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Temp. Use Permit - Weiinkauf BBQ FundraiserCity of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763-9821 Temporary Use Permit Permit Number: 17-008 Date(s) of Event: December 15, 2017 8am-4pm Permit Expiration: December 15, 2017 11:59PM Purpose of Request: Weiinkauf BBQ Fundraiser Property Owner: Karla Roby & Debra Sales Address: 1906 SW 5th Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Kristie Courson Applicant's Address: 3666 NW 3411 Avenue Phone Number: 863-447-3929 Address of Project: 1600 S Parrott Ave Current Zoning: Heavy Commercial (CHV) FLU Designation: Commercial (C) Subdivision: 1St Addition S Okeeechobee Lots 1-12 & alley Block 29 Restrictions/Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. 1�_ q�>\ Date: la (`�1-7 pplicant's Signature ` ouck l ei D tkvartamli Date: December 14, 2017 Administrative Secretary REF:.ORD.716, Temporary Structures CITY OF OKEECHOBEE General Services Department, Room 101 55 Southeast 3rd Avenue Okeechobee, FL 34974 e• 863-763-337? ext.2f7 Fax: 863-763-1686 • TEMPORARY USE PERMIT APPLICATIO ORES 666 APPLICANT II Name of Property • w ells):.. b jL E►ltug�ri Se s / rj;4-hryi ( Ili 2 CL44 i_ I/ trC:A. K e cilo ( e. c ( 44f o�` �a"" f�,W e * ;;,•• �""""", DATE RECEIVED: I Z 18-- 14 DATE ISSUED: lot / _l 7• Pager: Name of Applicant: 1.&,`6* e_ C' oU,x- soy • APPLICATION NO: 3008"DATE(S) OF EVENT: 12/15b'7 ,, �" / 7 � _ p 175.00 DATE PAID: c T If Non-Profit/Civic Organization ,� " TEMPORARY USE PERMIT APPLICATIO ORES 666 APPLICANT II Name of Property • w ells):.. b jL E►ltug�ri Se s / rj;4-hryi ( Ili 2 CL44 i_ I/ trC:A. K e cilo ( e. c ( 44f .3(-)q rig Address: Telephone Numbers: Home: Wohc:'" 76 3 -7 )vNloblle/Cell: Pager: Name of Applicant: 1.&,`6* e_ C' oU,x- soy • • Address: r5 ((i (L * 1,3(-0/h. 1\40_, p ` Teleplione Numbers: Home: Work: Mobile/Cell: c�.J ti(I7 ager M t:r� rk i c 5 % `1 E. Pis.. DO: q,nva, . c.o ua cc Future Land Use Map Designation: • Current Zoning Designation: (J / -j l,! Legal Description of Property: 151- CDU , or Address of Property: • Ib oc Aye Please Explain Type of Use: kkv\Ara t ��e 131 C. Q?teQchobee, rt_. 3q9.73' 73' Briefly describe use of adjoining property: North: Li CoN , SE AS East: t _.r0 -Z:Or�IL South: 1-(p1� 7-_vr1 S 1)/1 r 1 q,,l E -Li S West: Other temporary structures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated, by a non-profit organization. 2. Carnival, circus, fair or other special event operated by a non-profit organization on or abutting their principal use. ' 3. Commercial carnival, circus or fair In commercial or industrial districts. 4. Similar temporary structures where the period of use will not exceed 30 days a year. nt shall: Submit proof of liability insurance, paid In full covering the period for which the permit is issued, in the minimum amount of $1,000,000.00 per occurrence. emove all debris within 48 hours of expiration of permit ave notarized written permission of property owner, if applicant Is notthe property owner. . ubmit Site Plan * 5. Submit State inspection Certificate(s) E. Submit State Annual Permit * The ap hereby certify that the information on this application Is correct. The Information Included in this application is for use by the City of Okeechobee in processing my request. False or misleading Information may be punishable by a fine of up to $500.00 and im ?risonment of • to thirty days and may result in the summary denial of this application. Signature of Applicant City Staff (Please review the application, attach comments or special conditions): Occupational and/or State License Verification: Flre Department Approval: Police Department Approval: Public Works Department Approval: Building Inspector Approv : I: G City Administrator Approval: Ravlsad 211!08 blc _ Date Date:) a 7 Date: . /a/i l l? Date: / /.0 Date: /2-)7-I 7 Date: '7 Date: Support a Local Veteran k v\ - 15-b icy- is tib. 1-j lherrk--1 U0(..!" Yi ave a GOFUNDME account set up Andrea Weinkauf on Facebook Thank you for all your support BRAHMAN THEATER 111 P.O. Box 1395 Okeechobee, Florida 34973 We give permission to _Kristie Courson , to hold a fundraiser on Our property located at 1500 S. Parrot Avenue, on _December 15, 2017. Said party is responsible for all trash removal for stated event. Debra S. Sales Owner x 1 WO - ,y_ Karla H. Roby Owner 00 Florida Su ►re sra %'•;DRIVER LICENSE CLASS E 'C625-514-79-671-0 KRISTIE NELL COURSON 535 NW 35TH AVE OKEECHOSEE, FL 34972-1 DOB: 05-11;7979 SEX: F 2011 1-20 Operation of a motor vehicle constrtotes consent to any sobnery test resit* by UNDERWRITERS GIC UNDERWRITERS, INC. 4075 SW 83rd Ave Miami, FL 33155 (305) 554-0353 ext. Ext 125 MSE017D1004 Quote is valid until 12/15/2018 Re: Kristie Courson To: Attn: Commission: From: Juan Carlos Diaz-Padron jcdp@gicunderwriters.com / (305) 554-0353 ext. Ext 125 Please bind effective: /4/5/21 0/ 7 • Co firm optional coverages: Do not include any optional coverages. ❑ Include the following optional coverages from Section V (Taxes & Fees may apply to optional premium if purchased) ❑ Option 1 - Set-up and/or Take-down Coverage ❑ Option 2 - (add: $50) - Rain Date Coverage ❑ Option 3 - (add: $100) - Banner Coverage ❑ Option 4 - Terrorism Coverage Signature: Uth 1. PREMIUM AND UNDERWRITING NOTES/REQUIREMENTS COMMERCIAL LIABILITY POLICY INFORMATION Carrier: Mount Vernon Fire Insurance Company Status: Non -admitted A.M. Best Rating: A++ (Superior) -X GENERAL LIABILITY GENERAL LIABILITY ADDITIONAL COSTS WHOLESALER AMOUNT DUE OCCURRENCE/AGGREGATE PREMIUM BROKER FEE ❑ $500,000/$500,000 $210 $12.50 $35.00 $257.50 ❑ $500,000/$1,000,000 $215 $12.75 $35.00 $262.75 1,000,000/$1,000,000 $245 $14.28 $35.00 $294.28 ❑ $1,000,000/$2,000,000 $250 $14.54 $35.00 $299.54 • $1,000,000/$3,000,000 $253 $14.69 $35.00 $302.69 ADDITIONAL QUOTE INFORMATION Policy Minimum Premium: $195 Personal & Advertising Injury: Same as the Occurrence Limit Products Aggregate: See L-535 Damages to Premises Rented: $100,000 Medical Payments: $1,000 Refer to Covered Events section for event dates covered Policy Period is 12/15/201-810 12/17/26t8' 4101 % X2017 • Please contact us with any questions regarding the terminology used or the coverages provided. **Read the quote carefully, it may not match the coverages requested** Page 1 of 4 Accurate Insurance Services, Inc. 101 S.W. Park St. Okeechobee, FL 34972 (863) 357-1707 Fax - (863) 357-0317 December 11, 2017 Kristie Courson 3666 NW 34th Ave Okeechobee, FL 34972 Receipt Date: 12/11/2017 Time: 2:36:52 PM Receipt #: 27999 Down Payment: $294.28 Company: GRANADA Policy Number: Pending Binder Number: Binder Date: 12/11/2017 Effective Date: 12/15/2017 Expiration Date: 12/16/2017 Thank you for your business! Accurate Insurance Services, Inc. 12-13-'17 12:11 FROM -Accurate Ins & Tax 863-357-0317 Aca T-946 P0001/0001 F-426 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/13/2017 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 pollcy(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 Accurate Insurance Services, Inc. 101 S.W. Park St. Okeechobee, FL 34972 Phone (863) 357-1707 Fax (863) 357-0317 CONTACT Marcus A Hardman NAME' PHONE (863) 357-1707 FAX 863) 357 0317 AIL ADDREs,s. gen@contaetmarcus com INSURER(S) AFFORDING COVERAGE NAIL a INSURER A: Mount Vernon Fire Insurance Company 0 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR INSURED Kristie Courson 3666 NW 34th Ave Okeechobee FL 34972 INSURER 8 CL 2723562 INSUREic ; 12/17/2017 INSURER D : $ 1,000,000 INSURER E : $ 100,000 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSRT,r TYPE OF INSURANCE �;POCY R POLICY NUMBER MM/DDY EFF EXP MWD LIMITS A 0 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CL 2723562 12/15/2017 12/17/2017 EACH OCCURRENCE $ 1,000,000 DAMA E TO RENTED u S aroccurtence $ 100,000 II:.. MED EXP Al one . -ron $ 1,000 ❑ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER ❑ POUCY El PRO- • LOC JEGT GENERAL AGGREGATE $ 1,000 000 PRODUCTS - COMProPAGGj$ MI OTHER $ AUTOMOBILE LIABILITY ■ ANY AUTO OWNED ❑ SCHEDULED • AUTOS ONLY AUTOS ■ HIRED El NON -OWNED O BINEDtSINGLE LIMITE $ BODILY INJURY (Per person) $ 80DILY INJURY (Per accident) $ PROPERTY DAMAGE -a ;.a..A $ AUTOS ONLY AUTOS ONLY • • UMBRELLA LIAB um OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ . e • $ E DEO • RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVC N /A ■ PER ■ O;H- E.LEACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I (Mandatory in NH) l it yes, deedibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • EA EMPLOYEE $ E L. DISEASE - POLICY LIMIT $ DESCRIPTION Fundraiser- 1 day OF OPERATIONS / LOCATIONS / VEHICLES Luncheon special event coverage 12/15/2017 (Attach ACORD 101, Additional Remarks Schedule, if more apace is required) CERTIFICATE HOLDER CANCELLATION CITY OF OKEECHOBEE 55 SE 3RD AVE OKEECHOBEE, FL 34974 I FAX 863.763.1686 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) QF © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD