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Temp. Use Permit - O.L. Raulerson Fund RaiserCity of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 (863) 763 -3372 Temporary Use Permit Permit Number: 16 -003 Date(s) of Event: February 26, 2016 11AM -2PM Permit Expiration: February 26, 2016 11:59PM Purpose of Request: Barbeque Fundraiser Property Owner: Karla Roby & Debra Sales Address: P.O. Box 1395 City: Okeechobee State: Florida Zip Code:34974 Applicant: O.L. Raulerson, Jr. Scholarship Fund Applicant's Address: 504 NW 4th Street Phone Number 863 - 763 -3117 Address of Project: 1600 S Parrott Avenue Current Zoning: Heavy Commercial (CHV FLU Designation: Commercial (C) Subdivision: 1st Addition to South 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 ,j ay . - addition I permits required from other govemmental entities. Applicant's Signature Ge eral Services Assistant REF: .ORD.716, Temporary Structures Date: Z7./...5--// February 23, 2016 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: - APPLICATION No: IL CO3 DATE ISSUED: `)/ 2 j / DATE(S) OF EVENT: FL c5 )0/1, FEE: $175.00 ,/ Pr DATE PAID: ❑f If Non - Profit/Civic Organization TEMPORARY USE PERMIT APPLICATION OTHER TEMPORARY STRUCTURES (sEc 666) PPLICANT I Name of Property Owner(s): 4 K £,41/02 - stcf Address: po• Qo}c St J V . 3� c Telephone Numbers: Home: Work: 763- 7.1Oa Mobile/Cell: Pager: ` Name of Applicant: O. L, c02.3w �(L, S0 (.#z SCij Ft.v% -� Address: 53L i, /JW �µ SJ 0 f/v Pk !J 1 _l7 2 Telephone Numbers: Home: Work: 763 -3)17 Mobile /Cell: 3y- er,SC Pager: ROPERTY Future Land Use Map Designation: Current Zoning Designation: /-j I% 1iT AN> i rr,Oct _ n Legal Description of Property: To �, /j(- 111.7C,A1.--krov Lai- 5 �[ Address of Property: 6 � Nd4i ` ��4 00 S Pin .K ,4. - O/c, / 3 (9 ) T Please Explain Type of Use: 84)--c/4 /J j�q wi 1)/ . — ,? /M Briefly describe use of adjoining property: North: 1 Gf21Nm:". ►) A,1 %-, East: %a t1 j o L•oh.t South: �'—`1. 0 i- i- 1/4E-kS West: / /Cy) 1 —ieA / Z ad -S Other temporary 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. Com mercial 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. The applicant sh all: 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 property owner. 4. Submit Site Plan* 5. Submit State Inspection Certificate(s) 6. Subm it State Annual Permit * hereby certify City of Okeech and impriso the infsrmation on u , application is correct. The information included in this application is for use by the e in p . •essing my ,f quest. False or misleading inform ation may be punishable by a fine of up to $500.00 nt of p :ythirty .a - and may result in the summary denial of this application. Signature of Applicant City Staff (Please review the application, attach comments or special conditions): ®,2 /7/ / Date Occupational and /or State License Verification: C ! £T �Z' l v Date: .1 ' `�� (. Fire Department Approval: Date: ,. .,23 rt ) a©16 Police Departm - • •4, aj • Date: i // Public Works Departm ent Apprf, . / Date: , %7 -/% Building Inspector A pprova / c Date: Z.1 - - ,y,„:,/;, 77/0. City Ad min istrator Approval: Revised 2/1/08 bjc Googie earth feet meters 10 LE 4 Om- Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Detail by Entity Name Florida Not For Profit Corporation O.L. RAULERSON, JR. SCHOLARSHIP FUND INC. Filing Information Document Number N11000006190 FEI /EIN Number 90- 0744698 Date Filed 06/28/2011 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 09/20/2013 Principal Address 23 NE 138TH ST OKEECHOBEE, FL 34972 Mailing Address 23 NE 138TH ST OKEECHOBEE, FL 34972 Registered Agent Name & Address STEPHEN, NOEL 23 NE 138TH ST OKEECHOBEE, FL 34972 Officer /Director Detail Name & Address Title PD STEPHEN, NOEL 23 NE 138TH ST OKEECHOBEE, FL 34972 Title D STEPHEN, LAURIE 23 NE 138TH ST OKEECHOBEE, FL 34972 Title D http: // search. sunbiz. org / Inquiry / CorporationSearch /SearchResultDetail ?inquirytype= Entity... 2/17/2016 Detail by Entity Name STEPHEN, KODI 23 NE 138TH ST OKEECHOBEE, FL 34972 Annual Reports Report Year 2014 2015 2016 Filed Date 02/24/2014 01/13/2015 01/25/2016 Document Images 01/25/2016 -- ANNUAL REPORT 01/13/2015 -- ANNUAL REPORT 02/24/2014 -- ANNUAL REPORT 09/20/2013 -- REINSTATEMENT 06/28/2011 -- Domestic Non - Profit View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Page 2 of 2 Copyright © and Privacy Policies State of Florida, Department of State http: / /search.sunbiz.org/ Inquiry/ CorporationSearch/ SearchResultDetail ?inquirytype= Entity... 2/17/2016 BBQ BE\EFIT FOR DALTON "BOOTS" & DIANE, TYSON OvIJanixaT 24, 2010 The -r-sow's hovvtie was destro jed -There was 415,000.00 worth of davu.age to the house. The worth haL f of the house was destro jed aLowg with all the Tjsow's beLowsLwgs. Come out and enjoy a delicious BBQ dinner or you can purchase a whole smoked Pork Butt and help support this wonderful family! What: $10 - pulled pork dinner with two sides $30 - Smoked Whole Pork Butt When: Friday - February 26, 2016 llam -2pm Where: Brahman Theater Parking lot *Delivery available for 5 or more dinners* For more info call Jamie 634 -1668 or Jimmy Howell 801 -4422 D & K Enterprises of Okeechobee, Inc. Brahman Theaters III P.O. Box 1395 Okeechobee, Florida 34973 To Whom It May Concern: I, Karla H. Roby and Debra S. Safes, owners of The Brahman Theatres III, located at 1500 S. Parrott Avenue in Okeechobee. Give permission for a BBQ Benefit for Dalton 'Boots' Tyson to be held in our parking lot on Friday, February 26th, 2016. Best Regards, Karla H. Roby Debra S. Sales atit./LCC 4r,t •Pykc CYNTHIA S. BOUNGER *: 4..` �!� MY COMMISSION N FF 073634 EXPIRES: December 7, �'a�.:o 2017 e I Bonded Thru Notary Pudic Underwriters DALTO -1 OP ID: MB ACORD7 l�„,� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD1YYYY) 02/2312016 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(les) 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 ISU Lawrence Insurance Agency PO Box 549 Okeechobee, FL 34973 Heath Lawrence CONTACT NAME: Heath Lawrence PHONE FAX (NC No, E :t): 863-467-0600 (ac, No): 863-467-5142 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Unites States Liability Ins Co COMMERCIAL GENERAL LIABILITY INSURED Dalton & Diane Tyson Benefit 1114 SW 9th St Okeechobee, FL 34974 INSURERB: CL2692193 INSURER C : 02/29/2016 INSURER D : $ 1,000,000 INSURER E : 10O 000 $ r INSURER F : 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/ YY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X CL2692193 02126/2016 02/29/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 10O 000 $ r CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV WJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER LIMIT APPLIES PRO JECT PER LOC PRODUCTS - COMPIOP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED NON -OWNED AUTOS (Ea SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y!N ANY PROPRIETORh'ARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER STATUTE OTH- ER E.LEACHACCIDENT $ E L DISEASE - EA EMPLOYEE $ E . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101., Additional Remarks Schedule, may be attached H more space is required) City of Okeechobee is listed as an additional insured with respect to General Liability a fl 1 rrra.nr G. nvLa+us CTYOKEE City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 I _... - ----- ..__._ 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,����� ; ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD