B.2 Pond Hockey Alcohol Special Event PermitCity of Ka
Post office Box 1997 - Kalispell, Montana 59903
Telephone: (406) 758-7755
.UONTANA city_clerk@kalispell.com www.kalispell.com
REPORT TO: Doug Russell, City Manager 35 Z
FROM: Aimee Brunckhorst, CMC, City Clerk & Communications Manager
SUBJECT: Alcohol Special Event Permit Application from the Chamber of Commerce
Montana Pond Hockey Classic as an Alternative Location at the Woodland
Park Ice Center
MEETING DATE: February 17, 2015
BACKGROUND: The Kalispell Chamber of Commerce Convention and Visitor Bureau has
submitted an application for the sale and consumption of alcohol February 20 - 22, for the
Montana Pond Hockey Classic at an alternative venue location — Woodland Park Ice Center. The
event is scheduled to be held at Foys Lake, however Woodland Park will be utilized if the ice
conditions at Foys Labe do not stabilize prior to the event.
The Special Event Permit and the Alcohol Addendum have been reviewed by the appropriate city
departments. The Chamber has made arrangements to provide parking for the event at the Conrad
Complex, with a shuttle bus running between the two locations.
RECOMMENDATION: It is recommended the City Council approve the Special Event
Permit for the Kalispell Chamber of Commerce and Convention and Visitor Bureau to allow for
the sale and consumption of alcohol at the Montana Pond Hockey Classic if it is to be held at the
Woodland Park Ice Center.
Respectively Submitted,
Aimee Brunckhorst, CMC
City Clerk & Communications Manager
ATTACHMENTS: Special Event Permit Application
Alcohol Addendum
Certificate of Liability Insurance
Date Issued:
CITY of IALISPELL
PARADE/SPECIAL EVENT PERMIT APPLICATION
Application must be filled in completely. Requests for a Parade/Special Event Permit must be received at
least 30 days prior to the requested activity.
1. Name of Event.
2. Event
e() � 1 Start Time: S� End Time: I to c
3. Group Name Sponsoring Event: . t� , r-_' jv r '
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4. Organization Officer/Authorised Representative:
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5. Daytime Phone #: �1 S
Email: Jua-VIL, C-) Ll L_�'
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6. Description of Parade/Special Event. Please include whether the parade/event will occupy all or only
a portion of the width of the streets, the location of any event areas, and the type of event including
any activities planned (floats, animals, etc). Please attach any other documentation that may be
helpful:
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7. Proposed Route (including starting and termination points):
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8. Describe any recording equipme t, sound amplification equipment, banners, signs, or other )tU�_
tention'F
getting devices to be used in connection with the parade/special event: G-AjA 1AU" L_
9. Street Closures/Parkin Restrictions requested, if any.,
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10. Please specify what (if any) city equipment/assistance is requested (road barricades, trash co tamers,
traffic assistance, crowd control}�, etc): - sty _'�� �k) (� 1. t3 1r C �)- ' -' t-� Q _ "3
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11. Please specify
hat arrangements have been madelor cl an -up u aPtei theOrade/special event,
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Revised September 2014
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A Certificate of Liability Insurance in the amount of at least $750,000 per occurrence and $1.5 million
aggregate must be submitted to the Kalispell City Attorney's office prior to any permit being issued. The
Certificate of Insurance must name The City of Kalispell as additionally named insured on the policy. For
insurance questions please contact the city attorney's office at (406) 758-7977.
PARADES
NO CANDY OR. OBJECTS MAY BE THROWN TO SPECTATORS. The applicant will ensure that
participants do not ride on floats with their legs hanging over the side. The applicant will brief
participants to maintain a safe and constant interval during the parade. This will help prevent the
"accordion effect" which results in gaps in the parade procession.
TERMS AND CONDITIONS
As an agent and acting on behalf of the requesting agency or organization, I hereby certify that the
information above is complete and correct. I further understand that it is my responsibility to ensure that
participants for the parade/event as requested fully understand that the City of Kalispell and the State of
Montana does not endorse, encourage, condone,, or protest the said parade/event, It is further any
understanding that each participant will be advised by the parade/event sponsor that the City of Kalispell
and the State of Montana will be held harmless and will not be responsible for injuries, damages, or
deb s resulting from or while participating in the parade/event.
Signature of Applicant Date
Print Name:
DO NOT WRITE BELOW THIS SPACE (FOR CITY USE ONLY)
Signature
Fire:
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Police:
Public Works:
City Attorney:
Date Permit Issued:
Reason for Denial:
Signature:
* * PLEASE CHECK APPLICABLE FEES
Parade Fee [ Date Paid:
Deposit [ ] Date Paid:
Barricade Fee [ ] Estimated Amount:
Circle One
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7pprovI Deny
1' eny
eny
Date Permit Denied:
Date Paid:
Solid waste Estimated Amount: Date Paid:
Date
Revised September 2014
ALCOHOL ADDENDUM
CITY of K4LISPELL
PARADE/SPECIAL EVENT PERNTIT APPEICATtON
If it is the requcst o f the iappl icant to sell, serve, consume Or posSCs-s hecr and/or wine at a. special
event held on City owned or maintained property the following information and documentation
must be provided;
Nance and c:onTac;t information of req uest.hi g Organization and Ikon -Profit group beneti tting fi'0111
event:
F
E \I;Sitars 1�vrGa��
Narnc� and contact information of licensed Waterer if applicable. -
Provide esdaaya to of the number and concentration of participants at the event:
LSnt/—
Provide a plan that ensures that widerage persons will not obtain alcoholic beverages sented at
the event, and the precautions proposed, such as fencin o barriers to create separation, use of ID
braceletsr and marmed security to adegtjatoly sccure and supervise the area and the particip,ants
duriri y the event:
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ape� C) ve-Y' `1"v- �
C'hcck tli:ii you have provided proof of liquor liability insurance coverage for the event: [�
Check that you haN c: prov'dcid prop I'() I'compliance e with Dcpartment of Revenue requirements
for the event: rvf
Revised September 2014
ACKNOWLEDGMENT NT F LEGAL RESPONSIBILITIES
The holder- of this special event permit is solely responsible for all actions of his/her group,
and for the wee fare o I'die publ is at the cvcn.t, for al I property be long i ma to the croup and to
die City, a%id for adhering to the Kalispell Municipal Code and the Laws of the State of
Montana.
r I understand that a. trained volunteer or employee in one of the preapprovcd MDOR train'1110
courses must be present at all points of sale and service.
i understand that I must pay all fees and deposits as required.
I understand that: my- permit czw be revoked at any brie For just cause, that mv deposit 11-uly
not he returned, and I may not be able to obtain a new permit in the future for violations of
the law such as providing alcohol to a m1nor (FICA 16�-6-'05). pro��idinv a�[�����oi to an
41toxicated person (MCA I6-3)6-3)04), drinking if not of legal drin�in.cT age (MCA 45-5-624)}
or driving while- intoxicated (MCA 61 R8-401).
I �a reo and undelld all of the.poileies and re.ulations contained in the pertTiit.
Sip-natUre of iicarlt Date
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Print_ Islame
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Approved by the City, Counci 1 this ... day of } .
Revised Sept ernber 21014
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State of Montana
Department of Re�',enue%
Liquor Control DiVI sion
2014=2015 License
License No. 07-999-24-1,83-002 S 650.00
TAMARACK ALA HOUSE AND GRILL, LLC
05 BL.ACKTAIL RD S T E 1 h
LAKESIDE MT 599 2-9628
OWNED BY: TAMARACK ALEHOUSE & GRILL, LL
1 o0a OR MORE MEMBERS.- JO HUA R. TOWNSLEY,ANDRA E.
TOW N SLEY
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LEGAL DESCRIPTION OF LICENSED PREMISES:
105 BLAKTAIL RIB Ste 1 LAES1 � s=E
Permission is hereby granted to the above named kcensee to SO "All -Alcoholic Beverages with Catering
Endorsement for On or Off Premises Consumption at the Premises designated above in accordance
with the Montana laws and rules of the Department of Revenue This license is a privilege persoriai to
the lioensee and is subject to suspension or revocation for eau . No transfer hereof as to either person
or location is valid until approved and endorsed upon the face h reof by said Department.
Montana Department of Revenue
Helena, Montana
License Must be prominently displayed in licensed premises.
Valid through June '00:
2015 Administrator,
Liquor Control Division
KALIARE-01 NSTEINBORN
CERTIFICATE OF LIABILITY INSURANCE -1
DATE (MMIDDIYYYY)
211212015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Kalispell O1=FICe
Pa newest Insurance, Inc.INC,No
33 Village Loop
Kalispell, MT 59901
CONTACT
NAME: Nicole Steinborn
PHONE (406) 758-4200 FAX
Ext ; i(AIC,No): (406) 7rJ5a�l 1 89
E-MAIL
ADDRESS: nsfeinhorn paynewes.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Cincinnati Surplus & Excess
INSURED
INSURER B :
Kalispell Area Chamber of Commerce
Kalispell Convention & Visitors Bureau
15 Depot Loop
INSURER C :
INSURER D
INSURER E :
Kalispell, MT 59901
INSURER E :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
DDL
IN
SUBR
WVD
I POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIA131LITY
CLAIMS -MADE OCCUR
X
BINDERNS
02/18/2015
02124/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE T RENTED
PREMISES Ea occurrence)
$ 100, 00
MED EXP (Any one person)
$ 1100
PERSONAL & ADV INJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER-
JECT LOC
POLICY [:] PRO- E:]
GENERAL AGGREGATE
$ 21000,000
GEN'L
PRODUCTS - COMPIOP AGG
$ ,000:000
LIQUOR
$ 11000,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident)
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DEL] I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N 1 A
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
I $
DESCRIPTION OF OPERATIONS below
A
Liquor Liability
BINDERNS
02/18/2015
02/24/2015
110001000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
2015 Pond Hockey Classic Event
CERTIFICATE HOLDER CANCELLATION
City of Kalispell
201 First Avenue East
Kalispell, MT 59901
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
L ,
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD