of buses

If yes list CTA Bus Routes impacted by street closure

If yes list CTA Facilities Usage (ie terminals bus turnarounds)

Have you determined how area residents and NO YES If yes include a description of community outreach plan businesses will be notified of street closures parking restrictions

Has the event already been publicized NO YES If yes include a copy of flyermailing or description of efforts

Will live music be performed at the event NO YES If yes how many stages or performance areas for live music will there be

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 4 of 17

SECURITYSAFETY PLAN

Name of Event Date of Event

Name and Date of your event in previous year

Name of Private Security Company (If applicable)

Address City Zip Code

Phone Number Number of Private Security Personnel hired per shift

Describe procedure for carding minors (if applicable)

Describe procedure for preventing over-consumption of alcohol (if applicable)

Please describe a Disaster Plan that addresses emergencies specific to your event (must include a plan for weather related emergencies and cancellations)

Ambulance Provider Contact Name Contact Number

Comments or Special Instructions

If applying for a large scale event liquor license a separate security plan may be requested

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 5 of 17

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
      534. Radio Button23 Off
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      538. Radio Button27 Off
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      540. Radio Button29 Off
      541. Radio Button30 Off
      542. Text31
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      546. Text55
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      562. Text95
      563. Text96
      564. Text97
      565. Text98
      566. Text99
      567. Text100
      568. Radio Button101 Off
      569. Radio Button102 Off
      570. Radio Button103 Off
      571. Radio Button104 Off
      572. Radio Button105 Off
      573. Text106
      574. Text107
      575. Text108
      576. Text109
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      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 4: PermitPacket2016.pdf

Recvd by FOR OFFICE USE ONLY SELA

16 -Scanned by

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ALDERMAN ________________________________________ WARD_________________________ POLICE DISTRICT _____________________________

GENERAL EVENT INFORMATION Name of Event First time event Yes No

Exact Street Address of Event - NO GROVES OR INTERSECTIONS

Date(s) of Event Hours of Event Step-off time (For athletic events only)

to

Phone numberwebsite for publication Estimated attendance Last years actual attendance

Last years location Last years date

Describe the events community andor cultural benefit

Name of Sponsoring Organization Contact person from Sponsoring Organization

Sponsoring Organization Address City Zip

Federal Employee ID Number or Social Security Number if not a corporation

Name of Producing Agent (if applicable) Federal ID Number

Producing Agent Address City Zip

Name of OrganizerCoordinator Email

OrganizerCoordinator Address City Zip

Phone Number Cell Number FAX Number

Name of Emergency Contact Email

Address City Zip

7 day24 hours Phone Number Cell Number FAX Number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 3 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT PERMIT APPLICATION continued

Name of Carnival Company (if applicable) Federal Employee ID Number

The carnival operator must obtain an electrical permit and an elevator permit from the Department of Buildings

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

Are you serving food at your Event NO YES If yes how many vendors This includes if you are the only vendor selling or serving food If yes you must submit the Temporary Food License Application twenty (20) LPG (Liquefied Petroleum Gas) A licensed propane company is required days prior to your event You must obtain a temporary Food Vendor at all festivals when propane usage exceeds 100lbs per booth License for each food vendor

Are you serving beer and wine at your Event NO YES If yes how many vendors If yes you must submit the Special Event Liquor License Application twenty (10) days prior to your event You must obtain a liquor license for each booth that will be serving liquor

Are you selling retail merchandise at your Event NO YES If yes how many vendors If yes you must submit the Itinerant Merchant Application twenty (20) working days prior to your event You must obtain an Itinerant Merchant License for each vendor

Are you erecting a tent over 400 sq ft NO YES If yes a Tent Canopy amp Platform permit is required from the Department of Building Visit the following link

httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you erecting a stageplatform greater than NO YES If yes a Tent Canopy amp Platform permit is required from the 24 in height Department of Building Visit the following link httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you closing the street for your festival NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

Type III barricades and detour signs are required for all Event Street Closure If your street closure has metered parking you will incur meter fees

Is there a Divvy Bike Station located NO YES A copy of this application will be sent to CDOT (Chicago Department of within your street closure Transportation) Project Development Division

Is this an Athletic Event NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

If your course is on or crosses city streets andor sidewalks a CDOT Athletic Public Right of Way Permit needs to be submitted

Will the street closure be on a CTA bus route NO YES If yes include a mapplan for the routing of buses

If yes list CTA Bus Routes impacted by street closure

If yes list CTA Facilities Usage (ie terminals bus turnarounds)

Have you determined how area residents and NO YES If yes include a description of community outreach plan businesses will be notified of street closures parking restrictions

Has the event already been publicized NO YES If yes include a copy of flyermailing or description of efforts

Will live music be performed at the event NO YES If yes how many stages or performance areas for live music will there be

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 4 of 17

SECURITYSAFETY PLAN

Name of Event Date of Event

Name and Date of your event in previous year

Name of Private Security Company (If applicable)

Address City Zip Code

Phone Number Number of Private Security Personnel hired per shift

Describe procedure for carding minors (if applicable)

Describe procedure for preventing over-consumption of alcohol (if applicable)

Please describe a Disaster Plan that addresses emergencies specific to your event (must include a plan for weather related emergencies and cancellations)

Ambulance Provider Contact Name Contact Number

Comments or Special Instructions

If applying for a large scale event liquor license a separate security plan may be requested

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 5 of 17

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
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      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
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      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
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      88. STREET 2_3
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      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
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      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
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      187. undefined_4
      188. undefined_5
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      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
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      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
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      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
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      756. Year
      757. name of carnival company
      758. federal employee ID number
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Page 5: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT PERMIT APPLICATION continued

Name of Carnival Company (if applicable) Federal Employee ID Number

The carnival operator must obtain an electrical permit and an elevator permit from the Department of Buildings

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

Are you serving food at your Event NO YES If yes how many vendors This includes if you are the only vendor selling or serving food If yes you must submit the Temporary Food License Application twenty (20) LPG (Liquefied Petroleum Gas) A licensed propane company is required days prior to your event You must obtain a temporary Food Vendor at all festivals when propane usage exceeds 100lbs per booth License for each food vendor

Are you serving beer and wine at your Event NO YES If yes how many vendors If yes you must submit the Special Event Liquor License Application twenty (10) days prior to your event You must obtain a liquor license for each booth that will be serving liquor

Are you selling retail merchandise at your Event NO YES If yes how many vendors If yes you must submit the Itinerant Merchant Application twenty (20) working days prior to your event You must obtain an Itinerant Merchant License for each vendor

Are you erecting a tent over 400 sq ft NO YES If yes a Tent Canopy amp Platform permit is required from the Department of Building Visit the following link

httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you erecting a stageplatform greater than NO YES If yes a Tent Canopy amp Platform permit is required from the 24 in height Department of Building Visit the following link httpwwwcityofchicagoorgcityendeptsbldgsprovdrsstand_planalerts2015junenew-permit-procedures-in-effect-for-tents--canopy-and-stages-plahtml

Are you closing the street for your festival NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

Type III barricades and detour signs are required for all Event Street Closure If your street closure has metered parking you will incur meter fees

Is there a Divvy Bike Station located NO YES A copy of this application will be sent to CDOT (Chicago Department of within your street closure Transportation) Project Development Division

Is this an Athletic Event NO YES If yes a permit application must be submitted by visiting the following link ipicityofchicagoorg

If your course is on or crosses city streets andor sidewalks a CDOT Athletic Public Right of Way Permit needs to be submitted

Will the street closure be on a CTA bus route NO YES If yes include a mapplan for the routing of buses

If yes list CTA Bus Routes impacted by street closure

If yes list CTA Facilities Usage (ie terminals bus turnarounds)

Have you determined how area residents and NO YES If yes include a description of community outreach plan businesses will be notified of street closures parking restrictions

Has the event already been publicized NO YES If yes include a copy of flyermailing or description of efforts

Will live music be performed at the event NO YES If yes how many stages or performance areas for live music will there be

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 4 of 17

SECURITYSAFETY PLAN

Name of Event Date of Event

Name and Date of your event in previous year

Name of Private Security Company (If applicable)

Address City Zip Code

Phone Number Number of Private Security Personnel hired per shift

Describe procedure for carding minors (if applicable)

Describe procedure for preventing over-consumption of alcohol (if applicable)

Please describe a Disaster Plan that addresses emergencies specific to your event (must include a plan for weather related emergencies and cancellations)

Ambulance Provider Contact Name Contact Number

Comments or Special Instructions

If applying for a large scale event liquor license a separate security plan may be requested

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 5 of 17

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
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      743. Liquor License Legal Name
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      751. restaurant Off
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      753. to am pm
      754. Print name
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      756. Year
      757. name of carnival company
      758. federal employee ID number
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      760. yes cta bus routes
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      782. How many arts organizations participated including forprofit and nonprofit
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      787. 4Group102 no live music Off
Page 6: PermitPacket2016.pdf

SECURITYSAFETY PLAN

Name of Event Date of Event

Name and Date of your event in previous year

Name of Private Security Company (If applicable)

Address City Zip Code

Phone Number Number of Private Security Personnel hired per shift

Describe procedure for carding minors (if applicable)

Describe procedure for preventing over-consumption of alcohol (if applicable)

Please describe a Disaster Plan that addresses emergencies specific to your event (must include a plan for weather related emergencies and cancellations)

Ambulance Provider Contact Name Contact Number

Comments or Special Instructions

If applying for a large scale event liquor license a separate security plan may be requested

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 5 of 17

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
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      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
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      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
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      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
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      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
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      753. to am pm
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      756. Year
      757. name of carnival company
      758. federal employee ID number
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      762. of Liq vendors
      763. of Merch Vendors
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      787. 4Group102 no live music Off
Page 7: PermitPacket2016.pdf

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________ ____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF TRANSPORTATION STREET CLOSURE INFORMATION

Name of Event Date(s) of Event

Please check one of the following FEE $25 BOULEVARD _____ ARTERIAL STREET(S)____ RESIDENTIAL STREET(S) ____ CURB LANE _____ SIDEWALK ONLY _____

Identify street name with numerical address range(s) with direction as in example Example Clark 5201(N) 5459 (N) 60104-6504 8am-11pm

Public Way Intended for Festival Set Up STREET FROM TO DATES TIMES

Public Way Intended for Event STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

Public Way Intended for Festival Tear Down STREET FROM TO DATES TIMES

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

____________________ __________ ___________ _____________ _____________

If an athletic event is produced along with the Festival please attach a course map and written description of route COMMENTS

Type III Barricade Company 24 Hour Phone Number

TYPE III BARRICADES ARE REQUIRED FOR ALL STREET CLOSURES REFER TO PAGE 3 OF THE RESOURCE GUIDE A detailed traffic and reroute plan is required for your event The plan must be submitted along with your Special Event application request to the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 78 E Washington St 4th Floor and to the Chicago Police Department Special Events Section - Unit 136 3510 S Michigan Ave Chicago IL 60653

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 6 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
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      692. state 3
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      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
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      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
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      766. 111a Off
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      772. 4Group102 cta Off
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      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 8: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION CITY SERVICE REQUESTS

Name of Event Date(s) of Event

Name and Date of your event in previous year

City Service Provided in

(Year) Current Request

(Year) Comments

Posting of No Parking Signs Street Closure Permit must be submitted

Towing

Snow Fence (indicate amount needed in feet)

Delivered in 50 foot bundles Maximum 50 bundles

Refuse Drums Number of drums will be determined by Department of Streets amp Sanitation

50 drums maximum

Refuse Collection Limited to after the event

Street Sweeping Limited to after the event

All the above services and equipment are subject to overtime costs and availability Refer to Guidelines for Obtaining City Services and Rate chart in the Special Event Resource Guide Book (pages 5 amp 6) After review of services with our Special services office (312) 744-1912 the organizer must submit a letter to Commissioner Charles Williams of Streets amp Sanitation highlighting the services and equipment needed stating responsibility for the return of all equipment borshyrowed or the reimbursement cost of lost or abused equipment (barricades brooms cones refuse drums recycle drums and snow fence shovels amp supercarts)

Name of Private Scavenger Company (if applicable) Contact Name 24 Hour Phone number

Name of Maintenance Company (if applicable) Contact Name 24 Hour Phone number

Type III Barricade company (if applicable) Contact Name 24 Hour Phone number

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 7 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
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      210. Food Item 2_3
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      212. Food Item 4_3
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      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
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      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
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      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
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      457. Zip code
      458. Home Phone
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      461. Email Address
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      463. Title Secretary Managing Member Other
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      486. Home Phone_3
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      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
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      711. Text45zz
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      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
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      738. Ward
      739. Name of Event
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      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
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      771. 4Group102 beer Off
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      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
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      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 9: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

DEPARTMENT OF STREETS AND SANITATION RECYCLING PLAN

Method of Garbage Collection City Private Scavenger

Method of Recyclable Materials Collection City Private Scavenger

Private Scavenger Company Name Contact for Recycling

If you do not have city collection how will you collect recyclables from the public

How will recyclables be collected from the vendorsmerchants

What recyclable materials will be collected from the public Cans and bottles Paper materials Other

What recyclable materials will be collected from vendormerchants Cans and bottles Paper materials Other

How will you notify the vendorsmerchants about their recycling options

How will you monitor the recycling throughout the event to avoid contamination problems

Contact the recycling hotline at (312) 744-1614 with any questions

NOISE CONTROL PLAN

Will electronic sound amplification equipment or a public address system be used at the event Yes No If yes Indicate on the Site Plan the location of the stages and sound systems the location and direction of all speakers and the prox-imity to residential addresses

Amplified sound will be used FROM_____________AMPM TO_____________AMPM

Describe the sound system(s)

Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary

The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor-dance with Section 11-4-1110 et seq of the Municipal Code and regulations promulgated thereunder Contact the Department of Environment at (312) 744-7606 with any questions

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 8 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
      534. Radio Button23 Off
      535. Radio Button24 Off
      536. Radio Button25 Off
      537. Radio Button26 Off
      538. Radio Button27 Off
      539. Radio Button28 Off
      540. Radio Button29 Off
      541. Radio Button30 Off
      542. Text31
      543. Text32
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      566. Text99
      567. Text100
      568. Radio Button101 Off
      569. Radio Button102 Off
      570. Radio Button103 Off
      571. Radio Button104 Off
      572. Radio Button105 Off
      573. Text106
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      637. Radio Button171 Off
      638. Radio Button172 Off
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      640. Radio Button174 Off
      641. Radio Button175 Off
      642. Radio Button176 Off
      643. Radio Button177 Off
      644. Radio Button178 Off
      645. Radio Button179 Off
      646. Radio Button180 Off
      647. Radio Button181 Off
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      649. Text185
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      658. Group126 Off
      659. Group127 Off
      660. Group128 Off
      661. Group129 Off
      662. Group130 Off
      663. Titlexxx
      664. Group1225 Off
      665. Group131 Off
      666. Group999 Off
      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
      672. City5
      673. Phone Number_61
      674. 25aa
      675. 25ab
      676. 25bc
      677. 24mm
      678. 24am
      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
      686. 21bcity
      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
      693. 23zip
      694. 23a zipp
      695. 23b zippw
      696. Text54file
      697. Textyearsz
      698. Group122 Off
      699. Group124 Off
      700. Group8s Off
      701. Group888 Off
      702. 27az
      703. Date_4z
      704. Group1a2 Off
      705. Group1b1 Off
      706. Group1c1 Off
      707. 31zz
      708. Check Box28 Off
      709. Group1c1c Off
      710. Group1c1d Off
      711. Text45zz
      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
      719. 27addd
      720. ppp 1
      721. Text11bb
      722. Text12ss
      723. Text15v
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      725. Text41sit
      726. Text43sac
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      728. Text45ll
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      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 10: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SITE PLAN

Please use this Site Plan to illustrate the layout of your event If you need additional space please attach a separate sheet

If applicable the following must be included Location of food vendors (FV) Location of beverage vendors both non-alcoholic (NAB) and alcoholic beverages (AB) along with number of serving stations at each location Location of toilets (T) Location of hand washing sinks (HWS) Location of retail merchants (RM) Location of First Aid (+) Location of garbage receptacles (G) and recycling receptacles (R) Show walk run and bike routes if athletic event Location and number of Type III Barricades (III) Location of fire lane (FL) Location of fire extinguishers (FE) Public entrances and exits Location of sound stages and amplified sound Location of residential streets surrounding event Location of ldquoFREE ADMISSION - DONATIONS ACCEPTEDrdquo sign Location of existing Divvy Bike Station (D)

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 9 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
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      674. 25aa
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      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
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      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
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      695. 23b zippw
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      735. Text10fed empl
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      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 11: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

TERMS AND CONDITIONS

The applicant must promptly reimburse the City for (and make good to it) any and all damage of any kind to any property of the City which may result from the use by the applicant of the Cityrsquos premises under the permission granted herein and the applicant further agrees that it will not hold liable the City for or in account of any loss or damage to property owned by it or controlled by the applicant or for or on account of any loss or damage susshytained by the applicant as a result of injuries to employees or agents of the applicant

By checking this box I agree that the information in this application is true and correct to the best of my knowledge

I agree to inform the CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS and the Chicago Police Department

of any changes in this application at least 20 days prior to the date of the event

I agree to the terms and conditions listed above

Electronic Signature of Organizer Date

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 10 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
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      756. Year
      757. name of carnival company
      758. federal employee ID number
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      787. 4Group102 no live music Off
Page 12: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE COMPLETED IN FULL amp SUBMITTED 45 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENTS POLICE DISTRICT COMMANDERrsquoS REVIEW LETTER

All organizersapplicants for a special event must make an appointment with the Local Police District Commander for the purpose of reviewing the plan for the proposed event The review by the District Commander must be scheduled at least forty-five (45) calendar days prior to the event Each applicant must bring a site plan and security plan for the event If liquor is to be served the site plan must include the liquor booth location(s) and the number of serving stations in each booth For athletic events a completed review letter is needed from all districts Commanders impacted by the course

ALDERMAN ________________________________________ WARD_______________

Please check all that apply FESTIVAL CARNIVAL ATHLETIC EVENT PARADE OTHER

THE DISTRICT COMMANDER MUST COMPLETE THE FOLLOWING

I have reviewed the proposed plan for_________________________________________________________________________________________________ NAME OF SPECIAL EVENT

to be held on____________________________________________________between the hours of________________________________________________ DATE(S) OF EVENT HOURS OF EVENT

at____________________________________________________in the___________________________________________________District LOCATION OF EVENT NUMBER

Liquor will be served at_______locations (ie booths) from______serving stations (ie taps) per location as designated on the attached Site Plan

Liquor will not be served

Street(s) will be closed Street Closed___________________From___________________to ____________________ (Intersecting street) (Intersecting street) Street(s) will not be closed

Walkathons and walks are athletic events requiring payment for police services at an overtime rate

Races and walks may require Traffic Control Aides or Police Officers at every intersection

COMMANDERrsquoS OBJECTION NO OBJECTION

COMMENTS ANDOR REASONS

Signature of Police District Commander Date

Print Name District

Note The original copy of this form will be forwarded to the Coordinator Special Events and Liaison SectionOOS (Unit 136) via police mail by the District Commander

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 11 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
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      216. Food Item 4_4
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      218. Dates of Event_5
      219. Hours of Event_2
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      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
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      244. List of Vendors Name of VendorRow2
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      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
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      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
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      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
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      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 13: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ART AND ENTERTAINMENT SURVEY Please complete

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

Types of ArtsEntertainment in 2016 Neighborhood Special Events

Will your event in 2016 include any of the following Check all that apply

[ ] Live Music (singers bands DJs rappers soloists musicians) [ ] Dance [ ] Theater [ ] FilmMedia [ ] ArtsCraft-Making [ ] Kids ArtsCraft-Making [ ] Circus Arts [ ] LiteraryStorytelling [ ] Performance Art [ ] Visual Art (includes sculpture) [ ] Public Art Installation [ ] Culinary Arts Demonstrations (not including food salesvendors) [ ] FarmersLocally Produced Food and Beverage [ ] Fashion (designers boutiques manufacturers suppliers) [ ] Other ____________________________________

Did you produce this event in 2015 [ ] Yes [ ] No

If yes in 2015

How many live music acts participated __________ Number of live music acts paid for participating __________

How many arts organizations participated (including for-profit and non-profit) __________

Number of arts organizations paid for participating __________

In all art forms how many individual artists (persons) participated __________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 12 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
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      279. 1 Off
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      285. )>NAME Row 2
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      290. 11
      291. 12 Off
      292. 13
      293. 14
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      299. 22c
      300. 23c
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      305. 32
      306. 33
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      308. 35
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      345. 11 TEXT
      346. SPECIFY
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      357. 15D
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      360. 18D
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      408. Check Box37 Off
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      411. Check Box96 Off
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      418. Text2
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      429. undefined_2
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      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
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      667. Text22
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      669. City2
      670. City3
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      672. City5
      673. Phone Number_61
      674. 25aa
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      677. 24mm
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      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 14: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

EVENT INFORMATION Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Event Sponsor Event Coordinator Phone Number

VENDOR INFORMATION Name of Food Vendor Contact Phone Number

Department of Business Affairs amp Consumer Protection BUSINESS ACCOUNT NUMBER (6 digits) _____ _____ _____ _____ _____ _____ If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the City of Chicago Business Information Sheets on pages 26 amp 27 of this packet or visit wwwcityofchicagoorgbusinessaffairs

Address of Food Vendor City Zip Code

Summer Festival Food Vendor Sanitation Certificate Number Each event requires a Certified person at each booth at all times food is handled

Print Name____________________________________________________________Title ______________________________________________________

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

List the name and address of the licensed kitchen or food establishment to be used for the initial food preparation and storage of equipment (where food is to be actually prepared and equipment is sanitized and stored) Food or equipment may not be stored in the home (Attached signed Affidavit)

Describe the method of transporting food and the temperature it will be held at the event site (ie refrigerated cold storage containers refrigerated vehicle capable of maintaining temperatures of 40deg F or below hot foods 140deg F or above)

Describe the method of storage at the event site (ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of 40deg F or below) Hot foods must be maintained at a temperature of 140deg F or above List the temperatures food items will be cooked to

Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan

Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 13 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
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      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
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      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
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      667. Text22
      668. City1
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      674. 25aa
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      676. 25bc
      677. 24mm
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      681. 111
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      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 15: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS SPECIAL EVENT FOOD LICENSE APPLICATION continued

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED All vendors must have a passing inspection dated not more than six months before the event Non-Chicago establishments must submit their latest sanitation report from their local Health Department jurisdiction dated no more than six months before the event A copy of the following must be attached to each application Site Plan Summer Festival Food Vendor sanitation certificates(s) signed affidavit if you received permission to use a licensed kitchen A copy of your current health inspection must be attached to each application

SPECIAL EVENTS MENU APPROVAL REQUEST

Must Be Filled Out (Provide detailed information for each question) Requirements may be imposed to protect the publics health or to prohibit the sale of some or all potentially hazardous foods such as raw foods sushi or oysters When no health hazard exists some requirements may be waived

List the proposed foods and ingredients to be served at the event You may list up to 4 items on one sheet (use back of sheet if necessary)

Food Item 1

Food Item 2

Food Item 3

Food Item 4

List source where items will be purchased (Name Address Phone Number retain all receipts for inspection) Food Item 1

Food Item 2

Food Item 3

Food Item 4

List any equipment that may be used at the event in the preparation of food or beverages (ie mixers blenders etc include drawings amp specifications

Food Item 1

Food Item 2

Food Item 3

Food Item 4

Describe the method of cooking at the event Raw animal products must be cooked to the following internal temperature for at least 15 seconds Poultry and stuffed foods - 165deg F Pork ground diced or shredded meats and fish eggs cooked in advanced - 155deg F whole cut meats and fish eggs 145deg F List the temperatures food items will be cooked to Food Item 1

Food Item 2

Food Item 3

Food Item 4

gt ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE DENIED lt

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 14 of 17

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
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      285. )>NAME Row 2
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      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
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      306. 33
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      449. Title Sole Proprietor President Managing Member Other
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      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
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      530. Check Box81 Off
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      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
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      775. 4Group102 tent Off
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      779. 4Group102 athletic Off
      780. Text1
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      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 16: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF Business and Consumer Protection

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

SPECIAL EVENT FOOD TRUCK SINGLE EVENT LICENSE APPLICATION

FEE $ 7500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO

Please type or print clearly Application will be returned if not completed in itrsquos entirety

Name of Event

Address of Event

Date(s) of Event Hours of Event

Name of Sponsoring EventCoordinator Phone Number

Name of Mobile Food Vendor Contact

Department of Business Affairs amp Consumer Protection Account Number Phone Number

Department of Business Affairs amp Consumer Protection account

Address City Zip Code

Mobile Food License License Expiration Date

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago

I acknowledge that I am only preparingdispensing food directly from a City of Chicago licensed Mobile Food vehicle (no outside boothtent) in compliance with all license requirements NO YES

I acknowledge that I am only selling items from our City of Chicago Department of Health pre-approved menu NO YES

SIGNATURE (Must be signed by an owner or officer) ______________________________________________ Date __________________________

Print Name____________________________________________________________Title ______________________________________________________

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 15 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
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      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
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      244. List of Vendors Name of VendorRow2
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      253. List of Vendors Name of VendorRow5
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      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
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      264. Check Box19 Off
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      266. Check Box21 Off
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      517. Check Box64 Off
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      758. federal employee ID number
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      787. 4Group102 no live music Off
Page 17: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 10 CALENDAR DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

ITINERANT MERCHANT LICENSE APPLICATION

FEE $ 2500 PER VENDOR MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO An Itinerant Merchant License is issued to any organizer of a short-term trade show exhibition event etc taking place in the City of Chicago where there will be vendors selling merchandise or providing services

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event

Address of Event

Event Start Date Event End Date

SPONSORING ORGANIZATIONBUSINESS

Sponsoring OrganizationBusiness Name Address City State amp Zip Code

Department of Business Affairs amp Consumer Protection Contact Name

Account Number Phone Number

If you do not know your account number please phone (312) 74-GOBIZ If you do not have a City of Chicago Department of Business Affairs amp Consumer Protection account number you will need to complete the Business Information Sheet on

pages 26 amp 27 or visit wwwcityofchicagoorgbusinessaffairs

Total of Vendors Phone Number

List of Vendors Name of Vendor Address Item to be Sold Ill Bus Tax Number

Only those vendors who are selling (not just displaying ) items needs to be included You may attach a printout of a list of the vendors if it is more convenient If the vendor does not currently have an Illinois Business Tax ( IBT ) Number they should contact the Illinois Department of Revenue at (217) 785-3707 to apply

I hereby swear that all the information I have stated above is true

Print Name Date

OrganizerOwnerOfficer Signature

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 16 of 17

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
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      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
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      253. List of Vendors Name of VendorRow5
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      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
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      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
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      467. Current Residential Address_2
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      470. State_2
      471. Zip code_2
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      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
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      477. Title Vice President Member Other
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      482. SuiteApt_3
      483. City_6
      484. State_3
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      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
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      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
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      508. Current Residential Address_5
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      512. Zip code_5
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      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
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      697. Textyearsz
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      731. Text48ln
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      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
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      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
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      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
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      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 18: PermitPacket2016.pdf

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS

SPECIAL EVENT PERMIT APPLICATION THIS FORM MUST BE SUBMITTED 20 BUSINESS DAYS PRIOR TO THE EVENT

INSTRUCTIONS PLEASE TYPE OR PRINT CLEARLY INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED

LIQUOR LICENSE APPLICATION gtgt For Profit Only

PLEASE CHECK ALL THAT WILL BE SERVED Beer amp Wine Spirits

FEE $150 PER LIQUOR LICENSEE MAKE CHECKS PAYABLE TO THE CITY OF CHICAGO THIS APPLICATION IS FOR THE SALE OF BEER AND WINE ONLY

ALDERMAN ________________________________________ WARD_______________

EVENT INFORMATION

Name of Event Address of Event

Department of Business Affairs amp Consumer Protection Account Number Date(s) of Event

If you do not know your account number please phone (312) 74-GOBIZ Hours of Event

Liquor License Holder Legal Entity NameDBA Name Contact Person (Liquor License Holder)

Business Address where City of Chicago Liquor License is held City State Zip Code

Phone Number

Check the type of liquor license already held by the establishment TAVERN RESTAURANT

Exact time liquor will be sold FROM__________AMPM TO__________AMPM

Note Liquor may not be sold or consumed after 1000PM Liquor sales cannot begin before 1100AM on Sundays

A copy of the following must be attached to every application Site Plan Alderman acknowledgement Police District Commander acknowledgement Certificate of Insurance evidencing Dramshop liability Letter from property owner acknowledging service of alcohol (Park District or Private Property Owner) Copy of security plan (for large events page 2 will not be accepted) Copy of current Liquor License All signatures must be original

Signature of Owner or Officer Print Name

Date of Application

Commissioner Department of Business Affairs and Consumer Protection

CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2016 Permit Application Page 17 of 17

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
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      449. Title Sole Proprietor President Managing Member Other
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      451. Middle Name
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      453. Current Residential Address
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      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
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      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
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      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
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      488. Date of Birth_3
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      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
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      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
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      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 19: PermitPacket2016.pdf

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateiluslcc

APPLICATION FOR STATE OF ILLINOIS SPECIAL USE PERMIT LIQUOR LICENSE

DEFINITION The Special Use Permit Liquor License shall allow an Illinois-licensed liquor retailer to transfer a portion of its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event A Special Use Permit Liquor License must be obtained for each location and cannot exceed 15 days in duration

ELIGIBILITY APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $5000 PER EVENT LOCATION EVENT DURATION MUST BE ONE DAY OR LESS (1 DAY ONLY) AND THE APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES

AT LEAST 14 DAYS IN ADVANCE OF THE SCHEDULED EVENT

FEE $10000 PER EVENT LOCATION EVENT DURATION CANNOT EXCEED 15 DAYS AND (2-15 DAYS) APPLICATION MUST BE RECEIVED AT COMMISSION OFFICES AT LEAST

14 DAYS PRIOR TO START OF EVENT

LATE FEE ADD $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLI-ADD $2500 CATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14

DAYS PRIOR TO THE SCHEDULED EVENT THE COMMISSION REQUIRES THIS LEAD TIME IN ORDER TO SCHEDULE SITE INSPECTIONS

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0050 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
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      663. Titlexxx
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      667. Text22
      668. City1
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      681. 111
      682. 121
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      685. 21acity
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      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
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      695. 23b zippw
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      710. Group1c1d Off
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      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
      719. 27addd
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      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 20: PermitPacket2016.pdf

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER

DATE ISSUED

LICENSE NO

EXPIRATION DATE

Application for State of Illinois Special Use Permit Liquor License

1 APPLICANT INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide your current State of Illinois Retail liquor license number provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your Illinois Department of Revenue IBT number (sales tax number) telephone number provide your corporateorganization mailing address and county

STATE LIQUOR LICENSE NO NAME

FEDERAL EMPLOYER ID NO ILLINOIS BUSINESS TAX AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

2 BUSINESS PREMISE INFORMATION Check here if license and ILCC correspondence should be sent to this address Provide business name (Doing Business AsDBA) telephone number address and county

NAME (DOING BUSINESS AS DBA ) AREA CODETELEPHONE NO

( )

ADDRESS CITY STATE ZIP CODE COUNTY

IL 567-0050 (072005) Page 2 of 4 Printed on Recycled Paper

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
      534. Radio Button23 Off
      535. Radio Button24 Off
      536. Radio Button25 Off
      537. Radio Button26 Off
      538. Radio Button27 Off
      539. Radio Button28 Off
      540. Radio Button29 Off
      541. Radio Button30 Off
      542. Text31
      543. Text32
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      564. Text97
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      566. Text99
      567. Text100
      568. Radio Button101 Off
      569. Radio Button102 Off
      570. Radio Button103 Off
      571. Radio Button104 Off
      572. Radio Button105 Off
      573. Text106
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      637. Radio Button171 Off
      638. Radio Button172 Off
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      640. Radio Button174 Off
      641. Radio Button175 Off
      642. Radio Button176 Off
      643. Radio Button177 Off
      644. Radio Button178 Off
      645. Radio Button179 Off
      646. Radio Button180 Off
      647. Radio Button181 Off
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      649. Text185
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      658. Group126 Off
      659. Group127 Off
      660. Group128 Off
      661. Group129 Off
      662. Group130 Off
      663. Titlexxx
      664. Group1225 Off
      665. Group131 Off
      666. Group999 Off
      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
      672. City5
      673. Phone Number_61
      674. 25aa
      675. 25ab
      676. 25bc
      677. 24mm
      678. 24am
      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
      686. 21bcity
      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
      693. 23zip
      694. 23a zipp
      695. 23b zippw
      696. Text54file
      697. Textyearsz
      698. Group122 Off
      699. Group124 Off
      700. Group8s Off
      701. Group888 Off
      702. 27az
      703. Date_4z
      704. Group1a2 Off
      705. Group1b1 Off
      706. Group1c1 Off
      707. 31zz
      708. Check Box28 Off
      709. Group1c1c Off
      710. Group1c1d Off
      711. Text45zz
      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
      719. 27addd
      720. ppp 1
      721. Text11bb
      722. Text12ss
      723. Text15v
      724. Text16sht
      725. Text41sit
      726. Text43sac
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      728. Text45ll
      729. Text46lk
      730. Text47lm
      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 21: PermitPacket2016.pdf

3 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

bull Provide the addresslocation of the event If an address is not available provide specific instructions to enable our investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days and locations covered by the event For example if your special event is held on three successive Fridays at the same location you are only required to fill out a single application and pay a single application fee since the total duration is 15 days or less and the location is the same If the location changes weekly in the aforementioned example however you will be required to fill out three applications and pay three fees

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

4 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0050 (072005) Page 3 of 4 Printed on Recycled Paper

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
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      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
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      336. 3TEXT
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      355. 13D
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      361. 13a
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      388. 19a
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      418. Text2
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      429. undefined_2
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      449. Title Sole Proprietor President Managing Member Other
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      451. Middle Name
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      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
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      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
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      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
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      481. Current Residential Address_3
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      483. City_6
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      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
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      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
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      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
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      667. Text22
      668. City1
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      683. 19 Dad
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      697. Textyearsz
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      728. Text45ll
      729. Text46lk
      730. Text47lm
      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
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      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
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      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
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      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 22: PermitPacket2016.pdf

5 PRIOR LIQUOR LICENSE INFORMATION

A Has the organization ever applied for and been denied a liquor license Yes If ldquoyesrdquo provide No a complete written explanation of the circumstances on a separate sheet of paper

NoB Has the organization had any previous Special Use Liquor License suspended or revoked Yes Ifldquoyesrdquo provide a complete written explanation of the circumstances on a separate sheet of paper

6 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL or (IF MISSING APPLICATION WILL BE REJECTED)

Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

7 DRAM SHOP INSURANCE

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

8 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

9 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

10 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0050 (072005) Page 4 of 4 Printed on Recycled Paper

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
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      666. Group999 Off
      667. Text22
      668. City1
      669. City2
      670. City3
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      672. City5
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      674. 25aa
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      677. 24mm
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      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
      686. 21bcity
      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
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      694. 23a zipp
      695. 23b zippw
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      697. Textyearsz
      698. Group122 Off
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      707. 31zz
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      710. Group1c1d Off
      711. Text45zz
      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
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      720. ppp 1
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      726. Text43sac
      727. Text44suc
      728. Text45ll
      729. Text46lk
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      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 23: PermitPacket2016.pdf

Illinois Liquor Control Bruce Rauner Commission Governor

100 W RANDOLPH ST 101 W JEFFERSON ST SUITE 7-801 SUITE 3-525 CHICAGO ILLINOIS 60601 SPRINGFIELD ILLINOIS 62702 TELEPHONE 312-814-2206 TELEPHONE 217-782-2136 FAX 312-814-2241 FAX 217-524-1911 TDD 312-814-1844 WEB SITE wwwstateilusLCC

APPLICATION FOR STATE OF ILLINOIS SPECIAL EVENT RETAILERrsquoS LIQUOR LICENSE (NOT-FOR-PROFIT)

DEFINITION A Special Event Retailerrsquos License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event in which case the licensee may purchase the alcoholic liquors from a licensed retailer) and shall allow the licensee to sell and offer for sale at retail alcoholic liquors for use or consumption but not for resale in any form and only at the location and on the specific date(s) designated for the special event on the license An ldquoeventrdquo can be defined as a single theme A Special Event Retailerrsquos License must be obtained for each single theme per location with a maximum duration of 15 days All not-forshyprofit corporations are required to secure a license for each 15-day increment and each special ldquoeventrdquo

ELIGIBILITY The Special Event Retailerrsquos License (Not-for-Profit) application form is to be used only for events conducted by an educational fraternal political civic religious or not-for-profit organization DO NOT use this form if you have a current Illinois Retailerrsquos liquor license (see Special Use Permit license instructions)

Local liquor licensing authority Dram shop insurance to the maximum approval is required for this license limit is required for this license

FEE $2500 PER APPLICATION IF THE EVENT IS 1) A SINGLE THEME 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE ADD AN ADDITIONAL $2500 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS)

NOTE ldquoFOR-PROFITrdquo ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailerrsquos Liquor License for $50000 that covers the date(s) of the special event This is the only way you will be able to purchase alcoholic beverages from a distributorYou will need to fill out the standard Retailerrsquos Liquor License application form (IL 567-0015)

PRIVATE PARTY is an event where attendance is by invitation only the host controls access to the premises and alcoshyholic beverages are provided to invited guests at no charge A Special Event Liquor License is not required for a private party

ON THE FOLLOWING PAGES PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED THE FORM MUST BEAR AN ORIGINAL SIGNATURE THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIEDRUBBER STAMPED SIGNATURES WILL BE ACCEPTED

IMPORTANT NOTICE THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 51 ET SEQ) DISCLOSURE OF THIS INFORMATION IS MANDATORY FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER

IL 567-0028 (072005) Page 1 of 4 Printed on Recycled Paper

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
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      273. Check Box32 Off
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      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
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      284. 6
      285. )>NAME Row 2
      286. 7
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      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
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      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
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      329. 37c
      330. 38 Off
      331. 39 Off
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      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
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      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
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      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
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      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
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      395. 28a
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      397. 19b
      398. 20b
      399. 22b
      400. 23b
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      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
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      425. Check Box26 Off
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      429. undefined_2
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      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
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      663. Titlexxx
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      665. Group131 Off
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      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
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      673. Phone Number_61
      674. 25aa
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      676. 25bc
      677. 24mm
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      679. 24bc
      680. 26 sex
      681. 111
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      683. 19 Dad
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      685. 21acity
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      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
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      692. state 3
      693. 23zip
      694. 23a zipp
      695. 23b zippw
      696. Text54file
      697. Textyearsz
      698. Group122 Off
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      702. 27az
      703. Date_4z
      704. Group1a2 Off
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      707. 31zz
      708. Check Box28 Off
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      711. Text45zz
      712. 21aa
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      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
      719. 27addd
      720. ppp 1
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      724. Text16sht
      725. Text41sit
      726. Text43sac
      727. Text44suc
      728. Text45ll
      729. Text46lk
      730. Text47lm
      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 24: PermitPacket2016.pdf

FOR OFFICIAL USE ONLY

FOR OFFICE USE ONLY

COUNTER sect

LICENSE NO

DATE ISSUED

EXPIRATION DATE

Application for State of Illinois Special Event Retailerrsquos Liquor License

1 APPLICANT INFORMATION Provide the corporateorganization name provide the corporateorganization Federal Employer Identification Number (FEIN) provide your corporateorganization mailing address county and telephone number

NAME FEDERAL EMPLOYER ID NO

ADDRESS CITY STATE ZIP CODE COUNTY

AREA CODETELEPHONE NO

2 CERTIFICATION

Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid ldquonot-for-profitrdquo organization Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event Please check the boxes that apply If either box is left unchecked the Commission will issue this license as ldquoNON-CERTIFIEDrdquo which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event The certifying officer must be listed under Section 5 of the application having provided all required identifying information Should you have any questions regarding sales tax liability or sales tax registration information please call the Department of Revenue Toll Free Hotline at 800-732-8866

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquorsectsectsectsectsectlicense is a valid ldquonot-for-profitrdquo entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the RetailersrsquoOccupationTax Act a sales tax registration [a sales tax num-ber] under Section 2(a) of the RetailersrsquoOccupation Tax Act or a current valid exemption identification number [a tax-exempt ldquoErdquonumber] issued under Section 1(g) of the RetailersrsquoOccupationTax Act

I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profitsectsectsectsectsectLiquor license has held no more than two such special events during the current calendar year (January 1 - December 31)This special event must be included in your calculation

Signature of Applicant Title of Applicant Date

3 STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details

sectsectsectsectsect A EDUCATIONAL DATE OF INCORPORATION

sectsectsectsectsect B FRATERNAL OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUEsectsectsectsectsect C POLITICAL SALES TAX EXEMPTION LETTER

sectsectsectsectsect D CIVIC sectsectsectsectsect E RELIGIOUS sectsectsectsectsect F OTHER NOT-FOR-PROFIT (SPECIFY)

IL 567-0028 (072005) Page 2 of 4 Printed on Recycled Paper

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
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      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
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      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
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      532. Text83
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      568. Radio Button101 Off
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      667. Text22
      668. City1
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      673. Phone Number_61
      674. 25aa
      675. 25ab
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      678. 24am
      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
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      687. area code 1
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      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
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      695. 23b zippw
      696. Text54file
      697. Textyearsz
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      711. Text45zz
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      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 25: PermitPacket2016.pdf

4 SPECIAL EVENT DETAIL

Provide the date(s) and time(s) that the event will be held When you receive your printed license certificate from the bull Commission times will be listed in military time ie ldquo0200rdquo = 2AM ldquo1200rdquo = noonrdquo ldquo2400rdquo = midnight etc

Provide the addresslocation of the event If an address is not available provide specific instructions to enable ourbull investigators to find the event Please note Only one location is allowed per application

bull Provide the nametype of the event ie neighborhood festival Octoberfest fish fry spaghetti dinner etc

bull Determine the total number of event themesevent types for which approval is requested Use a separate application for each event themeevent type

bull Determine the total number of days covered by the event If your neighborhood festival runs for 16 days you will be required to fill out two applications and pay two fees For example if you are holding a fish fry on three successive Fridays (15 days) at the same location you are only required to fill out a single application and pay a single application fee since the theme is identical the total duration is 15 days or less and the location is the same

DATE OF EVENT EVENT STARTS

(MONTHDAYYR)

EVENT TIME TIME FROM

( AMPM )

DATE OF EVENT EVENT ENDS

(MONTHDAYYR)

EVENT TIME TIME TO ( AMPM )

LOCATION OF EVENT STREET ADDRESS CITYSTATEZIP

EVENT THEME TYPE OF EVENT

5 CORPORATEORGANIZATION OFFICER INFORMATION The individual signing this application at the bottom of page 4 MUST be listed in this section

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

NAME (LAST FIRST MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP

SOCIAL SECURITY NO DATE OF BIRTH SEX TITLEPOSITION AREA CODETELEPHONE NO OWNED

IL 567-0028 (072005) Page 3 of 4 Printed on Recycled Paper

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
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      333. DATE
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      451. Middle Name
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      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
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      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
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      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
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      510. City_8
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      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
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      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
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      770. 111e Off
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      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 26: PermitPacket2016.pdf

6 PRIOR LIQUOR LICENSE INFORMATION

NoA Is this your first state liquor license application Yes

B If this is not your first state liquor license application provide the date of your first filing

C Has the organization ever applied for and been denied a liquor license Yes If so provide a complete written explanation of the circumstances on a separate sheet of paper

No

D Has the organization had any previous Special Event Retailerrsquos Liquor License suspended or revoked Yes No If yes provide a complete written explanation of the circumstances on a separate sheet of paper

7 LOCAL AUTHORITY APPROVAL You MUST submit proof of local authority approval for your special event Generally your local municipality will issue approval in the form of a letter a certificate or a rubber stamp If the event is taking place in an unincorporated area the County will need to provide the approval If the event is taking place on State or Federal property please contact our office as special approval will be necessary Local authorities will use the box below for ldquoapprovalrdquo stamps or seals such as the City of Chicago Liquor Commission if not applicable ATTACH a photocopy of the approval letter or certificate

ATTACH

LOCAL AUTHORITY APPROVAL

(IF MISSING APPLICATION WILL BE REJECTED)

8 DRAM SHOP INSURANCE

or Local Liquor Commissionerrsquos Event Approval Stamp Here ( if applicable )

You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event ATTACH a photocopy of the insurance rider to this application Remember it must cover the LOCATION where the special event is being held and the coverage must COINCIDE WITH THE DATES OF THE EVENT

ATTACH

DRAM SHOP INSURANCE RIDER (IF MISSING APPLICATION WILL BE REJECTED)

9 PAYMENT

Determine the payment amount for your application(s) For efficiency you may group multiple applications and submit a single check to cover all events Make your check or money order payable to the Illinois Liquor Control Commission

10 LATE FILING FEE

If you expect that your application(s) will not arrive at Commission premises within the required 14-day advance notice period submit an additional $2500 late fee for EACH application If late fee is missing application(s) will be rejected

11 SIGNATUREDATETITLE

The application must be signed and dated by the applicant or an authorized agent of the applicant along with the titleposition of the person signingThe signature must be an original (do not send in a copied or faxed form)

I THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF SWEAR OR AFFIRM THAT THE MATTERS STATED IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND INFORMATION THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE HEREIN APPLIED FOR THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR AND THE APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS IN PARTICULAR THE ILLINOIS LIQUOR CONTROL ACT RULES AND REGULATIONS AND THE CIVIL RIGHTS SECTIONS THEREOF FURTHER I AGREE TO NOTIFY THE COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE INFORMATION

SIGNATURE OF APPLICANTAUTHORIZED AGENT TITLEPOSITION DATE

IL 567-0028 (072005) Page 4 of 4 Printed on Recycled Paper

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
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      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
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      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
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      463. Title Secretary Managing Member Other
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      471. Zip code_2
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      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
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      477. Title Vice President Member Other
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      486. Home Phone_3
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      488. Date of Birth_3
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      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
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      507. Last Name_5
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      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
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      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
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      771. 4Group102 beer Off
      772. 4Group102 cta Off
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      775. 4Group102 tent Off
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      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 27: PermitPacket2016.pdf

____ ____ ____ ____ ____ ____

CITY OF CHICAGO Business License Information

Entity Information

Account Number (DEPT USE ONLY)

Type of Business Sole Proprietorship Corporation LLC Non-for-Profit Partnership Other

Legal Name of Business For Sole Proprietors this is the name of the business owner For all others print the exact legal name of the corporation LLC Partnership etc

ldquoDoing Business Asrdquo Name The exact ldquoDoing Business Asrdquo name of the establishment applying for a license (usually the name on the sign over the business)

An Illinois Business Tax number is REQUIRED for all businesses that make RETAIL SALES in the state of Illinois

Illinois Business Tax IBT Assigned by the Illinois Department of Revenue apply at 100 W Randolph or wwwrevenuestateilusappibri

A Federal Employee Identification number and formation information is REQUIRED for all businesses other than Sole Proprietorships

Federal Employer Ident FEIN Assigned by the IRS apply at wwwirsgovbusinesses or by calling 800-829-4933

Incorporation Date State of Incorporation

A State of Illinois File number is REQUIRED for Corporations LLCs and Non-for-Profit Corporations

State of Illinois File Assigned by the Illinois Secretary of State available online at wwwilsosgovcorporatellc

A Sales-Tax Exemption Number is REQUIRED for non-for-profit corporations that have tax-exempt certificates from the state of IL

Illinois Exemption Assigned by the Illinois Department of Revenue call 217-782-8881 or wwwrevenuestateilusNonProfits

Expiration Date

-

E --

02

-

Business Activity and Location

Business Activity List your businessrsquos activities including all products or services you offer

Does your business sell goods at this address YES NO

If YES what kind of sales are made RETAIL WHOLESALE BOTH

If BOTH what percentage of your floor space is devoted to retail sales

Business Site Address

Provide the address where business transactions andor activities occur If the business operates from an extended address please provide the full extended address

Primary Contact Person

Contact Phone

Contact Email

City

Street Number NSEW

Sq Footage used by business

Street Name Ave St etc

State Zip Code

of Employees at this site SuiteApt Number Floors Occupied

Middle

JrSr

Fax -

First Name

Last Name

-

FLIP OVER AND COMPLETE BACK

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
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      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
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      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
      672. City5
      673. Phone Number_61
      674. 25aa
      675. 25ab
      676. 25bc
      677. 24mm
      678. 24am
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      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
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      685. 21acity
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      712. 21aa
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      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 28: PermitPacket2016.pdf

Owner and Officer Information Sole Proprietors are required to provide information about the Sole Proprietor that owns the business

Corporations are required to provide information about their President Secretary and any other shareholders with a major beneficial interest

Non-for-Profit Corporations are required to provide information about their President and Secretary

Limited Liability Corporations are required to provide information about Managing Members and any other shareholders with a major beneficial interest

Partnerships amp Limited Partnerships are required to provide information about all Partners with a major beneficial interest

The information above is required for all business More information on owners and officers may be required by the

Department of Business Affairs and Consumer Protection depending on the licensing requirements of your specific business Ownership Title

Sole Proprietor President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Secretary Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State Zip code

Home Phone

( ) Social Security

- -

Date of Birth

Email Address

PLEASE DO NOT SEND ANY PAYMENTS WITH THIS PRE-APPLICATION CITY OF CHICAGO Department of Business Affairs and Consumer Protection Business Assistance Center City Hall Room 800 121 N LaSalle Street Chicago IL 60602 (312) 74-GOBIZ (744-6249) wwwcityofchicagoorgbusinessaffairs 122608

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
      534. Radio Button23 Off
      535. Radio Button24 Off
      536. Radio Button25 Off
      537. Radio Button26 Off
      538. Radio Button27 Off
      539. Radio Button28 Off
      540. Radio Button29 Off
      541. Radio Button30 Off
      542. Text31
      543. Text32
      544. Text33
      545. Text34
      546. Text55
      547. Text61
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      564. Text97
      565. Text98
      566. Text99
      567. Text100
      568. Radio Button101 Off
      569. Radio Button102 Off
      570. Radio Button103 Off
      571. Radio Button104 Off
      572. Radio Button105 Off
      573. Text106
      574. Text107
      575. Text108
      576. Text109
      577. Text110
      578. Text111
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      637. Radio Button171 Off
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      640. Radio Button174 Off
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      643. Radio Button177 Off
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      645. Radio Button179 Off
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      649. Text185
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      658. Group126 Off
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      660. Group128 Off
      661. Group129 Off
      662. Group130 Off
      663. Titlexxx
      664. Group1225 Off
      665. Group131 Off
      666. Group999 Off
      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
      672. City5
      673. Phone Number_61
      674. 25aa
      675. 25ab
      676. 25bc
      677. 24mm
      678. 24am
      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
      686. 21bcity
      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
      693. 23zip
      694. 23a zipp
      695. 23b zippw
      696. Text54file
      697. Textyearsz
      698. Group122 Off
      699. Group124 Off
      700. Group8s Off
      701. Group888 Off
      702. 27az
      703. Date_4z
      704. Group1a2 Off
      705. Group1b1 Off
      706. Group1c1 Off
      707. 31zz
      708. Check Box28 Off
      709. Group1c1c Off
      710. Group1c1d Off
      711. Text45zz
      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
      719. 27addd
      720. ppp 1
      721. Text11bb
      722. Text12ss
      723. Text15v
      724. Text16sht
      725. Text41sit
      726. Text43sac
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      728. Text45ll
      729. Text46lk
      730. Text47lm
      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 29: PermitPacket2016.pdf

CITY OF CHICAGO Commission on Animal Care and Control

CACC Temporary Animal Exhibition

Permit Application

Temporary Animal Change of location Type of Application Exhibition

PLEASE NOTE THAT THIS PERMIT IS FOR ANIMAL EXHIBITIONS 30 DAYS OR LESS AND APPLICATIONS MUST BE SUMBMITTED AT LEAST 30

Date of Exhibit

Entity Information

DAYS BEFORE THE EXHIBITION

Sole Proprietor Partnership LLC Corporation Non-Profit Trust Other Type of Business

Legal Name of Business

The exact ldquolegal namerdquo as it appears in the official business formation documentation

For Sole Proprietors this is the full name of the business owner as it appears on the Sole Proprietorrsquos government-issued photo ID

ldquoDoing Business Asrdquo Name

The exact ldquoDoing Business Asrdquo (DBA) name as it appears in the official business formation

documentation

Sole Proprietors or Partnerships conducting business in Illinois under an assumed name (a name other than your own) are required to file for an Assumed Name Certificate with the Cook County Clerkrsquos office at 50 W Washington St East Concourse (Lower) Level - 27 (312) 603-5652 or wwwcookcountyclerkcom gt Vital Records gt Assumed Business Name Registration

A State of Illinois File Number is REQUIRED for all (Illinois and Non-Illinois based) LPs LLPs LLCs Corporations and Non-Profit Corps

State of Illinois File Assigned by the Illinois Secretary of State at 69 W Washington St Suite 1240 (312) 793-3380 or wwwcyberdriveillinoiscomdepartmentsbusiness_services

A Federal Employer Identification Number (EIN) is REQUIRED for all business entity types except for Sole Proprietorships

Employer Identification Assigned by the Internal Revenue Service at 230 S Dearborn St (312) 566-4912 or (800) 829-4933 or wwwirsgovbusinesses gt Employer ID Numbers (EINs) -

An Account ID Number is REQUIRED for ALL business entity types that conduct business in the state of Illinois or with Illinois customers

(formerly IBT ) IDOR Account ID Assigned by the Illinois Department of Revenue at 100 W Randolph St (800) 732-8866 or httptaxillinoisgovBusinessesindexhtm gt Business Registration -

PUBLIC WAY Permit (IF

APPLICABLE)

Exhibition Activity and Location

Exhibition Activity

List your animals and activities to be offered

Exhibition Site Address

Provide the full business location address where the exhibition andor activities occur

If applicable provide the extended address (eg 100-102 N Main St)

Street Number(s)

City

NSEW Street Name

State

AveSt

ZIP Code

SteApt Floor

Square footage used by the business Amount of employees at this site SQ FT

Primary Veterinarian

Emergency Contact

Contact Phone

Contact E-mail Address

Name Phone Number

First Name

Fax

----

PLEASE COMPLETE THE BACK SIDE OF THIS FORM AS WELL

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
      534. Radio Button23 Off
      535. Radio Button24 Off
      536. Radio Button25 Off
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      538. Radio Button27 Off
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      662. Group130 Off
      663. Titlexxx
      664. Group1225 Off
      665. Group131 Off
      666. Group999 Off
      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
      672. City5
      673. Phone Number_61
      674. 25aa
      675. 25ab
      676. 25bc
      677. 24mm
      678. 24am
      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
      686. 21bcity
      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
      693. 23zip
      694. 23a zipp
      695. 23b zippw
      696. Text54file
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      700. Group8s Off
      701. Group888 Off
      702. 27az
      703. Date_4z
      704. Group1a2 Off
      705. Group1b1 Off
      706. Group1c1 Off
      707. 31zz
      708. Check Box28 Off
      709. Group1c1c Off
      710. Group1c1d Off
      711. Text45zz
      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
      718. 27cdvf
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      720. ppp 1
      721. Text11bb
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      731. Text48ln
      732. Text49lq
      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 30: PermitPacket2016.pdf

Owner and Officer Information o Sole Proprietors are required to provide information about the Individual who owns the business o Partnerships amp Limited Partnerships are required to provide information about all the Partners of the organization o Limited Liability Companies are required to provide information about the organizationrsquos Members and any other shareholder(s) with a major beneficial interest o Corporations are required to provide information about the organizationrsquos President Secretary and any other shareholder(s) with a beneficial interest o Non-Profit Corporations are required to provide information about the organizationrsquos President and Secretary

Proof of identification may be required to complete the actual application

Ownership Title

Sole Proprietor Partner President Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Secretary Partner Managing Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Vice President Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Treasurer Member Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

Ownership Title

Shareholder Other

First Name Middle Name Last Name

Current Residential Address SuiteApt City State ZIP Code

Home Phone

( ) Social Security Number

- -Date of Birth

Email Address

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
      71. FROM 1_2
      72. FROM 2_2
      73. FROM 3_2
      74. FROM 4_2
      75. TO 1_2
      76. TO 2_2
      77. TO 3_2
      78. TO 4_2
      79. DATES 1_2
      80. DATES 2_2
      81. DATES 3_2
      82. DATES 4_2
      83. TIMES 1_2
      84. TIMES 2_2
      85. TIMES 3_2
      86. TIMES 4_2
      87. STREET 1_3
      88. STREET 2_3
      89. STREET 3_3
      90. STREET 4_3
      91. FROM 1_3
      92. FROM 2_3
      93. FROM 3_3
      94. FROM 4_3
      95. TO 1_3
      96. TO 2_3
      97. TO 3_3
      98. TO 4_3
      99. DATES 1_3
      100. DATES 2_3
      101. DATES 3_3
      102. DATES 4_3
      103. TIMES 1_3
      104. TIMES 2_3
      105. TIMES 3_3
      106. TIMES 4_3
      107. Type III Barricade Company
      108. 24 Hour Phone Number
      109. Name of Event_4
      110. Dates of Event_3
      111. Current Request
      112. Year_2
      113. Provided in YearPosting of No Parking Signs
      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
      119. Provided in YearRefuse Drums
      120. Provided in YearRefuse Collection
      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
      123. Current Request YearStreet Sweeping
      124. Name of Private Scavenger Company if applicable
      125. 24 Hour Phone number
      126. Name of Maintenance Company if applicable
      127. Contact Name_2
      128. 24 Hour Phone number_2
      129. Type III Barricade company if applicable
      130. Contact Name_3
      131. 24 Hour Phone number_3
      132. Private Scavenger Company Name
      133. Contact for Recycling
      134. How will recyclables be collected from the vendorsmerchants
      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
      145. NAME OF SPECIAL EVENT
      146. DATES OF EVENT
      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
      150. locations ie booths from
      151. serving stations ie taps per location as designated on the attached Site Plan
      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
      159. Intersecting street
      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
      162. COMMENTS ANDOR REASONS 2
      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
      169. District
      170. Event Start Date
      171. Event End Date
      172. Other_2
      173. How many music acts participated
      174. How many individual artists participated
      175. Address of Event_2
      176. Dates of Event_4
      177. Hours of Event
      178. Name of Event Sponsor
      179. Event Coordinator
      180. Phone Number_3
      181. Name of Food Vendor
      182. Contact
      183. Phone Number_4
      184. Department of Business Affairs Consumer Protection BUSINESS ACCOUNT NUMBER 6 digits
      185. undefined
      186. undefined_3
      187. undefined_4
      188. undefined_5
      189. Address of Food Vendor
      190. City_3
      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
      193. Print Name_2
      194. Title
      195. Date_3
      196. Describe the method of transporting food and the temperature it will be held at the event site ie refrigerated cold storage containers refrigerated
      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
      201. Food Item 1
      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
      205. Food Item 1_2
      206. Food Item 2_2
      207. Food Item 3_2
      208. Food Item 4_2
      209. Food Item 1_3
      210. Food Item 2_3
      211. Food Item 3_3
      212. Food Item 4_3
      213. Food Item 1_4
      214. Food Item 2_4
      215. Food Item 3_4
      216. Food Item 4_4
      217. Name of Event_5
      218. Dates of Event_5
      219. Hours of Event_2
      220. Name of Sponsoring EventCoordinator
      221. Phone Number_5
      222. Name of Mobile Food Vendor
      223. Contact_2
      224. Department of Business Affairs Consumer Protection Account Number
      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
      226. Address_3
      227. Mobile Food License
      228. License Expiration Date
      229. Title_2
      230. ALDERMAN_3
      231. WARD_3
      232. Address of Event_3
      233. Event Start Date_2
      234. Event End Date_2
      235. Sponsoring OrganizationBusiness Name
      236. Address City State Zip Code
      237. Contact Name_4
      238. Phone Number_7
      239. Total of Vendors
      240. Phone Number_8
      241. List of Vendors Name of VendorRow1
      242. AddressRow1
      243. Ill Bus Tax NumberRow1
      244. List of Vendors Name of VendorRow2
      245. AddressRow2
      246. Ill Bus Tax NumberRow2
      247. List of Vendors Name of VendorRow3
      248. AddressRow3
      249. Ill Bus Tax NumberRow3
      250. List of Vendors Name of VendorRow4
      251. AddressRow4
      252. Ill Bus Tax NumberRow4
      253. List of Vendors Name of VendorRow5
      254. AddressRow5
      255. Ill Bus Tax NumberRow5
      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
      264. Check Box19 Off
      265. Check Box20 Off
      266. Check Box21 Off
      267. Check Box22 Off
      268. Check Box23 Off
      269. Text24
      270. Check Box25 Off
      271. Check Box30 Off
      272. Check Box31 Off
      273. Check Box32 Off
      274. Check Box33 Off
      275. Check Box34 Off
      276. Check Box36 Off
      277. Check Box39 Off
      278. Text40
      279. 1 Off
      280. 2
      281. 3
      282. 4
      283. 5
      284. 6
      285. )>NAME Row 2
      286. 7
      287. 8
      288. 9
      289. 10
      290. 11
      291. 12 Off
      292. 13
      293. 14
      294. 15
      295. 16
      296. 17
      297. 18
      298. 19
      299. 22c
      300. 23c
      301. 24c
      302. 25c
      303. 26c
      304. 30
      305. 32
      306. 33
      307. 34
      308. 35
      309. 36
      310. 37
      311. 30a
      312. 31a
      313. 32a
      314. 33a
      315. 34a
      316. 35a
      317. 36a
      318. 37a
      319. 27c
      320. 28c
      321. 29c
      322. 30c
      323. 31c
      324. 32c
      325. 33c
      326. 34c
      327. 35c
      328. 36c
      329. 37c
      330. 38 Off
      331. 39 Off
      332. TITLEPOSITION
      333. DATE
      334. Text3
      335. TEXT2222222
      336. 3TEXT
      337. 4 TEXT
      338. 5 TEXT
      339. 6 TEXT
      340. 7 TEXT
      341. 8 TEXT
      342. 9a Off
      343. Title of Applicant
      344. Date_4
      345. 11 TEXT
      346. SPECIFY
      347. Text84
      348. Check Box85 Off
      349. Check Box86 Off
      350. Check Box87 Off
      351. Check Box88 Off
      352. Check Box89 Off
      353. Check Box90 Off
      354. Check Box91 Off
      355. 13D
      356. 14D
      357. 15D
      358. 16D
      359. 17D
      360. 18D
      361. 13a
      362. 14a
      363. 15a
      364. 16a
      365. 17a
      366. 18a
      367. 13b
      368. 14b
      369. 15b
      370. 16b
      371. 17b
      372. 18b
      373. 13c
      374. 14c
      375. 15c
      376. 16c
      377. 17c
      378. 18c
      379. 20 D
      380. 21
      381. 22
      382. 23
      383. 24
      384. 25
      385. 26
      386. 28
      387. 29
      388. 19a
      389. 20a
      390. 22a
      391. 23a
      392. 24a
      393. 25a
      394. 26a
      395. 28a
      396. 29a
      397. 19b
      398. 20b
      399. 22b
      400. 23b
      401. 24b
      402. 25b
      403. 26b
      404. 27b
      405. 31
      406. TITLEPOSITION_2
      407. DATE_2
      408. Check Box37 Off
      409. Check Box38 Off
      410. 1_3
      411. Check Box96 Off
      412. Check Box97 Off
      413. Check Box98 Off
      414. Check Box99 Off
      415. Check Box100 Off
      416. Check Box101 Off
      417. Other
      418. Text2
      419. Text8
      420. Text12
      421. Text13
      422. Text14
      423. Text15
      424. Text16
      425. Check Box26 Off
      426. Check Box27 Off
      427. Check Box29 Off
      428. Check Box35 Off
      429. undefined_2
      430. Text41
      431. Text42
      432. Text43
      433. Text44
      434. Text46
      435. Text47
      436. Text48
      437. Text49
      438. Text50
      439. Text51
      440. Text52
      441. Text53
      442. Text56
      443. Text57
      444. Text58
      445. Text59
      446. Text60
      447. Text17
      448. Ownership
      449. Title Sole Proprietor President Managing Member Other
      450. First Name
      451. Middle Name
      452. Last Name
      453. Current Residential Address
      454. SuiteApt
      455. City_4
      456. State
      457. Zip code
      458. Home Phone
      459. Social Security
      460. Date of Birth
      461. Email Address
      462. Ownership_2
      463. Title Secretary Managing Member Other
      464. First Name_2
      465. Middle Name_2
      466. Last Name_2
      467. Current Residential Address_2
      468. SuiteApt_2
      469. City_5
      470. State_2
      471. Zip code_2
      472. Home Phone_2
      473. Social Security_2
      474. Date of Birth_2
      475. Email Address_2
      476. Ownership_3
      477. Title Vice President Member Other
      478. First Name_3
      479. Middle Name_3
      480. Last Name_3
      481. Current Residential Address_3
      482. SuiteApt_3
      483. City_6
      484. State_3
      485. Zip code_3
      486. Home Phone_3
      487. Social Security_3
      488. Date of Birth_3
      489. Email Address_3
      490. Ownership_4
      491. First Name_4
      492. Middle Name_4
      493. Last Name_4
      494. Current Residential Address_4
      495. SuiteApt_4
      496. City_7
      497. State_4
      498. Zip code_4
      499. Home Phone_4
      500. Social Security_4
      501. Date of Birth_4
      502. Email Address_4
      503. Ownership_5
      504. Title Shareholder Other
      505. First Name_5
      506. Middle Name_5
      507. Last Name_5
      508. Current Residential Address_5
      509. SuiteApt_5
      510. City_8
      511. State_5
      512. Zip code_5
      513. Home Phone_5
      514. Social Security_5
      515. Date of Birth_5
      516. Email Address_5
      517. Check Box64 Off
      518. Check Box65 Off
      519. Check Box66 Off
      520. Check Box67 Off
      521. Check Box68 Off
      522. Check Box69 Off
      523. Check Box70 Off
      524. Check Box71 Off
      525. Check Box72 Off
      526. Check Box73 Off
      527. Check Box74 Off
      528. Check Box75 Off
      529. Check Box80 Off
      530. Check Box81 Off
      531. Check Box82 Off
      532. Text83
      533. Radio Button22 Off
      534. Radio Button23 Off
      535. Radio Button24 Off
      536. Radio Button25 Off
      537. Radio Button26 Off
      538. Radio Button27 Off
      539. Radio Button28 Off
      540. Radio Button29 Off
      541. Radio Button30 Off
      542. Text31
      543. Text32
      544. Text33
      545. Text34
      546. Text55
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      567. Text100
      568. Radio Button101 Off
      569. Radio Button102 Off
      570. Radio Button103 Off
      571. Radio Button104 Off
      572. Radio Button105 Off
      573. Text106
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      637. Radio Button171 Off
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      643. Radio Button177 Off
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      649. Text185
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      660. Group128 Off
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      662. Group130 Off
      663. Titlexxx
      664. Group1225 Off
      665. Group131 Off
      666. Group999 Off
      667. Text22
      668. City1
      669. City2
      670. City3
      671. City4
      672. City5
      673. Phone Number_61
      674. 25aa
      675. 25ab
      676. 25bc
      677. 24mm
      678. 24am
      679. 24bc
      680. 26 sex
      681. 111
      682. 121
      683. 19 Dad
      684. city 7
      685. 21acity
      686. 21bcity
      687. area code 1
      688. area codec
      689. area code 1q
      690. state 1
      691. 22a state 2
      692. state 3
      693. 23zip
      694. 23a zipp
      695. 23b zippw
      696. Text54file
      697. Textyearsz
      698. Group122 Off
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      700. Group8s Off
      701. Group888 Off
      702. 27az
      703. Date_4z
      704. Group1a2 Off
      705. Group1b1 Off
      706. Group1c1 Off
      707. 31zz
      708. Check Box28 Off
      709. Group1c1c Off
      710. Group1c1d Off
      711. Text45zz
      712. 21aa
      713. 21ba
      714. 21ca
      715. 29a owned
      716. 29b owned qq
      717. 27mnb
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      731. Text48ln
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      733. Text50date
      734. Text9ilbus
      735. Text10fed empl
      736. Text11incorp date
      737. Alderman
      738. Ward
      739. Name of Event
      740. address of Event
      741. DBACP Account Nuber
      742. Date of Event
      743. Liquor License Legal Name
      744. Hours of Events
      745. Contact Liq Lic Holder
      746. Business address
      747. city
      748. state
      749. zip
      750. tavern Off
      751. restaurant Off
      752. from am pm
      753. to am pm
      754. Print name
      755. date of applic
      756. Year
      757. name of carnival company
      758. federal employee ID number
      759. cta bus routes
      760. yes cta bus routes
      761. of Food Vendors
      762. of Liq vendors
      763. of Merch Vendors
      764. Owners phone number
      765. comm outreach plan
      766. 111a Off
      767. 111b Off
      768. 111c Off
      769. 111d Off
      770. 111e Off
      771. 4Group102 beer Off
      772. 4Group102 cta Off
      773. 4Group102 street close Off
      774. 4Group102 stage Off
      775. 4Group102 tent Off
      776. 4Group102 merch Off
      777. 4Group102 food Off
      778. 4Group102 divvy Off
      779. 4Group102 athletic Off
      780. Text1
      781. publicized descript of efforts
      782. How many arts organizations participated including forprofit and nonprofit
      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off
Page 31: PermitPacket2016.pdf

CACC CITY OF CHICAGO Commission On Animal Care and Control Animal Exhibition Permit

2741 S Western Ave Chicago Il 60608 wwwcityofchicagoorgcacc

EXHIBITION SITE PLAN

Event _____________________________________________________________

Address ____________________________________________________________________

City State Zip Code __________________________________________________________

OwnerOperator ______________________________________________________________

Not to Scale

All Boundaries are Approximate

  • Untitled
      1. ALDERMAN
      2. WARD
      3. First time event Yes No
      4. Dates of Event
      5. Hours of Event to
      6. Stepoff time For athletic events only
      7. Phone numberwebsite for publication
      8. Estimated attendance
      9. Last years actual attendance
      10. Last years location
      11. Last years date
      12. Name of Sponsoring Organization
      13. Contact person from Sponsoring Organization
      14. Sponsoring Organization Address
      15. Zip
      16. Name of Producing Agent if applicable
      17. Federal ID Number
      18. Producing Agent Address
      19. Zip_2
      20. Name of OrganizerCoordinator
      21. Email
      22. OrganizerCoordinator Address
      23. Zip_3
      24. Phone Number
      25. Cell Number
      26. FAX Number
      27. Name of Emergency Contact
      28. Email_2
      29. Address
      30. Zip_4
      31. 7 day24 hours Phone Number
      32. Cell Number_2
      33. FAX Number_2
      34. Name of Event_2
      35. Address_2
      36. Zip Code
      37. Phone Number_2
      38. Number of Private Security Personnel hired per shift
      39. Describe procedure for preventing overconsumption of alcohol if applicable
      40. Please describe a Disaster Plan that addresses emergencies specific to your event must include a plan for weather related emergencies and cancellations
      41. Ambulance Provider
      42. Contact Name
      43. Contact Number
      44. If applying for a large scale event liquor license a separate security plan may be requested
      45. Name of Event_3
      46. Dates of Event_2
      47. STREET 1
      48. STREET 2
      49. STREET 3
      50. STREET 4
      51. FROM 1
      52. FROM 2
      53. FROM 3
      54. FROM 4
      55. TO 1
      56. TO 2
      57. TO 3
      58. TO 4
      59. DATES 1
      60. DATES 2
      61. DATES 3
      62. DATES 4
      63. TIMES 1
      64. TIMES 2
      65. TIMES 3
      66. TIMES 4
      67. STREET 1_2
      68. STREET 2_2
      69. STREET 3_2
      70. STREET 4_2
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      112. Year_2
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      114. Current Request YearPosting of No Parking Signs
      115. Provided in YearTowing
      116. Current Request YearTowing
      117. Provided in YearSnow Fence indicate amount needed in feet
      118. Current Request YearSnow Fence indicate amount needed in feet
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      121. Current Request YearRefuse Collection
      122. Provided in YearStreet Sweeping
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      125. 24 Hour Phone number
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      127. Contact Name_2
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      133. Contact for Recycling
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      135. What recyclable materials will be collected from the public
      136. How will you monitor the recycling throughout the event to avoid contamination problems
      137. Contact the recycling hotline at 312 7441614 with any questions
      138. Amplified sound will be used FROM
      139. TO
      140. Explain how the sound will be controlled and identify the means by which it can be further controlled if necessary
      141. The Department of Environment has the right to require applicants to revise locations hours or plans to control amplified music in accor
      142. Date
      143. ALDERMAN_2
      144. WARD_2
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      147. HOURS OF EVENT
      148. LOCATION OF EVENT
      149. NUMBER
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      152. Liquor will be served at Off
      153. Liquor will not be served Off
      154. Streets will be closed Street Closed Off
      155. Streets will not be closed Off
      156. Walkathons and walks are athletic events requiring payment for police services at an overtime rate Off
      157. Races and walks may require Traffic Control Aides or Police Officers at every intersection Off
      158. From
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      160. Intersecting street_2
      161. COMMENTS ANDOR REASONS 1
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      163. COMMENTS ANDOR REASONS 3
      164. COMMENTS ANDOR REASONS 4
      165. COMMENTS ANDOR REASONS 5
      166. COMMENTS ANDOR REASONS 6
      167. Date_2
      168. Print Name
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      171. Event End Date
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      174. How many individual artists participated
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      191. Zip Code_2
      192. Summer Festival Food Vendor Sanitation Certificate Number
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      194. Title
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      197. Describe the method of storage at the event site ie refrigerated cold storage containers refrigerated truck capable of maintaining temperatures of
      198. Indicate the location of restroom facilities within proximity to the food vending booth on the attached site plan
      199. Describe hand washing facilities at the food vending booth Portable hand sinks are required A permit will not be issued without hand washing facilities
      200. CHICAGO DEPARTMENT OF CULTURAL AFFAIRS AND SPECIAL EVENTS 2015 Permit Application_2
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      202. Food Item 2
      203. Food Item 3
      204. Food Item 4
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      225. If you do not know your account number please phone 312 74GOBIZ If you do not have a City of Chicago
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      228. License Expiration Date
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      256. Check Box1 Off
      257. Check Box2 Off
      258. Address of Event
      259. Event Community Benefit
      260. Fed Employee ID
      261. City
      262. If an athletic event is produced along with the Festival please attach a course map and written description of route
      263. Check Box18 Off
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      265. Check Box20 Off
      266. Check Box21 Off
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      756. Year
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      763. of Merch Vendors
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      783. of live acts paid
      784. of art organizations
      785. 4Group102 street closed Off
      786. 4Group102 not publicized Off
      787. 4Group102 no live music Off

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