Park Use Permit - Leadership Class BBQCITY OF OKEECHOBEE
55 SE THIRD A VENUE
OKEECHOBEE, FL 34974
Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686
e -mail: iciunham(c�citvofokeechobee. com
Park Use Permit
Permit Number: 015 Date(s) of Event: August 19, 2016 6AM -2PM
Permit Expiration: August 19, 2016 11:59 A.M.
Purpose of Request: Chamber Leadership Class BBQ Fundraiser
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee State: Florida Zip Code: 34974
Applicant: Jennifer Busbin Applicant's Address: 55 S. Parrott Avenue
Phone Number: 863 - 763 -5548 Address of Project: Park 5
Current Zoning: P FLU Designation: Public
Subdivision: City of Okeechobee
Restrictions /Remarks: All debris must be removed within 24 hours of expiration date.
*Memo attached regarding political rallies and similar events held in City Parks
Tctckt &
General Services Assistant
August 9, 2016
Date
Page 1 of 3
CITY OF OKEECHOBEE
.A•Of•p FC 55 SE THIRD AVENUE
.
` ��°��,� OKEECHOBEE, FL 34974
m
m` Tele: 863 - 763 -3372 ext. 218 Fax: 863 - 763 -1686
° PARK USE AND /OR TEMPORARY STREET/
_ . 0 SIDEWALK CLOSING
PERMIT APPLICATION
Date Received:
/ 4•
Date Issued:
4 . (L.5. I ii , 2.c j
Application No:
14- of 5
Date(s) of Event:
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Information: I-01 suSVY �,p,S9
Organization:
3v-%c g orxrpc cej Tax Exempt No:
Mailing Address:
55 a `Ng-. (As_ex, pp,,` TL. 34004
Contact Person:
j Ly1,).; -0-4- `- b;►t
E -Mail Address:
3bus6 :n til ca • oxeechobee. V t. a5
Telephone:
Work:
i' o3 '1(,2 -S5y`b
Home:
- - - --
Cell:
p-Dic 3 (¢q`1 -,ASS
Summary of activities:
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Proceeds usage:
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Please check requested Parks:
Flagjer Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 ❑ #4 a' #5 ❑ #6
OR
Address of event:
Parcel ID:
Page 2 of 3
TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION
(If not using Park(s), provide address)
Street Address City State Zip Code
Street(s) to be closed:
Date(s) to be closed:
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
$1,000,000.00 with the City of Okeechobee as
additional insured.
• 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.
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Applica 'gnature Date
****OFFICE USE ONLY"
Staff Review
II
Fire Department:
Date:
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Building Official:
/ C
Date:
5/711
Public Works:
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Date:
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Police Department:
i
Date:
1" j!;
BTR Department:
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Date:
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City Administrator:
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Date:
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City Clerk:
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Date:
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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
Date
Temporary Street and Sidewalk Closing reviewed by City Council and approved
Date
INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
DateMAY 1 2 2011
BUSINESS DEVELOPMENT BOARD OF
OKEECHOBEE COUNTY INC
C/O CHAMBER OF COMMERCE OF OKEECHOBEE
315 NW 4TH AVE
OKEECHOBEE, FL 34972
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
27- 4426593
DLN:
17053102368021
Contact Person:
JEFFERY A CULLEN
Contact Telephone Number:
(877) 829 -5500
Accounting Period Ending:
December 31
Form 990 Required:
Yes
-Effective -Date of Exemption:
January 1, 2011
Contribution Deductibility:
No
ID# 31215
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)(6) of the Internal Revenue Code. Because this letter
could help resolve any questions regarding your exempt status, you should keep
it in your permanent records.
Please see enclosed Publication 4221 -NC, Compliance Guide for Tax - Exempt
Organizations (Other than 501(c)(3) Public Charities and Private Foundations),
for some helpful information about your responsibilities as an exempt
organization.
Enclosure: Publication 4221 -NC
Sincerely,
Lo' G. Lerner
Director, Exempt Organizations
Letter 948 (DO /CG)
Jackie Dunham
From: Jackie Dunham
Sent: Tuesday, August 09, 2016 3:50 PM
To: Jennifer Busbin (jbusbin @co.okeechobee.fl.us)
Cc: info @okeechobeebusiness.com
Subject: Chamber Leadership Class Fundraiser
Attachments: 015- Leadership Class BBQ Fundraiser.pdf
Please see the attached Park Use Permit for your upcoming event in Park 5 on August 19`x'. If you need
anything further please let me know.
Jcu k e/ Du.n ha wv
Aci4vuvu.strau'we/ Secv'eta.vy
cty ofOkeech
55 SE Thdvc,Avevuce
Okeechab-ex/, FL 34974
rein 863 - 763 -3372 e-xt. 217
Fa ': 863 -763 -1686
jdunham cr,cityofokeechobee.com
Website: http: / /www.cityofokeechobee.com
NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.