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Park Use Permit - Ride for the FightPermit Number: 021 CITY OF OKEECHOBEE 55 SE THIRD A VENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686 e -mail: ,jdun.han(d)ci yok key= ch b(ee, ;oir Park Use Permit /Street Closings Date(s) of Event: October 22, 2016 7AM -3PM Permit Expiration: October 22, 2016 11:59 A.M. Purpose of Request: Crossfit /Firefighter Fundraiser Competition Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Applicant: Ride for the Fight Phone Number: 863 - 634 -3971 Current Zoning: P Subdivision: City of Okeechobee Zip Code: 34974 Applicant's Address: 6830 SW 13th Street Address of Project: Parks 2 & 3 FLU Designation: Public Restrictions /Remarks: All debris must be removed within 24 hours of expiration date. Tacki,e/Dtkruhaimi General Services Secretary October 5, 2016 Date Page 1 of 3 CITY OF OKEECHOBEE +�`\�.0F�01(6.- _ 55 SE THIRD AVENUE .�'z ° OKEECHOBEE, FL 34974 u. o .--% Tele: 863- 763 -3372 ext. 218 Fax: 863 - 763 -1686 =_6 f .4 •'� PARK USE AND /OR TEMPORARY STREET/ ..41,lei'' SIDEWALK CLOSING PERMIT APPLICATION Date Received: 9 I j_/ / t•, Date Issued: 1 c / - / / (4- Application No: IL, -L ; r Date(s) of Event: 3(.7 ;Z x 6 f 6 7 r4 _ ? ;',,,' Information: Organization: ,,K....-',,),;- t:<;„,._ Ti e �`� �. Tax Exempt No: "_ "_ �; v l,; `% i' 21 `{ . L. — i Mailing Address: Gi� i,, : 3 7 � , .. �,,e J y ,f 7t1 t Contact Person: Ji.,,.r 0 C ;, Z.,i .:i.a (1t, i•A , . 4,,,C E -Mail Address: ° hl �_ - " fit' �,. t. / !, , �.'�, j e" G`J( ,s,} J Telephone: Work: Home: Cell: -' ' y 7/ Summary of activities: yJ 1 , h k..' .7i' -,,4 C=rU f- Cie-sSt , i !r;,::_,/ >: • ,;z„, A; J / , , / A 1 : ) , ( Proceeds usage: ii-ti /1.., ,,..v-, l.C.. it_ ' lei,'." 2 -, - ' t.. /''t, i /` ':'41 SC.%I t s r / % // C .�r� � �' r' fr, /= S s r'' % 6f� � t :,� 1 ff /�.. f ..c',."Fi�c C-i Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park (ti #2 1 4 3 " ❑ #5 ❑ #6 OR Address of event: 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: Date(s) to be closed: / Time(s) to be closed: 1 4 Purpose of Closing: (i 6/ .,./ - ; iktfr Li , r' , . y ; 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 ■)t) ► 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 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 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 ADDITIONAL INSURED. 1 / /7/S" /G No.(s) 03- is correct, and and obey all the or Applicant Signature Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: is5611 Date: aosie so<c Building Official: G Date: • Zv • «o Public Works: l).:si.i....: 17.----6'.-- Date: q-2o - l b Police Department: Date: 7/2 -e,, BTR Department: .?(,11t(t cli Date: ; Go .. gle Earth feet{ metersf 100 i Od,J CQ )-(,_ sQ - Flom 0 aro P4AT y ( clgo.41 a, iic"TQ►ta ) 3 L x eat; si47,'d,ii5 eizo 2- 600 A \ gXe_zs y/ Consumer's Certificate of Exemption FLORIDA 85- 80169921420 -1 Issued Pursuant to Chapter 212, Florida Statutes T DR -14 R. 10/15 04/12/2016 Certificate Number This certifies that RIDE FOR THE FIGHT CORP 6830 SW 13TH ST OKEECHOBEE FL 34974 -3301 Effective Date 04/30/2021 501(C)(3) ORGANIZATION Expiration Date Exemption Category is exempt from the payment of Florida sales and use tax on real property rented. transient rental property rented, tangible personal property purchased or rented, or services purchased. GI FLORIDA Important Information for Exempt Organizations DR -14 R. 10/15 1. You must provide all vendors and suppliers with an exemption certificate before snaking tax - exempt purchases. See Rule 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 2.00% 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. Jackie Dunham From: Sent: To: Subject: Nano Corona <coronacattle @icloud.com> Monday, September 19, 2016 11:13 AM Jackie Dunham Re: Park Use /Street Closing The party place store in front of the park. I don't believe any other requirements. Thank you Sent from my iPhone Sent from my iPhone On Sep 19, 2016, at 9:52 AM, Jackie Dunham <jdunham @citvofokeechobee.com> wrote: Nano, I notice on your site plan you are placing a bounce house in Park 3. I need to know where you are rent s _ the bounce house from and if there are any special requirements other than electric. Thank you. <image001.png> Jackie D wvi.hcwvv Aa;vwi*urtva t'vve' Se-ore-04,y Cry of Okeechobee 55 SE T hi,rd Avenkce Okeechobee, EL 34974 Tee 863- 763 -3372 ext. 217 Faix" 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 09/27/2016 12:19 8637631624 FARM BUREAU #4981 P. 002 AC CERTIFICATE OF LIABILITY INSURANCE DATEimWOD/YYYY) 09/2V2016 FR. THIS QLICIES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIYICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSL- REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLD BY THE 1 RER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endomtnont. this certificate does not confer rights to the certificate holder in lieu of such andorsomont(s). or be endorsed. A start ment on PRODUCER 863 - 763 -3101 863 - 763 -1624 SOUTHERN INSURANCE UNDERWRITERS INC 1265 S. SEMORAN BLVD WINTER PARK, FL 32792 NAMg GT TIMOTHY M CRAIG 863- 763 -3101 is ,Na): 863 - 763 -1624 _(Pn"c°l,"1tEa,sC ADDRESS; TIM.CRAIG @FFBIC.COM NAICA INSURER(S) AFFORDING COVERAGE INSURER A: MOUNT VERNON FIRE INSURANCE COMPANY INSURED RIDE FOR THE FIGHT CORP 6830 SW 13TH STREET OKEECHOBEE, FL 34974 INSURER 8 : INSURER C: INSURER 0: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMB :R: THE POLICE TO WHICH T TO ALL THs PERIOD THIS TERMS, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FbR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RIESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE Of INSURANCE AODL SUER POLICY NUMBER POLICY Of (M.M/D( YYI.,,jMM 10/22/2016 POLICY EXP /DP/YYYY) LIMITS LTR A ✓ GEN'L ,IN3n COMMERCIAL GENERAL LIABILITY ✓ WV]) TBD 10/23/2016 EACH OCCURRENCE $ 1 ,OQC ,000 OCCUR PREMISES (FA n cyr °, zp) S 100.0 $ 1.00( 00 CLAIMS -MADE MD EXP IAnonepn) PER: PERSONAL 5 ADV INJURY $ 1 ,00(,ppo $ 2,00C $ Q $ . 000 GENERAL AGGREGAT AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- 1 1 LOC JECT FI�ODUCTS • COMP /0h 400 AUTOMOBILE LIABILITY COMBINED E cc clt� SINGLE LI IT $ ram) $ __„ ANY AUTO BODILY INJURY (Pot p OWNED AUTOS ONLY HIRED AUTOS ONLY —•_ SCHEDULED AUTOS NON -OWNED AUTOS ONLY BODILY INJURY (Per a cMunp $ PROPERTY DAMAGE PR r PEold Y $ 5 $ '� UMBRELLA LIAe EXCESS UAB � 1 OCCUR CLAIMS -MADE EACHOCCuRRENCE AGGREGATE $ $ WORI(ERSCOMPENSATION DED RETENT ON t NIA _ STATUTE l _ =R AND EMPLOYERS' LIABILITY Y 1 N ANYPROPRIETOR/PARTNER/EXECUTIvB 1 I OFFICER1MBMBEREXCLUDED? L i (Mandatory In NH) If vas, deecribe under 0ESCRIPTION OF OPERATIONS below E.L. EACH ACCIDENT 5 E.L. DISEASE - EA EM LOYEE 5 E.L. DISEASE - POLIC' LIMIT $ _ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Romarke Schedule, may be attached if mare epaco ie required) SPECIAL EVENT POLICY - CROSSFIT COMPETION- FLAGLER PARK - DOWNTOWN C OKEECHOBEE ADDITIONAL INSURED: CITY OF OKEECHOBEE TY OF CANCELLATION CERTIFICATE HOLDER CITY OF OKEECHOBEE 55 SE 3RD AVE OKEECHOBEE, FL 34974 SHOULD ANY OF THE ABOVE DESCRIBED POLICle THE EXPIRATION DATE THEREOF, NOTICE ovILL ACCORDANCE WITH THE POLICY PROVISIONS. BE CANCELLIP BEFORE BE DEL FRED IN AUTHORIZED REPRESENTATIVE TIMOTHY M CRAI 3 1 ©1988 -2015 ACORD CORPORA-10N. ACORD 25 (2016/03) The ACORD name and 1090 are registered marks of ACORD All rights reserved - Jackie Dunham From: Jackie Dunham Sent: Thursday, September 22, 2016 9:46 AM To: Herb Smith; David Allen; Major Peterson; Lane Gamiotea Cc: Patty Burnette Subject: Upcoming Street Closings and Park Use Permits Attachments: Ride for the Fight.pdf; FBC Fall Festival.pdf Tracking: Recipient Read Herb Smith David Allen Read: 9/22/2016 9:47 AM Major Peterson Lane Gamiotea Patty Burnette Robert Peterson Read: 9/22/2016 10:19 AM For your information I am attaching two permits for the month of October. One is a street closing only and the other is a Park Use Permit with a street closing. Your signatures have already been obtained but they both need to go to City Council for approval at their October 4th meeting. I'm still waiting on insurance for both these organizations and I have e- mailed both of my contacts. Jctcki,e/ Du.vt,ha tav Amara i'wei Secretcwy C ity o f O keech alp 55 SE Th v-cl, Avevu,+.e' Okeechobee', FL 34974 Toe: 863-763-3372 ext. 217 Fax' 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 Jackie Dunham From: Jackie Dunham Sent: Wednesday, October 05, 2016 10:03 AM To: mc@rideforthefight.com Subject: Park Use Permit & Street Closing Attachments: 021 -Ride for the Fight.pdf Please see the attached approved Park Use Permit /Street Closing for your upcoming event on October 22nd. It was approved at the City Council meeting held 10/4/16. Thank you. Jack -,ems DwvlhaA ' A d n ' tr'atwe/Secv'etcwy City of Okeechobee/ 55 SE Th.i rc&Avevwue. Okeechobee; FL 34974 To ems' 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. i