The URL can be used to link to this page

Park Use Permit - Pan-Florida Challenge Bicycle RacePermit Number: 005 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 e-mail: ldunham(a)cityofokeechobee.com Park Use Permit Permit Expiration: March 11, 2018 11:59AM Date(s) of Event: March 11, 2018 7AM — 1 PM Purpose of Request: Pan -Florida Challenge Bicycle Ride Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee Applicant: Pan Florida Challenge Phone Number: 239-293-6521 Current Zoning: P Subdivision: City of Okeechobee State: Florida Zip Code: 34974 Applicant's Address: 2097 Trade Center Way Naples, FL 34109 Address of Project: Park #6 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. ��, 4.,e/ February 9, 2018 Administrative Secretary Date Page l of 3 Re%i 12-11-17 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 PARK USE RIND/OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: j 1 -5 -IF I Date Issued: 9- I fl A lication No: ( - � Date(s) &Times of Ecent: � 1 information: Organization: i Mailing Address: 20q r ' r Contact Name: -� E -Mail Address: , —Telephone: Work: ; I Home: ; Cell: 2.3 - Summar%- of activities: t' ►I ti Proceeds usage: Please check requested Parks: Flagler Parks: c City Hall Park =1 Memorial Park a =2 1: _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: Pace 2 of 3 Revised 12-11-17 TEMPORARY STREET AND SIDEWALK CLOSING INFOILNIATION (Street Cloringn require City Council approval. Meetings I" & 3`d Tuesdays but subject to change) Address of I :vent: Strcet(s) to Ix; closed: �Q I)atc(s)to he closed:_ i I'intcis) to he closed: I'urltose o�i�tg; N 1 Pt Attachluenim t2tanuirnil fitr Ilan of Parbe A!lanh-la Dai. f rna- Cfrmf/C:rinu•nIL- i'Incinne -' _► Site Plan C\alN\.a■■aa\r{a{J 1\L Ya■LY ■V■ vaa a.a. a. vaua. ,. a{a{\ �. ► Site Plan ► �'opy of liability insurance in the amount of ► Copy of liability insurance in the amount of S 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.** Properiv owner, if a licablc.* 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 apple 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). ► 'rhe 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 Cite 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. o i 1 hereby acknowledge that I have read and completed this application, the attachod Resolutions \0.0 0 ,--S and 04-03, concerning the use and the rules of using City pmpert-t. corm t. that the information is cort, anal thm 1 am tit: duly authorized agent of the organization. I agree to contbrnj NN ith, abide bN and .,tvN all the rules and regulations, which may be lawfully prescribed by the City Council of the Cite of 0k,*Lxv hoNvt Or its o is i t , for the issuance Certificate of Insurance must name City of Okeechobee as Additional Insured as "ell ar RX. Hamrick Testamentary Trust if closing streets or sidewalks. Applicant Signature Staff Review Fire Department: Building Official: Public Works: Police Department: BTR Department: City Administrator: City Clerk: fr.4- I& 1 Date 0000OFFICE USE ONLY••'• Date: _ .Q ? Ar -b '2ffl1R I��_ _Dart•'--•-� �J ' ��J Date: Date - Date: • (✓+- t— i Date: 2151" ' Date: NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE CONIPLETF.D AND RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (3t)) DAN'S 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 Datr Date -LAN LOA ^CSLr_ C'v .4 '�. •, tom:.%it - AW j 31;S1L'.bY3 t { r f I • . 1�-L , 14 - ':;G34at113S� , 11{'°K:em.i . y '�.�Jh �t.t �S �i1t –"- r+ +. L '' f. •t•1 �.� �y�` f� V '� �—.� ` i +� !� P ' - "C--h�c�y � Y , 'i _f �f••-•,�rl -'� y..y �-:-...._-.r-v�..r _ �r __— - 40 r� .�: . Wx ry y r per" t �4 rwj _ 1 r Wr i {� l ;. - - - • V • i a � r fi'i � x t. �t {>}`' . i.�, _fir �"i ', ��•, ♦ - •, •.,,JS, x: 'd ..'moi �� ri '��' ,._rI`-`.,f � I�r _• MMER 11 fi . f ;ki4: 4, N- FIAI, it W !. :z w'j'av7 ;4�J{';:3�x �.., °�5' �l�?!� ; 6:/; f'�{ • is ILI PAA K CERTIFICATE OF LIABILITY INSURANCEOAICNWHYYYYY) 2/5/2018 11418 CpRTIrICAlP UI 188URt) AS A MATTEN Or Im'ORMATION ONLY AND CON►ERB NO RI0IIT8 UPON THE CERTIFICATE HOLDER. THIS CrR1IrICAT11 DOf.A NOT AfFORMA11VEtLY ON Nf;OA11VrLY AMEND, EX1EN0 OR ALTER THE COVERAGE AFFORDED BY THE POLICIES "IOW. 11403 CrR11fiCATQ Or INBUNANCf! DOPS NOT CON8111U1E A CONTRACT-EIWEEN THE ISSUING INSURER(S), AUTHORIZED RGPRF81'NTAT1Vr OR PRODUCRR, AND THE CENIIFICATE 1101-8-. iMPON1AN1; 11 Rhe cerilhcsle holder Is an AD-I110NAL IN3lIRE-, the pellcy(Ns) mltel Its olldoraocl. II SUBROGATION 19 WAIVED, snlhJoct to -he Urtne and conditions of the policy, certain Policies may relpllre an endorsement. A slatamant on this corillicalo duos not confor rights to tho rarx,urra 30110ghar I.1119"It InsufAnca • foil Mynis 12fWA Wolld f IarA I Ann llktg 73 'Orl Myers I L 33001 *•soar" Ilan f loud* Challalvo. Inc 1400 Gull Shote tllvd N. N 1110 Naples r L 34102 PANE I.OR-01 CrRTIrICA7P Nt1MRr a. 103110!'128 N);s`&" Mildroll Krntijnlls �AI�� rNl 23-4182114 jAIC. Nor: 23rD -9313-8288 tuiwr'�ss: can INeURTR(j) ArrOMINNO COVI'MOE NAIL • 011UNItR A � Phdmdelphln Indemnity Ins Co 18058 RrrUIIrR R eIwNTR C erluarR n e1e11Rr11 K; 73YIC1TiT�P H I?.l :T d: t IIlls K-10 CI 11111 Y IIIAI till (YX ICII !i Ill IN!,IIIIAN('I 115111) 111 (OW IIAVC 111 I N [WAII h IU IIIC IWWRLO NAMLD AIIOVE rOR THE POLICY PERIOD INOICA111) NOIW III%IANIXN4 ANY 111 W11111 MI NI. 11 RM Om CONOIIION Or ANY (;ONtRACr OR Otii[H DOCI1M17Nr WIIII RESPECT TO WHICH THIS Cl RIII ICAiI MAY 111 INV III 1) OR MAY IN WAIN. 1111' WWRANCl- Al' I OROI D BY 11117 Pel lclr.s DUSCRIl11 U IICRIAN IS SUBJECT TO ALL THE TERMS. t XCl IJ%ION3 AND C.ONDIIInN!t nl r.IICII POtICII S I IMli S SIIOWN MAY 1IAVI. III I.N RI DUCI D IIY PAID Ct.AIMS wa Ann! s1mR ra ICY rrr M ICY rxr �fe; Tire or t*sll*ANcr Win!ti]fy+uMe_tn ;� LIMITS A X comWMCIAI UtWRAI llAeallY PHPK1ee03n I10/11!011 10/112010 rAt:nOccuRRrrx:r- s1,000,000 i I VI AIM% MM R x I Orkilk I I nAMA(CTORfNTCD 1'RLM15LS ll. occurrence) =1410.000 Mt n t X11 (Any mr CnstAq $ 5,000 01 R!A*AL A AW INA RY 3 1,000.000 !111!1 AWAlflAtt t,MItAPMIeePrR Or. NE RAL AGGREGAIr $2.000,000 X P(_4 0.1 , i )IV, I IrR: PROnUCtS-COMPILR`AM, $2,000.000 -- oils* $ AYTOMOeaaLlAaa$rt (f••axxwIII j $ _ ANY AU10 DWLY INA WY (f`w p,us0„) $ wMu/l�f(.IAe "LY INAIItY(flat wrridoN) •A,ILUNr1POtAW'6'00 HWDAUTos Au PROPERTY t)AMACE_--- pwArtwtw,x) $ A x MMNOWAL08 x PHUsssasss 181112011 1011/2010 rAC110MIRRCNCr $5.000.000 100108" AWAt* ACGREGAtr$5,000.000 __ X t r 10000 s NIOIet"acounnunm I SIAIUIL LR �... AfWeMnorr*s•wss�rY R _ ANr roco-mr rtarA*INI*1 smulr r. MIA t L CACtIAcciocNt $ UA1K.IaMIM*tM11tl IXd UI �J iM•waMNr M *N) C L MrASE - EA EMPLOYE $ ir ,ref! R "n2 - - ,r20 -r 1, �,►r, *At EL DISEASE -POLICY LIMIT s oe sun.rloN or oPr*ATloffs / LocArloNs (vrlean IAco*o 1171, AMMIwn•1 a.ar.►• e•Ird,Y•, m•T b•.N.•h.d r awn .P.c. a afyux.al Date Of Event, Match 11th, 2018 The City of Okeechobee is listed as an Additional insured with respect to General Liability. '�8E ftwd� C)kewivibee rL 341114 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. &e tD 1888.2014 ACORD CORPORATION, All rights reserved. ACORD 26 (2014181) The ACORD name and logo ars registered marks of ACORD INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: DEC 03 2015 4tl DEPAR v r: D: r.?iti5: _Y Q�-------- ft oyer Identificaticn Num=;er: 47-2993766 DLN: PAN FLORIDA CHALLENGE INC 11053274318045 C/O AARON A FARMER Contact Perscn: 999 VANDERBILT BEACH RD STE 503 MITCHELL P STEELE :C= 313EC NAPLES, FL 34108 Contact Telephone Nu.:ber: (877) 829-5500 Accounting Period Ending - December 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990/990-Ez/990-N Required: _ Yes Effective Date of Exerptien: Decerher 10, 2014 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: We're pleased to tell you we determined you're exenpt _'rix federal inane tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors car. deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve cruesticns on }cur exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. we deterai ed you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Fo 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990 -EZ) or electronic notice (For-= 990-h, the e -Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be autcKatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter '4221 -PC' in the search bar to view Publication 4221 -PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirene-nts. Letter 947 ACOR" CERTIFICATE OF LIABILITY INSURANCE ATE D02/08/2018DnYYY) 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 Marsh USA Inc. One Towne Square, Suite 1100 CONTACT NAME: PHOE AX A/NC,No Ext): aC No): Southfield, MI 48076 Attn: detroit.cerlrequest@marsh.com ADDRESS: 11/03/2017 11/03/2018 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Safety National Casualty Corp. 15105 5212--GAWU-17-18 INSURED .United Site Services of Florida, LLC INSURER B: N/A N/A INSURER C: N/A N/A 3540 Burris Road Davie, FL 33314 INSURER D: INSURER E: AUTOMOBILE X INSURER F : COVERAGES CERTIFICATE NUMBER: CHI -008905101-02 REVISION NUMBER- 3 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx] OCCUR John C Hurley GL4057787 11/03/2017 11/03/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC [:_] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CAS4047369 11/03/2017 11/03/2018 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N ❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A LDS4047370 11/03/2018 X PER oTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requ d) City of Okeechobee and Pan -Florida Challenge are included as Additional Insured on General Liability where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 55 SE Third Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okeechobee, FL 34974 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. John C Hurley @ 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Jackie Dunham Sent: Friday, February 09, 2018 10:25 AM To: jessica@panfloridachallenge.org Cc: David Allen; Herb Smith; Lalo Rodriguez (Irodriguez@cityofokeechobee.com); Stevie; Chief Peterson; Major Hagan; Lt. Bernst Subject: Permit for Pan Florida Challenge Attachments: 005 -Pan Florida Challenge.pdf Tracking: Recipient Read jessica@panfloridachallenge.org David Allen Herb Smith Lalo Rodriguez (Irodriguez@cityofokeechobee.com) Read: 2/9/2018 11:57 AM Stevie Chief Peterson Major Hagan Lt. Bernst Robert Peterson Read: 2/9/2018 10:50 AM Read: 2/9/2018 10:25 AM Attached is your approved permit for your upcoming event on Sunday, March I 1 th, in Park 6. If you need anything further please let me know. Much success with your event. Jackie., D wi l� Admi.*V10rarL ve1Secreta*-y city of okeechol� 55 SE 77iird/Avena& Off, FL 34974 863-763-3372 (Maivv) 863-763-9821 (Direct) 863-763-1686 (Fax) j dunham@,cityo fokeechob ee. com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1