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Temp. Use Permit - For Okeechobee Christmas Tree SalesCity of Okeechobee 55 S.E. 3`d Avenue Okeechobee, Florida 34974 (863) 763 -3372 Temporary Use Permit Permit Number: 16 -009 Date(s) of Event: November 18 — December 20, 2016 Permit Expiration: December 20, 2016 11:59 A.M. Purpose of Request: Christmas Tree Sales Property Owner: Downtown Okeechobee LLC Address: 205 SW Park St. City: Okeechobee State: Florida Zip Code: 34974 Applicant: For Okeechobee, Inc. Applicant's Address: P.O. Box 9, Okeechobee, FL Phone Number. 863 - 634 -6322 Address of Project: SW Park St, Lot 6, Block 167 Current Zoning: Commercial Business District (CBD) FLU Designation: Commercial (C) Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 48 hours of expiration 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 b- - • ditional permits required from other govemmental entities. y t at e examined his permit, it is correct and 1 will abi a by its requirements. // plicant's S gn re neral Se ices Coordinator REF: .ORD.716, Temporary Structures Date CITY OF OICEECHOBEE General Services Department, Room 101 55 Southeast 3rd Avenue Okeechobee, FL 34974 e 863- 763 -337? ext. 17 Fax: 863 - 763 -1686 � ,o �,` DATE RECEIVED: 't - DATE ISSUED: , I -'V _, Name of Property Owner(s): Deru yl,-E•a -ijjYt ���(aeQe,O',� -Obee_ ) (r(.,C,, ...%,:z „``�� 4• �m .:I/L.4 sr • APPLICATION No: DATE(s) OF EVENT:// �� �� / - Q4')'7 4 I Q ,-Ito, TuR �t i:� °�o it FEE: $175.00 DATE PAID: 1`°1 X,r If Non-Profit/Civic Organization ,,// Telephone Numbers: Home: Work: Mobile /Cell:8(a3 %(O343AEger: TEMPORARY USE PERMIT APPLICATION • APPLICANT 11 Name of Property Owner(s): Deru yl,-E•a -ijjYt ���(aeQe,O',� -Obee_ ) (r(.,C,, Address: LEA-- "� otk- ( (PI 3(,&) P/,,..: Telephone Numbers: Home: Work: Mobile /Cell: Pager: Name of Applicant: • % / ,_ J.j.„•_, i I- ,O ' 4.0—ta, %a A. n//l Address: p p. 3t,C q Dk;ee,�h4� 31473 ,,// Telephone Numbers: Home: Work: Mobile /Cell:8(a3 %(O343AEger: • a L 0 cc a, Future Land Use Map Designation: G Current Zoning Designation: G8 D Legal Description of Property: (Op p& 104- an i9a.fi 2 S1 • b�.Q 1 . 1''• x I Address of Property: Lo}- (a (I oe , (07 �1 Please Explain Type of Use: ��.LQ-,t. l .�,� , North: describe ( use of;dJoipin property: l j104 p.. t �” w/' f�JJ `t East: l n c3. South: ^" nn $ West: 3 I Other temporary ures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated, by a non - profit organization. 2. Carnival, circus, fair or other special event operated by a non - profit organization on or abutting their principal use. ' 3. Commercial carnival, circus orfalr In commercial or industrial districts. . 4. Similar temporary structures where the period of use will riot exceed 30 days a year. The applicant shall: 1. Submit proof of liability insurance, paid In full covering the period for which the permit Is issued, in the minimum amount of $1,000,000.00 per occurrence. 2. Remove all debris within 48 hours of expiration of permit 3. Have notarized written permission of property owner, if applicant is not'the property owner. 4. Submit Site Plan * . 5. Submit State inspection Certificate(s)' • 5. Submit State Annual Permit' d d ' th' a llcation is for use by the hereby ce ► fy that t City of 0 - echobee and Argrature of App ormatlon on this application is correct. The Information Inclu a In is pp ocessi ' y request. False or misleading Information may be punishable by afine of up to $500.00 to thirty da s and may result in the summary denial of this application. D// 9 /6 conditions)• City Staff (Please review the application, anacn cunuiiduw ui f.10‘..1[31 Occupational and /or State License Verification: 1 ntni Date: / , /� Fire Department Approval; A r-oVp.L. - �ribri �P� Oily Q.teib)In� Ash.ltimi lv+cs Date: . 11/01....72016 Date: Police Department Approval: �j Public Works Department Approval: Date:`/ `10 _ , f (� Building Inspector Approv- . / C ' _ Date: '(•/ O • 1 6 Date: City Administrator Approval: R6vlsad 2!1108 b(c Okeechobee County Property Appraiser Bill Sherman, CFA Parcel: « 3- 15 -37 -35 -0010- 01670 -0060 » Owner & Property Info Result: 1 of 3 DOWNTOWN OKEECHOBEE LLC Owner 205 SW PARK ST OKEECHOBEE, FL 349724160 Site SW PARK ST, OKEECHOBEE CITY OF OKEECHOBEE (PLAT BOOK 1 PAGE Description 10 & PLAT BOOK 5 PAGE 5) LOT 6 BLOCK 167 Area 0.162 AC S/T /R 15 -37 -35 VACANT COM (001000) The Description above is not to be used as the Legal Description for this parcel in any legal transaction. The Use Code is a Dept. of Revenue (DOR) code. Please contact the Okeechobee County Planning & Development office at 863- 763 -5548 for specific zoning information. Use Code Tax District 50 Property & Assessment Values 2015 Certified Values 2016 Certified Values Mkt Land (1) Ag Land (o) Building (o) XFOB (o) Just Class Appraised Exempt Assessed Total Taxable $36,975 Mkt Land (1) $0 Ag Land (o) $0 Building (o) $0 XFOB (o) $36,975 Just —$0 Class $36,975 Appraised $0 Exempt $36,975 Assessed county:$36,975 city:$36,975 Total otner:$36,975 Taxable school :$36,975 $36,975 i - - -- $0 • Sales History Sale Date 6/17/2016 12/10/2015 7/13/2015 10/21/2014 6/11/2004 7/14/2000 Sate Price $53,000 $100 $100 $15,000 $0 $250,000 Building Characteristics Bldg Sketch Bldg Item $0 $0 $36,975 $0 $36,975 . _..... -... . $36,975 county:$36,975 city:$36,975 otner:$36,975 schooi:$36, 975 Page 1 of 2 2016 Tax Roll Year updated: 10/27/2016 Aerial Viewer Pictometery Google Maps • 2015 2014 2011 2009 2005 Sales SW PARK ST e tee! - "7 "r • • AWNS Book/Page Deed 777/0346 WD 768/1520 I WD 782/1667 WD 752/0616 534/1360 441/0975 RCode 01 11 11 16 03 Extra Features & Out Buildings Code Desc Year Bit Bldg Desc Year Blt NONE Value Units NONE Base SF Dims Actual SF Bldg Value Condition (% Good) http://ap2.okeechobeepa.com/gis/recordSearch 3 Detai1 s/ 11/9/2016 ��0 1 i 4; (-, ISSUED TO: �� y °d $ CITY OF OKEECHOBEE 55 SE THIRD AVENUE BUILDING PERMIT # .0F'OKFF� _ ELECTRIC ∎LL Framing .1 OKEECHOBEE, FL 34974 DATE ISSUED 6 _- Wall Assembly Tel: 863 - 763 - 3372 X217 Fax: 863 - 763 -1686 Pool Steel /grounding ' . *�° * o��* • i� website: citvofokeechobec.com Pool Bond THIS CARD MUST BE POSTED AND VISIBLE FROM THE CLOSEST STREET UNTIL CERTIFICATE OF OCCUPANCY OR COMPLETION IS ISSUED. FOR INSPECTION CALL 863 -763- 3372 EXT. 217 BY 4:00 P.M., 24 HOURS NOTICE REQUIRED. NO INSPECTIONS SCHEDULED ON FRIDAY. Note: Failure to call for final inspection could result in code violation. NOTICE: This permit expires in 180 days if work has not commenced or it has been over 180 days since the last approved inspection. 1 1 BUILDING ISSUED TO: MECHANICAL SITE ADDRESS: PLUMBING DESCRIPTION: _ ELECTRIC TYPE INIT & DATE TYPE INIT & DATE TYPE T -pole Trusses Sewer Tap Underfloor Plumb Framing Pool Pressure Underfloor Elec Wall Assembly Pool Steel /grounding Pilings Above Ceiling Pool Bond Grade Beam Rough Electric Deck Steel Monolithic slab Rough Gas Final Pool Slab /Pre -pour Rough HVAC Fire Wall Screw Footing 2nd Rough Plumb In- Progress Footing Ground Roof Dry In* Form Board Survey Tie Beam Insulation Driveway Lintel Final Electric Elevation Certificate Rake Beam Final Gas Other Wall Sheeting Final HVAC Other Roof Sheathing* Final Plumbing Other Elec. Svc /Pwr Release Final Building Other COMMENTS: *Photos & Affidavit accepted in lieu of these inspections & must be included with Permit Card on site. F.S. 713.135 FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. THE NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. ISSUED BY: 1012712016 14:46 Okeechobee City Hall 5i&' PAL sreeel- (FAK)863 7631 P.0041014 Made this 1151)10 Leae day of October, 2016 Ip anb 3ettneen Downtown Okeechobee, LLC, hereinafter called the Lessor, and 1 Stop Party Shop, hereinafter called the Lessee, Vitneo9ettj: That in consideration of the covenants herein contained, on the part of said Lessee to be kept and performed, the said Lessor does hereby lease to the said Lessee the following described property: Lot 6, Block 167, City of Okeechobee babe anb To 30[b the same for the term of two (2) months from the 1st day of November, 2015 the said Lessee paying therefore the total rent of Five Hundred and 00 /100 Dollars ($500.00) plus 7% state sates. + r And the said Lessee covenants with the saidsLess6il to pay the said rent in one payment of Five Hundred Thirty-five and 00/100 Dollars ($535.00) on the 1st day of November, 2016; to make no unlawful, improper or offensive use of the premises; not to assign this lease or to sublet any part of said premises without the written consent of the Lessor; not to use said premises for any other purpose than as a Christmas tree sale lot; and to quit and deliver up said premises at the end of said term in as good condition as they are now (ordinary wear and decay and damage by the elements only excepted). And the said Lessee hereby covenants and agrees that if default shall be made in the payment of rent as aforesaid, or if said Lessee shall violate any of the covenants of this lease, then said Lessee shall become tenant at sufferance hereby waiving all right of notice, and the Lessors shall be entitled immediately to re -enter and re -take possession of the demised premises. ri 1.V9 I1e$1 VIjere0f, the said parties have hereunto set their hands and seals this day of October, 2016. DO-toyrzybor a _MM Lessor Ls she Signature 41n' Printed Name di/Lessee J19 (5Z)) Pal azad2ebez, Mailing Address of Lessee 1 STOP -1 OP ID: S2 ACC :30R C CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYY` ) 11/0812016 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 Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974 -6179 Kristina M. Morgan CONTACT NAME: Kristina M. Morgan PHONE FAX (AIC No, Eat): 863- 763 -7711 (ac, No): 863- 763 -5629 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC it INSURERA:Ohio Security INSURER B: 24082 INSURED 1 Stop Party Shop, LLC 319 SW Park Street Okeechobee, FL 34972 INSURER C: BKS57419072 INSURER D : 06/30/2017 INSURER E : $ 1,000,000 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. ILTRR TYPE OF INSURANCE INSD SUBR POLICY NUMBER (MMJDDIDIYYY) (MNWDfyWY) LIMITS A X COMMERCIAL GENERAL LIABILITY BKS57419072 06/30/2016 06/30/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISESO(E Eoccur ence) $ 300,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY PRO JECT LOC PRODUCTS - COMP /OP A.GG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED BODILY INJURY (Per accident) $ (P r accciident)�GE $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION $ $ WORKERS COMPENSATION PER STATUTE OTH- ER AND EMPLOYERS' LIABILITY Y ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) / N N / A E.L. EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ If yes. describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) ANCELLATION DOWNT -2 Downtown Okeechobee LLC 320 SW Park Street Okeechobee, FL 34972 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 � �� V i2i�; ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 STOP -1 OP ID: S2 ,ACORL:, CERTIFICATE OF LIABILITY INSURANCE �►�- -- ' OATS {MMlDDlYYYY) 11/08/2016 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 Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974 -6179 M. Morgan CONTACT NAME: Kristina M. Morgan N(CO"No, Ext : 863- 763 -7711 FAX No): 863- 763 -5629 ADDRESS: ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Ohio Security INSURERB: 24082 INSURED 1 Stop Party Shop, LLC 319 SW Park Street Okeechobee, FL 34972 INSURERC: BKS57419072 INSURER D : 06/30/2017 INSURER E : $ 1,000,000 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. ILTRR TYPE OF INSURANCE IINSD yy Bp POLICY NUMBER POLICY EFF {MMIDOtriYYi POLICY EXP (MMIDDIWYI) LIMITS A X COMMERCIAL GENERAL LIABILITY BKS57419072 06/30/2016 06/30/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X occuR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS - COMP /OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED HIRED AUTOS _ SCHEDULED NON-OWNED BODILY INJURY (Per accident) $ PROPERTY deerD)AM4GE $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER STATUTE OTH- ER Y ANY PROPRIETOR/PARTNERIEXECUTWE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) f N N / A E.L. EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CANCELLATION CITY -92 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 ACORD 25 (2014101) @ 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1STOP-1 OP ID: S2 ACORCP CERTIFICATE OF LIABILITY INSURANCE DATE (MMRDD1YYYY) 11/08/2016 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 Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974 -6179 Kristina M. Morgan CONTACT NAME: Kristina M. Morgan PHONE FAX 'Arc No, Exq: 863 -763 -7711 (NC, No): 863- 763 -5629 'MAIL ADDRESS: 1NSURER(S) AFFORDING COVERAGE NAIL S INSURER A : Ohio Security 24082 INSURED 1 Stop Party Shop, LLC 319 SW Park Street Okeechobee, FL 34972 INSURER B : BKS57419072 INSURERC: 06/30/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F : DAMAGE TO RENTED PREMISES (Ea occurrence) 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. 1NSRR TYPE OF INSURANCE ADDL YWO POLICY NUMBER POLICY EFF (MMroomyY) I POLICY EXP tMMIODrY�'» LIMITS A X COMMERCIAL GENERAL LIABILITY BKS57419072 06/30/2016 06/30/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I iq OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 300 000 $ , MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER. LIMIT APPLIES JECT PER LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT jEa accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE JPer accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUI1VE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 1 N N 1 A PER STATUTE OTH- ER E L. EACH ACCIDENT $ E L. DISEASE - EA EMPLOYEE $ E . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION FOROK -1 For Okeechobee Inc PO Box 9 Okeechobee, FL 34973 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 10127/2016 14:48 Okeechobee City Hall TA i)663 7631 P.0111014 Certificate of Flame Resistance FLa latereSd: Fabric! Or Concern Numbar i F-12123 Iifhesid ay; TrivatftQgt, .t.LC 1031 North Park Ave, Glen Rem, NC 27217 Data treated or menu/echoed; 0911612013 This is to each* that file materiels deactibed'bek w have been treated Wit, et flwr r- re>ltarriacit cheft)ieel or the Inherently oottnetflh eht0 FQft. Trivanta e. LLO um ': Glen Ravers sTik th', NC 27217 ADDlitSS: 1.8M North Park Ave_ Codification is hereby made they (Check "a" or Vi te) The erodes deacribed rat the bottom of this CadL1 c to have been treated With n fla`ne- relerdarit chemical approved arid registered by the Slate sire Marshal and the application of Said chemical was done In eznforrneaatcn with the taus of the silts of California and the Rules and Regulations of the State Fire Marshal. Nen19 of ahamlral need: Chemical Regietrati n ft: Method of eaapplic aftion: (b) The articles described at the bottom of this Certificate are made from a eaener- reaiatent febrfes Or mutariei registered arrd approved by the State Fire Marshal for such use Trade Nerno or fleme- reailtant fabric er mate:lei need. RENTERS CHOICE 16 OZ a,e9gletratton air. P-12123 The Flame-Re-Virden( process Used Will Not Be Removed By Washing ALBERT E JOHNSON VICE PRESIDENT, BUS, DEVELOPME }Went° W ApplIQattlr or Produalon Superintendent Title 100 968340 16 103 968340 16 76 cum -01 %ER QRDER No. FRED / ROAD SAL CUSTOMER INVOICE NO. 268852 YARDS OR QuANTiT"r' DE5CRIP1"ION 1000.00 . grlter's Cholc 1 , kout 61" 16-oz WhitelSljjdarrf PO ;1,00 Yerci , s.i item riumaeR 088340 We herebby Certify the shovel to eccuretetyt retied the information contained wiihiri a °CERTIFICATE OF FLAME RESISTANCE" ;clued to Trewl'tr toge, LL.0 frorfi the,regiitrartt sit fc>Yth abbima. A 64114 &f the trriglraf OfirlifiCaltf of Fiume Resistance is available Won reo eet to Inver !age, LL'C and the registration information eel forth above is on rot with the California State Fire Merest &, A 1 TENTS AND STRUCTURES 234 WEST 24TH ST fti4AisrIhl4 ADL)Re$S 1.11A1 FAH. FL. R,' nio 10/27/2016 14:48 Okeechobee City Hall VI R1r)A 1) .PAItIMFNI OF DIvINW\ t?i COP.i'1)N\IW \', Detail by Entity Name ITAX)863 7631686 P.0091014 FI nida Non Profit Corporation FOR OKEECHOBEE, INC. Filing Information Document Number N14000003911 FEI /EIN Number 46- 5296185 Date Flied 04/2212014 State FL Status ACTIVE Principal Address 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 Mailing Addresg PO BOX 9 OKEECHOBEE, FL 34973 Registered Agent Name & Address MIXON, JOSHUA 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 Officer /Director Detall Name & Address Title P MIXON, JOSHUA 501 S.W, 9TH STREET OKEECHOBEE, FL 34974 Title T/D WALLACE, MICHAEL 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 Title D DECARLO, FRANK 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 10/27/2016 14:48 Okeechobee City Hall . , Title 5 BRYANT, CAROL H 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 Title D iVIIXON, HOLLY 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 Title D SHIRTS, SHANNON 501 S.W. 9TH STREET OKEECHOBEE, FL 34974 Annual Reports No Annual Reports Filed Document Imams 04/22/2014 -- Domestic Non-Profit View image in PDF format Convriqbke and privacy Panda State or Florida, Department a( State M8637631686 P.010/014 1012712016 14:46 Okeechobee City Hall Set-up of tent will begin on November It will be open everyday from 10 am - 9 pm Tiara 76316116 ap .,DI(v take down will occur on or before December 29, WIN Restroom Facilities are located within 1 Stop Party Shop P.0031014 10/27/2016 14:47 Okeechobee City Hall No l sst14$ U \csS S i c .e.s b 4 w art-- at'}om duf-iyut 31-4\ Tent Checklist Tarots TAX)863 7631 P.005/014 Lot 4770 O C 9-4' 1. No person shall erect, operate, or maintain a tent covering an area in excess of 200 square feet without a pennit. a. Exception: Tents used exclusively for camping purposes. 2. Tents erected for the sale of fireworks shall comply with the criteria set forth within this checklist and criteria set forth by Florida Statute 791. 3. Tents shall be permitted only on a temporary basis. 4. Tents shall be erected to cover not more than 75 percent of the premises, unless otherwise approved by the authority having jurisdiction. Flame Resistance I. All tent fabric shall be flame resistant. (1.-o 1 2. One of the following shall serve as evidence that the tent fabric materials have the required flame resistance: a. The authority having jurisdiction shall require a certificate or other evidence of acceptance by an organization acceptable to the authority having jurisdiction, b. The authority having jurisdiction shall require a report of tests made by other inspection authorities or organizations acceptable to the authority having jurisdiction. Location and Spacing _1.. - Therc.sha*ll -be-a minimum -of- 0- 4t13-rn'rMt'i i'i stake'lines:_-_. _ A j cent tentsi a11-be_spaort.tt?.pxovid aptisma_t ..kused,4S..t !eons of emergency.greSs.,._Where,10, -ft (3 m) between stake lines does not meet the requirements for means of egress, the distance necessary for means of — egress shall govern, ^a_ 'Exee ition No. Z:: ', notstccupieci.b the. public.and.not.used..for the ntq' ge,of combustible material shall be permitted to be erected less than 10 if (3 m) from other structures wiiefetlxe' -• .... authority having jurisdiction deems such close spacing safe from hazard to the public. b,,._..,Exception.No.•2: Tents,- eaeh•aot,exceeding-1 200 °ft2 (11-l:gm2).'in- grontttd-ares -acrd located in fairgrounds or similar open spaces, shall not be required to be separated from each other, provided that safety precautions meet the approval of the authority having jurisdiction. y' c. Tents ha �g .att.area.o#15,.QQQ,ssluareleet or zrlare shall be located not less than 50 feet from any ----other structure as measured from the sidewall of the ieii tribe§ Si !lien "t-ogetfier"Gy a cotriddr:' "W--- - 3. The placement of tents relative other structures shall be at the discretion of the authorit,� having juns iedon, wit consideration given to occupancy, use opening exposure, and other similar fetors. e'z• Br ✓ v.42— L�! z�` G� L FCwr ? - L..b e,on,5 6'1,5 C. f vt � 6" ce Ca mete. fi �v._ c t 0,s raft° 4")-re>,-,%- Sl'r.t) U to t.- a surc- aee s5 Page 1 of 4 04/09/04 10/27/2016 14:47 Okeechobee City Hall {r5 � � . e. _Eira- bnse•.linearwater -su lies- and..nther ent-sl�all•be maintained -on- the - site -in Pp AklXllia�c.ftre.�quipcn !" ... _.such_numbers- and•sizes -as- directed- by- tite-fire`tsffreiat, Means m1 Egress � ' �' �)ti c,"-t003 � " J ?cw s c -00- -- _ --AI. atumber of means of egrem_(Exits)jha11 mgt edASS_ than -tuuo_ with•.a .minimum- with..of.6 feet-for- each - exile . 'IL)''! )., 64:—.(7 a. Te t3 wit an.occupantdaad- greater -thazt200-burless-than -500 shaU-be °provrrded with- net- less.than �i 1-S,:1----- 51 a 3 exits with a minimum with of 6 feet for each exit. t" ..,`."..W 5e� W!" " b. Tents with an occupant load gfe$�than lon.but.less.than -a W00- shah --be- provided -with -oat less .than amits-with TT"mtnimum with of 8 feet for each exit (FAX)863 7631686 Tent Checklist Fire Hazards P.0061014 1. The ground enclosed by any tent, and the ground for a reasonable distance but for not less than 10 -ft (3 m) outside of such a tent(s), shall be cleared of all flammable or combustible material or vegetation. 2, The premises shall be kept free from such flammable or combustible materials during the period for which the public uses the premises. 3. No fire works, open flame, or other device emitting fire or flame shall be used in or immediately adjacent to a tent. 4. Smoking shall not be permitted in any tent. a. "NO SMOKING" Signs shall be posted at 20 foot intervals around the perimeter of the tent. 5_ Portable fire-extinguishing equipment of approved types shall be furnished and maintained in tents in such -' quantity and in such locations as directed by the authority having jurisdiction, One 2A 1 OBC rated fire extinguisher shall be provide for every tent having a floor area more than 500 square feet but less than 1000 square feet and one in each auxiliary tenet adjacent thereto.. b. -- One- axlditiorrai- LAI01Seyated°frrcextirtguisher shall- isep rovided- foreaeh- additiona12,000.square feetor €raetioni•thereof:u._., c.-- At.- least one -K-- class -f' ire -extinguisher- shall -be- provided for •each- kiteherrand4ness«hal1,— d. —.-At least-oue-40,BC-rated- fire- stskiuguisher, jl be pfgyl44d.11„gower.ge a Qrs.arid -a locations --. . }3ere- flammable- liquids- are - used,— atvredrer-dispensed: - c. Tents with an occupant ad.. greater .than- - .00:0.- butless.thaa ti2,9 shall be provided with not less *- --"than 5 "exits with a minimum with of 10 feet for each exit d. Tents with an occupant load greater_thas2Eid hiillhe- provicjed with not less than 6 exits w tltg '-nrinimul trWitfi of 10 feet for each exit 1: - Means•o€ egress (Exitsj-shall- be- marked. wit.h exit.signage._-- lumination of Means of E. Tess, square feet shall be illuminated. sir other- than -for- private -pa "tones- net- exesediag,1200..r,..._ -r.- _ Page 2 of 4 04/09/04 10/27/2016 14:47 Okeechobee City Hall Tent Checklist 1A)O863 7631686 P.007/014 4 ,-- a ney- lighti . Pi IVIlt' partq'Tt=rtorexceeding.12.QQ s feet shall not be required to have emergency lighting. d.-8 e,;1,&- v\ 5. .,...---1A-. $ �c x—. )'1.i— Electrical Service 1. Permit required for the erection of temporary power poles. ( j `r U a. Note: The electrical plan examiner may require electrical load calculations. A.e,2.',5 "For rte vdo 2. Permit required if new wiring is run from an existing electrical service. (Extension Cords are Exe a. Note: The electrical plan examiner may require electrical load calculations. 3. Permit required when using generator(s) having a 5 kW rating or greater to provide power to the tent. Filrect.Heaters. . 1. On1ylabeled he sting'ttevices•ahall- be^used --• yin 2. Fuel, fired heatp , &tlaeirinstatlation- shall- be-approved by the° authority -having_jutisdiction. 3. Containers for liquefied petroleum gases shall be installed not less than 5-11(1.5 m) from any tent and shall - be-irr accordance' with- the'provistons-rirNppq ttiquefiezt'Petrolearn Gas -ewe: 4. Tts.shall- be•securd'd °iri file upttglit' position and protected from_Xhicular tr�ffc. Electric Heaters ,r r, rd' t 1. Only labeled heaters shall be permitted. C r ~?l «g r6'' ' 2. Heaters used inside a tent shall be approved. 3. Heaters shall be connected to electricity by electric cable that is suitable for outside use and is of sufficient size to handle the electrical load. 1. Finrika u s t Fire ),, lllm nalios,.tharA 2Q-R(d.m) -of unobstructed *idtli; able to-withstand.li.v.e.loacis of fire 'apparatus, and have a minimum of 13 ft 6- in,(4: -1 m) of vertical clearance. 2. FiW- lanes - shalt -be- maintained"free-of -el ,istruetious ..: tir}jeaq Fire Hydrants and (Fire Protection Applianc=es 1. No person shall place or keep any post, fence, vehicle, growth, vegetation, trash or storage of other materials that would obstruct a fire hydrant or fire protection appliance and hinder or prevent its immediate use by fire department personnel. Such fire hydrant or fire protection appliance shall be maintained readily visible at all times. 2- Fire hydrants and fire protection appliances shall be kept accessible to the fire department at all times, The following clearances shall be maintained for all fire hydrants and fire protection appliances. Page 3of4 04/09/04 10/27/2016 14:48 Okeechobee City Hall Tent Checklist FAX)863 7631 P.008/014 3. Hydrants. Clearances of seven and one half feet (7 ft - 6 in.) in front of and to the sides of he fire hydrant, with a four foot (4 ft) clearance to the rear of the hydrant. 4. Fire Protection Appliances. Clearances of seven and one half feet (7 ft - 6 in.) in front of and to the sides of the appliances. Inspections 1. Once erected the tent shall be inspected for code compliance and approval by the authority having jurisdiction prior to the event, Page 4of4 04/09/04 jjd;;P/' `L7