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Park Use Permit - IRSC Recruiting EventPermit Number: 007 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 X9821 Fax: 863-763-1686 e-mail: idunham(c�cityofokeechobee.com Park Use Permit Permit Expiration: April 14, 2018 11:59AM Purpose of Request: IRSC Recruiting Event Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee Applicant: Indiana River State College Phone Number: 863-824-6000 Current Zoning: P Subdivision: City of Okeechobee State: Florida Date(s) of Event: April 14, 2018 10AM-2PM Zip Code: 34974 Applicant's Address: 2229 NW 9th Avenue Okeechobee, FL 34972 Address of Project: Park #2 FLU Designation: Public Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. The Public Works Director requests 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. Three tents being used are 20x40 without sides. Fire extinguishers will be on site. �TaJ4& March 8, 2018 Administrative Secretary Date General Services Department 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: - Date Issued: ,' - Application No: _ Date(s) & Times of Event: y Ml Information - Organization: ive- ST,g7E 601-e, 6c Mailing Address: 4jzltN o�F� c,L/a8�`" I-rl 3,497,2 Contact Name: af-rklAl iT/ E6c -1"60 ,ws« E 2 5C1V E -Mail Address: r-6raw►-n & "yc Telephone: Work: I 863-Y1y6ono Home: Cell: 7�,I-�z8s-99jy" Rummnry of activities: Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park#2 ❑ #3 ❑ #4 ❑ #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is loca ion 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: rV ot«Gc'. SST of TE.v7.s h Es ,mod c >/- o ARa F PRd 04 IN S A -J- T cl' CoLlEG 6410LU till LFS iT/ E6c -1"60 ,ws« E 2 5C1V `: +t ei`T T -sAb 4�D 1466 av x Y Alb 'b' -U0-r 9461E 0i66-5 • F- ti E)L-rj i ►1t & ' r C &Ac 64Li AA, Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park#2 ❑ #3 ❑ #4 ❑ #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is loca ion 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 require City Council approval. Meetings 1" & 3rd Tuesdays but subject to change) Address of Event: Street(s) to be closed: Date(s) to be closed: Time(s) to be closed: Purpose of Closing: Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closines ► Site Plan ► Site Plan ► Copy of liability insurance in the amount of ► Copy of liability insurance in the amount of $1,000,000.00 $1,000,000.00 with the City of Okeechobee as with the City of Okeechobee and R.E. Hamrick Testamentary additional insured. Trust as Additional Insured. ► Proof of non-profit status s of all residents, property owners and ► Original sign;Zected business owners by the closing. ► State Food Service License if > 3 days. ► State Food ervice License if > 3 days. ► Notarized letter of authorization from ► State Alc otic Beverage License, if applicable.** property owner, if applicable.* * Required if private property used in conjunction with ** Alcoholic beverages can be served only on private p Parks, City streets or City sidewalks. See additional ark Use application. iperty. Alcoholic beverages NOT ALLOWED in City below. ❑ Please check if items will be sold on City stre /sidewalks. Each business will need to apply for a Temporary Use Permit 667 along with/umption et Closing plication. Note: ► Clean-up is required wiours. ► No alcoholic beveragesd o City property, streets or sidewalks. ► No donations can be reqf ny type of alcoholic beverages are served on private property/business unlesssess a State Alcoholic Beverage License. Please note there are inside consumption and outsidmption licenses. You must have the appropriate license(s). ► The Department of Pubs will be responsible for delivering the appropriate barricades. ► Dumpsters and port-o-lquired when closing a street for more than three (3) hours. Applicant must meet y insurance coverage and code compliance requirements of the City and other regulations of other movernment6l regulatory agencies. The applicant will be responsible for costs associated with the event, includ/and e f property. By receipt of this permit, the applicant agrees and shall hold the City harmless for any acj ry, claim or demand whatever arises out of applicant's use of location for such event, and shall indemdefend the City for such incident, including attorney fees. The applicant shall be subject to demanpayment of, all of the actual costs incurred by the City pertaining to the event including, but not limitee, Fire, Public Works or other departmental expenses. The City reserves the right to require from an appashier's check or advance deposit in the sum approximated by the City to be incurred in providing City sny such sum not incurred shall be refunded to the applicant of this Park Use/Street Closing Permi Page 2 of 3 Revised 12-11-17 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Motings 0 & 3rd Tuesdays but subject to change) Address of Event: Street(s) to be closed: Date(s) to be closed: Time(s) to be closed: Pumose of Closinel. nts Required for Use of Parks Attachments Required for Street/Sidewalk Closings ► Site Plan ► Site Plan ► Copy of liability insurance in the amount of ► Copy of liability insurance in the amount of $1,000,000.00 $1,000,000.00 with the City of Okeechobee as with the City of Okeechobee and R.E. Hamrick Testamentary additional insured. 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 ► State Alcoholic Beverage License, if applicable.** property owner, 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. ❑ 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 a eg ncies. 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. 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 Trust if closing streets or sidewalks. Applicant Signature Date Staff Review ••••OFFICE USE ONLY**** !il Fire Department: �y� d ri cc t+ti yJf ► �ri c Date: Building Official: Ex•�v+..a Date: •?•! Public Works: Date: Police Department: Date: g BTR Department: Date:,4 % 9 City Administrator: Date: City Clerk: Date: 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 Temporary Street and Sidewalk Closing reviewed by City Council and approved Date Date Jackie Dunham From: Russell Brown <rbrown@irsc.edu> Sent: Wednesday, March 07, 2018 4:58 PM To: Jackie Dunham Subject: Re: IRSC Recruiting Event We will be using 3 tents, no sides on any of them, they will have fire extinguishers with them. 2 of the 3 tents are from OCSO. Sent from my iPhone On Mar 7, 2018, at 4:12 PM, Jackie Dunham <idunham@citvofokeechobee.com> wrote: Will you be using 2 (two) 20x40 Tents or 3 (three) 20x40 Tents? I was looking at your site plan and there appear to be 3 (three). To clarify for the Fire Chief, is it correct that the tents do not have sides?? Lastly, do you intend to have any portable fire extinguishers on site? Thank you. <image001.png> Jackie, -0"'Vl wv Ad.ntii4�a twe, Secret"y CXy of okeech 55 SE 1hi�rdlAveywwl Okeechoixee, FL 34974 863-763-3372 (Madvv) 863-763-9821 (DL+-ect) 863-763-1686 (Fax/) j dunham(a,cityofokeechobee. corn Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. F— CL D ru I C rm Highway 76 X X X X 10 q X X X X X X X X ,5LAJ Parkstreet X X X X 90.X qo X = Table 0 = Tent N D m rm Detail by Entity Name Pagel of 3 Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Not For Profit Corporation INDIAN RIVER STATE COLLEGE FOUNDATION, INC. Filing Information Document Number 709584 FEI/EIN Number 59-1105591 Date Filed 09/14/1965 State FL Status ACTIVE Last Event NAME CHANGE AMENDMENT Event Date Filed 07/28/2008 Event Effective Date NONE Principal Address 3209 VIRGINIA AVE FORT PIERCE, FL 34981-5596 Changed: 03/03/2000 Mailing Address 3209 VIRGINIA AVE FORT PIERCE, FL 34981-5596 Changed: 03/03/2000 Registered Agent Name & Address Neill, Richard V., Jr. 311 SOUTH 2ND STREET FT PIERCE, FL 34950 Name Changed: 01/09/2018 Address Changed: 01/04/2007 Officer/Director Detail Name & Address Title D IRBY, FRANK M 1385 S.E. 23RD STREET OKEECHOBEE, FL 34994 httn://search. sunbiz.org/Inciuirv/CorDorationSearch/SearchResultDetail?inoui... 3/2/2018 Detail by Entity Name Title D ADAMS, MICHAEL L P.O. BOX 12909 FT. PIERCE, FL 34979 Title EXED DECKER, ANN L PO BOX 497 JENSEN BEACH, FL 34958 Title D CLEMONS, SUSANNE H 4853 NW 30TH ST OKEECHOBEE. FL 34972 Title D LEMBO, JOSEPH 940 66TH AVENUE VERO BEACH, FL 32966-1127 Title Director Minton, Michael D. 1903 South 25th Street Suite #200 Fort Pierce, FL 34947 Annual Reports Report Year Filed Date 2016 01/06/2016 2017 01/11/2017 2018 01/09/2018 Document Images 01/09/2018 —ANNUAL REPORT View image in PDF format 01/11/2017 --ANNUAL REPORT View image in PDF format 01/06/2016 -- ANNUAL REPORTI View image in PDF format 01/12/2015 --ANNUAL REPORT View image in PDF format 01/07/2014 -- ANNUAL REPORT View image in PDF format 01/11/2013 — ANNUAL REPORT View image in PDF format 01/04/2012 — ANNUAL REPORT View image in PDF format 01/05/2011 --ANNUAL REPORT View image in PDF format 01/06/2010 -- ANNUAL REPORT View image in PDF format 01/15/2009 --ANNUAL REPORT View image in PDF format 07/28/2008 -- Name Change View image in PDF format 01/08/2008 --ANNUAL REPORT Page 2 of 3 httn-//search-sunbi7_org/lnouirv/CerncrationSearch/SearchResultDetaiI?inaui--- 3/2/2019 Exempt Organizations Select Check Page 1 of 1 Exempt Organizations Select Check Exempt Organizations Select Check Home Organizations Eligible to Receive Tax -Deductible Charitable Contributions (Pub. 78 data) - Search Results The following list includes tax-exempt organizations that are eligible to receive tax-deductible charitable contributions. Click on the "Deductibility Status" column for an explanation of limitations on the deductibility of contributions made to different types of tax-exempt organizations. Results are sorted by EIN. To sort results by another category, click on the icon next to the column heading for that category. Clicking on that icon a second time will reverse the sort order. Click on a column heading for an explanation of information in that column. 1.1 of 1 results Results Per Page 25 v OK I a Prev 1 1-1 1 Next » EIN - Legal Name (Doing Business As) City . State .Country Deductibility Status . 59-1105591 Indian River State College Fdn Inc. Ft Pierce FL United States PC a Prev 1 1-1 1 Next » Return to Search https:Happs. irs. gov/app/eos/pub78 Search.do?ein 1=59-1105 591 &names=&c... 1/25/2018 (ijjsc INDIAN RIVER STATE COLLEGE U ,�oO�E COUNTys � �rI EXC o Okeechobee County DOWNTOWN OKEECHOBEE AT FLAGLER PARK #2 SATURDAY APRIL 14 r" q� Certificate of Flame Resistance F RF Registered Fabric or Concern Number F-12123 Issued By: Trivantage, LLC 1831 North Park Ave. Glen Raven, NC 27217 Date treated or manufactured: 09/16/2013 This is to certify that the materials described below have been treated with a flame-retardant chemical or are inherently nonflammable. FOR: Trivantage, LLC cITY: Glen Raven Certification is hereby made that: (Check "a" or "b") ADDRESS: 1831 North Park Ave. STATE: NC 27217 (a) The articles described at the bottom of this Certificate have been treated with a flame-retardant chemical ii approved and registered by the State Fire Marshal and the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used: Method of application: Chemical Registration #: (b) The articles described at the bottom of this Certificate are made from a flame -resistant fabric or material X registered and approved by the State Fire Marshal for such use. Trade Name of flame -resistant fabric or material used RENTERS CHOICE 16 OZ Registration # F-12123 The Flame -Retardant Process Used Will Not Be Removed By Washing ALBERT E JOHNSON VICE PRESIDENT, BUS. DEVELOPME Name of Applicator or Production Superintendent Title RCN # 100 968340 16 103 968340 16 79 CUSTOMER ORDER NO. FRED / ROAD SAL CUSTOMER INVOICE NO. 266852 YARDS OR QUANTITY 1000.00 DESCRIPTION Renter's Choice Blackout 61" 16 -oz White (Standard Pack 100 Yards) ITEM NUMBER 968340 We hereby certify the above to accurately reflect the information contained within a "CERTIFICATE OF FLAME RESISTANCE" issued to Trivantage, LLC from the registrant set forth above A copy of the original Certificate of Flame Resistance is available upon request to Trivantage, LLC and the registration information set forth above is on record with the California State Fire Marshal. A 1 TENTS AND STRUCTURES MAILING ADDRESS 234 WEST 24TH ST HIAI FAH. Fl. 33010 Al w4firate of Nitune lRes-stance ertt -&-i-e 't -re—& —red a-!- USEMENT PL APICATION ANVAS CONCERN 140. #11 LAA TEITTERS August 2011 #29261 419.01 7- SOW HAima Ave. fart)Par FL 336610 I 900/865-50fA FAx 813/74(? -9370 Thi* i,,; i'o cedify 11r,dl thc� mWe-i'Os desiUribed on U: t certificate have been llaftle- 6, 1 ki d had al W�li rimi; NAME. Okeedho%ee Co §'Aeri s ice .-__­ AT ___ CITYOkeedhbbeSTAl34972- heretw made thal: The articles described on this Gettificate have been treated with a flame-telardant approved chernic;,4; and tri he alicatinn of sald chemical wa-- ed done in con!orrnance with Feral `v peri#icatior! NFA -701pp Method of appi-cation:_tqherent!y_Flame resistant T i arip ramp. of !lame-re-sistan! fahric ,)r majerialrr�ecfHi-Gloss Ghem. Reg. No, _ F-4119-01 The Flame Retardant Process Used will not Be Removed By Wast -ting (wx;" m w ' "t rl()I) and is good for the life of the fabric. Renewal Certification unnecessary. Color and weight of labric, Sunblock White 15-16 oz. psy rne V)Pscription of ;tern cerlified., _112-G1. AD _1__Ef I -aTe-0-t-T—OD Thomas Sciortino Production Supervisor By Name t;f Almlichooe or Pindtiction SuperwifenJen' We hereby certify this to be a true copy of the orig)"al "CERTIFICATE OF FLAME RESISTANCE" Issued to us, "original copy" at which has been filed with the California, State Fire lWarthal. Signed by Lori Walker I SSC INDIAN RIVER STATE COLLEGE • Quick job Training for In -Demand Jobs • Associate Degrees for University Transfer • Bachelor's Degrees for in High Growth Careers Online Programs • Specialized Training for Business Career and Transfer Services Dual Enrollment GED/ESL Financial Aid o�N E X Job Opportunities CTE/Vocational Programs OHS Clubs Early Literacy Program Skyward Family Access Student Resources and Services SATURDAY APRIL 14 T" 11:00-1:00 PM DOWNTOWN OKEECHOBEE AT FLAGLER PARK #2 �oO00ECOU/yrys 1 0 �1 k0 r o�N E X Job Opportunities CTE/Vocational Programs OHS Clubs Early Literacy Program Skyward Family Access Student Resources and Services SATURDAY APRIL 14 T" 11:00-1:00 PM DOWNTOWN OKEECHOBEE AT FLAGLER PARK #2 A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2i28i2018 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 Arthur J. Gallagher Risk Management Services, Inc. 200 S. Orange Avenue Suite 1350 CONT NAMEACT Kelly Nace PHONE Fax 407-370-3057 E-MAIL . Kelly_Nace@ajg.com INSURERS AFFORDING COVERAGE NAIC p Orlando FL 32801 INSURERA:United Educators Ins 10020 J0693Q INSURED FLORCOL-01 INSURER B:Safety National Casualty Corporation 15105 INSURER C :Qualified Self Insurer Indian River State College 3209 Virginia Avenue Fort Pierce, FL 34981-5596 INSURER D: INSURER E: INSURER F: DAMAGE TO RENTEI5__ PREMISES Ea occurrence $ rn%/FRAC=FC rPPTIPIrATF NIIMRFR• 14982703355 RFVIS1t7N NIIMRFR- 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 ADDLISUBR INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY J0693Q 3/1/2018 3/1/2019 EACH OCCURRENCE $800,000 CLAIMS-MADEX OCCUR DAMAGE TO RENTEI5__ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,200,000 PRODUCTS - COMP/OP AGG $ X POLICY F]JECTPRO ❑ LOC $ OTHER: A AUTOMOBILE LIABILITYJ0693Q 3/1/2018 3/1/2019 Ea accident $800,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED ASCHEDULED AUTOS ONLY UTOS BODILY INJURY (Per accident) $ _i5R0Pr1RrY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLALIAB X OCCUR J06930 3/1/2018 3/1/2019 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 X EXCESS LIAB CLAIMS -MADE DED X I RETENTION $1,000,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ SP4058295 3/1/2018 3/1/2019 H X STATUTE ER E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYEE $2,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - POLICY LIMIT $2,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C WORKERS COMPENSATION RMC20180301 3/1/2018 3/1/2019 Self Insured $750,000 AND EMPLOYERS' LIABILITY Retention DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) "General Liability and Auto Liability policies shown above are subject to a self-insured retention of $200,000 per occurrence. Excess Aggregate applies to Products, Completed Operations, Employee Occupational Disease, Sexual Molestation and Athletic Traumatic Brain Injury." RE: Education Showcase (student recruiting event) All dates within the term shown above See Attached... L;tK I It-lt A I t r1ULUtK I .W., City of Okeechobee 55 S.E. 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. REPRESENTATIVE tV TU00-LUTD AL.UKLJ trUKYUK/%I IUN. AN n9m:5 re5erveo. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: FLORCOL-01 LOC #: ACO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. Indian River State College 3209 Virginia Avenue POLICY NUMBER Fort Pierce, FL 34981-5596 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE City of Okeechobee and R.E. Hamrick Testamentary Trust are shown as an additional insured solely with respect to general liability coverage as evidenced herein as required by written contract to the extent of such obligation and with respect to operations by or on behalf of the Named Insured or operations of facilities of the Named Insured or use of facilities by the Named Insured. (form BLX 06). MN Mu ,V, k4VU01V 1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD