Temp. Street Closing - MLK ParadeRu) i4'C c 35(1)(0). F A C STATE OF FLORIDA OF OF TRANSPORTATIGTi
Date:
12/22/2016
TEMPORARY CLOSING OF STATE ROAD PERMIT
CITY OF On ,Entity
850.040 .65
P AlNTENNICE
1:T1I
2016 -F- 191 -0039
Permit No
Approving Local Government bb SE 3rd AVENUE Contact Person Te F,. < _
OKEECHOBEE, FL34974
Address
Telephone Sc 3 "7b 6 -337.A »' 7 Email Q
Organization Requesting Special Event
Name of Organization - t C n�il<;rt �} l- n��;w :u,r 4 s,Contact Person S LiIUc'74-cr _ ��tr L4r
Address
Telephone d 3 -L:,' Li-c-1(doc Email u1 {11 4..“ yeitAL`'Z CTf IAA
Description of Special Event
Event Title j4Uk �'1 LiI�I -lac ( u, t. ( 4 t�T �i4 i Date of Event `lf. J1A 4 ,: v . Zot'
f -
Start Time cc.ob Ar.1A. End Time 1 . Lt) riit
Event Route (attach map)
Detour Route (attach map)
Law Enforcement Agency Responsible for Traffic Control
Name of Agency 0)1%1. c' 1,
t2 1l C
US Coast Guard Approval for Controlling Movable Bridge
Not Applicable I2"- j
Copy of USCG Approval Letter Attached ❑
Bridge Location
The Permittee will assume all risk of and indemnify, defend and save harmless the State of Florida and the FDOT from
and against any and all Toss, damage, cost or expense arising in any manner on account of the exercise of this event.
The Permittee shall be responsible to maintain the portion of the state road it occupies for the duration of this event, free
of litter and providing a safe environment to the public.
Signatures of Authorization
`5
( Event Coordinator •`t 1,2es ie- Id It. , i /1 i<. Signature .J Date ! Z`j�/
Law Enforcement /
signature �' Date /Z /�y0e
Government Official
NamefTitle c r o.r �.,1+4-u Signature �.. Date i V/ 4/4
FDOT Spacial Conditions
Traffic Control shall comply with Federal Manual of Uniform Traffic Control Devices (MUTCD) and FDOT Design
Standards 600 Series.
IName/Title
--f
FDOT Authorize
Signature
}(even T Mcrrisey,D1 Permit Engineer
Date 12122,2016 11
INDEMNIFICATION AGREEMENT
This AGREEMENT, by and between the CITY OF OKEECHOBEE, FLORIDA,
(hereinafter "CITY ") and 0(-‹C nt4.x- C n11' 1it1 Mert.veene4 ,1 � c� �{� 0v1
(hereinafter "APPLICANT "), dated this 1 .15k day of O ,-..be.- ,
WHEREAS, APPLICANT desires to hold or sponsor a special event, parade,
festival, or other activity requiring the temporary closure of a state - controlled
roadway in the City of Okeechobee, Florida, and therefore requires the execution
and submission of an application for such temporary closure to the State of Florida
Department of Transportation by the CITY pursuant to regulations of said
Department, and
WHEREAS, pursuant to Resolution No. 88 -5 the CITY requires
indemnification by any applicant for temporary road closure before the appropriate
CITY officials may execute such application to the Department.
NOW, THEREFORE, in consideration of the mutual obligations and covenants
set forth hereafter, the parties agree as follows:
1. APPLICANT shall indemnify, protect, defend, and hold harmless the CITY
from any and all losses, injuries, damages, or claims of any nature or type
resulting directly or indirectly from the temporary road closure and the
special event, festival, parade, or other activity to be held on I tf day of
CA,rti , .2 1 1 . Applicant shall further reimburse the CITY for any
and all attorneys' fees, court costs or other legal costs incurred by the
CITY as a result of any such losses, injuries, damages or claims.
2. If the APPLICANT is a corporation, partnership or other legal entity (other
than an individual), APPLICANT shall attach hereto a duly executed
resolution, partnership agreement or other document in legal form
evidencing the authority of the officers of such entity to enter into this
indemnification agreement.
3. Upon the APPLICANT complying with paragraph 2 above, the requirements
of Resolution No. 88 -5 of the CITY, and any other reasonable requirements
of the CITY, the CITY shall cause the appropriate City officials to execute
the necessary forms to make application to the State of Florida,
Department of Transportation, for temporary road closure.
APPLICANT
BY: L& 1 t r
TITLE: r rek-o
CITY OF OKEECHOBEE, FLORIDA
BY: l ' + 4- 1lrv`-
TITLE: General Services Assistant
FOR CITY USE ONLY
XX Proof of liability insurance
Corporate resolution completed
XX Other requirements (specify) Indemnification Agreement
REVIEWED BY:
TITLE:
DATE:
General Services Assistant
Cc,
J4WRL
CERTIFICATE OF LIABILITY INSURANCE
OKEE -44 OP ID: S2
DATE (MM /DD /YYYY)
12/19/2016
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
Lowell H Pritchard
INSURED Okeechobee Community
Improvement Association
275 SW 25th Street
Okeechobee, FL 34974
CONTACT Sand Hines
NAME -_ -- --._ y - - - - -_ __ - - - -. -- _..
PHONE 863- 763 -7711
E -MAIL
ADDRESS: shines2pritchardsinc.com
INSURER) AFFORDING COVERAGE
INSURERA: Philadelphia Indemnity Ins -
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
L/c, No): 863- 763 -5629
NAIC #
18058
•
REVISION NUMBER:
_.JY1..r \MVVV v. -..... .v ..... ........__...
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
ADDL
ILTR
SUBR POLICY EXP`
LIMITS
LTR
POF INSURANCE INSD
URANCEBILITY
WVD POLICY NUMBER (MM DD YYYY) , (MM /DD /YYYY)
A
X
COMMERCIAL GENERAL
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS -MADE
X OCCUR PHPK1431610 01/14/2017 01/16/2017 PREMISES (Ea occurrence)
$ 100,000
$ 0
MED EXP (Any one person)
PERSONAL & ADV INJURY I
$ 1,000,000
GEN'L
AGGREGATE LIMIT
APPLIES PER
GENERAL AGGREGATE
$ 3,000,000
POLICY II1 -I JERCOT
OTHER:
I _I LOC
'
1
1 PRODUCTS - COMP /OP AGG
$ 3,000,000
j
$
COMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY (Ea accident)...
ANY AUTO BODILY INJURY (Per person)
$
- - J
ALL OWNED SCHEDULED
BODILY INJURY (Per accident) $
AUTOS
I
AUTOS
'
PROPERTY DAMAGE
HIRED AUTOS
NON -OWNED
AUTOS
(Per accident)
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
i CLAIMS -MADE
�, 4 AGGREGATE
$
I—
1
DED 1 ` RETENTION $
I
$
WORKERS COMPENSATION
I AND EMPLOYERS' LIABILITY
Y / N
PER I OTH-
STATUTE ER - -
L EACH ACCIDENT $
ANY PROPRIETOR /PARTNER /EXECUTIVE
E
OFFICER /MEMBER EXCLUDED
N / A
(Mandatory in NH)
E . DISEASE - EA EMPLOYEEr $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
DESCRIPTION
OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Special Event - MLK Parade
ctt< I IbIUA I t hOLUttC
Florida Department of
Transportation
801 N Broadway Avenue
Bartow, FL 33830
F LO RI41
" ^ ""-`-" ` ""'.
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 %�� � - (j
„v�� ViZLi
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD
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(MUTCD) and FDOT Design Standards 600 Series.
Manual on Uniform Traffic Control Devices
Traffic Control shall comply with the Federal
Jackie Dunham
From: Jackie Dunham
Sent: Wednesday, December 21, 2016 11:37 AM
To: kevin.morrisey @dot.state.fl.us
Subject: 2017 MLK Parade
Attachments: MLK Parade 2017.pdf
Please review the attached permit application for the annual MLK Parade to be held on Saturday, January
14th 2017. I will wait for your approval. Have a very Merry Christmas too.
Jcu k;,eJ Dtknha 'ZJ
Acliniiivu'istratwe Secv'eta'vy
City of Okeechaime'
55 SE 71 rol/Avei'ute
Olceechab-oe3 FL 34974
Tee/: 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.
1