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Park Use Permit - Top of the Lake Christmas FestivalPermit Number: 004 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686 e -mail: jclum'3 rn tc w _; Park Use Permit Date(s) of Event: December 9 & 10, 2016 Permit Expiration: December 10, 2016 11:59PM Purpose of Request: Top of the Lake Christmas Festival Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee Applicant: Okeechobee Main Street Phone Number: 863 - 357 -6246 Current Zoning: P Subdivision: City of Okeechobee State: Florida Zip Code: 34974 Applicant's Address: 55 S. Parrott Avenue Address of Project: Parks #3, & #4 FLU Designation: Public Restrictions /Remarks: All debris must be removed within 24 hours of expiration date. Jack & General Services Administrative Secretary August 17, 2016 Date Page 1 of 3 CITY OF OKEECHOBEE e . 55 SE THIRD AVENUE 1'4; ECy0 , OKEECHOBEE, FL 34974 Tele: 863- 763 -3372 ext. 218 Fax: 863- 763 -1686 4 PARK USE AND /OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: 11/20/2015 Date Issued: F f t. t k Application No: 11.•004i. Date(s) of Event: December 9th & 10th, 2016 Information: Organization: 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: 863- 357 -6246 Horne: Cell: Summary of activities: Traditional Christmas event with snow play area on Friday night. movie in the park and entertainment from 6 -9pm. Saturday Christmas vendors bring out their holiday best. Includes a variety of vendors ready to help you mark everyone off on your Christmas list. DJ music, lights and of course the spectacular lighted night parade beginning at 6pm. 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 OR Address of event: ✓ #3 n #d ❑ #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 .JCF.7b kik A ti Street(s) to be closed: 3rd and 4th Ave J c , ,,,'c =. ., ,r 7 -,„,, �a Date® to be closed: December 9th, 2016 C.4.-.:: La A i C .�C t kir Time(s) to be closed: spm t7 Phi c ri 5i i u k6Ai Purpose of Closing: To allow set up of vendors and use of streets Attachments Required: Ch aritable Function Tem )ora Street and Sidewalk Closing • Original signatures of all residents, property owners and business owners affected b the closint. • Site Plan • 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 51,000,000.00 with the City of Okeechobee as additional insured. 0-Proof of non - profit status 0-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. r 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. 11/20/2015 Applicant Signature Date ""OFFICE USE ONLY"" Staff Review Fire Department: Date: j7lg J"DIyaO,/ Building Official: _.Ali / Date: ?,1') Public Works: Date: /( /( /`' p j / Police Department: Date: c77/ 7/6" BTR Department: CI Y1 iii/ti Date: R/ // ( ., City Administrator: Date: 4 City Clerk: \Q, 11 ' , i Il C'► Daterr /; 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 `n It, 1 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved /L. i Li Date „ (-CAL' Ct-)f-t5thIcis 1-("STIucd ?et(' -I LA to eje, 7?)ici lit 1).tit,_ C. tate Road 70 L._ c3 CL Subject to change. C71 rfl N Cc/ m m CO rJ r-I m rI N N LO ri rJ rn N r• r•I 0 CPI CV N c-I C'sJ N N <-1 245 cm N m 0 m m Capital Pawn 4) a u c State Road 70 OKEEMAI -01 SFISHER "--is ' "f CERTIFICATE OF LIABILITY INSURANCE DATE(MAIIDD/YYYY) 7/2812016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE HOLDER. THIS 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 CONTACT Maury, Donnelly & Parr NAME: 24 Commerce St. Baltimore, MD 21202 ,Arc°Nr o, Exq; (410) 685-4625 FAX (410) 685 -3071 (ac, No): E-MAIL ADDRESS: 07/01/2016 07/01/2017 INSURER(S) AFFORDING COVERAGE NAIC I/ INSURER A : Transportation Insurance Services, Inc 20494 INSURED S 1,000,000 GEN'L X INSURER B: S 10,000 Okeechobee Main Street INSURER C : S 1,000,000 55 S. Parrott Avenue INSURER D : Okeechobee, FL 34972 INSURER E: $ 2,000,000 PRODUCTS - COMP/OP AGG ',en tram a rr-n .- ___.._. - - __ _ ._ INSURER F : S • —.___. __"- -•- RC V 10101 IV UIVICICK: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDING 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 LTR TYPE OF INSURANCE ADDL [NW SO WVD POUCY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 4025933977 07/01/2016 07/01/2017 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE I ^ I OCCUR DAMAGETORENrED PREMISES {Ee occurrence) S 1,000,000 GEN'L X MED EXP (Any one person) S 10,000 PERSONAL &ADV INJURY S 1,000,000 AGGREGATE POLICY OTHER: LIMIT APPLIES JECOT- PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 S AUTOMOBILE LIABIUTY ANY AUTO ALL OYVNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED COMBINED SINGLE LIMIT (Ea accident) s BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per acddent) S S UMBRELLA LIAB EXCESS LIAB __ CLAIMS -MADE EACH EACH OCCURRENCE S AGGREGATE S DED I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I ( (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA STATUTE 1ERH- E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Okeechobee is named as Additional Insured. CANCELLATION City of Okeechobee 55 SE 3rd Avenue Okeechobee, FL 34874 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 REEPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Form (Rev. August 2013) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Herne (as shown on your income tae return) Okeechobee Main Street, Inc. Business name/disregarded entity name, ii different from above Print or type See Specific Instructions on pa Check appropriate box for federal tax classiFation: o (ndivlduatisole proprietor 1 C Corporation fa S Corporation !♦ Partnership ❑ Trustfestata Ej Limited liability company. Enter the tax classification (C=C corporation, SeS corporation. Pepartnership) D Exemptions (see instructions): Exempt payee code fif any) Exemption from FATCA reporting code (if awry) ■ Other (sc-e instructions) le Address (rsmuber, street, and apt or suite no) 55 S. Parrott Ave Requester's name and address (optional) City. state, and ZIP code Okeechobee, Florida 34972 List account numbers) here (optional) Part °I Taxpayer Identification Number (TIN) Enter your 11N 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 (SSW). However, for a resident alien, sole proprietor, or disregarded entity, seethe Part I instructions on page 3. For other entities. it is your employer identification number (EMI. If you do not have a number. see Hoy to Qet a Social security number _ J! t TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Employer identifcahon number 6 5 1 81 8 7 9 2 9 Partll: Certification Under penalties of perjury, l certify that: 1. The number shown on this form is my correct taxpayer identification number (or i am waiting for a number to be issued to me), and 2. t am not subject to backup withholding because: (a) 1 am exempt from backup withholding, 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 all interest or dividends, or (c) the IRS has notified me that t am no longer subject to backup withiuMng. and 3. t am a U.S. citizen or other U.S. person (defined below), and 4. The FATCA codes) enteral 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. For real estate transactions, item 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 I Signature of t Here U.S. person ► - L\J . General Instructions Section references are to the internal Revenue Coda unless othereriee noted. Future developments. The IRS has created a page on IRS.gov for information about Form W -9. at wwvc&s.govlw.9. 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 rile an information retw i with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example. income paid to you, payments made to you in settlement of payment card and third party network transactions. seat estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA Use Form W -9 onty if you area U.S. person (including a resident alien), to provide your correct TIN to the person requesting k (tho requester) and, When applicable, to: 1. Certify that the 1114 you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Clan exemption from backup withholding if you are a U.S. exempt payer,. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the Date withholding lex on forelan partners' share of effectively connoted income, and 4. Certify that FATCA codes) 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 11N. you must use the requester's fort nit is substantially similar to this Form W -9. Definition of a US. person. For federal tax purposes, you are considered a U.S. person if you era • 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 the United States are generally required to pay a withholding tax under 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's a foreign person, and pay the section 1446 withholding tax. Therefore. it you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W -9 to the partnership to establish your U.S. status and avoid sedion 1446 withholding on your share of partnership income. Cat. No. 10231X Form W -9 (Rev. e.aoia3) INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: APR 29 2105 OKEECHOBEE MAIN STREET INC 111 NE 2ND ST OKEECHOBEE, FL 34974 • Dear Applicant: RECEIVED JAN 1- 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) Jackie Dunham From: Jackie Dunham Sent: Wednesday, August 17, 2016 9:24 AM To: Brittany Carner Subject: Park Use Permits Attachments: 003- Summertime Festival.pdf; 004 -Top of the Lake Christmas Festival.pdf Brittany, the street closings for both the Summertime Festival and Christmas Festival were approved at last night's City Council Meeting. I am attaching the Permits for your use and recordkeeping. Thank you. Jackie D uv Adm(ain is-tra twee Se cr etcwy City of Okeechobee/ 55 SE 71.1.GrcLAve.0 e. Okeecho-bee,, FL 34974 TeLe: 863 - 763 -3372 ext. 217 7a-w 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. 1