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Temp. Street Closing-2017 Christmas ParadeRule 14-65.0035(1)(c), F.A.C. Date: 10/26/2017 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION TEMPORARY CLOSING OF STATE ROAD PERMIT Permit No. 2017-F-191-014 Governmental Entity 850-040-65 MAINTENANCE 12/11 Approving Local Government CITY OF OKEECHOBEE Address 55 SE Third Avenue Contact Person JACKIE DUNHAM Telephone (863) 763-9821 ext. _ Email jdunham@cityofokeechobee.com Organization Requesting Special Event Name of Organization Okeechobee Main Street Address 55 S Parrott Ave Contact Person Jonathan Holt Telephone (863) 357-6246 ext. Email jonathan@okeechobeemainstreet.org Description of Special Event Event Title OKMS Christmas Festival Parade Start Time 6:00 PM (EDT) End Time 8:00 PM (EDT) Event Route (attach map) Detour Route (attach map) Date of Event 12/9/2017 Law Enforcement Agency Responsible for Traffic Control Name of Agency City of Okeechobee Police Department US Coast Guard Approval for Controlling Movable Bridge Not Applicable Copy of USCG Approval Letter Attached ❑ Bridge Location The Permittee will assume all risk of and indemnify, defend and save harmless the State of Florida and the FDOT from and against any and all loss, damage, cost or expense arising in any manner on account of the exercise of this event. The Permittee shall be responsible to maintain the portion of the state road it occupies for the duration of this event, free of litter and providing a safe environment to the public. Signatures of Authorization Event Coordinator Jonathan Holt, Executive Director Law Enforcement Name/Title Bob Peterson / Chief of Police Signature Bob Peterson Date 10/26/2017 Signature Jonathan Holt, Executive Directc Date 10/26/2017 Government Official Name/Title Marcos Montes de Oca / City Administrate Signature Marcos Montes de Oca Date 10/26/2017 FDOT Special Conditions FDOT Authorization Name/Title Lori Benton / DISTRICT PERMIT COORD Signature Lori Benton Dat_ 101 25/2017___ Rule '4-65.0035(1)(c), F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Date: j v' TEMPORARY CLOSING OF STATE ROAD PERMIT Governmental Entity Approving Local Government eeh t' Address 6T. S';. 3r '�%�/� Ot-'eecho6e J• 13 / Telephone Q� '�%Cy� • Email �I,1 IIC•r'1 (� [ t" -I de oLeeciAci, e•e_ , ccrr, Permit No. 850-040-65 MAINTENANCE 12111 Contact Person k Duiihr-n Organization Requesting Special Event � Name of Organizatio ,�QgQ 0/1 r 1 ' -+ Contact Person nrACV'l }/614- `� 5 • 1 (re4-} P /� �� e2 , `� 'j�n7 Address '7, � Telephone p�s Email30r1Cr-ihG✓1 Cd (k ec hche-cryIGti nS (,e,l-4- /] Description of ecial E ent Event Titl�(/�M j (h(1 S /17GiG Date of Event Start Time0,- End Time L_ Event Route (attach map) L/ S+ c� /�� y iPt/ 'Uy+/1 fp /-11-v/ -76 1,veSf(bP(4) -ia a( -7.1h4�Y Detour Route (attach map) Law Enforcemehl Agency Responsible for Traffic Control Name of Agency rrj(,Qe/riG)�� US Coast Guard Approval for Controlling Movable Bridge Not Applicable] Copy of USCG Approval Letter Attached ❑ Bridge Location The Permittee will assume all risk of and indemnify, defend and save harmless the State of Florida and the FDOT from and against any and all loss, damage, cost or expense arising in any manner on account of the exercise of this event. The Permittee shall be responsible to maintain the portion of the state road it occupies for the duration of this event, free of litter and providing a safe environment to the public. Event Coordinator Law Enforcem Name/Title Government Official Name/Title Signatures of Authori �� ._._iJ► % Sign Signature Date Date /c). 547 Signature Date FDOT Special C •.'ditions FDOT Authorization Name/Title Signature Date INDEMNIFICATION AGREEMENT This AGREEMENT, b d between the CITY OF OKEECHOBEE, FLORIDA, (hereinafter "CITY") and .wee ee ti Sire -e--7- /p. (hereinafter "APPLICANT"), dated this day of J719el ,c2Z/ ---.- WHEREAS, WHEREAS, APPLICANT desires to hold or sponsor a special event, parade, festival, or other activity requiring the temporary closure of a state-controlled roadway in the City of Okeechobee, Florida, and therefore requires the execution and submission of an application for such temporary closure to the State of Florida Department of Transportation by the CITY pursuant to regulations of said Department, and WHEREAS, pursuant to Resolution No. 88-5 the CITY requires indemnification by any applicant for temporary road closure before the appropriate CITY officials may execute such application to the Department. NOW, THEREFORE, in consideration of the mutual obligations and covenants set forth hereafter, the parties agree as follows: 1. APPLICANT shall indemnify, protect, defend, and hold harmless the CITY from any and all losses, injuries, damages, or claims of any nature or type resulting directly or indirectly from the temporary road closurenand the special event, festival, parade, or other activity to be held on / day of b I Applicant shall further reimburse the CITY for any and all attorneys' fees, court costs or other legal costs incurred by the CITY as a result of any such losses, injuries, damages or claims. 2. If the APPLICANT is a corporation, partnership or other legal entity (other than an individual), APPLICANT shall attach hereto a duly executed resolution, partnership agreement or other document in legal form evidencing the authority of the officers of such entity to enter into this indemnification agreement. 3. Upon the APPLICANT complying with paragraph 2 above, the requirements of Resolution No. 88-5 of the CITY, and any other reasonable requirements of the CITY, the CITY shall cause the appropriate City officials to execute the necessary forms to make application to the State of Florida, Department of Transportation, for temporary road closure. APPLICANT CITY OF OKEECHOBEE, FLORIDA BY: .eigj ,, P a.l L �� 4 ivy e�iY 2 c TITLE: Administrative Assistant General Services Department FOR CITY USE ONLY XX Proof of liability insurance Corporate resolution completed XX Other requirements (specify) Indemnification Agreement REVIEWED BY: TITLE: DATE: Administrative Assistant, General Services 1o/(ti/ 0t<E.ECI-H0(3EE ft_.0Rtfl/ • • 1;11.1; ST i`:HS'I, t^. ,41 � •.:......:....-.;-...._,. ... - .i .. 1::GT :, ST N. "• :,..• .:'.. - 1' _`. 21:D :=1 Si . I•. i. 1 1 • .1.,:" .�i:i . J1 �'••ate .�• .f.1}1__111. ._. _. ,t i. lv1U Pi+RK' S; .f. _ SW PAt�K i;771 I t. .,i . "!.�1 i.•• ; C.1 li.•. .. t / 1. 1.11,:1• • i ;;i117/ 7T1 E; ST, :? 1 1 , • T.* cr: 1';111L1::(011 t. tO'..11.Z1 .• ( {4 Jan'Ll? LatiL 1.1•1.0.-•r S v1 .`1 ' sT 111: :71 •ti 9t O7 9061 • ; t- :`r U: • 1:1i,Jliti . 70 • •i • • • C. 1 it •!A 1ioLo 9,o1 o J \-4W 2ndyJ NW 3rd St r Jt\ 5th J West SR Y 70 West e— Cipt CD CD Ave 000 Dk_ KEY • Cone ii Officer or Flagman ® Detour Sign —Parade Route —Detoured Traffic S 5 1 5 000 — i 000. Parade Float Stagin Area a It.. S SR 70 East MOT Plan Provided by LT. Bernst 3 d A v e t S E 3 r A v Not To Scale OKEEMAI-01 SOHARE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/02/2017 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 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 INSURED Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 CONTACT NAME: PHONE FAX (ac, No, Ext): (410) 685-4625 (ac, No): (410) 685-3071 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Transportation Insurance Services, Inc INSURER B : 20494 INSURER C : INSURER D : INSURER E : INSURER F : 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 POLIC ES 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 JNSD_WV)Z SUBR POLICY NUMBER POLICY EFF IMM/DD/YYYYI POLICY EXP IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY 4025933977 07/01/2017 07/01/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGEES TO(Ea RENTEDrrence) PRoccu $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PE0 PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILECOMBINED LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS NON-OWNED ONLY SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per accident) $ PROPERTY accidentDAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY ANY OFFICER/MEMBER/ EXCLUDED? ECUTIVE (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 more space is required) CERTIFICATE HOLDER CANCELLATION Florida Department of Transportation P p 801 North Broadway Avenue Bartow, FL 33831 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 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD