Park Use Permit-Chamber Ldrship BBQ FundraiserCITY OF OKEECHOBEE
55 SE THIRD A VENUE
OKEECHOBEE, FL 34974
Tele: 863-763-3372 ext. 9821 Fax: 863-763-1686
e -mail: jdunhamC cityofokeechobee. corn
Park Use Permit
Permit Number: 015 Date(s) of Event: July 21, 2017 6AM — 4PM
Permit Expiration: July 21, 2017 11:59 A.M.
Purpose of Request: Chamber Leadership Class BBQ Fundraiser
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee State: Florida Zip Code: 34974
Applicant: Melisa Jahner
Phone Number: 863 - 763 -5573
Current Zoning: P
Subdivision: City of Okeechobee
Applicant's Address: 55 S. Parrott Avenue
Address of Project: Park 4
FLU Designation: Public
Restrictions /Remarks: All debris must be removed within 24 hours of expiration date.
*Memo attached regarding political rallies and similar events held in City Parks
, Tack(& l7
Administrative Secretary/General Services
July 11,2017
Date
Page 1 of 3
Revised 3 -21 -17
CITY OF OKEECHOBEE
100.-„,,,..„,
+`� 55 SE THIRD AVENUE
s.� ,� ��; OKEECHOBEE, FL 34974
�- " Tele: 863 -763 -9821 Fax: 863 - 763 -1686
'a y�' PARK USE AND /OR TEMPORARY STREET/
"1x i. , SIDEWALK CLOSING
PERMIT APPLICATION
Date Received:
4,4,2 4,7
Date Issued: '///, // 7
Application No:
/1 - 0 a"
Date(s) & Times of Event: "1- ,7. 1_1-1 6 A -y..
Information: c /'7 7k k &fj c 1ea ev5 /u , (7c ss
Organization: Nia,)/6C,- OF on ( l)lc,
Mailing Address: 55 Sc. Parry f/ 4 ' CilifY(/i r'l_ -zc IL 3t{q7.
Contact Name: He (A:5, :ra it, >_.c.-
E-Mail Address: rn) aftttQ,_ 2 (/1'k,-5 -.25 714-4 b(lI /5.. 0O01
Telephone:
Work:
863 213- 55 23
I Home:
I Cell:
I 5-63 - 6:,.3y- 6PSVS/
Summary of activities:
�}
13 i& At i LE r -c —s r (.(4 'Liu K
Sef -up -f•e r1l- 4' (/)c,r- :3u (5361 C/7
f' ()ck, pa 55 co- 66 1( !u r-5 ,� CcC 1. o?t /7
y
(I) /(k -zC /) n</L1)
_
GC�,AIG 614E0,, 1-i-'S Dc.- .PA -tit TENT ao )c'f0 - PLAT, Fie AI (-
OF %'--74A E /C17-5 iS iAnT /1TiAc hte.
Proceeds usage: e /fl OiKeee tC /a k te;( -cr }ky C°.�aSS �z /)( /uu,u - PrejPe,f=
- 12U1tet' s txitl be rio,ta-k/ 41-; 0, 17 (1 (7.(eirke
tt i'/(6 l .r; k eAckfs .
Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 #4 ❑ #5 ❑ #6
[Park 3 is location of Gazebo. Park 4 is location of Bandsta ]
(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
TEMPORARY STREET AND SIDEWALK CL I . 'G INFORMATION
(If not using Park(s), provi I . ent address)
Street Address City State Zip Code
Street(s) to be closed:
Date(s) to be closed:
Time(s) to be c :
Purpose losing:
ttachments Required:
Charitable Function
Temporary Street and Sidewalk Closing
• Site Plan
► Original signatures of all residents, property
owners and business owners affected by the closing.
• 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 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. TUP 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 sum approximated by the City to be incurred in providing City services. Any such
sum not incurred shall be refunded to the applicant.
Page 3 of 3
I hereby acknowledge that I have read and completed this application, the attached Resolutions
08 and 04 -03, concerning the use and the rules of using City property, that the information
that I am the duly authorized agent of the organization. I agree to conform with, abide by
rules and regulation, which may be lawfully prescribed by the City Council of the City of
its officers, for the issuance of this Charitable Function Permit.
CERTIFICATE OF INSURANCE MUST NAME CITY OF OKEECHOBEE AS ADDITIONAL
INSURED.
No.(s) 03-
is correct, and
and obey all the
Okeechobee, or
Applicant Signatur Date
••••OFFICE USE ONLY""
Staff Review
Fire Department:
(cr
Date:
10 j u Ir &i r
Building Official:
d/ G+
Date:
le ' 2S • ( 7
Public Works:
p
Date:
6-2 ^ f 2
Police Department:
!'
Date:
Zo l7
BTR Department:
al <<%
Date:
Date:
740 17
?-740// 7-
(pi3o (� (� ( i
City Administrator:
City Clerk:
0,. l� �1 `
• 1
Date:
i
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
Date
Date
4 7-r3 L+t-19d CY) 3
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ij
A anipa ita
,
5110P+ C11
04 ear
y
3N 9,9 'gg-
a
Mile istante
USEPiENT
A.P1011C1.116(..'. .
()ate treared of
CONCERM Nisr &LkILIUII ERS
August 2011
F-419.01 Rtnters
#29261
s(.108 HiEmna Ave. -Tampa, L 33610
800/865-5064 rax 83.3/740-8170
hi: ft;af the describe°, ce ..i:ertific-afe have been flame-
relatdanAr;eatetlar are_intierotaLii an804:-NwlittiliesItto:
NAME: L1^eecliotee uo snentfs Utrice _ AT
ciTy Okeechobee FL', 34972
(fiuiu)ii /s STATE
heo#,y nde that:
The articles described on this Certificate have been treated with a fiame-tetardant approved
chemical and that the pn rir 0f chemical was done in conformance with Federal
'
Specification NFPA 701
Method of appitation: Inherently Flame resistant
Trade name of 'lame-resistant fabric or inalerial lised Hi-Gloss
Chem. Reg. No F-419.01
The Flame Retardant Process Used will not t3e Removed 13y Washing
(wilt or Wit( riol)
and is good for the life of the fabric.. Renewal Certification unnecessary.
Sunblock White 15-16 oz. psy
Color and weight of fabric:
Description of item certified; (1) 20' x 40' Frame Tent Top
Thomas Sciortino
Name of ApoltrAtor or Productron Superrntendent
,
Production Supervisor
Sy
We hereby certify this to be a true copy of the original "4;ERTIFICATE OF FLAME
RESISTANCE" issued to us, "original copy" of which has beers flied with the California
State Fire Marshal.
Lori Walker
Signed by
Chamber of Commerce Friday July 21, 2017 - 11A - 2P
o O eec6oLee Coup%
2017 Okeechobee Leadership Fundraiser
BBQ Pulled Pork Lunch $10
Plate Includes:
. Pulled Pork /BBQ Sauce
. Baked Beans and Grean Beans
. Bread Roll and a Cookie
FREE Delivery for
3+ Plates
or
Pick It Up At
Flagler Park #4
Help the 2017 Okeechobee Leadership Class Raise
Funds for New Picnic Tables in Flagler Park!
Tickets Available for Purchase At:
Okeechobee Chamber of Commerce - (863) 467 -6246
INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
DateMAy 1 2 2011
BUSINESS DEVELOPMENT BOARD OF
OKEECHOBEE COUNTY INC
C/O CHAMBER OF COMMERCE OF OKEECHOBEE
315 NW 4TH AVE
OKEECHOBEE, FL 34972
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
27- 4426593
DLN:
17053102368021
Contact Person:
JEFFERY A CULLEN
Contact Telephone Number:
(877) 829 -5500
Accounting Period Ending:
December 31
Form 990 Required:
Yes
Effective Date of Exemption:
January 1, 2011
Contribution Deductibility:
No
ID## 31215
We are pleased to inform you that upon review of your application for tax -
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(6) of the Internal Revenue Code. Because this letter
could help resolve any questions regarding your exempt status, you should keep
it in your permanent records.
Please see enclosed Publication 4221 -NC, Compliance Guide for Tax - Exempt
Organizations (Other than 501(c)(3) Public Charities and Private Foundations),
for some helpful information about your responsibilities as an exempt
organization.
Enclosure: Publication 4221 -NC
Sincerely,
r49
Lo G. Lerner
Director, Exempt Organizations
Letter 948 (DO /CG)
Jackie Dunham
From: Jackie Dunham
Sent: Wednesday, June 28, 2017 11:34 AM
To: Chief Herb Smith - City of Okeechobee (Chief Herb Smith); Chief Peterson; David Allen
(dallen @cityofokeechobee.com); Kim Barnes (Kim Barnes); Lane Gamiotea
(Iamiotea @cityofokeechobee.com)
Cc: Patty Burnette
Subject: Leadership Class BBQ 7 -21 -17
Attachments: Leadership Class BBQ.pdf
I am in receipt of a new Park Use Permit in Park 4 on July 21st, 2017. I am attaching part of the application for
your review. No street closing required. Please stop by my desk sometime in the next couple of weeks to sign
your approval. Should you have issues please advise. Thank you.
Jack.;,e. Di/w/
AdNViiv►.istra we' Secretary
CLty o f Okeechobee/
55 SE Th;,rd'Avevuue,
Okeecho-1, FL 34974
863-763-3372 (Mct vv)
863 -763 -9821 (tXrect)
863-763-/686 (Fay)
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