Loading...
Park Use Permit -Everyday's Heroes Chili Cook-OffCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 we 11111 even+ la +er I n yea - Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686 1-1-Lo- 1 e -mail: jdunham @citvofokeechobee.com Park Use Permit Permit Number: 008 Permit Expiration: April 29, 2017 11:59PM Purpose of Request: Everyday Hero's Walk -Run Chili Cook Off Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Date(s) of Event: April 29, 2017 8:OOAM — 200PM Applicant: Pregnancy Center of Okeechobee Phone Number: 863 - 467 -8748 Current Zoning: P 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 Fire & Life Safety Plan Review Zip Code: 34974 Applicant's Address: 808 NE Park St. Address of Project: Park #4 FLU Designation: Public 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. Ta,d ,e/ March 10, 2017 General Services Secretary Date Patty Burnette From: Patty Burnette Sent: Thursday, April 06, 2017 11:47 AM To: Herb Smith; Bob Peterson (rpeterson @cityofokeechobee.com); David Allen; Cc: Subject: Attachments: 'Iamiotea @cityofokeechobee.com' Jessie Weigum (jweigum @cityofokeechobee.com) FW: Park 6 Event for April 29th Everyday Hero's Site Plan.pdf * * * * * ** *Please note this event has been cancelled * * * * * * ** Pa4±j M. genera( Services Coordinator City of Okeechobee 55 Southeast 3rd Avenue Okeechobee, EL 34974 Ter 863-763-3372 Direct: 863- 763 -9820 'Fax: 863-763-1686 e rriai( pburnerre @cityofokeechobee.com webs ite: www.cittjofokeechobee. corn NOTICE: Due to Florida's broad public record laws, this email may be subject to public disclosure. From: Jackie Dunham Sent: Friday, March 10, 2017 8:44 AM To: Herb Smith; Robert Peterson; David Allen; Lane Gamiotea Cc: Patty Burnette; Jessie Weigum Subject: RE: Park 6 Event for April 29th My apologies. 1 should have attached this site plan for all of you. 1 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686 e -mail: jdunham @citvofokeechobee.com Park Use Permit Permit Number: 008 Permit Expiration: April 29, 2017 11:59PM Purpose of Request: Everyday Hero's Walk -Run Chili Cook Off Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Date(s) of Event: April 29, 2017 8:OOAM — 200PM Applicant: Pregnancy Center of Okeechobee Phone Number: 863 - 467 -8748 Current Zoning: __E 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 Fire & Life Safety Plan Review Zip Code: 34974 Applicant's Address: 808 NE Park St. Address of Project: Park #4 FLU Designation: Public 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. ,Tack e/ General Services Secretary March 10, 2017 Date Page 1 of 3 Revised 11/4/16 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 217 Fax: 863 - 763 -1686 PARK USE AND /OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: Application No: Date Issued: ih,mcm 3, Do' `7 Date(s) & Times of Event: op; l ,2g R all - g..00 Information: Organization: f /7J7C ! hr. o ahechobee ..,...ug Address. 7 g 'qvl l�e�e1�062P� Fl�r 9 %� Contact Name: ti,54 / ,fn E -Mail Address: 0 ge.e 13 iei c e/7 i--4 p hm, (0/P d m o y eMGL—: pas � C, C c: Arica 4 . 0-0-1, -(, Telephone: Work: 3- ii/o`i – %7N Home: Cell: 7(D -6 ?V -r /X`5 Summary of activities: aJ ( to -4- Thn n - f a e aJh-iir� — 600 h 1 o/o 0o fh J hotsr�rather 6aziar0p / trounce Ifoase -- low- - h i i i o Koff - Main 5 w► I I pr a.r c Chili 0 Me giver -yu-///6 ii/11/ Au,/ zltie opoor Ln i'lli -h) `S'a in.a l i each 4eL 2 Ohs 1/' aid 171L/? Vote 1, Proceeds usage: L4 c bz1 U Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 A4 ❑ #5 ❑ #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 1st & 3rd Tuesdays but subject to change) Address of Event: Street(s) to be closed: N 1 4- Date(s) to be closed: Time(s) to be closed: Purpose of Closing: 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 $1,000,000.00 with the City of Okeechobee and R.E. Hamrick Testamentary Trust as Additional Insured. ►Proof of nnn -profit status (IRS Determination Letter) • Origin91 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 ** Alcoholic beverages can be served only on private Parks, City streets or City sidewalks. See additional ❑ Please check if items will be sold on City streets Use Permit 667 along with the Street Closing application. with a Park Use application. property. Alcoholic beverages NOT ALLOWED in City note below. /sidewalks. Each business will need to apply for a Temporary streets or sidewalks. beverages are served on private Beverage License. Please note there are inside You must have the appropriate license(s). for delivering the appropriate barricades. a street for more than three (3) hours. Note: • Clean-up is required within 24 hours. • No alcoholic beverages permitted on City property, • No donations can be requested if any type of alcoholic property /business unless you possess a State Alcoholic consumption and outside consumption licenses. • The Department of Public Works will be responsible • Dumpsters and port-o -lets are required when closing Applicant must meet any insurance coverage and of other governmental regulatory agencies. The applicant code compliance requirements of the City and other regulations will be responsible for costs associated with the event, permit, the applicant agrees and shall hold the City harmless for out of applicant's use of location for such event, and shall including attorney fees. The applicant shall be subject to incurred by the City pertaining to the event including, but not expenses. The City reserves the right to require from in the sum approximated by the City to be incurred in providing be refunded to the applicant of this Park Use /Street Closing including damage of property. By receipt of this any accident, injury, claim or demand whatever arises indemnify and defend the City for such incident, demand for, and payment of, all of the actual costs limited to, Police, Fire, Public Works or other departmental an applicant a cashier's check or advance deposit City services. Any such sum not incurred shall Permit. 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. I 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. a A plicant Signature Date ••••OFFICE USE ONLY"" Stan. Review Fire Department: (op?, (5 et. �. � Date: 020feBaur Building Official: Date: 2 • I •17 Public Works: -111 - 17 Police Department: f Date: :, ,4 -/ , BTR Department: cam° , / r ' n t _1 Date: 1 / i 17 City Administrator: Date: City �� Date: 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 CITY OF OKEECHOBEE FIRE & LIFE SAFETY PLAN REVIEW THIS REVIEW IS BASED ON THE MOST CURRENT STATE ADOPTED LIFE SAFETY CODES AND ITS REFERENCES Name: Special Event in the Park Date: 29 April 2017 (08:00 -14:00 hrs.) Business: Pregnancy Center of Okeechobee Occupancy: Outdoor event Reviewed by: Herby Smith (Fire Chief) Date returned to building department: 21 February 2017 The Site Plan is approved with the following comments /requirements: The Fire Inspector may field verify the location of all required fire extinguishers. Additional items may be required during the field inspections. Please see attached tent guideline: Please note that most items on the guideline will not necessarily apply to your special event. 1. Please keep access for our fire vehicles to reach your event in case of emergency. Although the vehicle will not likely leave the road, the firefighters would need to pull fire hose up to 200 feet around obstacles. 2. Fire Extinguishers are required but the fire department allows for "common" use of extinguishers if the travel distance to the extinguishers does not exceed 75 feet. We do allow the use of fire extinguishers located in open businesses nearby but please speak with business out of courtesy. 3. One special fire extinguisher required when cooking is a Class K fire extinguisher. This type is designed specifically for grease fires. 4. Please use only extension cords designed for that environment and are UL listed. 5. LP gas tanks shall be required to be a minimum of five feet from the cooking appliances. Tent sides shall be required open when using a cooking appliance. 6. The fire department will make every effort to attend this event as a courtesy and we will have fire extinguishers available on our "Golf Cart" to alleviate the burden of acquiring fire extinguishers. OFD wants you to have a "safe" event and we look forward to seeing you there and assisting with fire & life safety. This is our way of supporting our local businesses and organizations. We appreciate the citizens support of our fire department and strive to obtain a good working relationship with all. 9,(9keedidee Fire and Emergency Services Department 55 SE 3rd avenue Okeechobee, Florida 34974 Telephone: (863) 467 -1586 Fax: (863) 763 -4489 www.cityofokeechobee.com 2017 Tent Guidelines 1. A11 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 (regardless of sire) 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- Y 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 AH.I. 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. Service doesn't come from a manual —it comes from the heart. IS filler Pea *if rep-hicli on / Winntr- '‘J C4 C; 0 () _ cSAI /04. ioy..io -ie le,f1 ic 0 '11' Tr cookoff- 14 y WM.K ou-TE 46 47 51 50 70 71 75 74 City of Okeechobee Future Land Use 2 1. 8 7 9''''' ...0. 5 24 23 7 8 25 10 9 42 4 40.. 45 1 7871.. .•711 73 S. • •..Zp . •. ,.. 99 98 ®7 98 89 � � • ii 2 21 100 101 182 "183,.,104 10l ■ III 4 3 2 1 5 5 6 7 8 2 11 10 9 3 14 15 16 A 18 17 194 195 218 yl 1:13: 14 5 15 n ( O 18 15 250 242 241 240 2 1 MC E LAND USE CLASSIFICATIONS SINGLE - FAMILY RESIDENTIAL MIXED USE RESIDENTIAL I MULTI - FAMILY RESIDENTIAL LL COMMERCIAL INDUSTRIAL PUBLIC FACILITIES - RAILROAD CENTERLINE UNINCORPORATED Lard Umetaiss Lend Use Ganges ore Senors 015-00,55, Ord 1,1121 art Dry of gene...des FL Cis Cie, Lane Genes. :42 ' 29 :48. 744. r :49 '45 147 i sr. .40._. m' 45 i 9 2 4 5 0.125 025 3 2 1 4 5 6 ) 5 9 8 i 7 10 11 12 0.5 0 75 General Notes: Alleys shovel or SO feet nw See appropriate subdivision Gal for specific alley widths. This map has been compiled from fine most current data available. The Cary of Okeedwbee is not responsible foray errors or omissions contained her. 2 ,getirt G'A'Y. w . fin 1 ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 2/8/2017 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 Patriot Insurance Agency, Inc. PO Box 1298 Sonoita AZ 85637 -1298 CONTACT Erika Hill NAME: PHONE (520) 455 -9252 FAX (520)455 -9358 No, Ext): (A/C No): _(A/C E -MAIL ADDRESS: ehill @patriot- insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Spirit Mountain Ins Co RRG Inc INSURER B : 10754 INSURED Pregnancy Center of Okeechobee 808 North East Park Street Okeechobee FL 34972 INSURER C : SMIC- LPP2016- CPP109 RETRODATE : 11/19/2010 INSURERD: 7/1/2017 INSURER E : $ 1,000,000 INSURER F : $ 100,000 $ 0 TIFICATE NUMBER:PKG 16/17 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 HA.VE „BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR W VD POLICY NUMBER POLICY EFF /Y (MM /DDYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X SMIC- LPP2016- CPP109 RETRODATE : 11/19/2010 7/1/2016 7/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREM SESO(Ea occurrence) MEDEXP(Anyoneperson) $ 100,000 $ 0 X CLAIMS -MADE 1 OCCUR X PROF. LIABILITY INCLUDED PERSONAL & ADV INJURY $ 1,000,000 X DED: $2500 GENERAL AGGREGATE $ 3,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC PRODUCTS - COMP /OP AGG $ 1,000,000 Professional Liability $ 1,000 , 000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / 1 N/A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EVENT: Everyday Heros Walk /Run & Chili Cook Off held on 4/29/2017. CERTIFICATE HOLDER CANCELLATION City of Okeechobee R.E. Hamrick 55 Southeast 3rd Street 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 Erika Hill /EEH ACORD 25 (2014/01) INS025 (2014011 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMENTS /REMARKS CERTIFICATE HOLDER TO BE NAMED AS ADDITIONAL INSURED UNDER THE ABOVEPOLICY BUT ONLY AS THEIR INTERESTS MAY APPEAR AND ONLY WITH RESPECT TO THE OPERATIONS OFTHE NAMED INSURED. NOTICE:THIS CERTIFICATE OF INSURANCE IS BASED ON POLICY COVERAGE ISSUED BY SPIRIT MOUNTAININSURANCE COMPANY RISK RETENTION GROUP, INC., TO ALL MEMBERS OF THE INTERNATIONALASSOCATION OF THE COMMUNITY SERVICES ORGANIZATIONS. SPIRIT MOUNTAIN INSURANCE COMPANYRISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OFYOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR SPIRIT MOUNTAIN INSURANCE COMPANY RISK RETENTION GROUP 0FREMARK COPYRIGHT 2000, AMS SERVICES INC. INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: OCT 19 Mg PREGNANCY CENTER OF OKEECHOBEE INC 1517 SW 7TH AVE OKEECHOBEE, FL 34974 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 331-1164762 D 17053176001027 Con act Person: EDWARD S SCHLAACK Contact Telephone Number: (877) 829-5500 AccOunting Period Ending: December 31 Public Charity Status: 170(b) (1) (A) (vi) FoLill 990 Required: Yes Effective Date of Exemption: April 23, 2007 Contribution Deductibility: Yes Advance Ruling Ending Date: December 31, 2011 Addendum Applies: Nip ID# 31536 We are pleased to inform you that upon re'kew of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(o)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. , You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this lettercould help resolve any questions regarding your exempt status, you should ceep it in your permanent records. Organizatio as eithe period, you begins with ending date the Code are further classified ublic charities or private foundation) your advance ruling will be treated as a public 4arity. Your advance ruling period the effective date of your exemption and ends with advance ruling shown in the heading of the letter. Shortly before the end'of your advance ruling period, we will send you Form 8734, Support Schedule for Advance RulingPeriod. You will have 90 days after the end of your advance ruling period to return the completed form. We will then notify you, in writing, about your pUblic charity status. Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 1045 (DO/CG) -2- PREGNANCY CENTER OP OKEECHOBEE Enclosures: Publication 4221--PC Statute Extension Ralbert Choi Director, Exempt Organizations Rulings and Agreements Letter 1045 (DO /CG) Forte 1023 (Rev, 54006) Name: Part X Public Charity Status (Continued) EIN; – L.l O Pam 11 e 549 (a)(4) --an organization organized and operated exclusively for testing for public safety. ❑ f 509(01) and 174(b)(1 )(A)(iv) —an organization operated for the benefit of a college or university that is owned or operated by a governmental unit_ g 509(a) {1) and 170(b)(1)(A)(vi) an organization that receives a substantial part of its financial support in the form • of contributions from publicly supported organizations, from a governmental unit, or from the general public. h 5O9a)(2) —an organization that normally receives not more than one -third of its financial support from gross ❑ Investment income and receives more than one -third of its financial support from contributions, membership fees, and gross receipts from activities related to its exempt functions (subject to certain exceptions)_ i A publicly supported organization, but unsure if it is described in 5g or 5h, The organization would like the IRS to 0 decide the correct status. ❑ 6 if you checked box g, h, or I in question 5 above, you must request either an advance or a definitive ruling by selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive. a Request for Advance Ruling: By checking this box- and signing the consent, pursuant to section 6501(c)(4) of O the Code you request an advance ruling and agree to extend the statute of limitations on the assessment of excise tax under section 4940 of the Code. The tax will apply only if you do not establish public support status at the end of the 5 -year advance ruling period. The assessment period will be extended for the 5 advance ruling years to 8 years, 4 months, and 15 days beyond the end of the first year. You have the right to refuse or limit the extension to a mutually agreed -upon period of time or issue(s). Publication 1035, Extending the Tax Assessment Period, provides a more detailed explanation of your rights and the consequences of the choices you make. You may obtain Publication 1035 free of charge from the IRS web site at www.irs.gov or by calling toll -free 1- 800-829 -3676. Signing this consent will not deprive you of any appeal rights to which you would otherwise be entitled. If you decide not to extend the statute of )imitations, you are not eligible for an advance ruling. For Organization (Signature of Offcer, Director, Trustee, w other authorized officio') k fat (Tyne or print name o' sgn (Typo or print titre or authority of signer) IRS Director, Exempt Organizations flutes b Request for Definitive Ruling; Check this box if you have com feted one tax year of at feast 8 full months and ❑ you are requesting a definitive ruling. To confirm your public support status, answer line 6b(i) if you checked box g in line 5 above. Answer line 6b(ii) if you checked box h in line 5 above. ff you checked box i in Tine 5 above, answer both lines 6b(i) and (ii). (1) (a) Enter 2% of line 8, column (e) on Part iX -A. Statement of Revenues and Expenses. (b) Attach a list showing the name and amount contributed by each person, company, or organization whose ❑ gifts totaled more than the 2% amount, If the answer is "None, ' check this box. (iq (a) For each year amounts are included on lines 1, 2, and 9 of Part IX -A_ Statement of Revenues and Expenses, attach a list showing the name of and amount received from each disqualified person. If the answer is "None," check this box. ❑ (b) For each year amounts are included on line 9 of Part IX -A. Statement of Revenues and Expenses, attach a list showing the name of and amount received from eaph payer, other than a disqualified person, whose payments were more than the larger of (1) 1% of line 10) Part IX -A. Statement of Revenues and Expenses, or (2) $5,000. If the answer is "None," check this box. 7 pfd you receive any unusual grants during any of the years shown on Part IX -A. Statement of ❑ Yes 1 No Revenues and Expenses? If "Yes," attach a list including the pare of the contributor, the date and amount of the grant, a brief description of the grant, and explair why it is unusual. Form 1023 (Rev. 6 -2006) Jackie Dunham From: Jackie Dunham Sent: Friday, March 10, 2017 8:28 AM To: cindy @okeepregcenter.com Subject: Everyday Hero's Walk Run Event Permit Attachments: Every Day Hero's Event Park 4.pdf Please see the attached approved permit for your event in Park 4 on April 29°i, 2017. I am also attaching a copy of the Tent Guidelines and the Fire Chief's Life and Safety plan review. Wishing you much success. Ja c i e' Du-vihwwv A dore tra- we/Secrota ry City of OkeechOIYee/ 55 SE 1 ddAvevute' Okeechabe.e/, FL 34974 Tee- 863 - 763 -3372 ext: 217 Tww 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. i Jackie Dunham From: Jackie Dunham Sent: Friday, March 10, 2017 8:32 AM To: Herb Smith; Chief Peterson; David Allen; Lane Gamiotea Cc: Patty Burnette; Jessie Subject: Park 6 Event for April 29th Attachments: Every Day Hero's Event Park 4.pdf Please see the attached, approved permit and application for the Pregnancy's event which will be held on April 29`x'. I'm sending a little early because I will be out beginning March 23`d for approximately 6 weeks. Please note your calendars and coordinate with your staff accordingly. Thank you. Jackie D wtih un i Ad tva we/Searetowy City of Okeech 1Jee/ 55 SE T1rcuAvev,ae' Off, EL 34974 Teti: 863 -763 -33 72 e-%t: 217 fax' 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