Temp. Street Closing - Rock Solid Academy 5KJackie Dunham
From: Jackie Dunham < jdunham @cityofokeechobee.com>
Sent: Thursday, December 17, 2015 3:18 PM
To: larson8 @embarqmail.com
Subject: Rock Solid 5K Run
Attachments: 005 -Rock Solid 5K Run Street Closing.pdf
Please be advised your request for street closings on January 9th for the 5K run was approved at the Regular
City Council meeting held December 15, 2015 at 6PM. Should you have any changes or questions please let
me know.
L,eed'iatur y 100'liean4!
Jack e' Dins' ha vw
Genev'a.LServLcea'Secretary
aty of Okeecho-1
55 SE Th&d.Avenue,
Okeechobee', FL 34974
Tele': 863-763-3372 ext. 217
Fouw: 863-763-1686
jdunham @cityofokeechobee.com
Website: http: / /www.cityofokeechobee.com
NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.
1
12/04/2015 09:24 Rock Solid
AX8637630968
CITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tele: 863-763-3372 ext. 218 Fax: 863-763-1686
SPECIAL EVENTS AND /OR, TEMPORARY
STREET AND SIDEWALK CLOSING
PERMIT APPLICATION
P.0011005
1 of 3
Date Received: ',t Sf -[
Date Issued:
Mailing Address:
Application No: iii_coff
Date(s) of Event
Date Paid:
Ta,n waezi 1
Fee: % 11 ii
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Al LA-
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Information:
Or11n17aiion: J
Setict Civris4iwilTax Exempt No: 1
Mailing Address:
40 l 5
I'm S- Okeechobee, FZ- .309 74
Contact Person:
0 , , •
lass a r! '
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E-Mail Address:
‘ errIbar4141431. e o yr
Tefenhone:
Work: -
, Home:
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3ommaryof activities:
Proceeds Usage
q,[1 Oryoe s,�,t s 141111 be Pi's- -the i ejs4-s erP RocH So 6;d ct.% ciR- Pietro
axAe l..etrui 4, Wt 11 i±.Litd i24-Nrvua -1 -4 e.1e -fi-ep . aTpe'Gev_!
Please check requested Parr:
FlagIer Parks: o City fall Park a ##1 Memorial Park ci #2 ❑ #3 o#4 o#5 0 #6
OR
Address of event: 1-tD I S v1/4) 4S.
Parcel ID:
12/0412015 09:25 Rock Solid
(FAX)8637630968
TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION
If not maw Park(s), provide event address:
/401 (5 w
Street Address
OkeecF,o6ee, 3'{474
City State Zip Code
P.0021005
Street® to be closed:
Temporary Street and Sidewalk Closing
• Original signatures of all residents, property
owners and business owners affected by the clo sing.
' SW 4 +h Si- b .1.1.t. A . L. - ._...4, . stA 544 ■ --ti .
Date(s) to be closed:
► Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee and
ILE. Hamrick Testamentary Trust as additional
insured.
Q-03.41 Gemini q. 01 •
(Q A,,n- — 11 = o ct„rs,
Time() to be dosed:
Purpose of Oozing:
• State Food Service License if a ' ' licable.
1"a..r- 'r. q r- R n t sh tire -Four 5K tecer..e,
Charitable Function
Temporary Street and Sidewalk Closing
• Original signatures of all residents, property
owners and business owners affected by the clo sing.
• Site Plan
• Copy of liability insurance in the amount of
S1,000,000.00 with the City of Okeechobee and
R.E. Hamrick Testamentary Trust as additional
insured.
► Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee and
ILE. Hamrick Testamentary Trust as additional
insured.
►Proof of non-prof ft status
•Letter of Authorization from Property Owner
• If any items are being sold on City streets or
sidewalks, a Temporary Use Permit (Tun must be
attached for each business. TUP can be obtained
from the General Services Department.
• Slate Food Service Linens = if a u i linable.
• State Food Service License if a ' ' licable.
• State Alcoholic Beverage License, if applicable. (Alcoholic beverage can be served only on private
property. No alcoholic beverages are allowed on City property, this included streets and sidewalks.)
Note:
• Clean up is required within 24 hours.
► No alcoholic beverages permitted on City property, streets or sidewalks.
• No donations can be regnested if any type of alcoholic beverages are served on private
property/buedness unless you possess a State Alcoholic Beverage License. Please note there are inside
consumption and outside consumption licenses. You must have the appropriate license(s).
• The Department of Public Works will be responsible for delivering the appropriate barricades.
• Dumpstem and port-o-lets are required when closing a street for more than three (3) hours.
Applicant must meet any insurance coverage and code compliance requirements of the city and other
regulations of other governmental regulatory agencies. The applicant will be responsible for costs
associated with the event, including damage of property. By receipt of this permit, the applicant agrees
and shah hold the city harmless for any accident, injury, claim or demand whatever arising out of
applicant's use of location for such event, and shall indemnify and defend the city for such incident,
including attorney fees. The applicant shall be subject to dead for, and payment of, all of the actual cost
incurred by the dty pertaining to the event including, but not limited to, police, fire, maintenance or other
departmental expenses_ The city reserves the right to require from an applicant a cash or cashier's check
advance deposit in the sure approximated by the city to be incurred in providing city services. Any such
sum not incurred shall be refunded to the applicant.
12/04/2015 09:25 Rock Solid
(FAX)8637630968
P.0031005
I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03-
08 and 04-03, concerning the use and the rules of using City property, that the information is correct, and
that I am the duly authorized agent of the organization. I agree to conform with, abide by and obey an the
roles and regulation, which may be lawfully prescribed by the City Council of the City of Okeechobee, or
its officers, for the issuance of this Charitable Function Permit.
CERTIFICATE 01? INSURANCE MUST NAME CITY OF OK ECHOBEE AND R.B. HAMRICK
ARY K ; IDS _ AS ADDITIONAL INSURED.
4i/i'
1 ' : (Ialga
!•••OFFICE USE ONLY••••
C Engneer
bade:
Date:
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Fire Department:
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Buldi ng Offidal:
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Date:
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Public 'Works:
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Dade:
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Police Department
Date:
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Date:
7
Administrator:
Dates
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City Clerk:
u /j(erlc �7�c.
Date:
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NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND
RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS 1 RIOR TO
EVENT FOR PERMITTING.
Temporary Street and Sidewalk Closing submitted for review by City Council en 1 Z / i 5 1 / S
Date
Temporary Street and Sidewalk Closing reviewed by CityCouncl and approved, Date id-11 5 l ( 5
12104/2015 09:25 Rock Solid
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12/08/2015 16:55 Rock Solid
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ROCKS -2
P.0071007
OP ID: ME
Adc-coRt•
`__,� CERTIFICATE OF LIABILITY INSURANCE
DAZE (MMIDOMYY)
1210e/2015
THIS CERTIFICATE 18 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
REPRBSBNTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED, the p011cy(Ies) must be erld0rsed. If SUBROGATION IS WANED, subject to
the terms and coneMlons of the policy, certain policies may require an endorsement. A statement on this certMcate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Prlchards & Associates, Inc.
1802 8 Patton Ave
Okeechobee FL 34974.6179
Krl stlna M Morgan. Agency
CONTACT Kristina M. Moran- Agency
it FAX
�+ . , Erla: 863-763-7711 1 p ic, Noi: 863.763.4629
moms: mferreit @pritchardsinc.com
INSURERS) AFFORDING COVERAGE
NAIC •
*remit A: Markel Insurance Company
38970
INSURE) Rock Solid Christian Academy,
Inc.
401 S.W. 4th Street
Okeechobee, FL 34874
INSURERS :AUtO Owners Insurance Co.
18998 —
INSURER C :
I0G7000128602
INSURER 0:
04/18/2016
INSURERS :
$
INSURER F:
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORME 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I{peF!
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TYPE OF INSURANCE
O WI.
wgD
UWO
VIVO
POLICY NUMBER
POLTCVEPP
IMM{DDIWYYI
POLICYEXP
M,IDDMWY)
LSIITS
A
X
COMMERCIAL GENERAL LIABILITY
OCCUR
X
I0G7000128602
04116/2015
04/18/2016
EACH OCCURRENCE
$
1,000,000
1 CummS -MADE X
P Es (Ea ov°ronoo)
$
100,000
MED EXP (My one person)
8
10,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GENt
AGGREGATE LIMIT APPLIES PER;
GENERAL AGGREGATE
5
3,000,000
POLICY M
OTTER:
LOC
PRODUCTS - COMP/OP AGO
$
3,000,000
$
B
AUTOMOBILE
LIABILITY
ANY Auro
HIRED AUTOS
58rED ri
� SDI.LED
NON-OWNED
oS
4881148800
07/02/2015
07/02/2018
CP_GeMl. SINGLE LIMIT
$
1,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
8
Ise deM E
$
$
UMBRELLA LIAR
EXCES6 MB
I
OCCLR
CLAIMS -MADE
EACH OCCURRENCE
$
1
AGGREGATE
8
Dap II
$
A
ON$
WP2R COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRETORIPARTNERIE)LECUME
OFFICERMIENIBER EXCLUDED'?
(Mandatory In NH)
li yyei aeaAbe 1FFUaf
DESCRIPTION OF OPERATIONS
YIN
N /A
MWC000769505
07117/2015
07117/1016
X 1 SARTUTE 1 1 Ow
E.L. EACHACCIDENT
$
100,000
E.L. DISEASE - EA EMPLOYEE
$
100,000
Mow
E . DISEASE - POLICY LIMIT
5
500,000
DESCRIPTION OF OPERATIONS !LOCATIONS J VEHICLES (ACORD 101, Additional Romano, IN:WuN, may be 'MOW Ir mon epees Is nqulnd)
Holder is listed as additional insured with regards to General Liability
when required by written contract par form HGL1209 01/14
OKEEC-6
City of Okeechobee
55 SE 3rd Avenue
Okeechobee, FL 34974
I
SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION ATE
ACCORDANCE WITH THE POLICY RPROVISIONS. H WILL MB DELNHRBD IN OF, WTI
AUTrIORIZGO REPFtEISEMTAllVE
C�°P
ACORD 25 (2014/01)
01988.2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
12/0812015 16:55 Rock Solid
0000036 04/11/15
r
OF REVENUE
(FAX)8637630968 P.0061007
[Consumer's Certificate of Exemption
Issued Pursuant to Chapter 212, Florida Statutes
85- 80153814400 -5
Certificate Number
This certifies that
04/30/2015
Effective Date
ROCK SOLID CHRISTIAN ACADEMY INC
401 SW 4TH ST
OKEECHOBEE FL 34874 -4240
04/30/2020
Expiration Date
DR -14
R. 04/11
-"Iola WE
Is exempt from the payment of Florida sales and use tax on real property rented, transient rental •J5ert
personal property purchased or rented, or services purchased.
F D
!Impo
rtant information for Exempt Organizations
nted,.tangible
DR -14
R. 04111
1. You must provide all vendors and suppliers with an exemption certificate before making tax - exempt purchases.
See Rule 12A-1.038, Florida Administrative Code (F.A.C.).
2. Your Consumer's Certificate of Exemption Is to be used solely by your organization for your organization's
customary nonprofit activities.
3. Purchases made by an Individual on behalf of the organization are taxable, even if the individual will be
reimbursed by the organization.
4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible
personal property, sleeping accommodations, or other real property Is taxable. Your organization must register,
and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this
requirement except when they are the lessor of real property (Rule 12A- 1.070, FA.C.).
5. It is a criminal offense to' fraudulently present this certificate to evade the payment of sales tax. Under no
circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for
payment of the sales tax plus a penalty of 20096 of the tax, and may be subject to conviction of a third -degree
felony. Any violation will require the revocation of this certificate.
6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account
Management at 800 -352 -3671. From the available options, select "Registration of Taxes," then "Registration
Information," and finally "Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480,
Tallahassee, FL 32314 -6480.