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Park Use Permit - Pregnancy Center Chili Cook-OffCITY 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: 016 Permit Expiration: November 4, 2017 11:59PM Purpose of Request: Pregnancy Center of Okeechobee- Walk/Run Chili Cook Off Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Date(s) of Event: November 4, 2017 2PM -6PM 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. Zip Code: 34974 Applicant's Address: 808 NE Park St. Address of Project: Park #4 FLU Designation: Public Clean-up i if A 3ark)ance'from the event i : an trash can liners aua ttamt Batter the l,* rlt , ,Ti r)r a��7t1! J X311* itr lf;h ,7- *An ; liil -FP,( ,') q.daad 1' July 18, 2017 Administrative Secretary /General Services Date Page 1 of 3 Revised 3 -21 -17 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863 - 763 -9821 Fax: 863 - 763 -1686 PARK USE AND /OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: -7 —, , _ , i Date Issued: •y- 0 b - 0 7 7q7 Application No: / 1 - o 1 4, Date(s) & Times of Event: / /Pp 7 - ,7 :c70pm - 6 200p/r� Information: 1 Organization: fr fur-4c _ & /2 fe, o( �/� eech o,b e e, Address.: 0 /V rH S . C Cep cho bee, Contact Name: (,/ n and E -Mail Address: ( i8 r0 �t - ho /r' ai 1. Cle m Telephone: Work: %G9 3 - l (,7 7q7 Home: Cell: g6, 3 - 53;2 -OTOY Summary of activities: W I K- Ru-n and Choi eo ko /i - IBS - FRu. -gib , iii in a" 1<,-t ��f - --hen a.lor?,r fixk" :51.1 4Y/ 30 fo ' 1 �� , A .U. — th . « J 1 I ni h # ! A — i "sip, - // //, 11 e f £D!/e. 'IA I7 _ ill alL` -1--. eAtii i M.l 11 111El i Q e, 'emu ., NIMBIEMIESMbtni: -o NW ' Proceeds usage: 0-1 proceed k front -fhe wytl o +owtr - - 7E01i1 Me cef7 r- rlarlc pew hr�n.� Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 � #4i ❑ #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is location of Bandstan (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: %/ ` r It vie_ do no n IA 6s r C o51`i9 . 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 9nd 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, 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 permit, 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 Testamenta Trust if closing streets or sidewalks. ,lrin7� z-, 6h 6 /`7 Ap hcant Signature Date ••••OFFICE USE ONLY•••• Staff Review ,/ Fire Department: i * Date: /sr t74)1y 02496 Building Official: lily C Date: 7' 18 .17 Public Works: / Date: 7-10 —17 Police De 1 artment: �1 Date: 6 i7 BTR De I artment: J.. Al 4i/./ %/ Date: 9 /g / C. Administrator: Date: City Clerk: f' OM I Date: &40% (jfl7 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 9/(9 Fire � � and '�M ergency 55SE 3rd avenue Moechobee.F|ohda 34974 Telephone: (863) 467-1586 Fax: (863) 763-4489 con 2017 Tent Guidelines i All tents I00 Square Feet or larger shalt have ocurrent (within the last 12 Fknidqor (}thurStatcCertifiud(niminnoo`ntiu80[2&:|0[\;C)pnrkJz|cGrccx(inguishor All Cooking, k��u(rcgood|cxxo[si,c shall ohar#qu�cocurrel Certified Class "K" portable fire extinguisher in addition to thc 2A10Bf` extinguisher, N[ you do not have o certified tire extinguisher, one may be purchased from any Fire and Safety equipment company, ^**Fiu: extinguishers poo:kaSwd fron` many retail stores are not certified and will not be accepted. Fire, Extinguishers can he "shared" in a/omnonun area used by multiple cooking tents if necessary. The travel distance should not exceed 75 feet. Z, Tents must be Flame Retardant and shall meet the flame propagation performance criteria specified by NFPA.70| . All te tS must be certified hv an approvcd testing ugencyun dd) the vendor shall provide evidence mf the flame spread certification. Keep the tag on the tent visible when setting up the tent for ease of inspection, "*Nun-F\urne retardant tcm fabrics or materials such as retail store camping tents or tarps do not meet UheN[P/\ 701 Standard and will not be accepted, 3. "Cooking Tents" must be located a minimum o[5kaway from buildings and ot1ie tents and must be located unnininoum V[|A feet away from any 'Public Use Tent". "Public Use" in this casc is defined as "Ifthe puhlic ean ei.iter under the tent to congregate, sit, \'iew merchandise, or any other activity that allows anyone from the public ro enter under the covered <eoiorea" 4. "Cooking ienix" shall be o.en on all sides, free, from grease residue, and arranged to keep the cooki appliances away from the puhlic. LP Gas Cylinders shall be located aminimum of 5Dmway from the cooking :Appliance & tent, protected from traffic, and secure always. 5. All cooking equipment must be in good working condUion and adhere to the testing agency label that certified the equipment. Deep-fat fryers shall he equipped with a separate high- limit control in addition to the ad\ostuhic operating control (thermostat) to shut off fuel or energy when the fat temperature reaches 475°F(Z46°C) at 1 in. (25.4 mm) below the surface. 6. Electrical Fire Safety as it relates to the use n[temporary wiring, extension cords, overloaded circuits, etc, will be evaluated on acone-by'cone basis for compliance. All equipment used during the event rnust he in good, safe working condition. The life sakty codes governing tents, purohlearnti e structures and temporary activities are far too numerous to list, This is only a summary of some of the guidelines. During the inspection process ancl at any time duringthe event, ifa situation is deerned "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 A.11,1, Public Safety io our foremost concern. YVe wish everyone a safe and enjoyable evenL|[ynu have any questions you may contact the Fire Department at 863-467-1586. Service doesn come from a rnanua/—it comes from the heart. flier kr 11 *if A Itteir4.;- A Sir k4 Iy; " •11 (Pr_o (tr.eg 1St 7 0 14 WALK; WE tflLT 46 51 47 50 City of Okeechobee Future Land Use 11 42 • sO. +. • • I ,..,•.• 5 5 62 .1 85 65 14 443 62 8; 69 19 — 66 69 N 71 22 73. 74 • 155: :55! 50 53 52 • 80 81 82 \ 10 p 5 4 3 3 2 1 4 5 2 6 7 9 8 2 3 4 Bi A 1 A E F 2 8 3 2 1 3 C .. ..... ........... . 98 97 95 95 1111 .. . .. 1111 '..'.. ' 21 100 10 102 103 104 10 ,. 111 • ....,.,.„ r ' 68 87 1...86 85 84 114 115 ..... 9 8 7 11 12 24 131 930 29 -128 121 ........ t 132 133 124 118 4 3 2 1 5 I 8 7 8 12011 10 9 III 11111111111111111 13 14 '194 19.3. 218' • 9 21 V14. E LAND USE CLASSIFICATIONS SINGLE - FAMILY RESIDENTIAL 511606 USE RESIDENTIAL MULTI . FAMILY RESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC FACILITIES --- RAILROAD CENTERLINE UNINCORPORATED (....f1sPATA L. L.L. Ism um Cmmv.mn POWs /11,00.S.S, ore /1121am 4==". 4 5 6 9 ! 8 2 7 10 11 12 0.125 025 0.5 075 IS General Notes S110. NILE., are 15 or 20 leer in width See appropriate subdivision plat Mr speak alley mdMs Thls map has been compiled Itom the most current eats available The Gay 01 (Meecimbes is not responsible (of any errors or omissions contained herein. Pk464 eme. w • M • • RESOLUTION NO. 03 -8 A RESOLUTION OF THE CITY OF OKEECHOBEE, FLORIDA TO ESTABLISH GUIDELINES FOR USE OF PUBLIC PARKS OR OTHER LANDS OWNED BY THE CITY OF OKEECHOBEE FOR CERTAIN CHARITABLE OR BENEVOLENT ORGANIZATIONS; OR THE GENERAL PUBLIC; PROVIDING FOR AUTHORITY TO REVIEW SUCH APPLICATIONS; PROVIDING FOR STANDARDS FOR REVIEW; PROVIDING FOR GUIDELINES FOR SUCH ORGANIZATIONS TO FOLLOW; PROVIDING FOR INSURANCE REQUIREMENT; PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, there are located within the City of Okeechobee certain public parks and other areas owned by the City of Okeechobee that are intended for, and open for use by, the general public, with certain restrictions; and 'WHEREAS, this functions range from large gatherings which ^ttract many participants, to very small groups, which may or may not cause traffic control problems, and vary in intensity; and WHEREAS, current regulations require the same liability insurance coverage for any such group authorized to gather in the parks or on city lands, which creates a hardship on the smaller gatherings; NOW, THEREFORE, be it resolved and adopted by the City Council for the City of Okeechobee, Florida the following resolution: 1. THAT permission for charitable or benevolent organizations, or non profit groups, to engage in certain activities in City parks or on City lands, is govemed by Article IV, Sections 14 -141 to 14 -149 of the City Code of Ordinances, which regulations and restrictions shall be considered by General Services whenever an application or request for use of public areas is made, and followed accordingly. 2. THAT for any permit or permission granted by the Department of General Services for such activities on public lands, such permit shall be also executed by the City Administrator, prior to such event taking place. 3. THAT most applicants for use of parks and public lands are charitable or civic groups, who stage large events and attract many people. However, smaller groups for prayer meetings; weddings; boy and girl scouting; and similar type events are also authorized in parks and in public places, but are also subject to the requirements of Article IV of the City Code. 4. THAT current regulations require the applicant for an event to procure liability insurance in the sum of $ 1 million; the cost of which is or may be prohibitive for smaller and more informal groups. 5. THEREFORE, for any application wherein it appears to the Department of General Services that the participants thereof may be 100 or fewer persons, the liability insurance requirement shall be waived. The City reserves the right to require the participants to execute a hold harmless agreement, depending upon the nature and impact of the event. Page 1 of 2 INTRODUCED AND ADOPTED this 5' day of August, 2003. • . ATTEST: (Lit A' J(JLthc. Lane Gamiotea, City Clerk REVIEWED FOR LEGAL SUFFICIENCY: • Cook, Citv Attorney Page 2 of 2 James. E. Kirk, Mayor • RESOLUTION NO. 04 -03 A RESOLUTION OF THE CITY OF OKEECHOBEE, FLORIDA SUPPLEMENTING RESOLUTION NO. 03-08; GUIDELINES FOR USE OF PUBLIC PARKS OR OTHER LANDS OWNED BY THE CITY OF OKEECHOBEE FOR CERTAIN CHARITABLE OR BENEVOLENT ORGANIZATIONS; PROVIDING FOR AUTHORITY TO REVIEW SUCH APPLICATIONS; PROVIDING FOR STANDARDS FOR REVIEW; PROVIDING FOR GUIDELINES FOR SUCH ORGANIZATIONS TO FOLLOW; PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, there are located within the City of Okeechobee certain public parks and other areas owned by the City of Okeechobee that are intended for, and open for use by, the general public, with certain restrictions; and WHEREAS, these uses change from time to time, and problems arise by certain uses that are not anticipated, but should be the subject of regulation and control by the City of Okeechobee for the safety and welfare of its citizens, and which requires supt1erne:;tTn::1 .n..irtin::; rules as necessary; NOW THEREFORE, it is resolved before the City Council for the City of Okeechobee, Florida; presented at a duly advertised public meeting; and passed by majority vote of the City Council; and properly executed by the Mayor or designee, as Chief presiding Officer for the City: 1. THAT permission for charitable or benevolent organizations, or non - profit groups, to engage in certain activities in City parks or on City lands, is governed by Article IV, Sections 14 -141 to 14 -149 of the City Code of Ordinances, which regulations and restrictions shall be considered by General Services whenever an application or request for use of public areas is made, and followed accordingly. 2. THAT for any authorized use of the public parks or rights -of -way within the City, the following regulations shall be followed, as applicable: a. The organization or permit holder, or their designee, shall be responsible to completely clean up the public area used by the permit, within two days of completion of the event, unless otherwise designated in the permit. b. No trailers unattached to a motor vehicle shall be parked along any street or avenue or public right -of -way, or in a marked parking spot, unless the right -of -way is closed for the event, not otherwise blocked off by the City. No other motor vehicles or trailers will be allowed to park or remain on the Park grounds unless prior written approval is obtained from the City Public Works Director or their designee, or such vehicle or trailer is participating in an event such as a permitted activity or car show. Any motor vehicle or trailer parked in violation of this section may be towed by the City at the owner's expense, who shall be liable for all towing and storage fees. c. Golf carts, 4- wheelers or other vehicles not licensed for use on public rights -of -way, will not be permitted on the Park grounds without prior written approval of the City Public Works Director or their designee. d. Certain events, such as but not limited to parades, or those which draw a large number of people, require significant incurring of costs Page 1 of 2 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: OCT 19 _ 007 PREGNANCY CENTER OF OKEECHOBEE INC 1517 SW 7TH AVE OKEECHOBEE, FL 34974 Dear Applicant: DEPARTMENT OF THE TREASURY Emp`3.oyer Identification Number: 33- 1164762 DLN: 17053176001027 Contact Person ED 8 SCHLAACK Co I(tact Telephone Number: 1 (8 7) 829 -5500 Acc unting Period Ending:' PubD cember 31 ic Charity Status: 1'70 (b) (1) (A) (vi) Form 990 Required: s Eff ctive Date of Exemption: A ril 23, 2007 Contribution Deductibility: Yes Advance Ruling Ending Date: D cember 31, 2011 Add ndum Applies: N We are pleased to inform you that upon re exempt status we have determined that you under section 501(c)(3) of the Internal R deductible under section 170 of the Code. tax deductible bequests, devises, transfe or 2522 of the Code. Because this letter regarding your exempt status, you should ID# 31536 iew of your application for tax are exempt from Federal income tax venue Code. Contributions to you are You are also qualified to receive s or gifts under section 2055, 2106 could help resolve any questions eep it in your permanent records. Organizatio - •� - • - - • 0].( the Code are further classified as either'.ublic charities or private foundations During your advance ruling period, you will be treated as a public c4iarity. Your advance ruling period begins with the effective date of your_exernption and ends with advance ruling ending date shown in the heading of the ltter. Shortly before the end'of your advance ruf 8734, Support Schedule for Advance Ruling the end of your advance ruling period to then notify you, in writing, about your pi ing period, we will send you Form Period. You will have 90 days after eturn the completed form. We will blic 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 OF OKBECHOBEE Enclosures: Publication 4221 -PC Statute Extension cerely, • R.I.ert Choi Director, Exempt Organizations Rulings and Agreements Letter 1045 (DO /CG) Form 1023 (Rev, 6-2006) Name_ Part X Public Charity Status (Continued) EIN: c-- /e' ,Y7 Page 11 e 509(a)(4) —an organization organized and operated exclusively for testing for public safety. f 509(a)(1) and 170(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 509(a)(2)--an organization that normally receives not more than ne -third of its financial support from gross ❑ Investment income and receives more than one -third of its fin ncial support from contributions, membership fees, and gross receipts from activities related to its exempt fu Lions (subject to certain exceptions)_ i A publicly supported organization, but unsure if it i$ described in 5g or 5h. The organization would like the IRS to ❑ decide the correct status. w 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 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 theiirst year. You have the right to refuse or limit the extension to a mutually agreed -upon period of time orissue(s). Publication 1035, Extending the Tax Assessment Period, provides a more detailed explanation of yoilr 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 limitations, you ars not eligible for an advance ruling. For Organization (Signature of Officer, Director, Trustee, or other authorized official) &7 {Type or print name o! sgn B (Type or print ,tltte or authority- of signer) ,k/s/09 OCT 19 2007 IRS Director, Exempt Organizations {pate} b Request for Definitive Ruling: Check this box if you have com feted one tax year of at least 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 above. if you checked box i in line 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. (ii) (a) For each year amounts are included on lines 1, 2, and 9 lef Part IX -A. Statement of Revenues and Expenses, attach a list showing the name of and amoun 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 -4l. Statement of Revenues and Expenses, attach a list showing the name of and amount received from each 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 t its box. 7 Did you receive any unusual grants during any of the years shown on Part IX -A. Statement of ❑ Yes Of No Revenues and Expenses? If "Yes," attach a list including the name 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. 5-2006) ACC) Ra CERTIFICATE OF LIABILITY INSURANCE L..----- DATE(MM /DD /YYYY) 7/5/2017 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 15 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 FAX Extl: (520)455 -9252 1a /c, No): (520)455 -9358 ADDRIESS:ehill @patriot- insurance.com INSURER(S) AFFORDING COVERAGE A NAIC 8 10754 INSURERA:Spirit Mountain Ins Co RRG Inc INSURER B : INSURED Pregnancy Center of Okeechobee BOB North East Park Street Okeechobee FL 34972 INSURER C : SMIC- LPP2017- CPP109 RETRODATE: 11/19/2010 INSURERD: 7/1/2018 INSURER E : $ 1,000,000 INSURER F : X CLAIMS -MADE L PROF. LIAB. INCLUDED COVERAGES CERTIFICATE NUMBER:PKG 17/18 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 A I SD WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X SMIC- LPP2017- CPP109 RETRODATE: 11/19/2010 7/1/2017 7/1/2018 EACH OCCURRENCE $ 1,000,000 _ X X X CLAIMS -MADE L PROF. LIAB. INCLUDED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 0 DED: $2500 PERSONAL &ADVINJURY $ 1,000,000 GEN'L AGGREGATE X POLICY OTHER' LIMIT APPLIES I PRO- jJECT PER: iLOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OPAGG $ 1,000,000 Professional Liability $ 1,000,000 AUTOMOBILE i—_ _ 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) $ 1 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 1OTH- 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 11/4/2017 CERTIFICATE HOLDER CANCELLATION City of Okeechobee 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 /JDS '< = �"---", 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 OFREMARK COPYRIGHT 2000, AMS SERVICES INC. Jackie Dunham From: Jackie Dunham Sent: Friday, July 14, 2017 1:16 PM To: Chief Peterson; Herb Smith; Lane Gamiotea; Kim Barnes; Jeff Newell Cc: Steve Weeks; Patty Burnette Subject: Upcoming Park Use Permit Attachments: Walk -Run Chili Cookoff.pdf I'm attaching the information for a Park Use application for the Pregnancy Center. Originally they planned to do this in April but it was postponed. I included the Tent Use guidelines which the Fire Department provided at that time. Even though this is not until November 4th, I am trying to get the proper signatures so I can get it back to the applicant. I will have it on my desk for signatures. Thank you all. Jackie Du.vthown/ AclAryu;vu'istratLve' Secretary City of Okeechal 55 SE TRLrdrA4vevu,t& Okeechobee-, EL 34974 863 -763 -3372 (Madvt) 863 -763 -9821 (Direct) 863-763 -1686 (Fax) jdunham4 cityofokeechobee.com Website: http: / /www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1