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Park Use Permit-2017 Small Business SaturdayCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 X9821 Fax: 863-763-1686 e-mail: jdunham(a)cityofokeechobee.com Park Use Permit Permit Number: 022 Date(s) of Event: November 25, 2017 8:30AM-3:00PM Permit Expiration: November 25, 2017 11:59AM Purpose of Request: Chamber of Commerce Small Business Saturday Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Chamber of Commerce of Okeechobee Applicant's Address: 55 S Parrott Ave Phone Number: 863-467-6246 Address of Project: Park #3 Current Zoning: P FLU Designation: Public Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. The Public Works Director requests 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. November 13, 2017 Administrative Secretary Date General Services Department Page 1 of 3 Revised 3-21-17 CITY OF OKEECHOBEE *1•°F oKFFcyo ,.4, ; .. 1 r� t.d :-0-t, s� ... *-9;;,.�� 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: // - s.-/ 7 Date Issued: // . i h - / 7 Application No: // - e�,=)-. Date(s) & Times of Event: -}-U L A0\krn aSA g 30.A -,3GPP' Information: Organization:('_ C'� c �r n(Ylecre . Cc c� .rf-rbee CQun- l Q Mailing Address: e .� J Contact Name: 1A--C-t� E-Mail Address:c+ r� — S .C-bee_baci fnez�' • Crim Telephone: - S f Work: 3(o3-- 1(07- Loy (O Home: Cell: k-26 k Summary of activities: (` lnbe c u o (1 4-o Ua p,-y, -�: '1- .:; : ,_ Si A ,� PT,%;:� Qx rnr 11 bv� e S ?Lr_l_t ern.. 1 , _ BSc t �s , 1 9. P Yen r� i 1 t o k Pavine_ 1 �. rept . ?c, -,g-e es weAl �S 9n -1-�ci / f2z s . Proceeds usage: ,r_ ( c-yi-- -r- 1Pr . C(rnrnun'-4j - Please check requested Parks: Flagler Parks: o City Hall Park o #1 Memorial Park ❑ #2 #3 ,` o #4 ❑ #5 o #6 [Park 3 is location of Gazebo. Park 4 is location o n stand] (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: Date(s) to be closed: I`I' 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 ** Alcoholic beverages can be served only on private • Parks, City streets or City sidewalks. See additional o Please check if items will be sold on City streets/sidewalks. Use Permit 667 along with the Street Closing application. with a Park Use application. property. Alcoholic beverages NOT ALLOWED in City note below. C 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 T''ereby acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03-8 and -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. rIT-Fk-aVAPe.c--6-1,i7\\13/17 Applicant Signature Date ••••OFFICE USE ONLY•••• Staff Review %� Fire Department: Date: 07/ �' ,2 /7 Building Official: 4___ d Date: (( •e '(7 Public Works: / 1 Date: /1 ^ 1-12 )lice Department: 7,0 Date: �/e37 BTR Department: kS(/fl'7 Date: ///g/17 City Administrator: Date: t(/4/0- 11 City Clerk: i` f & $ j,_, Date: . (a le9 O(') NOTE: APPLICATION AND INSURANC 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 Park ,t3 340 339 338 334 333 _7 341 312 313011 \ \ / State Road 70 33 336 335 334 333 1111 am 326 a 324 111 332 315 316 IVA 317 331 111 327 328 { 318 342 330 329 321 111F 320 i 310 308 307 306 t*411X 305 �t304 )M1 Park Street 303 302 301 BUSIN-1 OP ID: S2 ,a►�`R[a CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYl1� 11/1 0/201 7 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 Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974-6179 Lowell H Pritchard CONTACT NAME: Hines PHOSandy PJC,, No, Ext): 863-763-7711 FAX No): 863-763-5629 E-MAILDRSS' shines@pritchardsinc.com INSURER(S) AFFORDING COVERAGE NAIC * INSURER A: Zenith Insurance Company COMMERCIAL GENERAL LIABILITY INSURED Business Development Board of Okeechobee dba Chamber of Comm 55 S. Parrott Ave Okeechobee, FL 34972 INSURER B: Philadelphia Indemnity Ins 18058 INSURER C: 07/20/2018 INSURERD: $ 1,000,000 INSURER E : INSURER F : X 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 LTR TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYWY) LIMITS B X COMMERCIAL GENERAL LIABILITY f -X PHPK1686305 07/20/2017 07/20/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PREM SES (Ea cGE TO cur ence) $ 100,000 MED EXP (My one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 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) $ (Peraccident)DAMAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A Z134078201 03/03/2017 03/03/2018 X PER STATUTE OTH- ER E. L. EACH ACCIDENT $ 100,000 E . DISEASE - EA EMPLOYEE $ 100,000 E . DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION CITY -92 Cityof Okeechobee 55 SE 3rd Ave 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 If0 V% /?a -4J ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Jackie Dunham Sent: Monday, November 13, 2017 11:16 AM To: Steve Weeks; Lalo Rodriguez (Irodriguez@cityofokeechobee.com); David Allen; Chief Peterson Subject: Upcoming Park Event The Chamber of Commerce turned into the City last week an application to expand their annual Small Business Saturday event to Park 3. This event will be held on Saturday, November 25`h, 2017 from 8:30A — 3:00P. Park 3 will be used to facilitate home operated businesses who wish to have a booth. It will also include some children's activities. The Chamber was not specific on this. Thank you. Jackte/Dt4.41.havyt. AclAniAliistratOveSecretary City of 0keecho-b-ee. 55 SE T u%rd 4vevuiei Okeechobee, EL 34974 863 -763 -3372 (Mc44'.) 863 -763 -9821 (Du'ect) 863 -763 -1 68 6 (FcA, ') jdunham@cityofokeechobee.com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1