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Park Use Permit - Food Truck Event (2)CITY OF OKEECHOBEE 55 SE THIRD A VENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -3372 ext. 9821 Fax: 863 - 763 -1686 e -mail: jdunham(a;cityofokeechohee.com Park Use Permit Permit Number: 011 Permit Expiration: April 13, 2017 11:59PM Purpose of Request: Food Truck Event Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Date(s) of Event: April 13, 2017 3:30pm- 9:30pm Applicant: Okeechobee Main Street Phone Number: 863 - 357 -6246 Current Zoning: P Subdivision: City of Okeechobee Restrictions /Remarks: All debris must be removed within 24 hours of expiration date. City water sources will not be utilized IMPORTANT REMINDERS Zip Code: 34974 Applicant's Address: 55 S. Parrott Avenue Address of Project: Park #3 FLU Designation: Public Fire Department Needs To Inspect All Food Trucks Please Call To Schedule At 863- 467 -1586 Main Street is responsible for removing all barricades, cones etc. from the street and placing them in the corner of the park to be collected after event. All street & sidewalks need to be open and clear of traffic control devices. Main Street is responsible for 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. Jackie/ Du.vi.Ytiamvv March 31, 2017 General Services Secretary Date " "'''• ``c OF�01tF�( 1 `� °� .... _ �� `0 " 4::,'� '...79, ,���' 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: 03/20/2017 Date Issued: 3 -'I - I 1 Application No: j "7 - 0 t, i Date(s) & Times of Event: 04/13/2017 3:30PM- 9:30PM Information: Organization: Okeechobee Main Street Mailing Address: 55 South Parrott Ave. Okeechobee, FL 34974 Contact Name: Brittany Carner E -Mail Address: brittany @okeechobeemainstreet.org Telephone: Work: 8633576246 Home: Cell: 8632731842 Summary of activities: A food truck event in Okeechobee's downtown. An evening to enjoy great food with friends and family. This night will include a DJ, craft vendors, and foods of all kinds. Main Street will provide volunteers for trash clean up and Port A Lets in the North East corner of Park 3. Ttiel/Lwi1I setup under the gazebo. Proceeds usage: Proceeds of this event will go to the operations and continuing efforts of Okeechobee Main Street to enhance the downtown area as the heartbeat of the community. Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 U #3 ❑ #4 ❑ #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 & 3" Tuesdays but subject to change) Address of Event: Street(s) to be closed: 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 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. • D_umpsters and . • r - o- - .. . - - . , ired when closing a street for more than three (3) hours. �O CITY WATER SOURCE WILL BE UTILIZED * ** App scan 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. Page 3 of 3 Revised 11/4/16 I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 04 -03, concerning the use and the rules of using City property, that the information is correct, and duly authorized agent of the organization. I agree to conform with, abide by and obey all the rules regulations, which may be lawfully prescribed by the City Council of the City of Okeechobee, or 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. OA 3/911 1 ) .-) 03 -8 and that I am the and its officers, for Applicant Signatur Date ••••OFFICE USE ONLY"" Staff Review Fire Department: v.' Date: 3 -423'13- Buildin: Official: / / LamtA G, _ A ' ' Date: 3'zi .17 Public Works: / Date: 3 `21 -17 Police Department: Date: 2-5--/ % BTR Department: t )1 4 ' , u I t-t-J� Date: -- `' " / City Administrator: Date: �. City Clerk: i (f t cr h Date: 5 NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS EVENT FOR PERMITTING. Temporary Street and Sidewalk Closing submitted for review by City Council on Temporary Street and Sidewalk Closing reviewed by City Council and approved AND PRIOR TO 1 t 1 Date l\' /'a- Date IMPORTANT REMINDERS Fire Department Needs To inspect All Food Trucks Please Cali To Schedule At 863-467-1586 Main Street is responsible for removing all arricades, cones etc, from the street and placing them in the corner of the park to be collected after event. AM street & sidewalks need to be open and clear of traffic control devices, Main Street is responsible for 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 Exempt Organizations Select Check Page 1 of 1 Du ) ,1:;,tt+, I St,i<< Organizations Eligible to Receive Tax - Deductible Charitable Contributions (Pub. 78 data) - Search Results The following list includes tax - exempt organizations that are eligible to receive tax - deductible charitable contributions. Click on the "Deductibility Status" column for an explanation of limitations on the deductibility of contributions made to different types of tax - exempt organizations. Results are sorted by EIN. To sort results by another category, dick on the icon next to the column heading for that category. Clicking on that icon a second time will reverse the sort order. Click on a column heading for an explanation of information in that column. 1 -1 of 1 results Results Per Page 25 V OK « Prev I 1 -1 I Next (Doing Business As) . . A. A. 65- 0887929 Okeechobee Main St. Inc. Okeechobee FL United States c Prev I 1 -1 I Next » Return to Search https: / /apps.irs.gov/ app /eos /pub78Search.do ?ein1 =65- 0887929 &names = &city= &state= A11... 3/21/2017 OKEEMAI -01 SOHARE .A∎C R ©T CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 /14/2016 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 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 Maury, Donnelly & Parr 24 Commerce St. Baltimore, MD 21202 CONTACT NAME: (A//cC, No, Ext): (410) 685 -4625 FAX No):(410) 685-3071 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Transportation Insurance Services, Inc COMMERCIAL GENERAL LIABILITY 20494 INSURED Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 INSURER B : INSURER C : 07/01/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF fMMIDD/YYYYI POLICY EXP (MMIDD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X 4025933977 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGES( PREMISES (ERENTED a occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE X POLICY OTHER: LIMIT APPLIES PRO- JECT JECT PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG 2,000,000 $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY __I SCHEDULED AUTOS NON -OWNED AUTOS ONLY 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 / N 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) The R.E. Hamrick Trust is listed as an additional insured. The R.E. Hamrick Trust owns the property that Okeechobee Main Street occupies. CERTIFICATE HOLDER CANCELLATION I R.E. Hamrick Trust 55 SE 3rd Avenue 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 CR�cJr�� ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OKEEMAI -01 SFISHER ,4coR0" CERTIFICATE OF LIABILITY INSURANCE `---� DATE (MM /DD/YYYY) 7/28/2016 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 Maury, Donnelly & Parr 24 Commerce St. Baltimore, MD 21202 CONTACT NAME: PHONE 410 685 4625 Ax INC No, Ext ): ( ( FA/C, No): 410 685 -3071 ( ) A ADD DREDRE SS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Transportation Insurance Services, Inc 20494 INSURED Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 INSURER B : 07/01/2016 INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : INSURER F : CLAIMS -MADE 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 TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDYYY) /Y LIMITS A X COMMERCIAL GENERAL LIABILITY X 4025933977 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GE X GENERAL AGGREGATE $ 2,000,000 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS 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 ¥ / N 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 mo e space Is required) City of Okeechobee is named as Additional Insured. CERTIFICATE HOLDER CANCELLATION City of Okeechobee 55 SE 3rd Avenue Okeechobee, FL 34874 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 ACORO® �, CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/28/2016 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 Robins Insurance Agency, Inc 30 Burton Hills Blvd. Suite 300 Nashville TN 37215 CONTACT Small Business Unit NAME: (a� No. Ext): (615) 665 -9200 FAX No): (615)665 -9207 E -MAIL bbache @robinsins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURER A :Southern Owners Ins 10190 INSURED What's Cooking Inc DBA: Gourmet Truck Expo 200 SW 32nd Avenue Deerfield FL 33442 INSURER B : 03928331 Blanket Waiver Subrogation INSURER C: 7/18/2017 INSURER D: $ 1,000,000 INSURER E : INSURERF: X COVERAGES CERTIFICATE NUMBER:2016-17 MASTER COI 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 TYPE OF INSURANCE INSD Swvo POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYl'Y) LIMITS A X COMMERCIAL GENERAL LIABILITY 03928331 Blanket Waiver Subrogation 7/18/2016 7/18/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMM GE ISES (Ea occurrence) $ 300,000 MEDEXP(Anyoneperson) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GEN'LAGGREGATE X X POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OPAGG $ 3,000,000 Hired & Non -Owned Aut $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 03928331 7/18/2016 7/18/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N 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) The Certificate Holder is included as an additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION City Of Okeechobee 55 SE 3rd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE Bruce Robins /BACH �� .1+''`- ACORD 25 (2014/01) INS025 (7014(1) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD