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Park Use Permit - Food Truck Event (3)CITY OF OKEECHOBEE 55 SE THIRD A VENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 ext. 217 Fax: 863-763-1686 e -mail: jdunham(a2cityofokeechobee.com Park Use Permit Permit Number: 022 Date(s) of Event: October 27, 2016 3:30pm- 9:00pm Permit Expiration: October 27, 2016 11:59PM Purpose of Request: Food Truck Event in Downtown Okeechobee Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Okeechobee Main Street Phone Number: 863 - 357 -6246 Current Zoning: P Subdivision: City of Okeechobee Applicant's Address: 55 S. Parrott Avenue Address of Project: Park #3 FLU Designation: Public Restrictions /Remarks: All debris must be removed within 24 hours of expiration date. *Main Street volunteers will assist with trash clean up *City water sources will not be utilized ** *PER FIRE CHIEF, FIRE DEPARTMENT NEEDS TO INSPECT ALL FOOD TRUCKS ** Jackie/ General Services Administrative Secretary October 19, 2016 Date '•'�,,< „,,,,..4.4„.... ; ' Iv. �,���`� '•- ;;;,'` Page 1 of 3 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 : Tele: 863 - 763 -3372 ext. 218 Fax: 863 - 763 -1686 PARK USE AND /OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: jo/ S- i/ (e Date Issued: /0-09-He , .. _ - Application No: 14 - OA A Date(s) of Event: 1 7/.6.. -- ,590 P- Q oo r _0727 Information: Organization: 00.1,OY O'OCL. (`4\CA1f Web- Tax Exempt No: Mailing Address: 55 $o(,1+ -1 Po�rrot-1- Rve iu OI( ec%Obee.7 EL 3L/972 Contact Person: me 4i-- j++any r E -Mail Address: brI nyc OKe choEZ�f'r1Cc.inS --ere--F. or9 Telephone: Work: g(03 "�51 - (p'a1 -i--1Co Home: Cell: R03 -D-13 -- la y Summary of activities: FOod Tract' ex-r'4 in Ot/r- eGholx .'S down +-o w r • Pin Palen i -+o Qn 'd r e a k - c - o c i Lui+h Fr e - n c a s and - r - e u - n i / . �rh iS n i h+ C u i l l in�lu e DS, crop -k- Vendors, pO1tfical Ccmpai9 11Sioc ncj 400i o-F ail kinds • In S+reCt 1QI11 have YoIuf-tcas Tor -t -rash Clean U. and Por -I-N as 11 Ko r+h EEas.+ cb rne.,r o f 3. DS will c +- u p in +he cenicx t.uda— - - aZbD 9 Proceeds usage: PO CZedS -CO r -this c vexu -- u) i t t Op *o +h e o pnrcu ors amd Con-Mta iq eft, r+s of pKeechobce_ ma+ n J-I-r + 4o ehhan ce. do wn -lor on areas as +lie hear-1- of -fhe COh1 Munr-% • Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 3 ❑ #4 ❑ #5 ❑ #6 OR Address of event: Parcel ID: M ia■ i id ST . E r v 0 L.. (.t. xi -r e ERs - -I-4po-S ii C kC: An! Lc P 0,114 wATCh Soct.ACtrS w∎ it .Jo1 3c ix.T► -1..E, to NA 5 P.E. be- P Am' m C n1 T nli C r s TO - - ti1.5 P(:, C-T Food -r4 I.c.,L.%, 5 if v. ()la n 3+ret f- (doeu,ld 1 i I(e P -r +4- -f-ix-- mod_ - c is ©n +1-ye east -, we- cam,(' d pa g, S -r^ .t'r . i cIe�S o4 Pcir� 3 , k)o ROW1t 0 03 u.((S J U S4- Page 2 of 3 l t,+112j -icn o -j-' t pax 4-; ^ 9 sp c -5 around fh.e Pa--k . 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: f\J 4 Date(s) to be closed: Time(s) to be closed: Purpose of Closing: 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 •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. Na Gl Wa71-ty (rouxce_. we r 11 be 1.1,f7 1, 2{'d . Applicant must n eet 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 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. G -t} �� /0- //46 Applicant Sign ure Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: t rUGA?, a . w,rL °ris erVo s Date: Date: I d Oa 4.01e, Building Official: (*. - • r 4,4 ,Q 9. i .7_1(, ) Public Works: Date: /0//7//6 O w �i i1/4----- Police Department: , tri Date : BTR De s artment: City Administrator: A h/ j// I Date: Date: /0 /9 /49 1 D /r // City Clerk: i ���, 1X,0 Date: ll /Q / /d/ko 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 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date 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 its officers, for the issuance of this Charitable Function Permit. CERTIFICATE OF INSURANCE MUST NAME CITY OF OKEECHOBEE AS ADDITIONAL INSURED. / qi 262//40 No.(s) 03- is correct, and and obey all the Okeechobee, or Applicant SignaG a Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: Date: 4927S9, Date: Date: clog.. ii' 27.0c) (1-o27-)1 Building Official: Public Works: Police Department: llpirw___Aop Date: ` Z7 -G BTR Department: h Ili \ / 4 Date: Date: 9 -a7 46 ci /Z +- 4 Cig1 I AND co T TO 4, City Administrator: City Clerk: Vftk Date: PRIOR it) /61/ OTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS EVENT FOR PERMITTING. Temporary Street and Sidewalk Closing submitted for review by City Council on Temporary Street and Sidewalk Closing reviewed by City Council and approved Date Date uunDAd/tef-' ACORt7® L----- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 9/28/2016 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(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 Robins Insurance Agency, Inc 30 Burton Hills Blvd. Suite 300 Nashville TN 37215 CONTACT Small Business Unit NAME: talc NNo EM (615)665-9200 (A/C, No): (615)665 -9207 E-MAIL ADDRESS: bbache@robinains.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Southern Owners Ins 10190 INSURED What's Cooking Inc DBA: Gourmet Truck Expo 200 SW 32nd Avenue Deerfield FL 33442 INSURER B : 03928331 Blanket Waiver Subrogation INSURERC: 7/18/2017 INSURERD: $ 1,000,000 INSURER E : INSURERF: X COVERAGES CERTIFICATE NUMBER:2 016 -17 MASTER COI 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 VVITH 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 ADOL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 03928331 Blanket Waiver Subrogation 7/18/2016 7/18/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES PREMISES (Ea occurrence) $ 000 MED EXP (Any one person) $ 10, 000 PERSONAL & ADV INJURY $ 1,000,000 GE X X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OPAGG $ 3,000,000 Hired & Non-Owned Aut $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 03928331 7/18/2016 7/18/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1, 000, 000 BODILY INJURY (Per person) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is included as an additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION City Of Okeechobee 55 SE 3rd Ave 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 Bruce Robins /BACH ��� �J ACORD 25 (2014/01) INS025 r?otaon © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Gourmet Truck Expo Gourmet Truck Expo. Doing Business As C Corporation, Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC ACORN►® CERTIFICATE OF LIABILITY INSURANCE (`./--- DATE(MM /DD /YYYY) 9/28/2016 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(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 Robins Insurance Agency, Inc 30 Burton Hills Blvd. Suite 300 Nashville TN 37215 CONTACT Small Business Unit NAME: PHONE FAX (615) 665 -9200 aC, No): (615)665 -9207 (A/C, No. E-MAIL ADDRESS: bbache @robinsins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Southern Owners Ins 10190 INSURED What's Cooking Inc DBA: Gourmet Truck Expo 200 SW 32nd Avenue Deerfield FL 33442 INSURER B : 03928331 Blanket Waiver Subrogation INSURER C: 7/18/2017 INSURERD: $ 1,000,000 INSURER E : $ 300, 000 INSURERF: COVERAGES CERTIFICATE NUMBER:2016 -17 MASTER COI 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD /YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 03928331 Blanket Waiver Subrogation 7/18/2016 7/18/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300, 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GE X X 'L AGGREGATE POLICY OTHER. LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OPAGG $ 3,000,000 Hired & Non -Owned Aut $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - X SCHEDULED NON-OWNED - - AUTOS 03928331 7/18/2016 7/18/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 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 /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is included as an additional insured as required by written contract. CANCELLATION ACORD 25 (2014/01) INS025 r?olami © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee Main Street l 55 South Parrott Ave Okeechobee, FL 34972 ��„ AUTHORIZED REPRESENTATIVE Bruce Robins /BACH r--- ACORD 25 (2014/01) INS025 r?olami © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Gourmet Truck Expo Doing Business As Gourmet Truck Expo. C Corporation, Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC OKEEMAI -01 SFISHER `....: — " -" CERTIFICATE OF LIABILITY INSURANCE DATE(MhIIDO/YYYY) 7/28/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED 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 Ileu of such endorsement(s). PRODUCER Maury, Donnelly 8 Parr 24 Commerce t. Baltimore, MD 21202 CONTACT NAME: PHO IA/C NNE o Ext): (410) 685-4625 FAX No): (410) 685 -3071 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 5 INSURER A: Transportation Insurance Services, Inc 20494 INSURED Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 r:r1VFRArFC .............____ INSURER 8 : X INSURER C: 4025933977 INSURER D : 07/01/2017 INSURER E: S 1,000,000 INSURER F : CLAIMS -MADE X OCCUR Mt VISION NUMBER: TI-HS INDICATED. CERTIFICATE EXCLUSIONS INSR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE ADOL"SUB)ff WVO POLCY NUMBER M YEFM (M/DD/YYYY) PINS() (M DD /YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 4025933977 07/01/2016 07/01/2017 _ EACH OCCURRENCE S 1,000,000 CLAIMS -MADE X OCCUR PREMISES ( etaar once) $ 1,000,000 MED EXP (Any one person) S 10,000 PERSONAL 8ADV INJURY $ 1,000,000 GENL X AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON - OWNED AUTOS BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Peraccdent) $ S UMBRELLA LIAR EXCESS LIAB -- OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED I RETENTION S S WORKERS COMPENSATION AND EMPLOYERS' L.IABIUTY Y / N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER T STATUTE I I ER H- E.L. EACH ACCIDENT S E-L. DISEASE - EA EMPLOYEE S E.L- DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mo e space is required) City of Okeechobee is named as Additional Insured. cFnTIGlrATC unr Horn ` City of Okeechobee 55 SE 3rd Avenue Okeechobee, FL 34874 vrlr•v�r -,n 1 rvty 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 ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E X A P L E-, or TOGO, --TRuf_,K S e-GLA • o FooD P4■34<ild& 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. Applicant Signatt�'e Date •••'OFFICE USE ONLY•••• Staff Review 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 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved di/u...ct. CL- C",-c -k -- . Date //Z li�‘(. 4c,c Fire De artment: •IgHfr Buildin ' Official: Public Works: Police Department: ir 14 Date: ,,27 e ,2o/4 , Date: cr. n • I A _ VI05.17. `mss Date: a-77- /6 Date: — Z7--/ BTR Department: . L 4 .., _ Date: Date: Date: 9 a 7,// tQ 0 //b City Administrator: City Clerk: �'� /a u'��� 'n n ,� v` t'1�N�- n / 1 �0�/1 /b / 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 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved di/u...ct. CL- C",-c -k -- . Date //Z li�‘(. 4c,c Robin Brock From: Sent: To: Cc: Subject: Jackie Dunham Monday, October 17, 2016 11:55 AM Marcos Montes De Oca Robin Brock FW: Food Truck Event Sir, please see the following e -mail from Brittany at Main Street. You mentioned you had a new application in your office. Are we able to add the date of October 27th? If so, perhaps we can try to obtain signatures at your staff meeting tomorrow. Jeff is out until the 27th of October so he won't be able to sign. Let me know. Thank you. Jackie, Dim/than/Li Ad tt tratwe-Secretary C i iy of c7keechal 55 SE T hi.rd'Avevwt.e/ Okeech i , EL 34974 Tee,: 863-763-3372 egt. 217 1a' 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. From: Brittany Carner [mailto:brittany okeechobeemainstreet.orq] Sent: Monday, October 17, 2016 11:42 AM To: Jackie Dunham Subject: Food Truck Event Could you change the date on the food truck event to the 27th of October which is a Thursday. If I need to resubmit a new one let me know. Thank you Brittany Carner Executive Director Okeechobee Main Street 55 S Parrott Ave Okeechobee, FL. 34972 863 - 357 -6246 Follow us on Facebook and Twitter. Visit us at www.okeechobeemainstreet.org 1 Jackie Dunham From: Jackie Dunham Sent: Thursday, October 20, 2016 8:36 AM To: Herb Smith; Major Peterson; David Allen Subject: Upcoming Food Truck Invasion Attachments: Upcoming Food Truck Invasion.pdf Please make note of the date and times for the upcoming Food Truck Invasion on 10/27 so your Department's staff are aware should any inspections be required. Ja cki,e,Du.n.ha wv Admiviiatra we.Secretary City of Okeechobee, 55 SE rh.ird'Avevwu', Okeechobee, FL 34974 reieA' 863 -763 -3372 ext. 217 Faux,: 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. 1 Jackie Dunham From: Jackie Dunham Sent: Thursday, October 20, 2016 8:31 AM To: Brittany Carner Subject: Food Truck Invasion 10/27 Attachments: 022 -Food Truck Invasion Downtown.pdf Please see the attached, approved Park Permit for the upcoming event on 10/27. Note: Fire Department will need to inspect the food trucks so you will need to contact Chief Smith at 863 - 467 -1586 once the trucks are set up. Ja ck ie Du*tha nv A clInlivtlistroutiNe. Secreta.vy aty of Okeechobee 55 SE T d/Ave.nue. Okeechobee, EL 34974 Ted' 863-763-3372 ext. 217 /ate' 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. i