Temp. Street Closing - OKMS Christmas Festival ParadeRule 14-65.0035(1)(c), F.A.C.
Date: 11/7/2018
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
TEMPORARY CLOSING OF STATE ROAD PERMIT
Permit No. 2018-F-191-028
Governmental Entity
850-040-65
MAINTENANCE
12/11
Approving Local Government CITY OF OKEECHOBEE
Address 55 SE Third Avenue Okeechobee, Florida 34974
Contact Person JACKIE DUNHAM
Telephone (863) 763-9821 ext. Email jdunham@cityofokeechobee.com
Organization Requesting Special Event
Name of Organization Okeechobee Main Street
Address 55 S Parrott Avenue Okeechobee, Florida 34974
Contact Person Lynda Powers
Telephone (863) 357-6246 ext.
Email lynda@okeechobeemainstreet.org
Description of Special Event
Event Title OKMS Christmas Festival Parade
Start Time 6:00 PM (EDT) End Time 8:00 PM (EDT)
Event Route (attach map)
Detour Route (attach map)
Date of Event 12/8/2018
Law Enforcement Agency Responsible for Traffic Control
Name of Agency City of Okeechobee Police Department
US Coast Guard Approval for Controlling Movable Bridge
Not Applicable 0
Copy of USCG Approval Letter Attached ❑
Bridge Location
The Permittee will assume all risk of and indemnify, defend and save harmless the State of Florida and the FDOT from
and against any and all loss, damage, cost or expense arising in any manner on account of the exercise of this event.
The Permittee shall be responsible to maintain the portion of the state road it occupies for the duration of this event, free
of litter and providing a safe environment to the public.
Signatures of Authorization
Event Coordinator Jackie Dunham Signature Jackie Dunham Date 11/2/2018
Law Enforcement
Name/Title Major Donald Hagan / Police Major Signature Major Donald Hagan Date 11/2/2018
Government Official
Name/Title Marcos Montes DeOca / City Administrate Signature Marcos Montes DeOca Date 11/2/2018
L
FDOT Special Conditions
FDOT Authorization
Name/Title Lori Benton / DISTRICT PERMIT COORD Signature Lori Benton
Da6e 1'70n1
1
Rule '4-65.0035(1)(c). F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
!1 TEMPORARY CLOSING OF STATE ROAD PERMIT
0
Date: 1" 11 - I Permit No.
Governmental Entity
Approving Local Government Lk t¼/U) 01`€-(.:1100-e.e Contact Person Jac. .e 1)1.thewn
n
Address 55 at.. 'bra 0 Keet.h bee, VL . �j X11'1i,l
Telephone Cii.CD 1(J Lj t"lg2-I • Email _0 l.t-V-1h cYVl @- Q h oP (1K-eec..hok'i e , ec '-vl
8500/0-55
MAINTENANCE
12111
Organization Requesting Special Event
Name of Organization 0I(eX C VILA't I"ICU.. I\'7-)Y't4 Contact Person L.'(v cL Pou..>crs
Address 55 S I & ij''rQ+)- Avet t1tC OKee c(1O6-e e fL. .3L1ci11
;�
Telephone 4' ?J' 351 Lo LL/ (P Email 1 r'1(Z7 fi C.> I eC.V! obey- i1'1(!u 057 1 f ee t ., C�Y-c:1
Ly,JDA G6.eechobee mA, si v-ec'r . vc-c) „j
Description of Special Event
Event Title OK -ill S Cilli (51-111 6 S 4511 v(:(. -i 6..-(C d C.J Date of Event M*=C'Ph a_c) I B
Start Time LQ p ill End Timee� �gjo"VA x'
Event Route (attach map) `0 ,5 e f f fp/ LI Li 1 Novi ovi P'1 "1 Li Li / /V✓ �f '70 Id LLe4)
• > e nd ct-4- 514 r7 r)` LaiI
Detour Route (attach map)
Law Enforcement Agency Responsible for Traffic Control
Name of Agency
US Coast Guard Approval for Controlling Movable Bridge
Not Applicable
Copy of USCG Approval Letter Attached 0
Bridge Location
The Permittee will assume all risk of and indemnify, defend and save harmless the State of Florida and the FDOT from
and against any and all loss, damage, cost or expense arising in any manner on account of the exercise of this event.
The Permittee shall be responsible to maintain the portion of the state road it occupies for the duration of this event, free
of litter and providing a safe environment to the public.
Signatures of Authorization
t t,i•e-.
Event CoordinatorLyricie,— (?('S Signature 92
Name/Title ivii00Law Enforcement- / ���Lv
f .
Government Official
Name/Title 77 dieL'-A^1S run Signature
Signature
'ik66
cite /0
Date /0 it
Date 11/;r//er"
FDOT Special ;'= ditions
FDOT Authorization
Name/Title Signature Date
INDEMNIFICATION AGREEMENT
This AGREEMENT, by and between the CITY OF OKEECHOBEE, FLORIDA,
(hereinafter "CITY") and ) eectiob2e S11'�'.e-F
(hereinafter "APPLICANT"), dated this 11 day of (kb)be r
WHEREAS, APPLICANT desires to hold or sponsor a special event, parade,
festival, or other activity requiring the temporary closure of a state-controlled
roadway in the City of Okeechobee, Florida, and therefore requires the execution
and submission of an application for such temporary closure to the State of Florida
Department of Transportation by the CITY pursuant to regulations of said
Department, and
WHEREAS, pursuant to Resolution No. 88-5 the CITY requires
indemnification by any applicant for temporary road closure before the appropriate
CITY officials may execute such application to the Department.
NOW, THEREFORE, in consideration of the mutual obligations and covenants
set forth hereafter, the parties agree as follows:
1. APPLICANT shall indemnify, protect, defend, and hold harmless the CITY
from any and all losses, injuries, damages, or claims of any nature or type
resulting directly or indirectly from the temporary road closure and the
special event, festival, parade, or other activity to be held on ?lir- day of
De ei , 120 (4 . Applicant shall further reimburse the CITY for any
and all attorneys' fees, court costs or other legal costs incurred by the
CITY as a result of any such losses, injuries, damages or claims.
2. If the APPLICANT is a corporation, partnership or other legal entity (other
than an individual), APPLICANT shall attach hereto a duly executed
resolution, partnership agreement or other document in legal form
evidencing the authority of the officers of such entity to enter into this
indemnification agreement.
3. Upon the APPLICANT complying with paragraph 2 above, the requirements
of Resolution No. 88-5 of the CITY, and any other reasonable requirements
of the CITY, the CITY shall cause the appropriate City officials to execute
the necessary forms to make application to the State of Florida,
Department of Transportation, for temporary road closure.
APPLICANT CITY OF OKEECHOBEE, FLORIDA
BY:-yvtdQ 7'ouou)e rS
TITLE: ge.0 /i ve Ye c fW
BY: r'
TITLE: General Services Assistant
FOR CITY USE ONLY
XX Proof of liability insurance
Corporate resolution completed
XX Other requirements (specify) Indemnification Agreement
REVIEWED BY:
TITLE:
DATE:
General Services Assistant
\NW 2nd $t)
Elm
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SI/ 70 West t SR 70 East
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Parade Float Stagin• Area —'t.. cwethsr
KEY I ( II
NW 3rd St) I
1
5
NE 3rd I�
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3
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1
• Cone
1 Officer or Flagman
(=Detour Sign
—Parade Route
—Detoured Traffic
MOT Plan
Provided by LT_ Bernet
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NNS PARK 57`
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SW PAP4 Si, .
q•D 1
:•1 it
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Parade Route,
Begin at (141 and SW 41h Street proceed to
the 441/70 intersection, turn west on 70.
End at SW 710 Avenue and SR 70,
UP;
qi1 —• .
,,, .iii. : •i... r. _
i,•
till;: Qeeia% • ;1'ii' :d- ,.
Traffic Control shall comply with the Federal
Manual on Uniform Traffic Control Devices
(w &J TCD) and FDOT Design Standards 600 Series.
70
:al ::i1e ;1 Vit tl;'OiS.,.i irtee C:"C
••iiF, •• aTwrd': t
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4 010
Florida Department of
Transportation
801 N Broadway Ave
Bartow, FL 33831
I
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
i'G `���o
.
ACORO'
OKEEC29
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
1013012018
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
ISU Lawrence Insurance Agency
PO Box 549
Okeechobee, FL 34973
Heath Lawrence
863-467-0600
INSURED Okeechobee Main Street
55 S Parrott Ave
Okeechobee, FL 34974
CONTACT Heath Lawrence
NAME:
PHONE 863-467-0600 I FAX 863-467-5142
(AJC, No, Ext): (AIC, No):
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Mt. Vernon Fire Insurance Co
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
CATS NUMBER:
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 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
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MM/DDIYYYY)
POLICY EXP
(MMIDDfYYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
NBP2552460
10125/2018
10125/2019
EACH OCCURRENCE
J 1,000,000
$DAMAGE 100,000
TO RENTED
PREMISES (Ea occurrence)
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL iR ADV INJURY
$
GENERAL AGGREGATE
$ 1,000,000
GEN'L
X
AGGREGATE
POLICY
OTHER:
LIMIT APPLIES
JEOT I
PER:
LOC
PRODIJCTS- COMP/OPAGG
$ Incl
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
AU ODS ONLY
X
SCHEDULED
AUTOS
W
AUUTOS ONLYY
NBP2552460
10/25/2018
10125/2019
COMBINED SINGLE LIMIT
(Ea accident)
1,000,000
$
BODILY INJURY (Per person)
$
$
BODILY INJURY (Per accident)
(Perr accidenDAMAGE
_$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVEN
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y 1 N
/ A
PER
H-
ERH
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
ACORD 25 (2016103)
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