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Park Use Permit - Castle FlagsCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 217 Fax: 863 -763 -1686 e -mail: Park Use Permit Permit Number: 008 Permit Expiration: April 8, 2016 11:59PM Purpose of Request: Child Abuse Memory Flags Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee Revised Date(s) of Event: 1; 1 6 thru 4 -8 -16 Applicant: Elena Trowel) (etruvv a" . Phone Number: 772 -465 -6011 X225 Current Zoning: P Subdivision: City of Okeechobee State: Florida Zip Code: 34974 )`LL Applicant address: 3525 W Midway Rd, Ft Pierce Address of Project: City Hall Park FLU Designation: Public Restrictions /Remarks: April 6th at 5:30- 6:30pm a dedication ceremony will be held. All debris must be removed within 24 hours of expiration date. Tackiz'Du- nha-wv March 1, 2016 General Services Assistant Date Jackie Dunham From: Sent: To: Jackie Dunham Friday, February 26, 2016 1:40 PM Marcos (mmontesdeoca @cityofokeechobee.com); David Allen (dallen @cityofokeechobee.com); Jeff Newell; Chief Davis; hsmith @cityofokeechobee.com; Kim Barnes; 'Lane Gamiotea' Cc: Patty Burnette Subject: CASTLE Child Abuse Memory Flags Each year CASTLE places the memory flags in our park for the victims of child abuse. We have already permitted them to do this April 1st through April 8th in the City Park where we hold our tree lighting. I received a request today to allow them to place the flags for a longer period due to some conflicts in St. Lucie County. They would like to fly the flags from March 18th through April 8th. Please e -mail me with your response so I know how to answer her and if allowed will send her a revised permit. Thank you. Ja ckLe' D wtihanv AcLitu'Aqi.stratwe. Secretary City of Okeechobee. 55 SE riti,rd,Ave.nuei Okeechobee, 1L 34974 Tele: 863-763-3372 ext. 217 ram' 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. VK^ %t-' a"3-- L<..C.,A' dK t d '-1 "Me ce Jackie Dunham From: Jackie Dunham Sent: Monday, February 29, 2016 3:44 PM To: 'Kaitlin Smith' Cc: Patty Burnette; Marcos (mmontesdeoca @cityofokeechobee.com); Robin Brock; David Allen (dallen @cityofokeechobee.com) Subject: RE: Checking In I sent an e -mail to all the Department Heads on Friday requesting their approval (or disapproval) of your request. I have only heard back from the Chief of Police. I will have them review it tomorrow at the weekly staff meeting to see how it stands. Our Public Works Director has a bit of a concern with the flags being in place for a longer period of time due to the inconvenience it will cause our lawn maintenance contractor. Will advise asap. Ja ckie Dw'th a vw Aclotin&s.Ya weSecreta.vy City of O keechai 55 SE Thi.rd/Ave.nkte. Okeechol,ee., EL 34974 7 e-Z.e. 863 -763 -3372 eut: 217 7a' 863-763-7686 jdunham@cityofokeechobee.com Website: http: / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. From: Kaitlin Smith [mai Ito :KSmith@castletc.orq] Sent: Monday, February 29, 2016 3:23 PM To: Jackie Dunham Subject: Checking In Hi Jackie, I hope you had a great weekend! Have you received any feedback yet on the Memory Field? Again, no pressure! We can keep it as is, if need be. © Just trying to make things on our firefighters that help with setup and takedown every move. Thanks again! Kaitlin Smith CASTLE Community Relations 3525 W. Midway Road Fort Pierce, FL 34981 ksmith @castletc.org (772)465- 6011x236 1 Jan. 13. 2016 4:57PM Castle No. 1082 Page 1 of 3 CITY OF OKEECHOBEE �,,F ' ',',1v,. .,. Q___ 55 SE THIRD AVENUE .� .'`;; `: OKEECHOBEE, FL 34974 Tele: 863- 763 -3372 ext. 218 Fax 863- 763 -1686 V. T PARK USE AND /OR TEMPORARY STREET/ '' ;;;;,. ' SIDEWALK CLOSING PERMIT APPLICATION A(L- u.'SED 6.-1-1u Date Received: Application No: 1 -13 1(� lie - pp e, Date Issued: ( -1 t) - I Date(s) of Event: 11M-FRIP - I-tn k. c_44 i fr 114 - APR 1 (-- f6 IN Information: 0 'D 6 y /t444(.4)5 Organization: I C(‘ Si' T Tax Exempt No: 1 Mailing Address: S,,1 ) , jr A :/-I / 1.x'1 c. 1 t2 c( C f' . P" -6C- 1 FL 3 c S Contact Person: at0. -v1 A r r.occ I. l E -Mail Address: e.. D (( C4).51 -(e fc - orj Telephone: ' .7 ,?--5 (Work: 77 - L((OS•(01 t 1 Home: 1 1 Cell: 1 q5'(- O%- 910 7 Summary of activities: 4 • V. Ak i' V it C id G, - ..l k e &le e ' 4- P= . 1- •- 4,.gA A nrair, ifirA _LrsTqrmoikt..• . , • MI 1°ArLYMIIMIPMEWIRMIIMMMENSTOWORMIMIll . a ir * • - 5 . 16 / K. -. i : 4P kiA n _ Proceeds u e Please check requested Parks: Flagler Parks: /City Hall Park ❑ #1 Memorial Park o #2 o #3 ❑ #4 o #5 o #6 OR Address of event: Parcel YD: Jan. 13. 2016 3:12PM Castle No. 1081 Page2of3 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (If not using Park(s), provide event address) Street Address City State Zip Code Street(s) to be closed: 4) /A- Date(s) to be dosed: Time(s) to be closed: Purpose of Closing: Attachments Required: Charitable Function Temporary Street and Sidewalk Closing • Site Plan • Original signatures of all residents, property owners and business owners affected by the closing. ■ Copy of liability insurance in the amount of • Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee as $1,000,000.00 with the City of Okeechobee as additional insured. additional insured. ►Proof of non -profit status • If any items are being sold on City streets or sidewalks, a Temporary Use Permit (TUP) must be •Letter of Authorization from Property Owner attached for each business. TUP can be obtained from the General Services Department. • State Food Service License, if applicable. • State Food Service License, if applicable. • 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 requested if any type of alcoholic beverages are served on private property/business 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. • Dumpsters 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 shall 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 demand for, and payment of, all of the actual cost incurred by the City pertaining to the event including, but not limited to, Police, Fire, Public Works or other departmental expenses. The City reserves the right to require from an applicant a cash or cashier's cheek advance deposit in the sum approximated by the City to be incurred in providing City services. Any such sutra not incurred shall be refunded to the applicant. Jan. 13. 2016 4 57P Castle No. 1082 P. 4 Page 3 of 3 I hereby acknowledge that I have read and completed this application, the attached Resolutions 08 and 04 -03, concerning the use and the rules of using City property, that the information that I am the duly authorized agent of the organization. I agree to conform with, abide by and rules and regulation, which may be lawfully prescribed by the City Council of the City of Okeechobee, its officers, for the issuance of this Charitable Function Permit. CERTIFICATE OF INSURANCE MUST NAME CITY OF OKEECHOBEE AS ADDmONAL INSURED. J 1 , e, //t Y7/5 No.(s) 03- is correct, and obey all the or App icant Signature Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: iir Date: /9 Tan ,to/, A Buildin L Official: 111 ,/i , f/.� a.. : • Date: Public Works: • t Date: !- /4 -`b Police Department: ,��'C�. --� Date: /- � BTR Department: If igri 6 2 Date: / - /5 ` /ao City Administrator: Date: ) / / 4 /4 City Clerk: %, 1 �� � • Date: 1 lc Q?Oi6 NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS EVENT FOR PERMITTING. Temporary Street and Sidewalk Closing submitted for review by City Council on Temporary Street and Sidewalk Closing reviewed by City Council and approved AND PRIOR TO Date Date Google earth feet meters 100 40 i7y !IAU P.. s ri&,s • It/ 4.) Atwas‘ Norio s;s& •a Agit Client #: 2414 CASTLE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 02/19/2016 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 Brooks Insurance Agency, Inc. 1120 Madison Ave. Toledo, OH 43604 419 243 -1191 CONTACT NAME: PHONE 419 243 -1191 FAx 4192555928 No, Ext): (A /C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: Philadelphia Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED CASTLE P.O. Box 12908 Fort Pierce, FL 34979 INSURER B: PHPK1451210 INSURER C 03/26/2017 INSURER D $1,000,000 INSURER E : $1,000,000 INSURER F : $ 20,000 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PHPK1451210 03/26/2016 03/26/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $ 20,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $3,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO JECT X PER: LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS PHPK1451210 03/26/2016 03/26/2017 (Eo aBccideDj INGLE LIMIT $1,000,000 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 ANY PROPRIETOR PARTNER'EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Professional Liab Sexual Abuse PHPK1451210 03/26/2016 03/26/2017 $1,000,000/$3,000,000 $1,000,000/$2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Okeechobee is an additional insured ATIMA per form CG2026 7/04 attached. CERTIFICATE HOLDER CANCELLATION City of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 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 ACORD 25 (2010105) 1 of 1 ffC 410710 /AA 110711A © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DAIWA POLICY NUMBER: PHPK1451210 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Jan. 13. 2016 3:13PM Castle No. 1081 OOOOOlD O11/29/14 DEPARTMENT OF REVENUE Consumer's Certificate of Exemption Issued Pursuant to Chapter 212, Florida Statutes 65-8012614831C-1 09/30/2014 Certificate Number Effective Dote Expiration Data This certifies that DR -14 R. 04111 EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC 3525WMIDWAYRD FORT PIERCE FL 34991.4962 is exempt from the payment of Florida sales and use tau on real property rented, transient rental property rented, tangible personal property purchased or rented, or services purchased, a£PARTMENT OF REVENUE Important Information for Exempt Organizations DR -14 R. 04/11 1. You must provide all vendors and suppliers with an exemption certificate before making tax- exempt purchases. See pule 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, F.A.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 200% 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_ Jan. 13. 2016 3:12PM Castle No. 1081 ,� C a�,�LE � �TF.A+CHING PARENTING FAX COVER SHEET Date: I11�1� r To. } !'11r 61 Company: Fax Number: From: De.t. k, a, Re: C: I 1 C 04 . 4 No. of Pages Including Cover: 11 Comments: Indian River County 148 Vista Royale Sq. Vero Beach, FL 32962 PH: 772 -567 -5700 FX: 772 -567 -7133 MISSION STATEMENT PREVENTING CHILD ABUSE AND NEGLECT THROUGH EDUCATION AND AWARENESS Martin County 3824 SE Dixie Hwy. Stuart, FL 34997 PH: 772 -781 -4510 FX: 772 - 219 -0791 Administrative Office 3525 W. Midway Rd. Fort Pierce, FL 34981 PH: 772 - 465 -6011 FX: 772- 465 -6013 Mailing Address: P.O. Box 12908 Fort Pierce, F134979 Okeechobee Co. New Endeavor H.S. 575 SW 28i° St. Okeechobee, FL 34974 PH: 863 -467 -7771 FX: 863 - 467 -9070 St. Lucie County Group Service Center 2967 W. Midway Rd. Fort Pierce, FL 34981 PH: 772- 461 -0863 FX: 772 - 468 -0690 The information contained in this fax message is privileged and confidential, and intended only for the individual or entity named above. If the reader of this message is not the intended recipient, you are Hereby notified that any dissemination, distribution or copying of this information is strictly prohibited, and may be in violation of the law. If you received this communication in error, please notify the sender immediately by phone. If you are the intended recipient and do not receive all of the pages for this fax, please call us as soon as possible. Jackie Dunham From: Sent: To: Subject: Kelly Owens <KOwens @castletc.org> Thursday, January 14, 2016 9:28 AM Elena Trowell; jdunham @cityofokeechobee.com Re: Memory Flags April 1 -8, 2016 Permit Hi Elena and Jackie, Yes - we definitely want to have the flags at City Hall Park. The flags will be placed toward the north side of the park where we had them in September. Elena - when you come out to Okeechobee I'll take you to the site. Jackie - Dowling will be able to clarify the layout for you. Original message From: Jackie Dunham <jdunham @cityofokeechobee.com> Date:01 /14/2016 8:47 AM (GMT- 05:00) To: Elena Trowell <ETrowell(,castletc.org> Subject: RE: Memory Flags April 1 -8, 2016 Permit Elena, our actual "City Hall Park" is the one between SE 2nd Avenue and SE 3rd Avenue between SR 70 (Park) and SE 2nd Street. The Police Department sits on the west side of the park and City Hall is actually on the east side of the park. Is this the one you plan to use? If so, I will use the one drawing you submitted and just change the streets. Thank you for your prompt response. Jackd e Dw' ha nv evtera.L Service' A Count City of Okeechobee, 55 SE T rd/Avevu,+.ei Off, FL 34974 Teter' 863 -763 -3372 ext: 217 863-763-/686 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 Jackie Dunham From: Jackie Dunham < jdunham @cityofokeechobee.com> Sent: Thursday, January 14, 2016 8:25 AM To: 'etrowell @castletc.org' Subject: Memory Flags April 1 -8, 2016 Permit Elena I am in receipt of your second fax for the above mentioned permit but am still unclear about the placement of the flags. From what I think I understand, it appears you want to place flags in Park 6, between 6th Avenue and 7th Avenue and also at the Chamber of Commerce location. Is that correct? Would it be possible for you to scan and email me the page which identifies the Chamber because it appears "black" on the fax. Where will you be hosting the dedication ceremony? Park 6 or Chamber property? Lastly, please note that your insurance certificate will expire on 3/26/16 so you will need to send me an updated copy at that time. Thank you for your assistance in completing this. If you have any questions just contact me at my number below. Ja.ck�,e' Du.nha.vw erLercaiService. A ksiistant aty of Okeechobee. 55 SE T hi rd/AvevuA.& Okeechc+ee, EL 34974 Tel' 863 - 763 -3372 each 217 Fax 863-763-/686 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 Jackie Dunham From: Jackie Dunham < jdunham @cityofokeechobee.com> Sent: Tuesday, January 19, 2016 11:42 AM To: etrowell @castletc.org Subject: CASTLE Memory Field of Flags Attachments: 008 Castle Memory Field.pdf Please find attached your 2016 Park Use Permit for the annual Memory Field of Flags. I will be needing an updated Certificate of Insurance after 3/26/16. If you have any questions or changes in dates please let me know. Jackde Du.nha wv qe 'iera.LServLce.s,A Wistcwit c cty of Okeechobee/ 55 SE Thi rdiAvev t& Okeec,hcybee,, FL 34974 Tele' 863 -763 -3372 ext. 217 Fax' 863-763-/686 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