Loading...
Park Use Permit-Movie in the Park Oct. 2017CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 ext. 9821 Fax: 863-763-1686 e-mail: ldunham(a�cityofokeechobee.com Park Use Permit Permit Number: 020 Date(s) of Event: October 28, 2017 7PM-9:30PM Permit Expiration: October 28, 2017 11:59 A.M. Purpose of Request: GFWC Okeechobee Junior Women's Club Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Holly Mixon Phone Number: 863-532-1778 Current Zoning: P Subdivision: City of Okeechobee Applicant's Address: 1800 SW 3rd Ave, Okeechobee 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 To ckJeJ Difunhamii Administrative Secretary/General Services October 23, 2017 Date Page 1 of 3 Revised 3-21-17 CITY OF OKEECHOBEE Ire 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 PARK USE AND/OR TEMPORARY STREET/ #M'-- o-, SIDEWALK CLOSING PERMIT APPLICATION Date Received: /0 - ft/ -17 Date Issued: /o ;3 i 7 Application No: / "7 - 07.0 Date(s) & Times of Event: 0 G --k- zg. `,A 11 1 - 9 :30 wi P Information: Organization: C- L OK,e_eckol ( or 1,4 bNl.Qns 6 Mailing Address: 1 75-"b66 3°-d fl/P 'N11�-/ �o ..-FL-3 Contact Name: 41)V �Xdn E -Mail Address: I p1‘3 ', vpr\ 0 M�,t . Ca Telephone: Work: Home: Cell: j -s 1 7 i - ,i-7.... Summary of activities: t\C-Q IA b\/ 1. in 1/6 ?C(K-- # 6(rliceSkAiVerr3 1-// n <be 5'J() 31 .U0 Proceeds usage: In k‘ Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 o #3 #4 o #5 o #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 3 of 3 Revised 11/4/16 I hereby 04-03, duly regulations, the issuance Certificate Test acknowledge that I have read and completed this application, the attached Resolutions No.(s) 03-8 and concerning the use and the rules of using City property, that the information is correct, and that I am the authorized agent of the organization. I agree to conform with, abide by and obey all the rules and which may be lawfully prescribed by the City Council of the City of Okeechobee, or its officers, for of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick entary Trust if closing streets or sidewalks. OckI9,7 Appl cant Si a re Date ""OFF CE USE ONLY"" Staff Review Fire Department: Date: a3 acr/ 7 Buildin: Official: .r Date: /v ' i i ' %% Public Works: Date: /Q- /4- 1) Police Department: Date: /v /e / 7 BTR Department: 41 '4 Date: /0 -/9-1.7 City Administrator:/ Date: 77ce/�- City.ilacClerk: //� U ���WI Ni Date: i /0 -/q5110,1 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 /u ! Date Temporary Street and Sidewalk Closing reviewed by City Council and approved / ^ I `� A- Date DIV!S ON OF COI? RAT;ON i Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name GFWC OKEECHOBEEOMAN'S CLUB, INC. Filing._Information Document Number N15000000595 FEI/EIN Number N/A Date Filed 01/20/2015 Effective Date 01/20/2015 State FL Status ACTIVE Principal Address 1800 SW 3RD AVENUE OKEECHOBEE, FL 32974 Mailing Address 1800 SW 3RD AVENUE OKEECHOBEE, FL 32974 Registered Agent Name & Address Tijerina, Alexandra E 1800 SW 3rd Avenue Okeechobee, FL 34974 Name Changed: 05/02/2017 Address Changed: 04/26/2016 Officer/Director Detail Name & Address Title VP MIXON, HOLLY 1800 SW 3RD AVENUE OKEECHOBEE, FL 34974 Title President TIJERINA, ALEXANDRA 1903 SW 22nd Terrace OKECHOBEE, FL 32974 ACORO GENEFED-01 AMILLER CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/18/2017 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 License # CA#0658748 AHT Insurance 20 S. King Street Leesburg, VA 20175 INSURED General Federation of Women's Clubs 1734 N Street, NW Washington, DC 20036-2990 CONTACT NAME: PHONE (A/C, No, Ext): (703) 777-2341 FAX (703) 771-1852 E-MAILDDRESS: INSURER(S) AFFORDING COVERAGE INSURER A : Hanover Insurance Company INSURER B : NAIC # 22292 INSURER C : INSURER D : INSURER E : INSURER F : 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 (MM/DD/YYYYI POLICY EXP (MMIDD/YYYYI LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR LHR984102504 02/01/2017 02/01/2018 PDAMMGEOERa EoNccTuErDrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS - COMP/OP AGG $ Included OTHER: $ AUTOMOBILE LIABILITY (COMBIEa NED SINGLE LIMIT nt) $ ANY AUTO BODILY INJURY (Per person) $ $ OWNED AUTOSRE�ONLY SCHEDULED AUTOS BODILYOINJURY (Per accident) AUTOS ONLY _ AUTO ONLY PROPERTY [DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY/N PER STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L. EACH ACCIDENT $ FFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is requir RE: GFWC Okeechobee Event to be held October 28, 2017,' The City of Okeechobee and R.E. Hamrick Testaments are named as additional insured CERTIFICATE HOLDER CANCELLATION Cityof Okeechobee 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 ea ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Go +ate aps GFWC Movie In the Park Site Plan ,iarrixr ri,,>Ipmeri 0 - N'A' Palk St iFS NW Park St SW Park St SW Perk St !ifajEFIMPROMPOOPPIPMNIFIC Parry-teaith SW Park St s. SWPa;k:;. Map data ©2017 Google United States 20 ft c.—,, ,,,,,,—,,.a Jackie Dunham From: Jackie Dunham Sent: Thursday, October 19, 2017 9:48 AM To: Chief Herb Smith - City of Okeechobee (Chief Herb Smith); Chief Peterson; David Allen (dallen@cityofokeechobee.com); Kim Barnes (Kim Barnes); Lane Gamiotea (Igamiotea@cityofokeechobee.com) Patty Burnette; Steve Weeks; Lalo Rodriguez (Irodriguez@cityofokeechobee.com) Free Movie in Park 4 on October 28, 2017 Cc: Subject: I just received an application from the GFWC Okeechobee Junior Women's Club to host a free movie in Park 4 on October 28th. For those of you able, please stop by my desk to sign as soon as possible as I need to have this back to them by next Friday. Thank you. Dacia& Du.nha m, A dmiimi4trawe, Secretary Cray of Okeechobee. 55 SE T .Lrd'Avevw+.e Off, FL 34974 863 -763 -3372 (Madv) 863 -763 -9821 (Direct) 863 -763 -1686 (Foord 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 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: 'Pa[K —I Street(s) to be closed: IIA, Date(s) to be closed: rl/A Time(s) to be closed: h /! Purpose of Closing: In/‘ 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. o 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. ► 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 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.