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
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CENTRAL ELEMENTARY
610 SW 5111 Ate. OEeehobee, FL - Google Maps
Address 610 SW 5th Ave
Okeechobee, FL 34974
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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