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Temp. Use Permit - Am. Leg. Fair
City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763 -3372 Temporary Use Permit Permit Number: 16 -001 Permit Expiration: February 2, 2016 11:59PM Purpose of Request: American Legion Free Fair Property Owner: American Legion Post 64 Address: 501 SE 2nd Street City: Okeechobee State: Florida Date(s) of Event: January 27- February 2, 2016 Zip Code: 34974 Applicant: American Legion Post 64 Applicant's Address: 501 SE 2nd Street Phone Number: 863 - 763 -2950 Address of Project: 501 SE 2nd Street Current Zoning: Residential Multiple Family (RMF) FLU Designation: Commercial (C) Subdivision: 1st Addition to City of Okeechobee Restrictions /Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. NO SET UP OR TEAR DOWN BETWEEN THE HOURS OF 12 MIDNIGHT AND 7:00 A.M. 48 HRS AFTER FAIR CLOSING, PROPERTY MUST BE VACATED. TRASH MUST BE PICKED UP DAILY IN PARKING LOT AT CITY HALL. I ce fy that I have ex mi ed this permit, it is correct and I will abide by its requirements. Ap can s Signature 1,P J�D(,t�c..0 t� mineral Services Assistant REF: .ORD.716, Temporary Structures Date CITY OF OKEECHOBEE General Services Department, Room 101 55 Southeast 3rd Avenue Okeechobee, FL 34974 Phone: 863 -763 -3372 ext. 218 Fax: 863- 763 -1686 DATE RECEIVED: 1 }/ f 7 APPLICATION No: f` ©O i DATE ISSUED: / // DATE(S) OF EVENT' A FEE: $175.00 DATE PAID: /,z1/ 7 b 5 off' If Non- Profit/Civic Organization TEMPORARY USE PERMIT APPLICATION on on is application is correct. The information included in this application is for use by the City of Okeechobee In processing my request. False or misleading information may be punishable by a fine of up to $500.00 a�imprisonm - t of up to thirty days and may result in the summary denial of this application. Signature of Applicant City Staff (Please review the application attach comments ors i I d' • 1 ;-- /7 / Date — .._.. .. -.... .v... -..., .� i ui 1 unr=o ,=ti 000) APPLICANT Name of Property Owner(s) aree ae,b ,ee, rfriQmiN e f jo i,.eal6Al /9057x` �" Address: f SE pjv� ot�6- cho6 Pe ,2 ,3 / 90.4 Telephone Numbers: Home: y47 -9 rk: Mobile /Cell: Pager: Name of Applicant: ee e,,A.P jee /yew ofpv. l? s1 � et,.P6`6 "41 /39f%4e Address: .J�C�,�.S � !.G sr tkeec U&i 12. Telephone Numbers: Home:4/67 9r/ Work:F63 -7 1e /Cell: Pager: South: on on is application is correct. The information included in this application is for use by the City of Okeechobee In processing my request. False or misleading information may be punishable by a fine of up to $500.00 a�imprisonm - t of up to thirty days and may result in the summary denial of this application. Signature of Applicant City Staff (Please review the application attach comments ors i I d' • 1 ;-- /7 / Date ito./- ak /-JC/ /- PROPERTY. Future Land Use Map Designation: ej eAriA4 Current Zoning Designation: //Jiff Legal Description of Pro a rr��- 1 isci-y-p&Tew T.2 aZ Address of Property: Seq�' r.3 x 5;.--, Of(' e r _ 06 ee �- '/ ?75 Please Explain Type of Use � fp � 04 p� j,9,,, i /j E /4 7i //U » M Briefly describe use of adjoining property: ` North: - SI /Mj°_ eD%'1fi1('4 /4/Si/2; East: t�AGC/ -- aRh 7 South: /i)E/ West: )2- A,4 e'1'tik„5 #e5/Dx 7;4/ h v' ,c..5 Other temporary The a structures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated, by a non - profit organization. 2. Carnival, circus, fair or other special event operated by a non - profit organization on or abutting their principal use. * 3. Commercial carnival, circus or fair in commercial or industrial districts. 4. Similar temporary structures where the period of use will not exceed 30 days a year. licant shall: 1. Submit proof of liability insurance, paid in full covering the period for which the permit is issued, in the minimum amount of $1,000,000.00 per occurrence. 2. Remove all debris within 48 hours of expiration of permit 3. Have notarized written permission of property owner, if applicant is not the Date: Date: /2 -zz -/> P/1`;'7/%73,/eX ublic Works Department A. property owner. 4. Submit Site Plan * 5. Submit State Inspection Certificate(s) * 6. Submit State Annual Permit * I hereby certify that the informati th' on on is application is correct. The information included in this application is for use by the City of Okeechobee In processing my request. False or misleading information may be punishable by a fine of up to $500.00 a�imprisonm - t of up to thirty days and may result in the summary denial of this application. Signature of Applicant City Staff (Please review the application attach comments ors i I d' • 1 ;-- /7 / Date Revised 2/1/08 his i pec a con ILIVI i. Occupational and /or State License Verification: �G '1 -/' �- Date: / -/ 715 Fire Department Approval: , // Date: Police Department Approval: a/ cr------ Date: Date: /2 -zz -/> P/1`;'7/%73,/eX ublic Works Department A. oval: Building Inspector Appro I: Date:, City Administrator Approval: Date: Revised 2/1/08 his i a* v. 4- or_ /<,D ILET7y t op 0 6/1frIE coNiciecsiotv:c- 369/11E sJ C.) 12/01/2015 4 :21 PM FAX 2039310682 Specialty_Insurance,LTD 0001/0001 ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DAT12f1/15YYY) PRODUCER Specialty Insurance LTD -T. Plouffe P.O. Box 16901 West Haven„ CT 06516 203 - 931 -70' 5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED John & Joyce Richardson dba J & J Amusements PO Box 485 New Middletown, Ohio 44442 I X INSURER A: Admiral Insurance Company 24$56 INSURERS: Progressive Express Insurance Co 02962. _ -__ INSURER C: INSURER 0: j CLAIMS MADE X OCCUR INSURER E. $ 5,000 THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L ADP'L Rd T VPEOFINSURANCE POLICY {� 04OZPR 001 POLICY EFFECTIVE DATEIMLVDD1YY1 6/28/15 POLICY EXPIRATION IY DATEfMNUDDYI 6/28/1 LIMITS EACH OCCURRENCE $ 1,000,000 A X GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY X DAMAGE 0 occureneel $ 50,000 ______ j CLAIMS MADE X OCCUR MED EXP (Arty one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP/OP AGG $ 1 ,000, 000 PIRA- LOC X POLICY AUTOMOBILE X _ x LIABILITY ANY AUTO ALL OWNED AUTO$ SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS PIP = $10,000 02666548 -0 9/11/15 9/11/16 COMBINED SINGLE LIMIT (E,tt) . -,. 2,000,000 BODILY INJURY, (Parporson) ' , BODILY INJURY (Peraccldent).. . PROPERTY.DAMAGE (Per accident) : GARAGE LIABILITY ANY AUTO AUTO ONLY :EA.ACCI DENT $ 1 OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY OCCUR I 1 CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS. LIABIUTY ANY PROPRIETOR /PARYNERJEXEOUTIVE OFFICER/MEMBER EXCLUDED? Ii yam, dq;,•crihe unddf SPECIALPROVISIONSbelow TwORY LIMITS I I ER E,LEACHACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS The American Legion Post 64 and the City of Okeechobee, FL are added as an additional insured but only with respects to the operations of the named insured during the policy period. Event Date: January 25, 2016 - February 8, 2016 CANCELLATION The American Legion Post 64 501 Southeast 2nd Street Okeechobee, FL 34974 Fax # 863 - 763 -9602 SHOULD ANY OF THE ABOVE DESCRIDEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE MOO INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIV 34: -11Pr - AUTHORIZED REPR 3� d Thomas A. Plouffe ACORD 25 (2001/08) Jackie Dunham From: Jackie Dunham < jdunham @cityofokeechobee.com> Sent: Thursday, December 17, 2015 12:03 PM To: Chief Herb Smith (Chief Herb Smith) Subject: Temporary Use Permit Attachments: American Legion 64th Annual Free Fair.pdf Chief, attached is the Temporary Use Permit application and site plan for the upcoming 64th Annual American Legion Free Fair. The dates are January 27th thru February 7th, 2016. If there is a staff meeting on Tuesday, December 22nd, I will send this for review and signatures. Otherwise, I'll need your or one of your staff to sign. NOTE: Their Certificate of Insurance show the dates of January 25th thru February 8th so hopefully they will be set up and ready for inspections in a timely manner!! ecidozaria9 /00'lieani Jackie D u.nth.avw e,nera.L Servtce.4( Secretary City of OkeechaUee- 55 SE T1u rd 4ve'ute. Okeeclwl>ee, FL 34974 Teel 863 - 763 -3372 east. 217 7a' 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. i Florida Department of Agriculture and Consumer Services Division of Consumer Services / Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code DATA Date Inspector '+ EventIltc'"� Location Phone 1- 800 - 435 -7352; Fax (850) 410-3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name MFG Serial # USAID # Permit # KIDDIE NON KID ''IE SUPER REQUIREMENTS: (Check each requirement as it is accomplished or place (N) if 1. RIDE STATUS a.( 4rmit b.(,surance ompliance/NDT Manuals 2. INS TALLATION locking encing /Guarding 44 races /Guys /Anchors Signs Electrical Sch dule Unannounced Re- inspection — Permit Inspection /Red Tag History Tem - Permanent Loca • n When Facing.; L. fie, vtn1F.t R. -., not applicable) 3. STRUCTURAL a.( it ydraulics /Pneumatics b.( ns /Bolts /Keys c.( Structural lntegrity d.(! ires/Wheels /Casters e.( Bearings /Spindles /Axles f. ( Track/Rim Iron 6. OTHER a.( Automatic Sprinkler /Smoke Detector b.( Water Quality,, c.( Bungy Cords d. Cranes Comments 4. ATA�IENi'_ a.(.. en Attacfrnents b. rrier/Tubs c. estraints d. ( Sweeps 5. OPERATION a.( PM Check b.( ontrols c.( rakes d.(.1- Limit Controls t 1 ) pidentified PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked, The above amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies, (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01109) # �. 7 noted above 1 acknowledge ride is Section operators receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the the last 14 daily inspection reports were completed and available upon request. Owner anager Signature ' Inspector's Signature { PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) MI Owner /Manager Signature inspector's Signature FDACS -03419 Rev, 12/09 White /Bureau Canary/ Owner or Manager ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code KIDDIE NON, KIDDIE REQUIREMENTS: (CNI 1. RIDE TATUS a.( rrnit b.( ; urance c.( mpliance /NDT d.(, anuals 4. ATT#CHMENTS a.( Iten Attachments b.( rrier/Tubs ''{ec.( straints d.( ""Sweeps DEFICIENCIES: Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Sc edu - Unannounced Ride Name 1� � r >, Re- inspection Porn* MFG Inspection/Red Tag History '' Serial # Temp y — Permanent USAID # Locat on When Facing: Permit # L. 3 wool R. SUPER ach requirement as it is accomplished or place (N) if not applicable) 2. INSTALLATION a.(113locking b.(ncing /Guarding, c.( ,)2taces /Guys /Anchors d.(..,Signs e.(,,).Electrical 5. OP RATION a.( PM Check b.(Tontrols c.( rakes d.( j'Limit Controls 1 }r' 3. STRUCTURAL a.(.„,etydraulics /Pneumatics b.( 'ns /Bolts /Keys c.( uctural Integrity d.( iresiWheels /Casters earings /Spindles/Axles f. (,*j'Track/Rim Iron 6.OTHER a.( Automatic Sprinkler /Smoke Detector b.(1Nater Quality c.(Bungy Cords d.( Kranes e.( Comments e.( RESULTS: FDACS- 03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event PURSUANT TO Section 616.242(7)„.$, AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above - .A h deficiencies identified amusement ride - fleets the requirements of Section 616;242, F.S. and Rule Chapter 5J -18, F C. and t noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # , �, d► I acknowledge ride is Section operator, receipt of this inspection incompliance with Section 616.242, 616.242(16), F.S. and he manufacturers an the last 14 d ' y in 7ction report and the NOTICE OF RIGHTS on the reverse side of this form. 1 certify this amusement F.S. The employee responsible for operating this ride has been trained in accordance with operating instructions or the operating fact sheets for this ride are available to the reports were completed and available upon re Owner/Manager Sign at a Inspector's igna ure PURSUANT TO Section 616.242(7), 616.242, F.S. and Rule Chapter STOP OPERATION ORDER ( FDACS F.S., the above identified amusement ride does not meet the requirements of Section 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. 03545, Rev. 12/09)# • Owner /Manager Signature Inspector's Signature FDACS- 03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J -18. 0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name 011AFG Serial # USAID # Permit # KIDDIE NON - IE SUPER REQUIREMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) Sc ed` ed — Unannounced Re- inspection — Permit Inspection /Red Tag History' Temp ary Permanent Loca4n When Facing: L. R. R. Z 1. RI ' STATUS a.( b.( surance c.( yJ4 ompliance/NDT Manuals 4. ATTACHMENTS a.( •en Attachments b.( wtarrier/Tubs c.(/estraints d. (Sweeps DEFICIENCIES: 2. INSTALLATION a.O'Blocking b.(.4-Fencing /Guarding c.( races /Guys /Anchors d.( igns e.( electrical 5. OPERATION a. b.( c.( d.( PM Check ontrols rakes imit Controls 3. STRUCTURAL a.Olydraulics /Pneumatics b.(4 Pins /Bolts /Keys c.( ,y6tructu ra l Integrity d.( ,,A„ires/ W h e e l s /Casters e.( earings /Spindles /Axles f. ( rack/Rim Iron 6. OTHER a.(4/Automatic Sprinkler /Smoke Detector b.(A),VVater Quality c.(ungy Cords d.(+''9Cranes e.(')''Comments RESULTS: FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager PURSUANT TO Section 616.242(7),'F.S.,`AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above ° identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deft ' ncies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # iil I acknowledge ride is Section operator, receipt of this inspection in with Section 616.242, 616.242(16), F.S. and he. manufacturers an the last 14 ily i pection ,, 1 ... report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement F.S. The employee responsible for operating this ride has been trained in accordance with operating instructions or the operating fact s ets for this ride are available to the reports were completed and available 4 pon equest. �o �pp ig Owher/ /Manager Signature l • igna PURSUANT TO Section 616.242(7), 616.242, F.S. and Rule Chapter STOP OPERATION ORDER (FDACS F.S., the above identified a usement ride does not meet the requirements of Section 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. 03545, Rev. 12/09) # Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1 -800- 435 -7352; Fax (850) 410 -3797 FairRides @FreshFrom Florida. com DATA: Date Inspector Event Location Ride Owner`" Ride Name FG Serial # USAID # Permit # KIDDIE NON- KIDDIE SL REQUIREMENTS: (Check each requiremn 1. RIDE STATUS a; rmit b. , _ ' surance c.( mpliance/NDT Manuals 4. ATTACHMENTS a.(04 -Gen Attachments b.(, 3- Carrier/Tubs c. (,,Restraints d.(4Sweeps ScKpduled — Unannounced Re- inspection - Permit Inspection/Red Tag History-00°' Tempir'ry - Permanent Location When Facing: L. . R. as it is accomplished or place (N) if not applicable) 2. INSTALLATION a.(,1013locking b.( .4''Fencing /Guarding c.( . races/Guys/Anchors d.( Signs e.( 40Electrical 5. OPERATION a.( },RPM Check b.( ,controls c.(4rakes d.(,, Limit Controls 3. STRUCTURAL a.(,,)-Hydraulics/Pneumatics b. (,,eins /Bolts /Keys c. (›Structural Integrity d.( j.Tires/Wheels /Casters e.(,,)06earings /Spindles /Axles f. (,,,,Wrack/Rim Iron 6. OTHER a.(4 ,Automatic Sprinkler /Smoke Detector b.(A Water Quality c.(YBungy Cords d.(I Cranes e.(1`Comments DEFICIENCIES: SST '/C Sc 4r 4/4. ' fer" -7 os-r / 017 0C. ►J r RESULTS: FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event PURSUANT TO Section 616.242(7), F.S AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above Identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficirpies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # / 0 ,p ► 1 • 1 acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the • aerating fact sheets «.r this ride are available to the a d the Mast 14 daily gspection reports were completed and available ion re• est t O>er/ (Manager Sigiiature ns> . s magna ure PURSUANT TO Section 616.242(7), F.S., the above identified a sement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name MFG Serial # USAID # Permit # KIDDIE NON- KIDDIE S R REQUIREMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) Scie,dled — Unannounced Re- inspection - Permit'` Inspection /Red Tag History Tempe Permanent Loca hen Facing: '1r ► L. v4 ' R. 'Zak !I 1. R D STATUS a.( rmit b.( surance ompliance /NDT `Manuals 4. ATTACHMENTS ien Attachments arrier/Tubs estraints weeps DEFICIENCIES: L44 k 'fry. 2. INSTALLATION a.( „Blocking b.( 4.5encing /Guarding c.( -aces /Guys /Anchors d.( Signs e.(,e7+Electrical 5. OPERATION a.(,,,RPM Check b.(,Controls c.(.iSrakes d.( 4.Cimit Controls (kdXLI 3. STRUCTURAL a.(„,•Hydraulics /Pneumatics b.( .Pins /Bolts /Keys c.( 4tructural Integrity d.( 4jires/Wheels /Casters e.( arings /Spindles /Axles f. (ack /Rim Iron 6. OTHER a.(Automatic Sprinkler /Smoke Detector b.(...Water Quality ungy Cords d.(^'j ,,cranes e.( Comments RESULTS: ❑ (PURSUANT TO Section 616.242(7), F.S„ ;ANIM PECTION CERTIFICATE IS ISSUED, when box is checked. The above dentified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # / 44 I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and he manufacturers operating instructions or the •perating fact shee s for this ride are available to the ar the lasty14 d • y i ection reports were completed and availabl= pan r -qu= t. / Owner /Manager Signature in .ec or's ignature PURSUANT TO Section 616.242(7), F.S., the above identified a usement ride does not meet t" equir - nts of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White/Bureau Canary/ Owner or Manager Pink/Event Inspection _ of Florida Department of Agriculture and Consumer Services ision of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1- 800 -435 -7352; Fax (850)410 -3797 FairRides@FreshFromFlorida.com ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location Ride Owner Ride Name MFG Serial # USAID # Permit # KIDDIE NO -KID, IE SUPER REQUIREMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) Sc ed d — Unannounced Re- inspection — Permit Inspection /Red Tag Histor Tempry— Permanent LocatiW` When Facing: L. 5 i k L R. •.aT 1. RI STATUS a. ermit b. surance c. Compliance /NDT d.,(`Manuals 4. ATTACHMENTS a.t„,.Gen Attachments b.(arrier/Tubs c.(,Restraints d.(A}tweeps DEFICIENCIES: /AL) 2. IN TALLATION a.( Blocking b.(IfTencing /Guarding c.( races /Guys /Anchors d.( )'Signs e.( }Larectrical 5. OPERATION a.( PM Check b. ontrols c.( akes d.( imit Controls 3. STRUCTURAL a.(lydraulics /Pneumatics b.( ,)Pins /Bolts /Keys c.( ,)..Structural Integrity d.( iires/Wheels /Casters e.( 4earings /Spindles /Axles f. ( rack/Rim Iron 6. OTHER a.( 4,Automatic Sprinkler /Smoke Detector b.(4Nater Quality c.(4)0,Bungy Cords d.(„4/Cranes e.( comments RESULTS: FDACS- 03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section.616 242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # I/742 f I acknowledge ride is Section, operator receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets fo this ride are available to the nd the last dilly inspection reports were completed and available •n re +uest. r •wner /Manager ignatur- 'rns• ►•" - �, PURSUANT TO Section 616.242(7), F.S., the above identified a +sement ride does not meet the requiremen of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # Owner /Manager Signature Inspector's Signature FDACS- 03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1-800-435-7352; fax (850) 410 -3797 FairRides@FreshFromFlorida.com ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location Ride Owner Ride Name MFG Serial # USAID # Permit # K E NON- KIDDIE SUPER REQUIREMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) Sc t a luted - Unannounce Re• inspection - Permit Tag HistOry'""°°- T pot ry - Permanent Location When Facing: L. -1" R. ts Thi r?G.r V Q" 1. RIDE STATUS a.(. ermit b.(..40fisurance c. (..rCo m plia nce /N DT d. Manuals 4.ACIMENTS a. ),,Gen Attachments b.(i,Carrier/Tubs c.( estraints d.(.' Sweeps DEFICIENCIES: 2. INSTALLATION ocking encing /Guarding c.( races/Guys/Anchors d.(4'5i.. ns e.(,,) Electrical 5.OtERATION a.(4 PM Check b.( ontrols c. rakes d.( Limit Controls 3. STRUCTURAL a.OI-lydraulics /Pneumatics b.( ,}.P1ns /Bolts /Keys c.( )08tructural Integrity d.( )Cires/W heels /Casters e.(,earings /Spindles /Axles f. (f►Track/Rim Iron 6r` OTHER a.( /j Automatic Sprinkler /Smoke Detector b. Water Quality Bungy Cords d. Cranes e.( Comments .( (AT lost )(1,2, RESULTS: ❑PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # ,J ail 1 acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the the last 14 da' inpction reports were completed and available upon re Owner /Manager Signature Inspector's Signature PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature AWF FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection _ Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location KIDDIE NO REQUIREMENTS: (C 1. RIDE STATUS a.( hermit b.( insurance c.( ompliance/N DT d. Manuals 4.AT HMENTS Ride Owner Ride Name MFG Serial # USAID # Permit # DIE SUPER each requirement as it is accomplished or place (N) if not applicable) Sche ,yke — Unannounced Re- inspection — Permit Inspection /Red Tag Histo Temr ry — Permanent Location When Facing: L.�. etti4 ht' 2. INS LLATION a.( locking b.L,)•P"encing /Guarding c.O races /Guys /Anchors d.(,,\Zigns e.O Electrical ATION 3. STRUCTURAL a. Hydraulics /Pneumatics b.( ns /Bolts /Keys c.( ;structural Integrity d. (4.Ti res/Wheels /Casters e.( 'earings /Spindles /Axles f. (A) Track/Rim Iron 6. OTHER Automatic Sprinkler /Smoke Detector Water Quality tangy Cords nes omments a. Attachments b.( rrier /Tubs c. straints d.( Sweeps DEFICIENCIES: RESULTS: [ PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # 2 O 1 acknowledge ride is Section operator receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact s s for this ride are available to the the last 14 'l l i ctionyyreports were completed and available upon request..';: , Owner/Manager Signature Inspector's Signe Signature TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection — of Florida. Department of Agriculture and Consumer Services Division of Consumer Services/Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J-18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER Phone 1-800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Sch ed — Unannounced Ride Name — Permit MFG �"�'"�: �"'� ! Inspection /Red Tag History . Serial # Temp — Permanent USAID # Locae� When Facing: Permit # .K ®" ° a. L. R. KI r NON- KIDDIE SUPER REQU REMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) 1. RID STATUS 2. INSTALLATION 3. STRUCTURAL rmit a.(,+)+Blocking a.(,i),.,H draulics /Pneumatics urance b.(,,encing /Guarding ompliance /NDT c.(,races /Guys /Anchors Manuals d. igns Electrical 4. ATTACHMENTS a.(eKen Attachments b.(,,/Carrier/Tubs c.("Restraints d.(weeps DEFICIENCIES: 5. OPERATION a.(+2PM Check b.(ontrols c.( %Brakes d.(x.yLimit Controls b.(„, ins/Bolts/Keys c.( tructural Integrity d.(. ires/Wheels /Casters e.( Bearings /Spindles /Axles f. ( Track/Rim Iron 6.OTHER a.( ) Automatic Sprinkler /Smoke Detector b.) Water Quality Bungy Cords ) Cranes ) Comments i RESULTS: FDACS - 03419 Rev. 12/09 White/Bureau Canary/ Owner or Manager Pink/Event Inspection _ PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and ,the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) 177. "` I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the an he las 14 dail .in Lion reports were completed and available upon r st. Ownerr/Manager SigrktJr Inspector's Signature PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature FDACS - 03419 Rev. 12/09 White/Bureau Canary/ Owner or Manager Pink/Event Inspection _ Florida Department of Agriculture and Consumer Services ' ",,Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT ADAM H. PUTNAM COMMISSIONER Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com DATA: Date Inspector Event Location Ride Owner Ride Name MFG Serial # USAID # d - Unannounced Re- inspection — Permit Inspection /Red Tag History;- Tem . rary — Permanent Loc t on When Facing: Permit # L. `'j 1'ti (. R. SUPER requirement as it is accomplished or place (N) if not applicable) NON- KIDDIE REEMENTS: (Check each 1. RIDE STATUS a.(.'ermit b.(nsurance c.(ompliance /NDT Manuals 2. INSTALLATION a.( ,,).Blocking b.(,,)0Fencing /Guarding c. (,,,,+Braces /Guys /Anchors d.(.i'Signs e.(.) Electrical 4. ATTACHMENTS a.( en Attachments Carrier/Tubs estraints Sweeps 5. OPERATION a.( ).RPM Check b.( 4" ontrols c.( Brakes d.( imitControls 3. STRUCTURAL a. (AH draulics /Pneumatics b.(.,rins /Bolts /Keys c.(., 5 ructural Integrity d.( ires/Wheels /Casters e.( earings /Spindles /Axles f. (rack/Rim Iron 6. OTHER a.( Automatic Sprinkler /Smoke Detector b. Water Quality c. ) Bungy Cords d. ) Cranes e.( Comments fa -ic64 DEFICIENCIES: RESULTS: FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection _ of PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # I acknowledge ride is Section operator in compliance 616 a receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the the last 14 d • i ction reports were completed and available upon request. CI(. Owner /Manager Signature- Inspector's Signature PURSUANT 616.242, STOP TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. OPERATION ORDER ( FDACS 03545, Rev. 12/09) Owner/Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection _ of Florida Department of Agriculture and Consumer Services Division of Consumer Services/Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER DATA: Date 4,3''' Li? inspector Event Location Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name MFG Serial # USAID # it # KIDDIE NON- KIDDIE REQUIREMENTS: (Check each requirem 1. RIDE STATUS a l; rm it b. urance ompliance /NDT Manuals 4. ATTACHMENTS a.( en Attachments b.( arrier/Tubs c.(.testraints d.( .weeps DEFICIENCIES: Schdted - Unannounced Re- inspection - Permit Inspection /Red Tag History Temp ry Permanent Loca on When Facing: L. vtr as it is accomplished or place (N) if not applicable) 2. INSTALLATION a.(,.Bbcking b.(J,Eencing /Guarding c. (jraces /Guys /Anchors d:O igns e.(1 Electrical 5. OP RATION a.( PM Check b.(,,,Controls c.(,,0Brakes d.(."Limit'Controls Y re 1 I1PR c40'tt'+rr 3. STRUCTURAL a.( - 14ydraulics /Pneumatics b.( -Ains /Bolts /Keys c. (. 'Stru ctu ral Integrity d.( rires/Wheels /Casters e.( earings /Spindles /Axles f. ( rack/Rim Iron 6. OTHER Automatic Sprinkler /Smoke Detector Water Quality Bungy Cords Cranes Comments C RESULTS: ❑ URSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above en tified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deft ' ncies A above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # 170 A. K 2 I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. : The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. an the manufacturers operating instructions or the operating fact sheets for this ride are available to the al the la t 14 Hy i s ' ction reports were completed and available upon reques . Owner /Manager Signature Inspector's Si ure ❑ PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER ( FDACS 03545, Rev. 12/09) # Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 Canary/ Owner or Manager Pink/Event Inspection _ of _ ,$ Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER Phone 1- 800 - 435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com DATA: Date Inspector Event Location Ride Owner ,).; Scheduled — Unannounced Ride Name t h'"t° Re- inspection — Permit MFG Inspection /Red Tag Histoi Serial # Temporary— Permanent USAID # Location When acing: Permit # L. Ft rpti R. w3(, /, „c KIDDIE NO REQUIREMENTS: (Ch 1. RIDkSTATUS hermit surance ornpliance/NDT Manuals DIE SUPER each requirement as it is accomplished or place (N) if not applicable) 2. INSTALLATION a.( ocking b.(encing /Guarding ( races /Guys /Anchors d. igns .(;, Electrical 3.STR1CTURAL draulics /Pneumatics s /Bolts /Keys tructural Integrity ires/W heels /Casters earings /Spindles /Axles rack /Rim Iron 4. AT CHMENTS n Attachments b. rrier/Tubs c.(� restraints d. weeps ATION M Check ntrols akes imit Controls 6. OTHER Automatic Sprinkler /Smoke Detector Water Quality Bungy Cords Cranes Comments DEFICIENCIES:,. rPr 1G!J RESULTS: +$; PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of`Sectitin 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the d ciencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # 147 I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. 1 certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the an the la s 14 d y {' ction reports were completed and available upon reques ‘" O er /Manager Signature Inspector's Sig rre PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature FDACS-03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection of ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location KIDDIE NO REQUIREMENTS: (C 1. RID TATUS a. b. c.(' d.( mit urance • mpliance /NDT anuals Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1- 800 - 435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name FG Serial # USAID # Permit # KID ► E SUPER each requirement as it is accomplished or place (N) 2. INSTALLATION a. ( „),1iilvcking b. (;;,).Gencing /Guarding c. (,),Bra ces /Guys /Anchors d.(;,y6igns e.(Jtectrical 4. ATTACHMENTS a Attachments b arrier/Tubs c. estraints d.( weeps DEFICIENCIES: Sthrofduled Unannounced Re- inspection - Permit Inspect /Red Tag History coe - Permanent Location W 5. OPERATION a.( 3011PM Check b.(...}. bntrols c.( akes d.( Limit Controls Facing: R 3- 1.0,,,,pe r if not applicable) 3. STRUCTURAL a.( 4.M raulics /Pneumatics b.( 4 s/Bolts/Keys c.( ISItuctural Integrity d.(, l es/Wheels /Casters e.( arings/Spindles/Axles f. (ack/Rim Iron 6. OTHER a.( Automatic Sprinkler /Smoke Detector b.( Water Quality c.( Bungy Cords d.(` Cranes e.( omments RESULTS: FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager ;Pink/Event PURSUANT TO Section 616.242(7), FS., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the deficiencies noted above (if any) have been corrected. INSPECTION CERTFICATE ( FDACS 03550, Rev. 01/09) # 1 acknowledge ride is Section operator, receipt of this inspection in compliance with Section 616.242(16), F.S. and the the las 14 daily inl p it ..M i 41,,i` k report and the NOTICE OF RIGHTS on the reverse side of this form. 1 certify, ts amusement 616.242, F.S. The employee responsible for operating this ride has been trained inarbordance with manufacturers operating instructions or the operating fact sheets for this ride are available to the ction reports were completed and available upon reques Owner /Manager S rtUre Inspector's ure PURSUANT TO,Bection 616.242t7), 616.242, F.S. and Rule Chapter STOP OPERATION ORDER F.S., the above identified amusement ride does not meet the requirements of Section 5J -18, F.A.C. and shall not operate until it passes a subsequent'inspection by the Deparlrnent. (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager ;Pink/Event Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event iime , Location Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name MFG 'Serial # USAID # Permit # KIDDIE NOP REQUIREMENTS: (Ch 1. RID STATUS a.( rmit b.(surance c.( ompliance /NDT I.( Manuals SUPER each requirement as it is accomplished or place (N) if not applicable) 2. INSTALLATION 3. STRUCTURAL Scaled - Unannounced Re- inspection — Permit Inspection /Red Tag History-" Tem ary — Permanent Loca6n When Facing: L. lot t ='' R. ft x eking ncing /Guarding races /Guys /Anchors Signs Electrical lydraulics /Pneumatics ins/Bolts/Keys uctural Integrity d.( ires/Wheels /Casters e.(. 3earings /Spindles /Axles f. (... '�frack/Rim Iron 4. AT CHMBNTS a.(en Attachments . b.( arrier/Tubs c.( orfiestraints d.(.weeps 5. OP ATION a.( PM Check b.( ontrols c.( rakes d.( 'Limit Controls THER utomatic Sprinkler /Smoke Detector Water Quality Bungy Cords Cranes Comments RESULTS: FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection of _ PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above , identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, `F.A C. and the defici ncies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # i,arknowIepge ide-'is n operaor,ad receipt of this inspection report in compliance with Section 616.242, 616.242(16), F.S. and the manufacturers the la t 14 d 'Iy i ejection and the •NOTI.GE' OF RIGHTS on the reverse side of this form. I certify this amusement F.S;The employee responsible for operating this ride has been trained in accordance with operating instructions or the operating sheets for this ride are available to the reports were completed and available upon re, Owner/Manager Signature Inspector s Signature PURSUANT TO Section 616.242(7), 616.242, F.S. and Rule Chapter STOP OPERATION ORDER (FDACS F.S., the above identified amusement ride does not meet the requirements of Section 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. 03545, Rev. 12/09) # Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary/ Owner or Manager Pink/Event Inspection of _ Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida. Statutes Rule 5J- 18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event Location 4 KI Phone 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name MFG Serial # USAID # Permit # NON - KIDDIE SUPER Sc led - Unannounced Re- inspection - Permit. -*"."" Inspection /Red Tag History Tem Lo L. - Permanent n When Facing: R. p REQUIREMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) 1. RIDE STATUS a.( rmit b.(,surance c.( ompliance/NDT d.( anuais 4. ATTACHMENTS a.( „Le yen Attachments b.(arrier/Tubs restraints Sweeps .( DEFICIENCIES: 2. INSTALLATION a.( iRlocking b.(encing /Guarding c.(,,yl4races /Guys /Anchors d.(.orSigns e.O'Electrical 5. OPERATION a.( . 4PM Check b.(ontrols c.(/l Brakes d.(.,, Limit Controls lior 1070, 3. STRUCTURAL a.( Hydraulics /Pneumatics b.( >Pi ns /Bolts /Keys c.( J,Structural lntegrity d.( res/Wheels /Casters e.(earings /Spindles /Axles f. ( rack/Rim Iron 6. OTHER a.( Automatic Sprinkler /Smoke Detector b. Water Quality c.( Bungy Cords d.( Cranes e.( Comments re 14 RESULTS: ❑ PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above entified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and the defic'encies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) #A I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the, manufacturers operating instructions or the operating fact sheets for this ride are available to the and the last 14 daily idtion reports were completed and available upon request. N. 0/Z---/„.. Owner /Manager Sign Inspector's Sig tuAa r PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of. Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER ( FDACS 03545, Rev. 12/09) # • Owner /Manager Signature inspector's Signature White /Bureau Canary/ Owner or Manger Pink/Event Inspection _ of Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT ADAM H. PUTNAM COMMISSIONER Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code Phone 1 -800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com DATA: Date —j Ride Owner Inspector " Ride Name Event }d'f Cir�H1G �Ir� MFG Location Serial # USAID #, Permit # NON- KIDDIE SUPER S to used - Unannounced Re- inspection - Permits Inspe• /Red Tag History Tem .. . ry - Permanent Location When Facing: L. C0144%.6 R. itroi REt341fREMENTS: (Check 1. RIDS STATUS a. rmit b. surance c.('ompliance /NDT .( Manuals each requirement as it is accomplished or place (N) if not applicable) 2. INSTALLATION a. („,locking b. (..•)fencing /Guarding c. (•- ra ce s /Guys /Anchors d.(4 igns e.(.,ptIectrical 4. ATTACHMENTS a.(4' en Attachments b.( arrier/Tubs c.(.rtestraints d.(s) Sweeps 5. OPERATION a.(.41PM Check b. (.•Controls c.(11?Brakes d.('4Limit Controls 3: STRUCTURAL a.( e Hydraulics /Pneumatics b.(„ins /Bolts /Keys c.(ructural Integrity d.( ires/W heels /Casters e.(or earings /Spindles /Axles f. (,,Track /Rim Iron 6. OTHER a.( Automatic Sprinkler /Smoke Detector b. Water Quality ) Bungy Cords Cranes Comments DEFICIENCIES: -nee RESULTS: FDACS- 03419 Rev. 12/09 White /Bureau. Canary/ Owner or Manager Pink/Event Inspection _ of PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.. . d f iencies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # ii, ri` > 1 acknowledge ride is Section operator, in 616.242(16), a receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. 1 certify this amusement with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with F.S. and th manufacturers operating instructions or the operating fact sheets for this ride are available to the A-1 the last 14 dal ins pe ion reports were completed and available upon req !? Owner /Manager Signature ; Inspector's i n p 9 i.a PURSUANT 616.242, STOP TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. OPERATION ORDER (FDACS 03545, Rev. 12/09) # Owner /Manager Signature Inspector's Signature FDACS- 03419 Rev. 12/09 White /Bureau. Canary/ Owner or Manager Pink/Event Inspection _ of Florida Department of Agriculture and Consumer Services Division of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code 1- 800 -435 -7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event A E' fit, Location Ride Owner Ride Name MFG Serial # USAID # it # KIDDIE NON- KIDDIE REQUIREMENTS: (Check each require 1. RIDE STATUS a.(ermt b. surance c. ompliance /NDT Manuals 4. AT►CHMENTS a. en Attachments b.L Carrier/Tubs c.(4Restraints d.(4 Sweeps DEFICIENCIES: S' `ed led — Unannounced Re- inspection — Permit Inspec 'on /Red Tag History Te — Permanent Loca h When Facing: L. fre , q, / R. tyt nt as it is accomplished or place (N) if not applicable) 2. INSTALLATION a.4✓f 'locking b.(4Fencing /Guarding c.1„, races /Guys /Anchors d.(4 Signs e.14 Electrical 5.O;ERATION a.("'}PM Check b.(1 Controls c.(,�+f Qrakes imit Controls 3. STRUCTURAL a.(.'iydraulics /Pneumatics b. (.''Pins /Bolts /Keys c. (,.tru ctu ra I Integrity d.(,)'ires/W heels /Casters e.O.Bearings /Spindles /Axles f. (Track/Rim Iron 6.OTHER utomatic Sprinkler /Smoke Detector ater Quality ungy Cords Cranes Comments SALTS! FDACS -03419 Rev. 12/09 White /Bureau Canary /Owner or Manager Pink/Event Inspection — of PURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above identified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A C fiw ' ies noted above (if any) have been corrected. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form, I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the an the last 14 d y i Tection reports were completed and available upon requ Owner /anag er Sig nature g ure Inspector's ture PURSUANT TO Section 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) # • Owner /Manager Signature Inspector's Signature FDACS -03419 Rev. 12/09 White /Bureau Canary /Owner or Manager Pink/Event Inspection — of =lorida Department of Agriculture and Consumer Services vision of Consumer Services /Bureau of Fair Rides Inspection AMUSEMENT RIDE INSPECTION REPORT Section 616.242(4), Florida Statutes Rule 5J- 18.0012, Florida Administrative Code ADAM H. PUTNAM COMMISSIONER DATA: Date Inspector Event g Location Phone 1- 800 -435- 7352; Fax (850) 410 -3797 FairRides@FreshFromFlorida.com Ride Owner Ride Name MFG Serial # USAID # Permit # NON - KIDDIE SUPER R V1f EMENTS: (Check each requirement as it is accomplished or place (N) if not applicable) 2. INSTALLATION 3. STRUCTURAL a.( ),elocking a.( Hydraulics /Pneumatics b.encing /Guarding b.(' Pins /Bolts /Keys c.(„ )ograces /Guys /Anchors c.( tructural lntegrity d.( ).6igns d.( ires/Wheels /Casters e.( ) Electrical e.('Bearings /Spindles /Axles f. (,,4'Track/Rim Iron 5. OPERATION 6. OTHER a.( PM Check a.( Automatic Sprinkler /Smoke Detector b.( ontrols b. Water Quality c.( rakes c.( Bungy Cords d.( imit Controls d.( Cranes e.( Comments Suled — Unannounced Re- inspection— Permit Inspection /Red Tag Histo Temper' — Permanent Locid When Facin L. c. R. 04 (;,,f 1. RIDE STATUS a.( rmit b. surance c.(4t ompliance/NDT d.(arianuals 4. ATTACHMENTS a.( en Attachments b. arrier/Tubs c. estraints d.( «+)`Sweeps DEFICIENCIES: cA 0 T • FDACS- 03419. Rev. 12/09 White Canary/ Owner or Manager Pink/Event Inspection — of _ FURSUANT TO Section 616.242(7), F.S., AN INSPECTION CERTIFICATE IS ISSUED, when box is checked. The above wfidentified amusement ride meets the requirements of Section 616.242, F.S. and Rule Chapter 5J -18, F.A.C. n %tkfe r e ncies a have been corrected.. INSPECTION CERTFICATE (FDACS 03550, Rev. 01/09) # _a� �• noted above (if any) I acknowledge ride is Section operator, receipt of this inspection report and the NOTICE OF RIGHTS on the reverse side of this form. I certify this amusement in compliance with Section 616.242, F.S. The employee responsible for operating this ride has been trained in accordance with 616.242(16), F.S. and the manufacturers operating instructions or the operating fact sheets for this ride are available to the anil the la t 14 cipilly in ction report we completed and available upon request f ter; a if t ` �-a Inspector's Signature Owner(Manager Signature P 9 PURSUANT TO Seen 616.242(7), F.S., the above identified amusement ride does not meet the requirements of Section 616.242, F.S. ar d iule Chapter 5J -18, F.A.C. and shall not operate until it passes a subsequent inspection by the Department. STOP OPERATION ORDER (FDACS 03545, Rev. 12/09) #„;,. • Owner /Manager Signature Inspector's Signature FDACS- 03419. Rev. 12/09 White Canary/ Owner or Manager Pink/Event Inspection — of _