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Park Use Permit - Chamber of Commerce Small Business SaturdayCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 X9821 Fax: 863-763-1686 e-mail: jdunham(a,citvofokeechobee.com Park Use Permit Permit Number: 013 Date(s) of Event: November 24, 2018, 8:30AM-3:OOPM Permit Expiration: November 24, 2018 11:59AM Purpose of Request: Chamber of Commerce Small Business Saturday Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Chamber of Commerce of Okeechobee Applicant's Address: 55 S Parrott Ave Phone Number: 863-467-6246 Address of Project: Park #3 Current Zoning: P FLU Designation: Public Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. Tha Publk, Works Doreccttor requests dean -up of a0[I garbage from the event IndudIng emptAng the trash cans ora the pars (s) used and Wadng dean trash can Hner_s on ,pans after the event. J November 15, 2018 Administrative Secretary Date General Services Department Page 1 of 3 Revised 3-21-17 CITY OF OKEECHOBEE 'Ira? 55 SE THIRD AVENUE •o ``� �O�` � .��, , OKEECHOBEE, FL 34974 it T$ Tele: 863-763-9821 Fax: 863-763-1686 _d ,.;.' PARK USE AND/OR TEMPORARY STREET/ +-.,irlai �'� SIDEWALK CLOSING PERMIT APPLICATION Date Received: II 01 118 Date Issued: i i -1 5 -1 Application No: 16-013 Date(s) & Times of Event: ii -;q -u S e=3oA - 3:oao9 Information: Organization: Chamber of Commerce of Okeechobee County Mailing Address: 55 S Parrott Ave. Okeechobee, FL 34972 Contact Name: Mariah Parriott E -Mail Address: info@okeechobeebusiness.com Telephone: Work: 863-467-6246 Home: Cell: 863-801-5324 Summary of activities: Opportunity for Home-based businesses to set-up in the park so they can be a part of the Small Business Saturday celebration just like the Brick & Mortar Businesses throughout the community! Proceeds usage: This is a FREE event for all and is sponsored by American Express and the Chamber of Commerce of Okeechobee County Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 X#3 ❑ #4 ❑ #5 ❑ #6 [Park 3 is location o Gazeb . 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: 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: Pit':/-------- 'Date(s) Date(s)to be closed: Time(s) to be closed: Purpose of Closi 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 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. D 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 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 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 conform 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. Mariah Parriott 11/6/18 No.(s) 03-8 and that I am the and its officers, for Applicant Signature Date •••'OFFICE USE ONLY"" Staff Review Fire Department: Date: //_/6---/ 2 // Building Official:/' ._75/ -``"44 L • — ----.---= Date: 1 • 1 3 ' ,r Public Works: f i" '"""-- Date: f / ` /3' t7 Police Department: Date: Date: Date: d/Sa- 1/ - i5 `I 1l/ /�/ /it ? PIT: BTR Department:9 City Administrator: City Clerk: F r ��� �( 1 Rkt Llam. Date: I (_ jcJ 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 Home -Based Retail X 7 t Z!?K,i,l-1f,i1U IK.lak Dl� IN10n1 • J ic 3 • w; TM C zt 69 .4; • 2018 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT DOCUMENT# Ni 000001 1 900 Entity Name: BUSINESS DEVELOPMENT BOARD OF OKEECHOBEE COUNTY, INC. Current Principal Place of Business: 55 S. PARROTT AVE OKEECHOBEE, FL 34972 Current Mailing Address: 55 S. PARROTT AVE OKEECHOBEE, FL 34972 US FEI Number: 27-4426593 Name and Address of Current Registered Agent: WISE, L PAULETTE 55 S. PARROTT AVE OKEECHOBEE, FL 34972 US FILED Mar 02, 2018 Secretary of State CC3308049916 Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: L PAULETTE WISE 03/02/2018 Electronic Signature of Registered Agent Officer/Director Detail : Title Name Address City -State -Zip: Title Name Address City -State -Zip: VP BURROUGHS, TERRY 55 S. PARROTT AVE OKEECHOBEE FL 34972 T BROWN, RUSS 55 S. PARROTT AVE OKEECHOBEE FL 34972 Title Name Address City -State -Zip: Title Name Address City -State -Zip: S CUNNINGHAM, WAYNE 55 S. PARROTT AVE OKEECHOBEE FL 34972 PRESIDENT TRENT, TABITHA 55 S PARROTT AVE OKEECHOBEE FL 34972 Date I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: TABITHA TRENT PRESIDENT 03/02/2018 Electronic Signature of Signing Officer/Director Detail Date ACO�RL�® V_ CERTIFICATE OF LIABILITY INSURANCE ( DATE (MM/DDIYYYY) 11/7/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAl1ON 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 Pritchards & Associates, Inc 1802 S Parrott Ave Okeechobee FL 34974 CONNAMEACT Sandy Hies sA/� No, Ext): (863) 763-7711 Ira, No): Ac, ritchardsinc.com ADDDRDRESS: shinesC.,P INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Insurance Co. COMMERCIAL GENERAL LIABILITY INSURED Business Development Board ofOkeechobee County, Inc. 55 S PARROTT AVE OICEECHOBEE FL 34972 INSURER B : ZENITH INS CO 18058 INSURER C: 07/20/2019 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : COVERAGES CERTIFICATE 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 NSU RANCE 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 HULL INSD SUER' WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X PHPK1827449 07/20/2018 07/20/2019 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMI r (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER I Y DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ B WORKERS COMPENSATIONOTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y /N OFFICER/MEMBER EXCLUDED? n (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA Z134078202 03/03/2018 03/03/2019 STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Directors and Officers Liability PHSD1353129 07/20/2018 07/20/2019 1,000000 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS ICLES ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ..---- City of Okeechobee is listed as Additional Insured in regards to the General Liability. ' CERTIFICATE HOLDER CANCELLATION City of Okeechobee 55 SE 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. AUTHORIZED REPRESENTATIVE Lowea N Priklu44-a4 ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Mariah Parriott - Chamber Administrator <info@okeechobeebusiness.com> Sent: Wednesday, November 07, 2018 3:00 PM To: Jackie Dunham Subject: Small Business Saturday Attachments: acord_25_2016-03_.pdf; Park Use and Resolutions 7-25-18.pdf; 2018 Non -Profit Filing.pdf Jackie, As I sent before, I have sent a site plan to David Allen and spoke with him about the park use. He was busy yesterday and today is graduating from Leadership Okeechobee! I have attached the documents you need for the park. If you have any questions please let me know and if I hear from David before you do I will call you! Also attached is our most recent Non -Profit Sunbiz Report. We are not a 501c3 so I cannot provide an IRS Determination letter, however this shows our non-profit status. 1Morial7 Farrriotto Office Mainager Chamber ber o fCommercce sof (Okeechobee County 55 S Parrott Ave, Okeechobee, FL 34974 Office: 863-467-6246 www.Ol eechobeeffi sfncss, r,o ri Partner in Florida's Research Coast ,& Florida's Heartland Regional Economic Development pmeont i nkaative Chamber of Commerce fit Okeechobee Cu,o f esearch Coast 1 Jackie Dunham From: Sent: To: Subject: Attachments: Jackie Dunham Thursday, November 15, 2018 4:08 PM Mariah Parriott - Chamber Administrator (info@okeechobeebusiness.com) Small Business Saturday 013 -Chamber Small Business Saturday.pdf Please see your approved Pen -nit for 11/24/18 for Small Business Saturday. Much success! Jack e' Dw'.ha.nv A dmiiin&stratOveiSecretary City of Okeechobee 55 SE Th+;rd,AvevuA.e Okeech keel, FL 34974 863-763-3372 (Maivv) 863 -763 -9821 (D%rect) 863-763 -1686 (Fated idunham@cityofokeechobee.com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.