Park Use Permit-Christmas Stroll in the ParkCITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tele: 863-763-3372 ext. 217 Fax: 863-763-1686
e -mail: jdunham(a,cityofokeechobee.corn
Park Use Permit
Permit Number: 023 Date(s) of Event: Nov 10 — Jan 10, 2016
Permit Expiration: January 10, 2017 11:59 P.M.
Purpose of Request: Display 4x8, 8x8 Cards for Individuals /Businesses
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee State: Florida Zip Code: 34974
Applicant: OHS Band
Phone Number: 863 - 801 -0807
Current Zoning: P
Subdivision: City of Okeechobee
Applicant's Address: 2800 Hwy 441 North
Address of Project: Park #6
FLU Designation: Public
Restrictions /Remarks: All debris must be removed within 24 hours of expiration date.
,.Tack.i ei P
General Services Secretary
10/28/16
Date
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:
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Date Issued:
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Application No:
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Date(s) of Event:
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Information:
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Summary of activities:
Proceeds usage:
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Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 ❑ #4 ❑ #5 ,. #6
Address of event:
Parcel ID:
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Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 ❑ #4 ❑ #5 ,. #6
Address of event:
Parcel ID:
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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:
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.
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.,"
No.(s) 03-
is correct, and
and obey all the
or
pplicant Signature Date
••••OFFICE USE ONLY••••
Staff Review
Fire Department:
Date:
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Building Official:
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Date:
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Public Works:
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Police Department:
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Date:
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BTR Department:
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Date:
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City Administrator:
Date:
City Clerk:
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Date:
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NOTE: 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
AND
PRIOR TO
Date
Date
UMBRELLA LIAR
EXCESS LUAU CLAIMS -MADE
I DED I ! RETENTION
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED>
(Mandatory In NN)
II yes, deIcribe under
DE8RIPTION OF OPERATIONS Dalow
.- I SCHEDULED
I AUTOS
X HIRED AUTOS X NON -OWNED
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OCCUR
EACH OCCURRENCE 1$ 1,000,000
07/01/2017 TIAIWCiiET RENTED S Included
PREMISES (Ea occurnny.Z 1
MED EXP (Any one person) 5 Excluded
PERSONAL C. AOV INJURY $ Included
FSBITI6CAS7 -1 07/01/2016 07/01/2017
GENERAL AGGREGATE S
PRODUCTS • COMP/OP AGO S Included
COMBINED SINGLE LIMIT $
allegalentl
BODILY INJURY (Per parson) $
BODILY INJURY (Par ...want) S
-- nOPERTY DAMAGE
(Per accident)
S
1,000,000
07/26/2016 10:52 FAX
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A►OR,a
CERTIFICATE OF LIABILITY INSURANCE
[2 004
FLOR3CH -04 COOPERCO
DATE (MMIODM/YY)
7/26/2016
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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain pollcles may require an endorsement. A etetemont on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
DU
pROCE. NAOIMJeCT Willis Towers Watson Certificate Center
Willis Administrative Services Corporation DBA Willis Pooling 'H NE - 877 946 -7378 Fuc,Ne 888 487 -2378
c/o 26 Century Blvd �,E�tJ: (.._ - - - - - -- ..._.- .. ( 1 )
P.O. Box 305191 ADDRESS. certlficatesewillls.com
Nashville, TN 37230 -6191 - --
INSURER(S) AFFORDING COVERAGE NAIC M
INGURBRA:Florida School Boards Insurance Trust D2772
INSURED
Okeechobee County School District
Attn: Jonl Ard
700 SW Second Avenue
Okeechobee, FL 34974
INSURER a
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 PERIOD
INDICATED. NOTWTHSTANDING 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 SUN ABBE - ' -- - -' POLICY EFF POLICY eV.
TYPE OP INSURANCE )NSD yyjD POLICY NUMBER (MM/DOA'YYYLI IMMIDOIYYYYI LIMITS
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AdelUonal Remart. scnanuta, may be attached II more apace la r.quIr.d)
Evidenee of Coverage ae respects to Okeechobee High School Band Is Having Holiday Stroll In the Park from November 10, 2018-January 2, 2017. The display
of 4X8 and 8X8 billboards for Individual bualneasos. The billboards will be located at SE corner of Park #6.
CERTIFICATE HOLDER -_ CANCELLATION
City of Okeechobee
66 SE 3rd Street
Okeechobee, FI,. 34974
SD 1988 -2014 ACORD CORPORATION. All rights reserved.
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) The ACORD name and logo are registered marks of ACORD
Jackie Dunham
From:
Sent:
To:
Subject:
Jackie Dunham
Friday, October 21, 2016 3:58 PM
Herb Smith; David Allen; Major Peterson; Lane Gamiotea; Kim Barnes
Need Signatures - Park Use Application
I have received the application for the annual Holiday Stroll in the Park for the OHS Marching Band. Please
stop by my desk to review and sign. Thank you.
Ja ck ie- Du.vth.cww
AclArn -ra-tLve' Secretary
City of Okeecho-6ee-
55 SE Th,Grd/Avevut '
Okeecho-b , FL 34974
Teie..' 863 - 763 -3372 e4ct 21.7
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