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Temp. Street Closing - Central Elem. Fall CarnivalPage 1 of 3 CITY OF OKEECHOBEE ��fs,' "f'� = 55 SE THIRD AVENUE \,`� OKEECHOBEE, FL 34974 : t .alt ; Tele: 863 - 763 -3372 ext.117 Fax: 863 - 763 -1686 -'.` ' PARK USE AND /OR TEMPORARY STREET! "'o'�� SIDEWALK CLOSING PERMIT APPLICATION Date Received: `j /fig /14, Date Issued: io - 1 r - i Application No: j t' -oV.y Date(s) of Event: 0a-atier' a8, aof(p Information: Organization: 1 Centro."( E lemerrtr,y/S 1•ua) Tax Exempt No: 1$s - $0I2teaa.141C -3 Mailing Address: WO &t) 5 Ohre., (Ate hobee Ft 30774 Contact Person: Uri &fins Coker Normam E -Mail Address: no email c.eokee. ki2.Pj.14 5 Telephone: Work: 9(,3- LW- 5617 Home: 1 1 Cell: '6103- (a34- 0g41-1- Summary of activities: Atfl&a t FaJ 1 Crn ;va.1 P seeds usage: r tChao1 iro Provernerl4- jelluseiionel reds of 6'64.41264 Please check requested Parks: 1\11A Flagler Parks: o City Hall Park ❑ #1 Memorial Park ❑ #2 c #3 ❑ #4 ❑ #5 ❑ #6 OR Address of event: (10 Su) 54 Ave. aeecbobee, Fl 314q Parcel ID: Page 2 of 3 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (If not using Park(s), provide event address) io 1 Sly5t� me. 0Keec. o F I 3474 Street Address City State Zip Code Street(s) to be closed: 5t) 5 {) Ave. ,etu) tr Si) tetb S +. and 5k) 8 ±.' Sf'. Date(s) to be closed: Fr;do1 Q be e?g+A , 20) to Time(s) to be closed: q: on p, m,, - 9: oa p. tn. Purpose of Closing: 5a.4 of -Pam iiie5 daring even-I-1 hurlde Attachments Required: �1 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 � rgr ghe City Councmil of the City of Okeechobee, ore rules and regulation, which may be lawfully prescribed by its officers, for the issuance of this Charitable Function Permit. CERTIFICATE OF INSURANCE MUST NAME CITY OF OKEECHOBEE AS ADDITIONAL INSURED. Applicant Signature 1,11 11 Date Staff Review Fire Department: Building Official: Public Works: Police Department: BTR Department: City Administrator: City Clerk: ••••OFFICE USE ONLY"" Date: Date: Date: Date: Date: Date: Date: D// lo-14- 1-4 ic/y//c 70//‘ t0(y \1 o - NOTE: APPLICATION AND AL SERVICES CES DEPARTMENIT THIRTY (30} DAYS PRIOR TO RETURNED TO THE GENERAL FOR PERMITTING. Temporary Street and Sidewalk Closing submitted for review by City Council on / 0 /1 /! Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date / /4p 10/01/2013 16 :20 863- 462 -5082 Turims Goggle CENTRAL ELEMENTARY 610 SW 5111 Ate. OEeehobee, FL - Google Maps Address 610 SW 5th Ave Okeechobee, FL 34974 PAGE 05/05 M 1 k,l emerrhn &k0 retued-e area ro a_ok -k, be. loser . me Q:c�o�►�, Sk ` Ave- beitoew 0 (pu a 4- St>3 ? a - hops : // maps. google. comfmaps9f= q&sourca~s_gah1= en&geocod� &q= 610 +SW +5th+A■e, +Ui¢ , +FL&eg7=0&aq= 610+ sw+50As11 = 27.240997,-80.828x... 1/1 d4WRL " CERTIFICATE OF LIABILITY INSURANCE FLORSCH -04 WILSONLR GATE (MMIDD/YYYY) 9/27/2016 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(les) 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 Willis Administrative Services Corporation DBA Willis Pooling c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 37230-5191 INSURED Okeechobee County School District Attn: Chris Lawrence 700 SW Second Avenue Okeechobee, FL 34974 CONTACT Willis Towers Watson Certificate Center PHONE Ext): (877) 945 -7378 _Na): (8881467-2378 EfiIML ADDRESS: Certlficates(_Wlllis_.COIri INSURER(S) AFFORDING COVERAGE NAIC 8 INSURER A Florida School Boards Insurance Trust D2772 INSURER B : INSURER C : INSURER D : INSURER E 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PERIOD THIS TERMS, _... _ LLT R TYPE OF INSURANCE L S - LTR 7A-01:97S-09-R.: INSD WVD • POLICY NUMBER .. .._........ POLICY EFF POLICY EXP LIMITS (MhWDlYYYY) (MMlDDlYYYY) A X COMMERCIAL GENERAL LIABILITY : CLAIMS-MADE X :OCCUR X 'FSBITI8CAS7.1 GEN'L AGGREGATE LIMIT APPLIES PER: • POLICY P LOC ._ -. JEc0 T OTHER: EACH OCCURRENCE $ 07/0112016 07/01/2017 DAMACE'raR'= NTEp-- - - - - -- PREMISESTaoccurrence) $ MED EXP {Any one person] $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP A • GG $ $ 1,000,000 - - -' Included Excluded Included Included AUTOMOBILE LIABILITY A X ANY AUTO FSBITI6CAS7 -1 ALL OWNED SCHEDULED . AUTOS X AVTDS 'X ' NON -OWNED HIRED AUTOS _ AUTOS COMBINED SINGLE LIMIT 5 (Ea accident) 07/01/2016 07101/2017 BODILY INJURY (Per person) :5 BODILY INJURY (Per accident) 5 PROPERTY DAMAGI= . 5 (Peracddentj__ _,._,__ 5 1,000,000 UMBRELLALIAB OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ EACH OCCURRENCE 5 AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YfN: A ANY PROPRIETORIPARTNERrEXECUTIVE DFFICER/MEMBEREXCLUDED? NIA FSBIT16CAS7 -1 (Mandatary In NH) — " N yes, describe under DESCRIPTION OF OPERATIONS below X PER ' OTH- STATUTE _, -_ -_ ER. __ 07107!2016 07101!2017 E.L. EACH ACCIDENT $ _ 2,000,000 - 2,000,000 2,000,000 . EL. DISEASE - EA EMPLOYEE 5 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space is required) Evidence of Coverage as it relates to the Fall Carnival -Central Elementary School, 610 SW 5th Avenue, Okeechobee, FL, 34974 on Friday, 1 012 812 0 1 6. City of Okeechobee is Included as additional Insured as respects to the General Liability policy. General Aggregate is Unlimited. CERTIFICATE HOLDER CANCELLATION City of Okeechobee 55 SE E 3rd Street 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 421 11.24/21- 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 0000011 03 /14/13 DEPARTMENT OF REVENUE Certificate Number This certifies that Consumer's Certificate of Exemption Issued Pursuant to Chapter 212, Florida Statutes Effective Date OKEECHOBEE COUNTY PUBLIC SCHOOL DISTRICT 700 SW 2ND AVE OKEECHOBEE FL 34974 -5117 Expiration Date DR -14 R. 04/11 ,40-00NTY=,QOVERNOENT is exempt from the payment of Florida sales and use tax on real property rented, transient rental property ented, tangible personal property purchased or rented, or services purchased. Jackie Dunham From: Sent: To: Subject: Jackie Dunham Thursday, September 29, 2016 11:27 AM Herb Smith; Major Peterson; David Allen; Lane Gamiotea; Kim Barnes Central Elementary Fall Festival I am in receipt of the Street Closing application for the annual Fall Festival for Central Elementary which will be held this year on 10- 28 -16. This will be placed on the agenda for the 10 -18 -16 City Council meeting. Please stop by my desk to review and sign. Thank you. Ja ck ie.V twihamv AdvnZniztrative, Se cs-etct y City ofOlcee,chobee. 55 SE T hr v'thAvevwte, Okeechoee., FL 34974 Tole:: 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. i Jackie Dunham From: Jackie Dunham Sent: Wednesday, October 19, 2016 9:37 AM To: normanc @okee.k12.fl.us Subject: Central Elementary Fall Festival Christina, please be advised, your request to close SW 5th Avenue on 10/28/16 was approved at our City Council meeting held 10/18/16. Wishing the school a successful, fun and safe event this year. Please note for future reference, our Street Closings will require the Certificate of Insurance to state City of Okeechobee as well as the R.E. Hamrick Testamentary Trust as additional insured. The City used to require this and a couple of years ago we stopped. It was brought to our attention recently that we are still mandated to request this information so we will begin doing on a going forward basis. Thank you. Jacj ,e, Dtuthvultv A dAniAlarotrove. Secretary city of Okeechobee 55 SE rlurd/Avev ue. Okeechobee, FL 34974 Tole,: 863 -763 -3372 e t. 217 /cuo' 863 - 763 -1686 idunham@cityofokeechobee.com Website: http: / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1