Park Use Permit - OHS BandCITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tele: 863-763-3372 ext. 9821 Fax: 863-763-1686
e-mail: idunham(a�cityofokeechobee.com
Park Use Permit
Permit Number: 011 Date(s) of Event: Nov. 18, 2018 — Jan. 11, 2019
Permit Expiration: January 11, 2019 11:59 P.M.
Purpose of Request: Display 4x8, 8x8 Cards for Individuals/Businesses
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee State: Florida Zip Code: 34974
Applicant: OHS Band
Phone Number: 863-801-7673 or 863-447-5509
Current Zoning: P
Subdivision: City of Okeechobee
Applicant's Address: 2800 Hwy 441 North
Address of Project: Park #6 (SE Corner)
FLU Designation: Public
Restrictions/Remarks: All debris must be removed within 24 hours of expiration date.
Jack iei
Administrative Secretary/General Services
10/24/18
Date
Page 1 of 3
Revised 3-21-17
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:
10- I I _1
'
Date Issued: /0 --d-ti -1 2
Sia...
Cell:
:
4if -
Application No:
; -,
Date(s) & Times of Event: ,
, IS -2b —
_. A 11
20
•
Information:
Organization: OHS
Mailing Address :2 cb I-1 yvyj i41 N , 0k'2eJ' bbee FL_
Contact Name: (' 1 i nt !.a 1=1am `4 Rhe -IN 1 Wa1� SSW
E -Mail Address: (ot-Flamc 01e . kl2 115. DHS
•
VJ
hrar�l bop s- ers l rnui C tst�
Melaqi VV
Work:
3.,001 •
43
Home:
Sia...
Cell:
:
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SJIA,,1.11Lflj Vl MVY.....vu.
'}� i r l S- -J- i day
LI ' y q' p14 tZ k)A1 boa rct � 61q n5 -Fd r air-147)11S-
Grreei i +0 -t-he CvrnM vn
4S
`l Ha I?'dicui Gird 11 I n +be Park
Pro:tecd-
Proceeds usage:
per fcAl.QP..3'l ; S-�'uder4--�' -�'or
i lAn orM< -'cue' -the 3rDL.) V1q (�j��r►
Please check requested Parks:
Flagler Parks: o City Hall Park o #1 Memorial Park o #2 o #3 ❑ #4 o #5�
[Park 3 is location of Gazebo. Park 4 is location of Bandstand] SesNe c 1�
(If other private property used in conjunction with this Park Use Permit please provide the address-afid
parcel number below along with notarized letter of authorization from property owner)
Additional Addresses, if applicable
Parcel ID:
Page 2 of 3
Revised 11/4/16
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:
Date(s) to be closed;
Time(s) to be closed:
Purpose of Closin
Attac
h ents Required for Use of Parks
► Site P
Attachments Requ
► Site Plan
ed for S
eet/Sidewalk C
0
gs
► 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
tter)
ate Food Servic
cense tf > 3 days.
Notarized letter of authorizf
o owner, ifa. 'cab e.*
on from
► Original signatures of all residents, property owners and
business owners affected by the closing.
► 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.
a 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 ofthe 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.
Page 3 of 3
Revised 11/4/16
I hereby acknowledge that I have read and completed this application, the attached Resolutions No.(s)
04-03, concerning the use and the rules of using City property, that the information is correct, and
duly authorized agent of the organization. I agree to conforrn with, abide by and obey all the rules
regulations, which may be lawfully prescribed by the City Council of the City of Okeechobee, or
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. '
i01 RIPS
03-8 and
that I am the
and
its officers, for
Applican Signature Date
OFFICE USE ONLY••••
Staff Review /
Fire Department:
7'
Date:
Date:
0 e-TA191. F
4C>%15• It)
Building Official:
i &
Public Works:
Date:
/0- I 7- 1 J7
Police Department:
Date:
BTR Department:
City Administrator:
17VNOUZ
Date:
lo othg
Date:
City Clerk:
.
(1fIM�
.
Date:
PRIOR
10 1( (.01 (e)
AND
TO
NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED
RETURNED TO TILE 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
Date
Date
CRAIDOla 12/21/10
Consumer's Certi mate. of Exemption
oeued ,t
pter 212,1FlOr1da.S
DR -14
01/18
85401222490-3
.0413012018
r413,0/202
C.OtJNTY OVERNME14T
Certificate, Ntyrbei.,
This -certifies that.
Effediv0 bate
'OKEECHOBEE COUNTY.PUBLIC SCHOOL DISIRICt
700.5VII.NDAVE
OKEECHOBEE FL•34874-5f1?
EXPitian Gatd
Is exempt/turnthe payment:of Florida sales andUse tax en reat property rented,transient rental property rented, tangibre
persthal.propertypurchased'orrepteid„or seryiceSPurchased.
FLORIN.
important Information for Exernpt Organizations
' DR -14
R. 01/18
1. You mustprovide all vendors and suppliers with en exemption certificate befbre Making tax-exerhot purchases..
See Rule 12A-1.338, PloridaMrnInietrative0ode (F.A.0.).
2. Your Consumer's Certificate of ..itvmption is to be used soiety:by your organizationfbryour organizetiont'
' customary. nonprofit actIVIties:
3.. Purchases Made by an individual on behalf ofthe organization are taxable; even If the individtietwill be
reiribursed:by the.ongahrtation.
4.. Thts-exemptlon spokes only to.purohases yourorganlzatlon makes, The sale.or leaSelooth&s.of.tarigible
peracinaf property. sleeping accommOciatiens. or other real prOpertyis taxable. Yourbrgenization rriust register
and cofiect and rernit.101es and taxbn suchtaxable transactions. Note: Churches are:exemptfrom tbfs
yagt,ifrerri_pnst xcept when they are theisissor of real property 'cRule 12A4.07.0,.
5. lt.ie acrirninal offAnse to traudijlently present this, certificate to evade the payment 'of sales tax. Under.rio
clrourristanoesshouldihis,cerlifiCata.beused fOF the.persbnal lOehefit of any InclividUat, Violators will liable tor
payrrientotthe.sales :tax plus-apenalty of, 200% eine tax, and maybe subject to conviction.a a. thlrd-.degree
fetony‘ Any Violation will requIrethe.nevocatfon ofthis:certlficate.
6. If Y,C16.have queStions about your exemption certificate, please. call TaxpayerServices at 850-488-6800. The
mailing address Is PO Box 84.80,.Tallahassee, FL 32314-648,0.
CORD
CERTIFICATE OF LIABILITY INSURANCE
Page 1 of 1
DATE (MMIDOIYYYY)
10/04/2018
Ttf13 CERTIFICATE I3 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 ho tder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions
0 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.
this certificate does not confer rights to the certificate holder In Ilou of such endoreement(s).
r be endorsed.
A statement on
ARODUCER
Willie Administrative Sosvioes Corporation DHA Willie Peeling
c/o 26 Century Blvd
P.O. Box 305191
Nashville, 'N 972905191 USA
CONYA
NAME:
PRONE
(Alp No. Ext
ErXML certil
AOORE33:
7-945-7
c
Orilla
INSURER(,) AFFORDING COVERAG
IC
INSuRERA; Florida Sehool Hoards Inlluranon Truet
D277
INSURED
Okeeohohoc County School District
Attn: Chris Lawrence
700 SW SooOnd Avenue
OkweOhobee, FL 5E974
INSURER B t
URER C :
URER t
3NSUR!R E
INSURER F
COVERAGES CERTIFICATE NUMBER: W9339363 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY
APO Type OF INSURANCE SABR POLICY POLICY !FI'
LTR e
babe V/JO jywDDrrYYTI (MMIDDIYYVYL
X
COMMERCIAL GENERAL UABILrrr
CLAIMS -MADE J X I OCCUR
GEN'LAGGREGATE UMtT APPLIES PER;
POLICY PRO -
LOC
OTHER:
AUTOMOBILE UABIUTY
ANY AUTO
— OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
UMBRELLA LIAR
EXCESS LIAR
SCHEDULED
AUTOS
NONAWNED
AUTOS ONLY
OCCUR
CLAIMS -MADE
DED
R6TENT ON$
FSHIT18CAS7-1
07/01/2018
07/01/2019
UMITS
EACH OCCURRENCE $
PREMISES (Ea occurrence) $
MED EXP?ny one peraan)
1,000,000
Included
Excluded.
PERSONAL 8 ADV INJURY $
Inoludod
GENERAL AGGREGATE
$ Unlimited
PROD
T
COMP/OP AGG S Included
1
COMBI. INOLE s
IEn ecodent)
BODILY INJURY (Per person) S
BODILY INJURY (Per
P•.- RTYDA'A€
(?or rJdenl)
$
EACH OCCURRENCE
$
$
AGGREGATE
$
WORKERS COMPENSATION
AND EMPLOYERS' LIAa1LITY
ANYPROPRIETOR,PARTNER/EXECUTIV E
OFFICER/MEMBEREXCLUDED7
(Mandatory In NH)
If yea, deacntM under
DESCRIPTION OF OPERATIONS below
YIN
NIA
STAT
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE • EA EMPLOYEE $
El. DISEASE • POLICY LIMIT $
DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached If more space le required)
$or the General Liability policy, General Aggregate is Unlimited.
Evidence or coverage in respect to the Okeechobee High School Band having Holiday Stroll in the Park from November 15,
2018 thru January 8, 2019.
The display of 4X8 and 8X8 billboards for individual business. She billboards will be located at the 8E corner of Dark
VE
CERTIFICATE HOLDER
CANCELLATION
City of Okeechobee
55 SE 9rd Avenue
Okeechobee, FL 34972
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZEDREPRESENTATNE
ACORD 25 (2016/03)
019B84016 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
sk rD, 16052905 EATC4; 897219
Jackie Dunham
From: Cheryl Worlow <ohsbandboosters18@gmail.com>
Sent: Friday, October 26, 2018 4:27 PM
To: Jackie Dunham
Subject: Re: OHS Holiday Stroll in Park 6
Attachments: image001.png
The dates are okay. Thank you for your assistance
Cheryl
On Wed, Oct 24, 2018 at 9:06 AM Jackie Dunham<jdunham@cityofokeechobee.com> wrote:
Please find attached your approved permit for the upcoming Holiday cards in Park 6. I noticed your General
Liability Insurance certificate indicates the dates to be November 15`h thru January 8, 2019 which differ from
the dates on your application you submitted which are November 18th thru January 11, 2019. Your permit was
approved for the latter dates. If that is not correct please let me know.
Thank you.
Ja.ckl e.Du.nha m'
AclAnixti,stratwei Secretary
City of Okeechal>eei
55 SE 71114rd Avevuce,
Okeechol, FL 34974
863-763 -3372 alca,v0
863-763 -9821 (Direct)
863-763-1686 (Fc140
)
j dunham(cr�cityofokeechobee.com
Website: http://www.cityofokeechobee.com
NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.
1