Loading...
Park Use Permit -March for BabiesCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686 e -mail: idunham(cucityofokeechobee.com Park Use Permit Permit Number: 004 Permit Expiration: April 1, 2017 11:59PM Purpose of Request: March for Babies Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee Date(s) of Event: April 1, 2017 7:30AM — 11:OOAM State: Florida Zip Code: 34974 Applicant: March of Dimes Foundation Applicant's Address: 112 43rd Ave SW Vero Bch, FL 32968 Phone Number: 772 - 410 -5461 Address of Project: Park #4 Current Zoning: P FLU Designation: Public Subdivision: City of Okeechobee Restrictions /Remarks: All debris must be removed within 24 hours of expiration date. Please read and review Fire Department's attached 2017 Tent/FireExtinguisher Guidelines Clean -up of all garbage from the event including emptying the trash cans in the park(s) used and placing clean trash can liners in cans after the event. ,.T at,o1 ei March 3, 2017 General Services Secretary Date its.'""{ "" �'� -� t ! >. �A ' °:;, ._ 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 STREE`1/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: - 3 - I (P Date Issued: Date(s) of Event: 3 ,2. 17 y - I - 11 '1: ho p - Ii pH Application No: 1 l --004 Information: Organization: WS('[ DkfJ Tax Exempt No: , j, c 0-0/1, Mailing Address: (i.. 011) a .- 1 1^ _ • ..� i� Contact Person: [ ,�,�" � ^' E -Mail Address: t1�1aw•TamerA . rr ytarrage Tele . hone: -101! Work: g lli Home: A Cell: Summary of activities: All_ % •iii alga se -As esii F+r Jai, Proceeds usa e: �► ra i 11• C di" ea ,. 6 A I1` • ". • 1, ali M s/ 11>•, a •.. fi► :�'•riiiIl IIlirMin iriaido rsat-wwrawrarrtahmteattwartaraintrosre Please check requested Parks: Flagler Parks: City Hall Park :: #1 Memorial Park ❑ #2 1 #3 iir#4 ❑ #S ❑ #6 OR Address of event: Parcel ID: Paige 2 of3 TEMPORARY STREET AND SIDEWALK CLOSING I,NFORMATiON (If not using Park(s), provide event address) Street Address City State Zip Code Street(s) to be closed: \\ITIN Date(s) to be closed: Time(s) to be closed: Purpose of Closing: Attachments Required: Charitable Function Temporary Street and Sidewalk Closing P. Original signatures of all residents, property owners and business owners affected by the closing. ► 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 51,900,000.00 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. TL :P 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 suns approximated by the City to be incurred in providing City services. Any such sum not incurred shall be refunded to the applicant. Page 3of3 1 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 1 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 Signature . Bate ""OFFICE USE ONLY•••• Staff Review ) , ---e -T-e.i.k., Department: /, 5E. 4- N- --TC,'"i5AVii3j%N-us--- •Fire bo,e p1G Date: a /�ar Z• 27 • t1 Buildin _ Official: everts G' Date: ' Public Works: A' Date: 2''27`1 ! a r' � Police Department: fr% Date: ,�z 5/, 7 BT'R Department: � ��� � ,�.;��;!„/� Date: Date: { s - �l ,, City Administrator: ! City Clerk: V . %. .1 ,-. Date: 3 1 l / i f 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 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date Fvg Vlc ThITI re and ergency Se ices 65 SE 3r° avenue 'Okeechobee, Florida 34974 Telephone: ephone: (363) 467.1586 Fax: 363; I Vaimpery Yomizie u www.cityofokeechobee.com 2017 Tent Guidelines 1. All tents 200 Square Feet or larger shall have a current (within the last 12 months) Florida or Other State Certified (minimum rating of 2A:10B:C) portable fire extinguisher. All Cooking tents ,r 1 izc) shall require a current Florida or Other State Certified Class "K" portable fire extinguisher in addition to the 2A:10B:C extinguisher. If you do not have a certified fire extinguisher, one may be purchased from any Fire and Safety equipment company. ** *Fire extinguishers purchased from many retail stores are not certified and will not be accepted. Fire Extinguishers can be "shared" in a common area used by multiple cooking tents if necessary. The travel distance should not exceed 75 feet. 2. Tents must be Flame Retardant and shall meet the flame propagation performance criteria specified by NFPA 701. All tents must be certified by an approved testing agency and the vendor shall provide evidence of the flame spread certification. Keep the tag on the tent visible when setting up the tent for ease of inspection. ** *Non -Flame retardant tent fabrics or materials such as retail store camping tents or tarps do not meet the NFPA 701 Standard and will not be accepted. 3. "Cooking Tents" must be located a minimum of 5ft away from buildings and other tents and must be located a minimum of 10 feet away from any "Public Use Tent ". "Public Use" in this case is defined as "If the public can enter under the tent to congregate, sit, view merchandise, or any other activity that allows anyone from the public to enter under the covered tent area." 4. "Cooking tents" shall be open on all sides, free from grease residue, and arranged to keep the cooking appliances away from the public. LP Gas Cylinders shall be located a minimum of 5ft away from the cooking appliance & tent, protected from traffic, and secure always. 5. All cooking equipment must be in good working condition and adhere to the testing agency label that certified the equipment. Deep -fat fryers shall be equipped with a separate high - limit control in addition to the adjustable operating control (thermostat) to shut off fuel or energy when the fat temperature reaches 475 °F (246 °C) at 1 in. (25.4 mm) below the surface. 6. Electrical Fire Safety as it relates to the use of temporary wiring, extension cords, overloaded circuits, etc. will be evaluated on a case -by -case basis for compliance. All equipment used during the event must be in good, safe working condition. The life safety codes governing tents, portable seating, portable structures, and temporary activities are far too numerous to list. This is only a summary of some of the guidelines. During the inspection process and at any time during the event, if a situation is deemed "unsafe" by Fire or Code Enforcement personnel, it will be required to be corrected immediately. If this is not done, the permit may be revoked, at the discretion of the AHJ. Public Safety is our foremost concern. We wish everyone a safe and enjoyable event. If you have any questions you may contact the Fire Department at 863 - 467 -1586. ervice t.oe — ..comes from .,irehea, Flagler Park #4 Parrott Ave w.. SW Sth Ave ' • CenterState Bank • Law Office of Cassels & McCall ▪ Okeechobee Health Care Facility Rotary Club of Okeechobee State Farm Insurance - Gretchen Robertson F AMf7US * :1N FPL t i Mission Flagler Park #4 ..i Parrott Ave / t A— SW 5th Ave ' FPL ` .Mission • • • Dr Trinidad Garcia Harbor Community Bank Hoskins, Turco, Lloyd & Lloyd Okeechobee Healthy Start Coalition Walpole's Feed & Supply Co Wemmer Family Orthodontics CenterState Bank Law Office of Cassels & McCall • Okeechobee Health Care Facility Rotary Club of Okeechobee State Farm Insurance - Gretchen Robertson Dr Trinidad Garcia Harbor Community Bank Hoskins, Turco, Lloyd & Lloyd Okeechobee Healthy Start Coalition Walpole's Feed & Supply Co. Wemmer Family Orthodontics arkbeNieNo- • C ertiftrnt.e of 311Itme ite. iotnnre H&OtITttattn USEMENT Arrt ICA1IOM ANVA5 CONGENN No. t /4AINa' �TFITIEIfS (F- 419.01 l %MR1 Naortahrr 1404sd 1r 3ltrti; Rtl(I /R(,; 4tif.4 fax R1 ii 140 RI Ali "'• h: . e :rrly 1140 (firs r: =,.+ r,«IS tICS1 ;fIt,t I u•,d4odr twit i $41 itrt.: 4n n1( r4, iaminahle an g/Nre.MtA/1 rgt t" NAME., i-'�Ceecnobee u'o sherldis t nice A, 1,11y Okeechobee 51 A r f. FL, 34972 r. oxhIrt er4011 r, hpii by most e' 'U ( rite Un this CNII:ticsile have tn.i'rr treated with . flame rrfliirltanl Al irrUyl!t: • r'hP*rtitr, 41 il►lrt t�. PtI ' application 411 ..;errf chemical Was tti)Ief irr f rtrt�t,1(1..Irtt f• ir*ttf+ 1 ('414,4,` S: nrrficat4Uh A 701 methodist aupht.atu,rt Inherently Flame resistant ) trade name nt flame l.il .r J" "fINrlicl lose() Hi-GIosS ('hnm ►1e No F- 419.01 August 2011 #29261 4. the f'lame now (tool f,r(>t:e:t "• (tried will not f3i' (titrllob('lt fly Wi►'.fting r tVr 14 or WI' P,::) anti is good for the lite of the fabric. Renewal Certification unnecessary c ;c,fur am, weight of labia Sunbtock White 15 -16 oz. psy Description of lien) (Crliftttti (1) 20' x 40' Frame Tent. TOP. . Thomas Sciortino .♦ . , tr.r..., ..., o two :ape. .•.........4 ey Production Supervisor :.4,, we+ le•r•by certify this to b• • frua copy of the original "CERTIFICATE OF FLAME PIRSISTANCR" Issued to us, "original oopy" of which has boon Most with Rho California state Firs Marshal. :Igby Lori Walker med 0000010 09/24/14 F 1 r.1 0A DEPARTMENT OF REVENUE 85- 8012566503C -5 Certificate Number This certifies that Consumer's Certificate of Exemption Issued Pursuant to Chapter 212, Florida Statutes 09130/2014 Effective Date MARCH OF DIMES FOUNDATION SOUTH FLORIDA DIVISION 1001 W CYPRESS CREEK RD STE 110 FORT LAUDERDALE FL 33309 -1947 09/30/2019 Expiration Date DR -14 R. 04/11 /; is exempt from the payment of Florida sales and use tax on real property rented, transient rental proper rated, tangible personal property purchased or rented, or services purchased. P IORI DA DEPARTMENT OF REVENUE important Information for Exempt Organizations DR -14 R. 04/11 1. You must provide all vendors and suppliers with an exemption certificate before making tax - exempt purchases. See Rule 12A- 1.038, Florida Administrative Code (F.A.C.). 2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property, sleeping accommodations, or other real property is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property (Rule 12A- 1.070, F.A.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third - degree felony. Any violation will require the revocation of this certificate. 6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account Management at 800 -352 -3671. From the available options, select "Registration of Taxes," then "Registration Information," and finally "Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480, Tallahassee, FL 32314 -6480. 1/18/2017 4:04:27 AM Faxserver 847 - 953 -5390 Page 3 �� s CERTIFICATE OF LIABILITY INSURANCE 'JAI M182017Y YY3 O 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services Northeast, Inc. New York NY Office 199 Water Street New York NY 10038 -3551 USA CONTACT PH ON: (A/CNNO Eoty_ (866) 283 -7122 I (AJJC. No.): (800) 363 -0105 E -MAIL ADDRESS: Ikici I17F P(q) ArrnpriNG rfIVFAAI:F PJAIr it INSURED March of Dimes Foundation 1275 Mamaroneck Ave White Plains NY 10605 USA INSURER A: The Travelers Indemnity Co. 25658 INSURER B: Great Northern Insurance Co. INSURER C: Vigilant Ins CO 20303 20397 INSURER D: /2017 INSURER E: 51,000,000 INSURER F: 33 "Vartfit3L� 3aTt1trt.S,wec,rumi ert-3T033M^L"3tA ZCV I.!2E1. iTSttS 7497-Ctt'- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INf)IC:ATFD NOTW ITHSTANDINC; ANY RFQI IIRFMFNT, TFRM OR CONDITION OF ANY CONTRACT OR OTHFR 1)0M IMFNT WITH RFSPFC.T 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICYEFF (MMIDDIvrYv) POLICY EXP J(MM/DD!YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY 35812529 10/31/2016.10/31 /2017 EACH OCCURRENCE 51,000,000 CLAMS-MADE X OCCUR DAMAGE TO REN I ED PREMISES (Ea occurrence) 51,000,000 MED EXP (Any one person) 510,000 PERSONAL 24 ADV INJURY 51,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 52,000,000 PRO- X POLICY X LOC PRODUCTS - COMP /OPAGG 52,000,000 OTHER: B AUTOMOBILE LIABILITY 7352 -50 -21 10/31,/2016 10/31/2017 COMBINED SINGLE LIMIT (Ea accident) 51,000,000 X — X X ANY AUTO BODILY INJURY ( Per person) OWNED AUTOS ONLY HIRED AUTOS ONLY Coll Ded ST000 — _ _ X SCHEDULED AUTOS NON -OWNED ALTOS ONLY Comp Ded $1,000 BODILY INJURY (Per accident) PROPERTY DAMAGE (Per a cident) A X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE ZUP71M1676716NF 10/31/2016 10/31/2017 EACH OCCURRENCE 55,000,000 AGGREGATE 55, 000, 000 DED X RETENTION 810 000 ProdwTs /Completed 0 55,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY .an,v nnonnicTOn EXCLUDED? sn) ExEculvc ^Y! N OFFICER/MEMBER EXCLUDED^ I ' (Mandatory in NH) If yes, desonbe under D DESCRIPTION OF OPERATIONS Chow N / A 1771737006 10/31/2016 10/31/2017 X I PER STATUTE OTH ER c.�. EAa l ACC �DCn(T 81, 000, 000 E.L. DISEASE -EA EMPLOYEE 51, 000, 000 E.L. DISEASE- POLICY LIMIT 51, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Event Name: March for Babies Okeechobee County, Event Location: Flagler Park No. 4, 55 SE 3rd Ave., Okeechobee, FL 34974, Event Date: 04 -01 -2017. City of Okeechobee is included as Additional insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION Holder Identifier: 570065295950 Certificate No ACORD 25 (2016103) ©1988 -2015 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 City of Okeechobee 55 SE 3rd Ave. Okeechobee FL 34974 USA EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (Li fr ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Jackie Dunham Sent: Wednesday, March 08, 2017 4:36 PM To: Hernandez, Cynthia (CHernandez2 @marchofdimes.org) Subject: March of Dimes Permit Attachments: 004 -March of Dimes.pdf; Tent -Fire Extinguisher Guidelines.pdf Attached is your approved permit for the upcoming March of Dimes walk. Please have it with you on the day of your event. Wishing you success. Jackie/ Du hamw ?4dvnim..stv-atwei Sec+retavy C(y of Okeechobee 55 SE Turd/Avevut.e' Meecho-beP, EL 34974 rote/ 863 - 763 -3372 ext. 217 Fcuw: 863-763-/686 jdunham(a,cityofokeechobee.com Website: http: / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. i Jackie Dunham From: Jackie Dunham Sent: Wednesday, March 08, 2017 4:33 PM To: Herb Smith; David Allen; Chief Peterson; Major Hagan; Lane Gamiotea Cc: Patty Burnette; Jessie Subject: March of Dimes Walk April 1st Attachments: March of Dimes Walk.pdf Attached is the approved March of Dimes event being held on April 1St. There are no street closings for this event. I have attached their walking map for your information and use. Please coordinate with your staff accordingly. Thank you. Jackie Dtinh m v 4ci4v v-at'vve/Secv'e-tcwy City of Okeecho1 ee 55 SE 7 d'Avevu e' Okeecho -lam, EL 34974 7'e1E' 863-763-3372 ext. 217 Fag./ 863 -763 -1686 jdunham a,cityofokeechobee.com Website: http: / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.