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Temp. Street Closing - Okeechobee Christian Academy Field DayPage 1 of 3 Revised 11/4/16 CITY OF OKEECHOBEE �'.''"""' 55 SE THIRD AVENUE y.Of •O�FcL .44 yam; OKEECHOBEE, FL 34974 vo 71,`, Tele: 863-763-3372 ext. 217 Fax: 863-763-1686 ==- ' 1'/OR TEMPORARY STREET/ ''• 4resea.i•SIDEWALK CLOSING PERMIT APPLICATION Date Received: i i - 2 l - i 8 Date Issued: I' • g - t K Application No: i -0 t ci Date(s) & Times of Event: F'h Cici.t, , Fe.orwtri 15 . , 0 Ic/ _ Information: Organization: O16eech o bee, Ch ri s fico- -4ca.cle rn j Mailing Address: 701 S Parrot+ ,4v'e. Contact Name: f'Yle I i ssa- ! L 40 E -Mail Address: ni k; n a ®GA e 1 in Ai / , (41, • 0 Telephone: Work: 7 3 -30-} Z Home: Cell: Summary of activities: Shu.clni W i I I paoricipcA-4--0.. in Fietc( Dai CO -5C11 00 anGA_ 1 i i 1 I be, nece s so..r of f r` Gh,tctert -iv i''ey, a.r't vJ be Cn scin-q Proceeds usage: Please check requested Parks: Flagler Parks: o City Hall Park o #1 Memorial Park o #2 0 #3 0 #4 0 #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: 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: IC 1 S i-)e11'Yoi-1- Ave ruci- .. 0 veecho bee FL 3(674 Street(s) to be closed: se anci Ave Fon'- 6 E; Cvwl S/re�t fit, SE 7 Sireef Date(s) to be closed: Fri d ay , F-e f j r- o rj / . a019 Time(s) to be closed: 8:0U curl - ):vu pnyl Purpose of Closing: &xc'eh,l of Chi 46rer\ CroSSi rIG_.) -14.1e.- She e.:f an- E se-A0 ,.Oc 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. O. 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. o 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 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. ��� 2 _ 1 t /2/zo _ Applicant Signature Date ••••0 E USE ONLY"" Staff Review 0 Fire Department: � Date: 27/14/M, 09.0kr Building Official: , Date: 11 ° 2 l • I e Public Works: Date: /1 2.7-" % Police Department: 0;1Date: %/ Z7-/ BTR Department: /,! /. Date: / 2(o ' City Administrator: i Date: K/i2R-//-- City Clerk: � dQ��-� „(., Date: 11-21 -IS 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 i l - 7-/a_____ Date Temporary Street and Sidewalk Closing reviewed by City Council and approved t 1 1 -t)-1 - . Date SW 6th Si. SE6thSt SE6thSt OVeeck obeE Chsistiari Acaderrvi Christ Fellowship Okeechobee S= Sth St SE 6th St Goring he rr tzl field i- A"s C 4t SE 7th St (.-.) Good C.7 re co BoarcitnQ Horn: — 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 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) 07/01/2018 POLICY EXP (MMIDD/YYYY) 07/01/2019 LIMITS EACH OCCURRENCE $ 1,000,000.00 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY n N PHPK1819381 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 5,000.00 INSURER E: Philadelphia Indemnity Insurance Company CLAIMS -MADE X OCCUR PERSONAL &ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 _ PRODUCTS - COMP/OP AGG $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PRO- RICPOLICY pl PER: LOC $ B AUTOMOBILE _ X LIABILITY ANY AUTO ATO AUTOS HIRED AUTOS '‘4,/ SCHEDULED AUTOS NON -OWNED AUTOS N N PHPK1819381 07/01/2018 07/01/2019 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ S C UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS -MADE N N PHUB628838 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000.00 AGGREGATE $ 1,000,000.00 $ DED X RETENT ON $ 10,000.00 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER EXCLUDED? ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YNN NIA N WFL 5042021 00 07/02/2018 07/02/2019 WC STATU- X OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 E Professional Liability PHPK1681466 07/01/2018 07/01/2019 Directors & Officers $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) The City of Okeechobee & R.E. Hamrick Testamentary Trust is named as Additional Insured in regards to the General Liability portion of policy. A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/05/2018 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 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 JDA Insurance Group 120 N Federal Hwy #301 Lake Worth , FL 33460 CONTACT NAME: kathy Maloney PHONE e. Extl; (561) 296-0373 FAX No): 5612960392 ADDRESS: kathy@thejdagroup.com INSURER(S) AFFORDING COVERAGE NAIC t# INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURED Okeechobee Chrlstlan Academy 701 South Parrott Ave Okeechobee, FL 34974 INSURER B : Philadelphia Indemnity Insurance Company 18058 INSURER C: Philadelphia Indemnity Insurance Company 18058 INSURER D : Insurance Co Of The West 27847 INSURER E: Philadelphia Indemnity Insurance Company 18058 INSURER F: CERTIFICATE HOLDER CANCELLATION City of Okeechobee R.E. Hamrick Testamentary Trust 55 SE 3rd Ave 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Jackie Dunham Sent: Wednesday, November 28, 2018 11:36 AM To: 'mking.oca@gmail.com' Cc: Gil Culbreth (gil@gilberthasit.com); Mike Hamrick (mhamrick@manateelegal.com); Kay Matchett (kmatchett@cityofokeechobee.com) Subject: Okeechobee Christian Academy Field Day 2019 Your request to close SE 2nd Avenue between SE 6th Street and SE 7th Street on February 15, 2019 between the hours of 8:OOAM and 1:OOPM was approved at the City Council meeting held November 27th, 2018. Please make a note of this since the date of your event is not until February of 2019. Thank you and much success with your annual event for the school children. Ja ckie' Dwi ha wv AGiAni.vuttra wei Secretary City of Okeechobee/ 55 SE Third'Avevuxe Okethitobee4 FL 34974 863 -763 -3372 (Mc ri) 863-763-9821 (Direct) 863 -763 -1686 (Fa/xi) jdunham@cityofokeechobee.com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. i