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Temp. Use Permit - BBQ FundraiserCity of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 (863) 763 -3372 X217 Temporary Use Permit Permit Number: 16 -007 Date(s) of Event: November 11, 2016 6AM - 2PM Permit Expiration: November 11, 2016 11:59PM Purpose of Request: Barbeque Fundraiser Property Owner: Karla Roby & Debra Sales Address: P.O. Box 1395 City: Okeechobee State: Florida Zip Code:34974 Applicant: Chaka Stars Applicant's Address: 1491 SW 86th Ave Phone Number: 706 - 305 -7613 Address of Project: 1600 S Parrott Avenue Current Zoning: Heavy Commercial (CHV FLU Designation: Commercial (C) Subdivision: 1st Addition to South Okeechobee Restrictions /Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additi. -aI permits required from other governmental entities. Apptica► 'Signature t LU ( /LA A /AAXA'L neral Services Assistant REF: .ORD.716, Temporary Structures Date: � f,G/ 20/ /i - /Q- Date CITY OF OKEECHOBEE General Services Department, Room 101 55 Southeast 3rd Avenue Okeechobee, FL 34974 Phone: 863 -763 -3372 ext. Mg Fax: 863 - 763 -1686 -f,'/ 3/ -,( TEMPORARY USE PERMIT APPLICATION OTHER TEMPORARY STRUCTURES (SEC 666 IAPPLICANT 1 Name of Property Owner(s): .0,;.- fL A'7 P5 ,''a 01 C, 'f Mfr 'rl" � (g '/4'4_' ;' 7� irf/;? / // DATE RECEIVED: DATE ISSUED: % Address of Property: /c.., /_ // ,ve , „, ��— `” "' `` ��` .": .i' • '' i South: iJ ('/ (/7-', ,, -., _5: West: .72,'',. APPLICATION NO: DATE(S) OF EVENT: l � E" (7 i Nit f to lf' 4k- a Pia ,....'r=t ,, FEE: $175.00 DATE PAID: :t .��;,�' Ar If Non - Profit/Civic Organization Al fr Public Works Department Apo • - -f,'/ 3/ -,( TEMPORARY USE PERMIT APPLICATION OTHER TEMPORARY STRUCTURES (SEC 666 IAPPLICANT 1 Name of Property Owner(s): .0,;.- fL A'7 P5 ,''a 01 C, 'f Mfr 'rl" � (g '/4'4_' ;' 7� irf/;? / // t Address: / f f & ,, r : , , / i Address of Property: /c.., /_ // ,ve Of'.,j ,SIt its, _.,i ., kgrIc i' , =y Telephone Numbers: Home: Work: i South: iJ ('/ (/7-', ,, -., _5: West: .72,'',. Mobile /Cell: Pager: Name of Applicant: ('4 ;4.et /�i:c; ,.1 c'.�L,f4 ;, J Police Depart , -1t '14 • • • • , -/ j ,/ Address: 4/1 / 5 .G 4 (,% y� t'"/.. :t '414''' `f Z _S 9'r W — ; / �, Telephone Numbers: Home: Work: Public Works Department Apo • - Mobile /Cell:74' ;i j ,14% / 3 Pager: l0 iv r'f 'r /C-f' 4`J` %fei3) &,'fL`I PROPERTY Future Land Use Map Designation: Current Zoning Designation: - / Legal Description of Property: zsli Y i — / 7 ,/ f I ,,. 'J1,_ 4 -/ ' 7 I Address of Property: /c.., /_ // ,ve Please Explain Type of Use: i ,b -��,r ,f`� -�; ed , vir ;/ ,,/ ; i y.�/,./ `�/, #,7 Briefly describe use of adjoining property: North: r << 1") r,1, j. "6;, t ,..: D & K Enterprises of Okeechobee, Inc. Brahman Theaters 111 P.O. Box 1395 Okeechobee, Florida 34973 10/11/16 To Whom It May Concern: I, Karla H. Roby and Debra S. Sales, owners of The Brahman Theatres III, located at 1500 S. Parrott Avenue in Okeechobee. Give permission for Chobee Nation Basketball, the use of our parking lot on Friday, November 11th, 2016 for a BBQ Fundraiser. Best Regards, Karla H. Roby Debra S. Sales Gocgle earth feet meters 10 3 i&cto 5 PMf�T( Ng raker AAA. MDT 0 X10 hogi er Detail by Entity Name FLORIDA DEPARTMENT OF STATE DIVISION Or CORPORATIONS Page 1 of 3 Detail by Entity Name Florida Not For Profit Corporation CHAKA'S STARS FOUNDATION, INC. Filing Information Document Number N07000001082 FEI /EIN Number 20- 8348641 Date Filed 01/31/2007 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 08/21/2007 Event Effective Date NONE Principal Address 1491 SW 86TH AVENUE OKEECHOBEE, FL 34974 Mailing Address 1491 SW 86TH AVENUE OKEECHOBEE, FL 34974 Registered Agent Name & Address SMITH, CHAKA 1491 SW 86TH AVENUE OKEECHOBEE, FL 34974 Officer /Director Detail Name & Address Title P SMITH, CHAKA 1491 SW 86TH AVENUE OKEECHOBEE, FL 34974 Title VP KOGER, DEREK 3816 NW 34TH AVE OKEECHOBEE, FL 34972 Title Director http: / /search. sunbiz. org/ Inquiry/ CorporationSearch /SearchResultDetail ?inquirytype= Entity... 4/5/2016 Detail by Entity Name CLEVELAND, TINA 1913 FIREFLY DR GREEN COVE SPRINGS, FL 32043 Title T SMITH, SURAIYA 1491 SW 86TH AVENUE OKEECHOBEE, FL 34974 Title S MORRIS, TERRA 1391 NW 14TH AVE OKEECHOBEE, FL 34972 Title VP CLEVELAND, KEVIN 1913 FIREFLY DR GREEN COVE SPRINGS, FL 32043 Title Director MILLER, LASHAWN 2021 NW 7TH AVENUE OKEECHOBEE, FL 34972 Annual Reports Report Year Filed Date 2013 05/14/2013 2014 04/25/2014 2015 02/27/2015 Document Images 02/27/2015 -- ANNUAL REPORT 04/25/2014 -- ANNUAL REPORT 05/14/2013 -- ANNUAL REPORT 05/25/2012 -- ANNUAL REPORT 02/22/2011 -- ANNUAL REPORT 02/09/2010 -- ANNUAL REPORT 04/22/2009 -- ANNUAL REPORT 03/25/2008 -- ANNUAL REPORT 08/21/2007 -- Amendment 01/31/2007 -- Domestic Non - Profit View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Page 2 of 3 http: // search. sunbiz. org / Inquiry / CorporationSearch /SearchResultDetail ?inquirytype = Entity... 4/5/2016 Jackie Dunham From: Sent: To: Subject: Jackie Dunham Wednesday, October 12, 2016 9:41 AM Herb Smith; David Allen; Major Peterson; Kim Barnes; Jeff Newell Temporary Use Permit Please stop by to review and sign a new TUP I have received for a BBQ Fundraiser at the Brahman Theater parking lot on November 11th. Thank you. Jack ie' Du,o.ha/vw A d A4vw4,14trcit" ve' S ec+reta.v y CCy of Okeechalee 55 SE 71i rd/ 4 ve vwxe' Off, EL 34974 Ted 863-763-3372 ext. 217 7aixi: 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. 1 CHAKA -1 OP ID: MB '4C RL CERTIFICATE OF LIABILITY INSURANCE DATE (M YID 04/051/201201 6 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 ISU Lawrence Insurance Agency PO Box 549 Okeechobee, FL 34973 Heath Lawrence CONTACT NAME: PHONE FAX (PJC, No Ekt): 1 (A/C, No): E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Scottsdale Insurance Co 41297 INSURED Chakas Stars Foundation Inc Chaka Stars Cheer PO Box 791 Okeechobee, FL 34973 -0791 INSURER B: 06/15/2016 06/15/2017 INSURER C $ 1,000,000 INSURER D : $ 100,000 INSURER E : $ 5,000 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 INSR SUER WVD POLICY NUMBER POLICY EFF POLICY EXP M' (MMIDDYY) I (MMIDDflYYY� LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPS2477185 06/15/2016 06/15/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP Any one person) $ 5,000 CLAIMS-MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPIOP AGO $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES X POLICY PRO JECT PER LOC AUTOMOBILE - LIABILITY ANY AUTO ALL OWNED ALTOS HIRED AUTOS SCHEDULED AUTO NCN- OVVNED AUTOS COMBINED SINGLE LIMIT (La accident) $ 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/PARTNERfEXECUTIVE OFFICER /MEMBER EXCLUDED' (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS bele, Y!N NIA W C STATU- TORY LIMITS OTH- ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Fund Raiser - Pulled Pork Dinner CERTIFICATE HOLDER CANCELLATION CTYOKEE City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 1 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 7‘c---/2d;.-0-------- ACORD 25 (2010/05) ® 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD