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Park Use Permit - 2018 March for BabiesCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 e-mail: jdunham(c�citvofokeechobee.com Park Use Permit Permit Number: 003 Date(s) of Event: March 10, 2018 7:30AM - Noon Permit Expiration: March 10, 2018 11:59PM Purpose of Request: March for Babies Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: March of Dimes Foundation Applicant's Address: 112 43rd Ave SW Vero Beach, FL 32968 Phone Number: 863-610-1562 Address of Project: Park 5 Current Zoning: P FLU Designation: Public Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. Please have one fire extinguisher on site per Fire Chief, Herb Smith 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. February 1, 2018 Administrative Secretary Date Page 1 of 3 Revised 3-21-17 CITY OF OKEECHOBEE ' 55 SE THIRD AVENUE %• ,Ar+ `- OKEECHOBEE, FL 34974 te q. 4 Tele: 863-763-9821 Fax: 863-763-1686 lw v. PARK USE AND/OR TEMPORARY STREET/ **-,00 SIDEWALK CLOSING PERMIT APPLICATION Date Received: i9.34i 8' Date Issued: Z -I - i r Application No: /y- 003 Date(s) & Times of Event: 4yt ,/ /0 go/8 #1430At.— I, Information: /12 riiCeH ,o r" D,u is 404,, le p 244,1 _s- sOrganization: Organization:/y(.40I.1 a ir0,K,,,4-. ( P t,(J.z) --lb AI Mailing Address: / qs-o j. eta `yv/r 0 sefr---�e /"OcAE FL 3 47 7-e-/ Contact Name: 61,4,49,( 4 77-7,-&-• E -Mail Address: / d/`y,C-, y fermi ® /Jaunt! C,,„i Telephone: '6 3 - 6 / p -/,14?--- Work: 35-a_- 727 _05-g 7- I Home: bxi- L 7- c/a -- Cell: yrc.) -6/0 - is -6_1_ Summary of activities: $ ' T 7-/-4014,c7 .R� 30 Pclget 14,4,-..eLCO. / _to- lt),09 2 6nd) cs 1 6 /.v, Jh1i , V 1°4le- k S wo Nuci .Z_eclre r/A)4/i ie6 c� T P, -Zr- 49169x>ax rr��.Y .._,) 431- ho ci 6LA .4A ,5" j ft -x_ a) , L -c. , For 6 ,f P kA' Sligd e= ac) 7 4' 01I e L y2-- / Ks i c)E Proceeds usage: 7 7 Z--7---- k � �f /1- jw(i Dr 44141ec,d1 o F''2)/4t Es • Please check requested Parks: Flagler Parks: o City Hall Park o #1 Memorial Park o #2 ❑ #3 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 Ai/j.1-- t%/ -Parcel ParcelID: Page2of3 Revised 3-21-17 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: JY,* Date(s) to be closed: 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. 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, 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 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 permit, 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 in City services. Any such sum not incurred shall Permit. Page 3 of 3 Revised 3-21-17 I hereby acknowledge that I 04-03, concerning the use and duly authorized agent of the regulations, which may be lawfully the issuance Certificate of I1 surance must have read and completed this application, the attached Resolutions the rules of using City property, that the information is correct, and organization. I agree to conform with, abide by and obey all the rules prescribed by the City Council of the City of Okeechobee, or name City of Okeechobee as Additional Insured as well as R.E. Hamrick • t ets or sidewalks. / /c// No.(s) 03-8 and that I am the and its officers, for Tes - rust if cl • : ��i/ APW2111."" i pplicant : ignatu e Date ••••OFFIC USE ONLY•••• Staff Review Fire Department: CDate: 3j -dm. ,20/Y Building Official: C.- di Date: I 1 z4.18 Public Works: VIII, Date: 1-4- ` Police Department: Date: / -3 C. Vdr' BTR Department: r ► a Date: 11241 City Administrator: - Date: Wcr- City Clerk: , i�A 10 %, �. 0�Ti( ¢, Date: a OZI t f i e NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS EVENT FOR PERMITTING. Temporary Street and Sidewalk Closing submitted for review by City Council on Temporary Street and Sidewalk Closing reviewed by City Council and approved AND PRIOR TO Date Date sJjV S Q / 1 o) t) r l vue7 095. any /NA w`ti ;,A PAS atv ,m5 .. , Wy►LA LJ '3 0 c;x� ^ ct f 111r 4c; YJCIPic and oc- •c E tr SW 2ND AVr lirjr LLJ W cn f/) 1-1— t— , — S 2NE) AV Ic-,7) (17)ij. I ci) t, (J) I 3R13 AVE i-- ,... 1— i-.„ . r— • 1— : i— , 1—,1 1-- , 1-- ..... up „co , I-- co a) a • 1— . c‘i cr):! .a kr) ', , P • i 2 SW 4TH AVE (f) tr) ul w1— SW1,47.1 AVE li w 0 Cr ea = tn 'SW 5THi AVE 11 _Iv\il5.1-14.Av,.._.,. SVIr6TH AVE iii 111,SW611TH AVE z ix 1— . 7TH AVE '. 11 ( ' CC a. I (WI r3:11 '4TH cn col . t C7? rttftaite of NI trite 4eijOunce ALOI/TIMID U$EMENT :, r APPI.ICATIOtt ANVAS vn r .n' . { ;; COMCEKN Mo, f j TFIT TEkS 2C1I t ))) .\\, ' r. August a ,. yNu I(� 1,.,,, 4r/.11,, ',„ I�riy 429261 4'i .r,� Ir "419.01 1 ti,KIN 1 14,u•rid Avr laright It SStu,. 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Ing I. )400% 1 r•littt44 ;\ :pn Pfi(;alic,h 701} method id appltc.Afiurr, Inherently Flame resistant tri rirr Warne of fLtnu, IP��F1,4ry 1.1t, ,i , ,"`+iteirt%11'd Hi -Goss ( c ilern rin N4: F-419.01 ) will not , ftp I.talrtit� F;t�.itltill 14) F fcx,r�s . it:,r.c] (3v 114 nwa,td ftp Wirt,r,rny Iwai o. w J' , .. and is good for the lite of tho fabric_ Renewal Ceetiltication unnrcessary (Ado/ anti wntghl of talon White 15-18 oz. psy Description of iiem tor Oliva (1) 20' x 40' Frame Tent Top. Thomas Sciortino Hr^•,• ..r 404,1, ,,., „ 1111.. 4 r • .ry•.,. .r • By Production Supervisor Mr• h•r•by certify this to as a true copy of the origin.' "CERTIFICATE OF FLAME RE$I$TANCR" lsswd to us, '«erielnoi copy" of which hay brim Nirlyd with the Csiiforrrta Stet* Flrr Marshal. tlfge.d by Lori Wdlker .4,i::31k FtGIP-CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/25/2018 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 Aon Risk Services Northeast, Inc. Morristown NJ Office 44 Whippany Road, Suite 220 Morristown NJ 07960 USA CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (NC. No. Ext): (A/C. No.): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED March of Dimes Foundation 1275 Mamaroneck Ave White Plains NY 10605 USA INSURER A: The Travelers Indemnity Co. 25658 INSURER B: Great Northern Insurance Co. 20303 INSURER C: vigilant Ins Co 20397 INSURER D: $1,000,000 INSURER E: INSURER F: CLAIMS -MADE X COVERAGES CERTIFICATE NUMBER: 570070059805 REVISION NUMBER: Holder Identifier : 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POUCY EFF MM/DD/YYYY) POLICY EXP IMM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY 35812529 10/31/201710/31/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X PRO - X JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: B AUTOMOBILE LIABILITY 7352-50-21 10/31/2017 10/31/2018 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY ( Per person) OWNED - SCHEDULED BODILY INJURY (Per accident) X AUTOS ONLY HIRED AUTOS ONLY _AUTOS NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) _ A X UMBRELLA LIAB X OCCUR ZUP71M1676717NF 10/31/2017 10/31/2018. EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 DED X RETENTION 510 000 Products/Completed O $5,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 1871737006 10/31/2017 10/31/2018 x PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER /EXECUTIVEE.L. Y / N N N / A EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) Event: March for Babies Okeechobee County, Location: Flagler Park 5, 55 SE 3rd Ave., Okeechobee, FL 34974, Date: March 10, 2018. City of Okeechobee and Flager Park #5 are included as Additional Insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION 570070059805 Certificate No City of Okeechobee 55 SE 3rd Ave. Okeechobee FL 34974 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Gary Ritter <garyritter23@icloud.com> Sent: Tuesday, January 23, 2018 4:14 PM To: Jackie Dunham Subject: Re: Better Map if you need it Yes she just sent me an email to change and initial so I will try to get down there tomorrow! On Jan 23, 2018, at 4:08 PM, Jackie Dunham <jdunham( cityofokeechobee.com> wrote: Thank you Gary. Still waiting for revision on insurance. Were you able to speak with anyone? <image001.png> Jackie Uu.n.ho m' Aclinimi.strat(we Secretary City ofOkeecho1 55 SE Thi,rd, Avevuice. Okeechobee', EL 34974 863 -763 -3372 (Ma 863 -763 -9821 (Direct) 863-763-/686 (Ecvxd jdunham(a,cityofokeechobee.com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. From: Gary Ritter [mailto:garvritter23@icloud.com] Sent: Tuesday, January 23, 2018 4:07 PM To: Jackie Dunham Subject: Better Map if you need it 1 +}r' jZ Deparimrnt oC the 'I r asury KAY. t RS Internal Revenue Service P.O. Box 2508 Cincinnati OH 45201 308239 MARCH OF DIMES FOUNDATION DAVID HORNE 1275 MAMARONECK AVE WHITE PLAINS NY 10605 In reply refer to: 0248219411 May 29, 2015 LTR 4168C 0 13-1846366 000000 00 00017224 BODC: TE Employer Identification Number: 13-1846366 Person to Contact: Laura A. Botkin Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your May 19, 2015, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in September 1950. Our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Please refer to our website www.irs.gov/eo for information regarding filing requirements. Specifically, section 6033(j) of the Code provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the filing due date of the third return for organizations required to file. We will publish a list of organizations whose tax-exempt status was revoked under section 6033(j) of the Code on our website beginning in early 2011. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours, Doris Kenwright, Operation Mgr. Accounts Management Operations 1 O0D0010 09/24/14 10f< 1 DA DEPARTMENT OF REVENUE Consumer's Certificate of Exemption 85-8012566503C-5 Certificate Number This certifies that Issued Pursuant to Chapter 212, Florida Statutes 09/30/2014 Effective Date MARCH OF DIMES FOUNDATION SOUTH FLORIDA DIVISION 1001 W CYPRESS CREEK RD STE 110 FORT LAUDERDALE FL 33309-1947 09/30/2019 Expiration Date DR -14 R. 04/11 r�8� .60144-110,:k1���y N -�kt is exempt from the payment of Florida sales and use tax on real property rented, transient rental rope ty anted, tangible personal property purchased or rented, or services purchased. IC 2 IDA DEPARTMENT OF REVENUE 11 Important Information for Exempt Organizations 11 DR -14 R. 04/11 1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. See Rule 12A-1.038, Florida Administrative Code (F.A.C.). 2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property, sleeping accommodations, or other real property Is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. s. Noe FAC.) Churches are exempt from this requirement except when they are the lessor of real property o 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account Management at 800-352-3671. From the available options, select "Registration of Taxes," then "Registration Information," and finally "Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480, Tallahassee, FL 32314-6480.