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Temp. Street Closing - Speck. Perch Fest. and Parade' trr.‘ 2■C TEMPORARY CLOSING (')F STATE ROAD PERMIT Date. Perrmt 1,1,) 2616 F - 19 1 — 5 Governmental Entity ,/?€(, Apprownn Lc Gotiemment contact Person titi Address 31; tetephor 3 3 2 LA A ) 1 Email .127),4_,J1 -0-1/`l KL: L f.)i: `( Organization Requesting Special Event Name of Organizatton Contact Person Address ,- Telephone 1 Email • Descrl.Uon of S ecial Event Event Title cpteA4f6:1 %ch._ _Pg,r4 Start Time j/)/?I End Time Event Route (attach map) Date of Event _Pio veil ur Rou ach map) Law Enforceinont Agency Responsible for Traffic Control Name of Agency , ! US Coast Gil Not Applicable 0 Copy of USCG Approval Letter Attached 0 Bridge Location 1 for Co oiling Movable Bridge The Permittee will assume all risk of and indemnify, defend and save harmless the Slate of Florida and the FDOT from and against any and all loss, damage, cost or expense arising in any manner on account of the exercise of this event The Permittee shall be responsible to mainlain the portion of the state road tt occupies for the duration of his event, free of litter and providing a safe environment to the public. Signatures of Authorization Event Coordinator Law Enforcement , NamefTitle L. I Signature 1 Date Signature ( Date Date Government ' Nametle pi2e)(-1 Signature mat cagisi Special Coilditions tti� Federal Margit:0o nom TWic-Crrtret DovicatL(kAUTCD) SLandart; 1600 Sent w • -11111611111111101 111- • m a 111 s 0 *MI • ..„ FOOT Authorization/ Name/TiUe DaVld-SMIth Signature ot,iLt Ptrunt Coy, nT Dale 016 INDEMNIFICATION AGREEMENT This AGREEMENT, by and between the CITY OF OKEECHOBEE, FLORIDA, (hereinafter "CITY") and -_i rbw -.4 /,L ; (hereinafter "APPLICANT "), dated this "' day of l , 4> : i ?z. WHEREAS, APPLICANT desires to hold or sponsor a special event, parade, festival, or other activity requiring the temporary closure of a state - controlled roadway in the City of Okeechobee, Florida, and therefore requires the execution and submission of an application for such temporary closure to the State of Florida Department of Transportation by the CITY pursuant to regulations of said Department, and WHEREAS, pursuant to Resolution No. 88 -5 the CITY requires indemnification by any applicant for temporary road closure before the appropriate CITY officials may execute such application to the Department. NOW, THEREFORE, in consideration of the mutual obligations and covenants set forth hereafter, the parties agree as follows: 1. APPLICANT shall indemnify, protect, defend, and hold harmless the CITY from any and all losses, injuries, damages, or claims of any nature or type resulting directly or indirectly from the temporary road closure and the special event, festival, parade, or other activity to be held on ir' day of 1`vlft(i,(.. , )i:i1 .. Applicant shall further reimburse the CITY for any and all attorneys fees, court costs or other legal costs incurred by the CITY as a result of any such losses, injuries, damages or claims. 2. If the APPLICANT is a corporation, partnership or other legal entity (other than an individual), APPLICANT shalt attach hereto a duly executed resolution, partnership agreement or other document in legal form evidencing the authority of the officers of such entity to enter into this indemnification agreement. 3. Upon the APPLICANT complying with paragraph 2 above, the requirements of Resolution No. 88 -5 of the CITY, and any other reasonable requirements of the CITY, the CITY shall cause the appropriate City officials to execute the necessary forms to make application to the State of Florida, Department of Transportation, for temporary road closure. APPLICANT BY: TITLE: F'x' (.)C 1.". i Fr( CITY OF OKEECHOBEE, FLORIDA BY: •-•;").1.-441 _TITLE: 6.;e66,4 \ FOR CITY USE ONLY -roof of liability insurance Corporate resolution completed .'Other requirements (specify) F eJ o CL: c.-Lt BY: TITLE: DATE: rn ""P 02 0. m OD iv lb 4, = *• '4 0 t < • -, 0. a. . = m c a * to ;,-,. ill., 0 s • C .••• VI -% ill **I et P M "0 er, . .. 4. cr. n O as = co ••••,1 C1. P •-* , . , t -•!.- ' ..". .."-- '',•;-,1,- . „-f '. l' . ..,..r. .-. - ..••• ,-, . ... 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It su 0.• 0 m • m -n m < m 747 0. 0 m m 4,4 OKEEMAI -01 AMINTZ ACORO 4.........--, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 9/24/2015 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 Maury, Donnelly & Parr 24 Commerce t Baltimore, MD 21202 CONTACT NAME: wit,. 685-4625 FAX 410 685 -3071 (A/C, No, Ext1: ( I (AIC, No) ( ) E -MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A :Transportation Insurance Services, Inc 20494 — — — INSURER B 4025933977 INSURED — — Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 INSURER C : EACH OCCURRENCE INSURER 0 : INSURER E : X INSURER F: DAMAGE(ORtNTED PREMISES (Ea axrrrrerx: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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AWL INSD SUER WVD POLICY NUMBER POUCY EFF IMDDIYYYY) POLICY EXP (MMIDDIYYYY) UNITS A X COMMERCIAL GENERAL UABIUTY X 4025933977 0710112015 07/0112016 EACH OCCURRENCE $ 1,000,000 I CLAIMS-MADE X OCCUR DAMAGE(ORtNTED PREMISES (Ea axrrrrerx:e) S 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY S 1,000,000 �GEN'L AGGREGATE LIMIT APPLIES PER: 1 POLICY I I JJECT n LOC OTHER GENERAL AGGREGATE 3 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 3 AUTOMOBILE _ UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) 3 BODILY INJURY (Per accident) $ "ROPERTY DAMAGE (Per accident) $ 3 UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I l RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I desctee under DESCRIPTION OF OPERATIONS below N / A ( PER T Tl1TE I I O E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LINK $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Department of Transportation is named as additional insured with regard to the 2015 Top of the Lake Christmas Parade. CA OLDER CANCELLATION I Department of Transportation 801 North Broadway Avenue Bartow, FL 33831 \ 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 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/ The ACORD name and Togo are registered marks of ACORD Jackie Dunham From: Smith, David M <David.Smith@dot.state.fl.us> Sent: Tuesday, January 26, 2016 3:58 PM To: Jackie Dunham Cc: Stewart, Douglas; Stub len, Robin; Mandl, Sandra; Morrisey, Kevin Subject: RE: Annual Speckled Perch Parade Permit Application Attachments: 2016 F I0I 5.pdf Hi Jackie, The attachment (2Olb-F-}91'5) contains o copy nf the approved FUOT perm rt for: • City of Okeechobee - Okeechobee Main Street 2016 Specked Perch Porade 3/12/2016 from 10:00 AM to 12:00 PM Attached Map details proposed parade route MOT by Cfty of Okeechobee P.b. Thank You David M. Smith District Permit Coordinator (863) 519-2319 doviJsmif6@dvtsfo+e.f[uy � eil/« '11111'/ Jackie Dunham From: Sent: To: Subject: Attachments: Jackie Dunham <jdunham @cityofokeechobee.com> Friday, January 15, 2016 10:12 AM david.smith @dot.state.fl.us Annual Speckled Perch Parade Permit Application Speckled Perch Parade 3- 12- 16.pdf David, I know we have some time on this but I'm trying to stay ahead of the ballgame! ! Thanks. Jackie'Du#th m. qeAlpAroa.Se,rvizeikAWistowtt City of Olceedurlyee. 55 SE 7hi rd'Avenu.e Okeechohe&, FL 34974 Tee.: 863 -763 -3372 exct. 217 1a44/. 863-763 -1686 j dunhamAcityofokeechobee. com Website: http: / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. i