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Park Use Permit - OKMS Christmas Festival Part 2CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 ext. 9821 Fax: 863-763-1686 e-mail: jdunhamcityofokeechobee.com Park Use Permit Permit Number: 023 Date(s) of Event: December 15, 2017 5pm — 7pm Permit Expiration: December 15th 11:59PM Purpose of Request: OKMS Annual Christmas Festival Part 2 Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Okeechobee Main Street Phone Number: 863-357-6246 Current Zoning: P Subdivision: City of Okeechobee Applicant's Address: 55 S. Parrott Avenue Address of Project: Park 4 FLU Designation: Public Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. Reminder: Main Street responsible for emptying trash receptacles and replacing with new liners per Public Works Director. _Tacki&Dccnhum/ December 14, 2017 Administrative Secretary Date Page 1 of 3 Revised 12-11-17 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: /,t_iz--i7 Date Issued: /1-74-17 Mailing Address: 5—. Application No: / .7 -0).3 Date(s) & Times of Event: bee. 1 ,ib_ P- ('> , --7,p, Information: Organization: x('10 x ,�,�i--am®yit yd. 5 -eW- �iif . Mailing Address: 5—. - {pme,6,0,. -4/ St -6) -7a - Contact Name: o✓ICrl-0.4 1 1+ E -Mail Addrec-s: - rviA4hn,n," okierkir.�eerri4t.)S-he .C(P. Telephone: J Work: d/J .357' /4,./,(4 Le Home: Cell: (113 • to.3 dLeciq Summary of activities: � )S CVfI iS4irL^t-S S71VCt1 (pzJ �}�2� �6 .5)0'1") 6-16-1w- - ey n,�l/F ; ✓44.0, ee/4,(Zo b2doivi_A7L- -21/41 91-e_(-%-e7i_P764_76z-J71-zi 14ad totif Procee usage. !JO ;11 (tl ' - td €4.44, . dri-A 4( kelA Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 n #3 5#4 ❑ #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is location of Bandstand] (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 12-11-17 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings re uire City Council approval. Meetings 1st & 3rd Tuesdays but subject to change) Address of Event: S.}LY i C 7Lrti wLC 1ti el&tJt 2, /7iCilte.of Street(s) to be closed: Date(s) to be closed: iii r C 1_ - ��, Time(s) to be closed: �/ O U V 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 ► 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). O. 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. OKEEMAI-01 SFISHER 1 acoRO CERTIFICATE OF LIABILITY INSURANCE �� DATE (MM/DD/YYYY) 07/10/2017 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 '—'.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE 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). 'RODUCER laury, Donnelly & Parr 4 Commerce St. Ialtimore, MD 21202 CONTACT NAME: PHONE (A/c, No, Ext): (410) 685-4625 FAX No):(410) 685-3071 E-MAILDSS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Transportation Insurance Services, Inc 20494 NSURED Okeechobee Main Street 55 S. Parrott Avenue Okeechobee, FL 34972 INSURER B : INSURER C : INSURER D : $ 1,000,000 INSURER E : INSURER F : CLAIMS -MADE • 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 VNTH 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. NSR LTR OF INSURANCE ADDL INSD SUBR W VD POLICY NUMBER (MPOLICY EFF M/DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X 4025933977 07/01/2017 07/01/2018 DAMAGES(Eao TED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY S 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: S .UTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO BODILY INJURY (Per person) S _ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ _ HIRED _ NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) $ AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION STATUTEPER T OOER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y! N E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N ! A E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requl ed) Certificate Holder is an Additional Insured. CERTIFICATE HOLDER CANCELLATION City of Okeechobee and R.E. Hamrick Testamentary Trust 55 SE 3rd Ave, Oke 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3 r C O r Page 3 of 3 Revised 12-11-17 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 Testamentary TrustAi — s or sidewalks. < f __ - - 1,7 12-- lr--- Applicant Signature Date ••••OFFICE USE ONLY•••• Staff Review Hike Hike Department: � .62 Date: ld- /5.47 Building Official: Date: 'M •'7 Public Works: I Date: /Z' I Z-17 Police Department: Date: /Z./,_0? V;aC. Mr Department: , 1 ; ,/j ti►- Date: 7 /8bp-A,160 City Administrator: t% Date: / /7/g).-- City Clerk: •' 4 ?wh (k T :4__. Date: 12_ i3 -11 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