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Park Use Permit - Speckled PerchCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 ext. 217 Fax: 863-763-1686 e -mail: jdunham a( ),cityofokeechobee. com Park Use Permit Permit Number: 002 Permit Expiration: March 13, 2015 11:59 A.M. Purpose of Request: 51st Annual Speckled Perch Festival Property Owner: City of Okeechobee Address: Park #2, #3, #4, #5 City: Okeechobee State: Florida Zip Code: 34974 Date(s) of Event: March 12 -13, 2016 Applicant: Okeechobee Main Street Phone Number: 863 - 357 -6246 Current Zoning: P Subdivision: City of Okeechobee Applicant's Address: 55 S. Parrott Avenue Address of Project: Parks #2 - #5 FLU Designation: Public Restrictions /Remarks: All debris must be removed within 24 hours of expiration date. TackieJ D General Services Assistant March 5, 2015 Date Page 1 of 3 CITY OF OKEECHOBEE '�-- i 55 SE THIRD AVENUE * • �'. OKEECHOBEE, FL 34974 ;' Tele: 863 -763 -3372 ext. 218 Fax: 863- 763 -1686 , �.yl PARK USE AND /OR TEMPORARY STREET/ +'-- ..;s SIDEWALK CLOSING PERMIT APPLICATION Date Received: I ! 7c:, ) t r5 Date Issued: i. - 3-1(1 Application No: ///- cc - Date(s) of Event: March 12 & 13, 2016 Information: Organization: I Okeechobee Main Street Tax Exempt No: Mailing Address: 55 S Parrott Ave Okeechobee, FL. 34972 Contact Person: Jayce Fitzwater E -Mail Address: info @okeechobeemainstreet.org Telephone: Work: 1863-357-6246 1 Home: 1 Cell: 1 Summary of activities: 51st Annual Speckled Perch Festival wit be the weekend of March 12th and 13th. This event is a celebration of the fishing industry that put Okeechobee on the map. This event will include artisans, vendors of all kinds, food, DJ, music, and an outdoor family friendly event. There will be parade accompanying the festival on Saturday morning as a tribute to our community. We will also be hosting an antique car show. Proceeds usage: Proceeds for this event will go to the operations and continuing efforts of Okeechobee Main Street to enhance downtown area as the heartbeat of the community. Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ✓ #2 Q #3 OR Address of event: [ ]#4 ✓0#5 ❑ #6 Parcel ID: Page 2 of 3 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: 2nd, 3rd, and 4th Ave $& 71J.:e „i N r .5 PAR A. f g:L E T..5 Date(s) to be closed: March llth- March 13th Time(s) to be closed: Beginning at 5pm March 11th and Ending 5pm on March 13th Purpose of Closing: To allow set up of vendors and use of streets • L11.t Wt. ll 1•1••• {u a,•••'• 11 va•• Charitable Function Temporary Street and Sidewalk Closing ► Original signatures of all residents, property owners and business owners affected by the closing. ■ Site Plan ► Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee as additional insured. O. Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee as additional insured. ■Proof of non -profit status •Letter of Authorization from Property Owner • If any items are being sold on City streets or sidewalks, a Temporary Use Permit (TUP) must be 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 check advance deposit in the sum approximated by the City to be incurred in providing City services. Any such sum not incurred shall be refunded to the applicant. Page 3 of 3 I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03- 08 and 04 -03, concerning the use and the rules of using City property, that the information is correct, and that I am the duly authorized agent of the organization. I agree to conform with, abide by and obey all the rules and regulation, which may be lawfully prescribed by the City Council of the City of Okeechobee, or its officers, for the issuance of this Charitable Function Permit. CERTIFICATE OF INSURANCE MUST NAME CITY OF OKEECHOBEE AS ADDITIONAL INSURED. Ap licint Signature Date ••••OFFICE USE ONLY•••• Ulall 1\C. sc.. Fire Department: Date: /9 <ran (94/4 Building Official: Date: 1 ' J 1 • kC„ Public Works: i� Date: j f'16 Police Department: / �- Date: /'/l`�/� BTR Department: (f) fula2_ Date: City Administrator: Date: //4/60 /-13:1- Q City Clerk: ; f Date: NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO 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 - I (p Date Date *ci ck Ve 4 ‘JeL( •E -1 5 lj OSP- Pn , tate Road 70 Subject to change. N m m m (N1 m m rJ N m r—i m m 'zr rJ cr) cv 00 rN N m rl 0 01 N N rl N N N N -1 245 Subject to change. rn m O m m CO m m m LO N Cr) M m M M M Cr) m m N m M CO M M Dl m m O m m LO N N m m ifl m N i-1 M O M CO 0 m 07 O m 0 m M Capital Pawn 1 N QJ L tate Road 70 al m CO m 416-417 m tr r Berger Real Estate Form Wma9 (Re-v. August 2013) Department of the Treasurf Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. no not send to the IRS. Print or type See Specific Instructions on page 2. Name (as shown on your income tax return) Okeechobee Main Street, Inc. Business name /disregarded entity name, if different from above Check appropriate box for federal tar, classification: f Individualisole proprietor 1 C Corporation 0 S Corporation Q Partnership Q Trust/estate El Limited liability company. Enter the tax classification (C=C corporation, S =S corporation. P= pertnt_ ship) te Exemptions (see instructions): Exempt payee code (if any) Exemption from FATCA reporting code (if any) II Other (see instructions) le Address (number, street, and apt or suite ro.) 55 S. Parrott Ave Requester's name and address (optional) City, state, and ZIP code Okeechobee, Florida 34972 List account number(s) here (optional) Part I Taxpayer identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, ter a resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is your employer identification number (E(N). If you do not have a number, see How to eret a Social security number - , jl I 11 - 1 `f T N on page 3. Note. If the account is in more than cne name, see the chart on page 4 for guidelines on whose number to enter. Employer ideniiication number S 5 0 8 8 7 9 2)9 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup wiihholdino, or (b) I have not been notified by the Internal Revenue Service (IRS) that 1 am subject to backup withholding as a result of a failure to report of interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. ( am a U.S. citizen or other U.S. person (defined below). and 4. The FATCA code(s) entered on this form (if any) indicating that 1 am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. Fcr real estate transactions, Rem 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. - Sign Signature of Here U.S. person t i Date P. l, t General Instructions i. Section references are to the internal Revenue Code unless otherxisc noted. Future developments. The IRS has created a page on IRS.gov for information about Form W -9, at www.irs.govteee. Information about any future developments affecting Form W -9 (such as legislation enacted after we release it) will be posted on that page. Purpose of Form A person who Is required to tile an information merit with the IRS must obtain your correct taxpayer identification number (RN) to report. for example. income paid to you payments rnade to you in settlement of payment cane and third party network transactions. real estate trarsactiors, mortgage Interest you paid. acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an iRA Use Form W -9 only it you area U.S. person ¢ncludi ng a r sident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the Thin you are giving is correct (or you are waiting for s number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withhclding it you are a U.S. exempt payeo. 11 applicable, you are also certifying that es a U.S. person, your allocable share of any partnership income from 5113. trade or business is not subject to the withholding ten on forelnn partners' share of effectively cownected ihtcome and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. Note. 11 you are a U.S. person and a requester gives you a form other than Form W -9 to request your TIN. you must use the requester's form if it is substantially similar to this Form W -9. Deinition of a V.S. person. For federal tax purposes, you aro considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation. company. cr association created or organized in the United States or under the laws of the United States. • An estate (other than a foreign estate), cr • A domestic trust (as defined in Regulations section 301.7701 -7). Special rules for partnerships. Partnerships that conduct a trade or business in I'rte United States are generally requked to pay a withholding tax ender section 1446 on any foreign partners- share of effectively connected taxable income from such business. Further, in certain cases where a Form W -9 has not been received, the rules under section 1446 require a partnership to presume that e partner is a foreign person, and pay the section 1446 withholding tax. Therefore. if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Fenn W -9 to the partnership to establish your U.S. status end avoid section 1446 -aithhotding on your share of partnership income. Cat. No. 10231X Form W -9 (Rev. 6.2013) INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: APR 29 2005 OKEECHOBEE MAIN STREET INC 111 NE 2ND ST OKEECHOBEE, FL 34974 Dear Applicant: RECEIVED JAN t 4 2015 DEPARTMENT OF THE TREASURY Employer Identification Number: 65- 0887929 DLN: 17053329002014 Contact Person: DEBRA JOHNSON Contact Telephone Number: (877) 829 -5500 Accounting Period Ending: September 30 Public Charity Status: 509(a)(1) Form 990 Required: Yes Effective Date of Exemption: November 22, 2004 Contribution Deductibility: Yes Advance Ruling Ending Date: September 30, 2009 ID# 75126 We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. During your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of your exemption and ends with advance ruling ending date shown in the heading of the letter. Shortly before the end of your advance ruling period, we will send you Form 8734, Support Schedule for Advance Ruling Period. You will have 90 days after the end of your advance ruling period to return the completed form. We will then notify you, in writing, about your public charity status. Please see enclosed Information for Exempt Organizations Under Section 501(c)(3) for some helpful information about your responsibilities as an exempt organization. Letter 1045 (DO /CG) OKEEMAI -01 SFISHER ACORE y 4....._,,_--- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 717/2015 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 St. Baltimore, MD 21202 CONTACT NAME: PHONE 410 685 4625 FAX 410 685 -3071 (A/C, No, Ext): ( ) (WC, No): ( ) E-MAIL DRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Transportation Insurance Services, Inc 20494 INSURED Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 INSURER B : 4025933977 INSURER C : 07/01/2016 INSURER D : $ 1,000,000 INSURER E : $ 1,000,000 INSURER F : 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 INSD SUBR W VD POLICY NUMBER POLICY EFF (MM /DDIYYYY) POLICY EXP (MM /DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 4025933977 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000 PREMSESO(Eaoccu TED $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL S. ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR JI OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I 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 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City of Okeechobee is an Additioanl Insured with resepcts to the Labor Day Celebration being heldp 9/6/15- 9/7/15, and hte Top of the Lake Christmas Festival being held 12/4/15 - 12/5/15. CANCELLATION City of Okeechobee tY 55 SE 3rd 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 C�fcLjZ�� ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Sent: To: Subject: Jackie Dunham <jdunham @cityofokeechobee.com> Tuesday, January 19, 2016 11:44 AM jayce@okeechobeemainstreet.org Speckled Perch Park Permit Just an fyi, your request for street closings for the upcoming 2016 Speckled Perch festival will go before the City Council on Tuesday, February 2 °d at 6:00 pm. Once approved I will be sending you your permit. Jacki-e Dum.ho nii evt.era.ii Sexy icedA i/sta.nt City of OkeecholyeeJ 55 SE Thi.rd/Avevutie/ Off, FL 34974 Teiet 863 -763 -3372 ext. 217 Faux,: 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 Jackie Dunham From: Jackie Dunham Sent: Wednesday, February 03, 2016 3:52 PM To: Jayce Fitzwater (Jayce @okeechobeemainstreet.org) Subject: Permit 51st Annual Speckled Perch Festival Attachments: 002- 51st Speckled Perch Festival.pdf The street closing for the upcoming Annual Speckled Perch Festival to be held on March 12th — 13th, 2016 were approved at the Regular City Council Meeting on Tuesday, February 2°'. I am attaching a copy of your permit for your files. Thank you. Jc ck e/ Du.vtha anti Gevteva.LSovvicedA wvtt City of Okeechol 55 SE Th ixd/ Avevu,u.e Okeechobee, EL 34974 Telex' 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 EETING • PAGE cc w CO N N CC 0) CO LL VOTE ON MOTION AS AMENDED: 1 K 2 c 00 (7) ao) 0_ 00 00a fl .. o U o o. w N On E ) o.. I_ c �_ N > (a a) Q c a r, 0 o"U"Q as d (O 0 L. 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