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Temp. Use Permit - American Legion Free FairCity of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763-3372 Temporary Use Permit Permit Number: 19-001 Date(s) of Event: 1-25-19 thru 2-2-19 (5P — 12A Weekdays; 12P — 12A Weekends) Date extended to February 9th, 2019 due to inclement weather Permit Expiration: February 09, 2019 11:59PM Purpose of Request: American Legion Free Fair Property Owner: American Legion Post 64 Address: 501 SE 2nd Street City: Okeechobee State: Florida Zip Code: 34974 Applicant: American Legion Post 64 Applicant's Address: 501 SE 2nd Street Phone Number: 863-763-2950 Address of Project: 501 SE 2nd Street Current Zoning: Residential Multiple Family (RMF) FLU Designation: Commercial (C) Subdivision: 1st Addition to City of Okeechobee Restrictions/Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. NO SET UP OR TEAR DOWN BETWEEN THE HOURS OF 12 MIDNIGHT AND 7:00 A.M. 48 HRS AFTER FAIR CLOSING, PROPERTY MUST BE VACATED. TRASH MUST BE PICKED UP DAILY IN PARKING LOT AT CITY HALL. I citify that I have examined this permit, it is correct and I will abide by its requirements. licant's administrative Secretary REF: .ORD.716, Temporary Structures 0 Date City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763-3372 Temporary Use Permit Permit Number: 19-001 Date(s) of Event: 1-25-19 thru 2-2-19 (5P — 12A Weekdays; 12P — 12A Weekends) Permit Expiration: February 02, 2019 11:59PM Purpose of Request: American Legion Free Fair Property Owner: American Legion Post 64 Address: 501 SE 2nd Street City: Okeechobee State: Florida Zip Code: 34974. Applicant: American Legion Post 64 Applicant's Address: 501 SE 2nd Street Phone Number: 863-763-2950 Address of Project: 501 SE 2nd Street Current Zoning: Residential Multiple Family (RMF) FLU Designation: Commercial (C) Subdivision: 1st Addition to City of Okeechobee Restrictions/Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. NO SET UP OR TEAR DOWN BETWEEN THE HOURS OF 12 MIDNIGHT AND 7:00 A.M. 48 HRS AFTER FAIR CLOSING, PROPERTY MUST BE VACATED. TRASH MUST BE PICKED UP DAILY IN PARKING LOT AT CITY HALL. 1 ertify that 1 have exa , i ed this permit, it is correct and I will abide by its requirements. 0(' pplic. nt's Signature Date PCLttj rB.Lft I.ttL Administhative Secretary REF: .ORD.716, Temporary Structures E stkJod F4r )3 7 0 tes e 0-A.1) e61 R'l Revised 115/18 jd PERMIT APPLICATION STRUCTURES (666) -General Services Department City Hall, Okeechobee, FL 34974 763-3372 ext. 9821 ,,��„yy TEMPORARY USE A {.OF•Okffr �� _ c OTHER TEMPORARY �O • r, Iv:lC T\ . City of Okeechobee 4.._ ;,t 55 SE 3rd Ave, Room 101, -' --” INV Phone: (863) DATE RECEIVED: - 9,8-i ? DATE ISSUED: APPLICATION NO.: EVENT DATE(S) & TIME: FEE: $175.00 Q'lon-Profit/Civic Organization DATE PAID: Name of Property Owner(s)/}p/ elk )C A�� ,� 10,v (Oke eG h of e �A✓ye,q 1'/ las T ' Address: .gyp, S t aquc'/S7 69k eec h D b -0 e-- F/- 3'/9 V4' Telephone Numbers: HomeBCd , 7623 —2.9.6--- Work: Cell: LI LI Name of Applicant:Dj ,' e f F., Fk AJC) // Address: S0 / ,5E ,�N‘e s7- ©k e ec h ©G -� 3 i 75' Cell: 9,3,616- 1-11/-. I 0' `.4. Telephone Numbers: pa, , srl Home•e(,,S-17(.- ,, l 5 Work: Future Land Use Map Desigation: C... Current Zoning Designation: ] ra Legal Description of Property:46T /3 I c'c- 7-S3 / STk, / // l)A Address of Property: 501 Se -and. 91- Please Explain Type of Use: AA ,tJc, ,q- / rip f` 1--,4/ll Briefly describe use of adjoining property- North: F/ R G ,5 1 4-1-,4_,-,0 _ East: OA GOP° fj .57(,) R 5e IO South: fib / r.J 43. West: R74' PO/`/ L5 Other temporary structures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated by a non-profit organizaiton. 2. Camival, circus, fair or other special event operated by a non-profit organization on or abutting their principal use. (*additional information required) 3. Commercial camival, circus or fair in commercial or industrial districts. 4. Similar temporary structures where the period of use will not exceed 30 days a year. The Applicant shall: 1. Submit proof of liability insurance, paid in full covering the period for which the permit is issued, in the minimum amount of $1,000,000.00 per occurrence. 2. Have notarized written permission of property owner, if applicant is not the property owner. 3. Remove all debris within 48 hours of expiration of permit. 4. Submit Site Plan, State Inspection Certificates and submit State Annual Permit * City Staff (Please review the application, attach comments or special conditions). Occupational and.or State License Verification: 4'f� ad, Date: / —,29— /9 /41, Fire Department Approval: r aft/ Date: 0` T r, r7 &9/ Police Department Approval: id !� ',_ Date: -O 9-/9 Public Works Department Approval: ' R Date: 1-2c -15 Building Inspector Approval: Date: 1 •2 . it •fi City Administrator Approval: Date: 174.0 T I hereby False certify that the informati • on this application is correct. The Information included in this application Is for use by the City of Okeechobee in processing my request. o- leading information may be punishable by a fine of up to $500.00 and imprisonment of up to thirty days and may result in the summary denial of this application. / II,. ,/ 4"/ —,28-15 Signature of Applicant Date Revised 1/5118 jd TEMPORARY USE PERMIT APPLICATION STRUCTURES (666) - General Services Department 101, City Hall, Okeechobee, FL 34974 a pm _ r �r4M �1E�=KE, t 763-3372 ext. 9821 54_ i 2,16,‘ Nee, K d/ il .F ,,'=``NC9 OTHER .LLl lit OTHER TEMPORARY City of Okeechobee .4,------=',-4-77.r �55 SE 3rd Ave, Room 'cc"�����"��4 Phone: (863) DATE RECEIVED: l 9-/ f DATE ISSUED: APPLI N NO.: 00 l EVENT DATE(S) & TIM6.41 J? — 2 _ ,L—t FEE: $175.00 Elslon-Proofit//Civic Organization DATE PAID: /et —/?._ , It &4q - Name of Property Owner(s): t) (' E E 64 6,6 _?z -'21%iikt iAt 4H..4-4( ,f)%.Cfo re ,t) 130.5-rcii Address: ,s5 9/ 6 -Eu Nee .r ©kee C'& .e ,e.._ F= NICOLE "NIKKI" FRIED COMMISSIONER Florida Department of Agriculture and Consumer Services Division of Consumer Services/Bureau of Fair Rides Inspection MEGERLE SHOWS PO BOX 310 GIBSONTON, FL 33534-0310 EVENT REPORT Phone 1-800-435-7352; Fax (850) 410-3797 FairRides@FreshFromFlorida.com INVOICE #: 3152039 PURPOSE: Scheduled EVENT NAME: POST 64 AMERICAN LEGION FAIR EVENT ADDRESS/LOCATION: 501 S.E. 2ND ST. EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE OPEN DATE: 01/25/2019 INSPECTION #: 1901-00712 # Rides: 16 # Rides Passed: 16 # Rides Failed: 0 # Rides Not Ready: 0 # Go Karts: 0 # Go Karts Passed: 0 # Go Karts Failed: 0 # Go Karts Not Ready: 0 USAID Theme Name I Status IC/RT # Deficiency OST # Unit 08211 PARATROOPER Pass 204039 08356 BEAR AFFAIR Pass 204040 08357 COMBO Pass 204041 09818 SWING CAROUSEL Pass 204042 09826 'SUPER SHOT (DROP TOWER) Pass 204043 Attachments - CarrierlTubs: Padding missing/damaged 13045 6 Attachments - Restraints: Other 13576 9 10939 CIRCUS TRAIN Pass 204054 11466 MERRY GO ROUND Pass 204055 Attachments - Sweeps: Sweep drive assembly damaged 13605 14 Attachments - Sweeps: Sweep drive assembly damaged 13606 18 Attachments - Sweeps: Sweep drive assembly damaged 13604 4 12172 POCK -N -ROLL Pass 1 204044 Attachments - Carrier/Tubs: Sharp edges 13962 # 7 Operation - Brakes: Inoperable 13393 1 Operation - Brakes: Inoperable 12671 10 Operation - Brakes: Inoperable 13464 2 12260 HANG 10 Pass 204045 13810 MINI JETS PETER PAUL Pass 204046 14339 FUN SLIDE Pass 204047 14704 HAMPTON DUNE BUGGY Pass 204048 14792 SCOOTERS Pass 204049 Operation - Rpm Check: Operational check not performed (ride wonLt run) 12966 11 Structural - Tires/Wheels/Casters: Damaged/excessive wear 13608 13 Operation - Rpm Check: Operations check failed 11711 6 Operation - Rpm Check: Operations check failed 13395. 7 15034 MOTORCYCLES Pass 204050 15035 GO GATOR Pass 204051 15087 GONDOLA WHEEL Pass 204052 LI acknowledge that all identified rides issued a stop operation order (RT #) and/or carriers or components issued an out of service (OST #) are not in compliance with Florida Statute 616.242 and/or Rule Chapter 5J-18, F.A.C. Further deficiencies may still exist and ride(s) shall not operate until it passes a subsequent inspection by the Department. /h4 MpSO/J Ins ;:s Ov4ner/ICianager Run Date: January 25, 2019 2:1 PM Date Page: 1 of 1 ACORD CERTIFICATE OF LIABILITY INSURANCE DAT BALViols 1) 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(les) 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 Allied Specialty Insurance, Inc. 10451 Gulf Blvd Treasure Island, FL 33706-4814 CONTACT NAME: ONE FAX WC. No. Ext): A/C. No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC R INSURERA: T.H.E. Insurance Company 12866 INSURED Megerle Shows LLC; Moegerle's Transport, Inc. PO Box 310 Gibsonton, FL 33534 INSURER (3: CPP0103765-05 INSURER C: 04/01/2019 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : 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. ILTR TYPE OF INSURANCE A ND D SMD POLICY NUMBER (MMIDD/YYYY) (MMIDD/Yl YPY) UMITS A X COMMERCIAL GENERAL LIABILITY CPP0103765-05 04/01/2018 04/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE T PREM SESO(EaENTED occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) S PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER POLICY JET LOC OTHER: PRODUCTS - COMP/OP AGG $ 1,000,000 $ A AUTOMOBILE X LIABILI ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY Y % /\ X SCHEDULED AUTOS NON -OWNED AUTOS ONLY CPP0103765-05 04/01/2018 04/01/2019 (Ea aBccl identj INGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ S A X UMBRELLAUAB EXCESS LIAR _ OCCUR CLAIMS -MADE ELP0011468-05 04/01/2018 04/01/2019 EACH OCCURRENCE $ 9,000,000 AGGREGATE S 9,000,000 $ DED RETENTION S A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFF10ERIMEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCP0004446-013 04/01/2018 04/01/2019 X STATUTE ETPER H E.L EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPT1ON OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Dates: 01/15/2019 - 02/12/2019 Additional Insured: Okeechobee Post 64 American Legion with respect to the negligence of the named insured. CERTIFICATE HOLDER CANCELLATION Okeechobee Post 64 American Legion 501 S.E. Second St. 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. AUTHO RATIVE 54.10 V ©1988-201 CORD CO RPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD