Loading...
Temp. Street Closing - Okee. Christian Academy Field Day.... Page 1 of 3 Revised 11/4/16 CITY OF OKEECHOBEE v�N °°o ��s= 55 SE THIRD AVENUE �4 ° °� OKEECHOBEE, FL 34974 � '® r. Tele: 863 - 763 -3372 ext. 217 Fax 863 - 763 -1686 • -' ai PARK USE AND /OR TEMPORARY STREET/ '�- ...w;o SIDEWALK CLOSING PERMIT APPLICATION Date Received: j - - / Date Issued: 3- ."7 -► i Application No: j -7 - co -7 Date(s) & Times of Event: FY -; CSC , Fe or c raj 1 ! n O'Ooe v - Information: Organization: a Lee Cy -,oFY} /1r')s!icri i ArcocieniL Mailing Address: 70 i Pcir rotf A-i c- Contact Name: t i'1 I i �cc� Kr 0 r E -Mail Address: m I_ r ri : 0CC;�(`= -cirri c.(_t I. CG 0^(0.. Telephone: Work: -7 t 01 a Home: Cell: Summary of activities: ( 1' ❑iC1 1-1tz, ti, i 1 1 j )Cv" c.c �C'.4_u ;tom t- ICI DCLV `f 5C.h0 f an r:►. -\( 1 1 1 1-K,1, np c _ e ; c , _ h. r _ ' i - i - - ,t c t e r L i s It' ( ( a 11 I- _f"1` `> >tt�� Proceeds usage: Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 ❑ #4 ❑ #5 at #6 [Park 3 is location of Gazebo. Park 4 is location of Bandstand] (If other private property used in conjunction with this Park Use Permit please provide the address and parcel number below along with notarized letter of authorization from property owner) Additional Addresses, if applicable Parcel ID: Page 2 of 3 Revised 11/4/16 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Meetings 1s` & 3rd Tuesdays but subject to change) Address of Event: . -7i ; j?,, -1..,:i---F- = , -t: r`1_. -lr 0 VCC'C_ lZc`c r-i_�ci f! c_ Street(s) to be closed: e ,,?r,,, , :1 ti't 14-,,,,,, t ,,,,--t4 t 4 , 7 - - , - -cr, Date(s) to be closed: -5-1 da.A , Fe 0, « t j j 70 Time(s) to be closed: 8 .co an-, ,,,-,,, Purpose of Closing. XX1 1 C-' r r , 1z lr f. i -1 ti1,-,, CI r2 -1-t >>y- c -, r-i t„,l { fi Attachments Required for Use of Parks Attachments Required for Street /Sidewalk Closings • Site Plan • Site Plan • 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 S1,000,000.00 with the City of Okeechobee and R.E. 4. Hamrick,Testamentau Trust as Additional Insured. • Proof of non -profit status (IRS Determination Letter) ► Original signatures of all residents, property owners and business owners affected by the closing. • State Food Service License if > 3 days. • State Food Service License if > 3 days. ► Notarized letter of authorization from property owner, if applicable.* • State Alcoholic Beverage License, if applicable. ** * Required if private property used in conjunction with a Park Use application. ** Alcoholic beverages can be served only on private property. Alcoholic beverages NOT ALLOWED in City Parks, City streets or City sidewalks. See additional note below. ❑ Please check if items will be sold on City streets /sidewalks. Each business will need to apply for a Temporary Use Permit 667 along with the Street Closing application. 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 arises 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 costs 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 cashier's check or 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 of this Park Use /Street Closing Permit. it RL -:AeD W ►iix1 S-ra,LCIT (s) Clow D A ;NI e;nt f F OKi:� cr4c bCC: oP4 0 1 t= 4. Ju.b D; u i 6 i ati( /al- A Z o i T i v4 -f D - Page 3 of 3 Revised 11/4/16 I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03 -8 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. 1 agree to conform with, abide by and obey all the rules and regulations, which may be lawfully prescribed by the City Council of the City of Okeechobee, or its officers, for the issuance Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick Testamentary Trust if closing streets or sidewalks. Applicant Signature N Date ••••OFFICE USE ONLY"" Staff Review Fire Department: ��/ 7 Date: 1-416 "/ Building Official: G Date: % • Z'4 y 1' Public Works: _-41{1/' / 1 (/ _ ^ — Date: / t Police Department: ! ' Date: / - Z4/--/7 BTR Department: 1 Date: ''- City Administrator: Date: V-1-'70-- City Clerk: 1\CrJCJhKXYJ Date: 1 -Z 1 1 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 02 ' -7 - *7 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved - 1 - t 1 Date 7_7 4) 0 • + 0 c-74 0 c • (Dc S Parrott Ave Google earth feet meters 2000 600 Se. Int ST• Aecas5 /AI " owar 5016EN7 e VS;AtI . AC R if CERTIFICATE OF LIABILITY INSURANCE r DATE(MM /DD /YYYY) 01/25/17 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 Jda Insurance Group Llc 120 N. Federal Hwy., #301 Lake Worth, FL 33460 Phone (561) 296 -0373 Fax (561) 296 -0392 CONTACT Danielle Marcinek NAME: (A /CONNo Ex (561) 296 -0373 1 FAX No): (561) 296 -0392 E- MAIL S: @ ) g oup.com E -MAIL Danielle the da r INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Indemnity Insurance Company 18058 18058 18058 INSURED Okeechobee Christian Academy 701 South Parrott Ave Okeechobee, FL 34974 INSURER B : Philadelphia Indemnity Insurance Company INSURER C : Philadelphia Indemnity Insurance Company INSURER D : Bridgefield Employers Insurance Company 10701 INSURER E : Philadelphia Indemnity Insurance Company INSURER F : 18058 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. INSR LTR ADDLSUBR TYPE OF INSURANCE INSR WVD • POLICY NUMBER POLICY EFF (MM /DD /YYYY) POLICY EXP kMM /DD /YYYY1 LIMITS EACH OCCURRENCE $ 1,000,000.00 07/01/2017 A GENERAL LIABILITY ,.• COMMERCIAL GENERAL LIABILITY , L CLAIMS -MADE 'VI OCCUR ` - Y -- N PHPK1335321 07/01/2016 DAMAGE TO RENTED PREMISES (_Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE PRODUCTS - COMP /OP AGG $ 2,000,000.00 $ 2,000,000.00 1 GEN'L AGGREGATE LIMIT APPLIES PER IV] POLICY API j T r 1 LOC ,- $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON L HIRED AUTOS dL AUTO-0W NED N PHPK1335321 07/01/2016 07/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000.00 BODILY INJURY Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accideoU $ $ $ C D L_ UMBRELLA LIAB I,/ OCCUR EXCESS LIAB r_. f.. CLAIMS -MADE N N / A N N PHUB499366 830 -39477 07/01/2016 07/02/2016 07/01/2017 07/02/2017 EACH OCCURRENCE $ 1,000,000.00 AGGREGATE $ 1,000,000.00 Li DED l RETENTION $ 10,000.00 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE _ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) LNJ If yes, describe under DESCRIPTION OF OPERATIONS below WC STATU - OTH- 1 TORY LIMITS L,I ER $ E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 E Professional Liability PHSD1058204 07/01/2016 07/01/2017 Directors & Officers $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Okeechobee & R.E. Hamrick Testamentary Trust is named as Additional Insured in regards to the General Liability portion of policy. CERTIFICATE HOLDER CANCELLATION City of Okeechobee R.E. Hamrick Testamentary Trust 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 Al p /-(lit(} j Ll ACORD 25 (2010/05) QF © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Sent: To: Subject: Jackie Dunham Wednesday, February 08, 2017 11:15 AM mking.oca @gmail.com Approved Street Closing Please be advised the City Council approved your street closing request for Okeechobee Christian Academy's Field Day event on February 17`" from 8AM — 1PM at the City Council meeting on 2 -7 -17. If you have any further questions please let me know. Jack i,e/ Dikvtham w Admitim istrat ve'Sec+ -eta, y City of Oiceeditolv,e, 55 SE 7 rd/Avev e/ Off, EL 34974 Teter 863 -763 -3 3 72 erect. 217 Fay 863 -763 -1686 jdunham(Ucityofokeechobee.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: Sent: To: Subject: Jackie Dunham Wednesday, February 08, 2017 11:13 AM mhamrick @manateelegal.com; 'gil @gilberthasit.com' Approved Street Closings Please be advised the City Council approved two street closings at the City Council meeting held 2 -7 -17. SW 4th Avenue between North and South Park Streets will be closed on Friday, through Sunday, February 12th until 5:OOpm for the annual Top of the Lake Art SE 2' Avenue between SE 6th Street and SE 7 °i Street will be closed on Friday, through 1 PM for a field day conducted by the Okeechobee Christian Academy. February 10°i at 5:00 pm Festival. February 17th from 8AM The City of Okeechobee has obtained the appropriate insurance for both of these events. Thank you. Jack &Du.vt.ha4w A ctvnwu4trc -t ve/Secv'etc ry Cry of Okeechoixe,e/ 55 SE nviircl/Avevu eJ Oke,echab-oe/, EL 34974 role,: 863-763-3372 ext. 217 Fax 863-763-1686 j dunham(a cityofokeechobee.com Website: http : / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1