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Park Use Permit - OCSB Free Movie in parkCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 e-mail: idunham(a�citvofokeechobee.com Park Use Permit Permit Number: 009 Date(s) of Event: June 21, 2019 8:30PM — 10:O0PM Permit Expiration June 21, 2019 11:59PM Purpose of Request: Free Movie for Community Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Okeechobee County School Board Applicant's Address: 700 SW 2nd Avenue Phone Number: 863-462-5000 X1041 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. Clean-up of all garbage from the event including emptying the trash cans in the park(s) used and placing clean trash can liners in cans after the event. Ensure emergency vehicles have access to site and fire extinguishers are on site or available nearby. Electrical wiring exterior rated, not overloaded. ,_Tctck/Ce' June 18, 2019 Administrative Secretary/General Services Date 1,`.4, .(0.004, + `•�� 0. 00 � ..: a�. .�: �_� , , ���� Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE 55 SE THIRD AVENUE ` OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 PARK USE AND/OR TEMPORARY STREET/ .-ate, ,70 SIDEWALK CLOSING PERMIT APPLICATION Date Received: 4/i/ /I s;;ofr Date Issued: Application No: /4 -e; 0 9 Date(s) & Times of Event: 3-1 147 : i s PAA - i c : v Information: //�� Organization: Otee J h z c an Jokii i 1»aJ' Mailing Address: o6 (A f ?, /1"i.C, , Contact Name: (Ja "ed E -Mail Address: flue( rt�(p Q d+L. 16/ 2-, -h. w Telephone: Work: gQ3 . (A,/ - db Cell: ,, //Horne: Summary of activities: x l a T% r -€ "KAY/ to %fur 4___de.441.01444 .i b'it Proceeds usage: d A L Please check requested Parks: Flagler Parks: o City Hall Park o #1 Memorial Park o #2#3 [Park 3 is location of Gazebo. Park 4 is location of (If other private property used in conjunction with this Park Use Permit parcel number below along with notarized letter of authorization from property Additional Addresses, if applicably, _ Parcel ID: ❑ #4 0 #5 ❑ #6 andstand] please provide the address and owner) Page 2 of 3 Revised 3/5/19 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION . (Street Closings require City Council approval. Meetings 1St & 3`d Tuesdays but subject to change) mart U -' Address of Event: "ft Street(s) to be closed: t\e f .€ Date(s) to be closed: Noe Time(s) to be closed: IV b 4, 6 Purpose of Closing: %46 V ft, 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;xnsured. 10-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 ofnow.Profit.status ► 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. 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 3/5/19 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 Certific to of Insuran : must name City of Okeechobee as Additional Insured as well as R.E. Hamrick Testan • r . Trclos;ng streets or s ewa ks. eif1W/7 il- f'_- Si atureDat pi1int � e ••••OFFICE USE ONLY•••• Staff Review Fire Department:Date: /I J ,, /7/9 Building Official:ri--T—Iff5r# ' L4. r7 Date: ic, ' / /, / `- IS 1 5 Public Works: Date: Police Department: Aloe_._/n? Date: 4 BTR Department: Ifilk w � I Date: 4 - / b 19 City Administrator: Date: G//��% City Clerk: le! / /' diiittiz— Date: (to -a b -7G - 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 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date Application #: Name Of Event: APPLICATION FOR /SPECIAL EVENT Date Submitted: ///, ..1! /1 Permit #: • Mthr e Address Of Event: / •'u fAM' POAL S yTl' Description Of Event: Natne Of Sponsor/Organization: AgerAhe to,i. ari/ 1 " Contact Number before/during event OF RESPONSIBLE PERSON: Date(S) And Time(S) Of Event: Date: (J,,L_ 24 Starting Time: `../1-- Closing Time:d ., 31 Jam: b �-If Date: � o 2,„: Starting Time: -----g":"#:—Closing Time: /( <1-Ei,,11 l_ Date: Starting Time: Closing Time: j is /P , ec f 1 od ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? D LOCATION Ft) i( �n f Will Emergency Apparatus (Fire and Ambulance) have access to area? IF NO, TIIEN EXPLAIN (provide alternatives): YES,O ❑ WILL ELECTRICITY BE USED? Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? YES FTNOOj Type of Heating Equiptnent Used: WILL A TENT BE ERECTED? YES ❑ NO4 Tent Manufacturer: Size fire rating posted: Tent have sides and how many? M`d '•' � ;�� - j=._,�:. ***ATTACH SI1'1, MAP OF EVENT LAYOUT*** The following items to be completed by .Fire Department only FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above) quired. iie4ifesafety-mspection- (90� square -feet or iess them iui.pe.r i* s require r plan / seating / setup drawing required showing exits, etc. Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) 0 Fire extinguishers must have current tag, and be operational and readily accessible. ■ _ • • s - • ent ••. • • •• • • 0 Electrical wiring exterior rated, not overloaded. 0 Other: Please call the FD at 863467-1586 for any questions. • 4;4 • • • • 64 • O. • • , • • .4 :19 US .s " • 1 4 s t'‘ • • Yr . • sik 1 • • ' • • Page 1 of 1 A`c o® CERTIFICATE OF LIABILITY INSURANCE DATE �MM�D!Y 9') 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 Willis Administrative Services Corporation DBA Willis Pooling c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA CONTACT NAME: PHONE FAX IA/C. No. Ext): 1-877-945-7378 (A/C, No): 1-888-467-2378 ADDRESS: certificates@willis.com INSURER(S)AFFORDINGCOVERAGE NAIC# INSURER A: Florida School Boards Insurance Trust D2772 INSURED Okeechobee County School District Attn: Chris Lawrence 700 SW Second Avenue Okeechobee, FL 34974 INSURER B: FSBIT18CAS7-1 INSURER C : 07/01/2019 INSURER D : $ 1,000,000 INSURER E : $ Included INSURER F : COVERAGES CERTIFICATE NUMBER: W11643253 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 QR 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/DD/YYYY) POLICY EXP /Y (MMIDDYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y FSBIT18CAS7-1 07/01/2018 07/01/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ Included CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $ Included GENERAL AGGREGATE $ Unlimited GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ Included $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) For the General Liability policy, General Aggregate is Unlimited. Evidence of Coverage for Community Event: June 21, 2019 Free Movie Night for the Community Park#3, 8:15-10:30pm City of Okeechobee is included as an Additional Insured as respects to General Liability. 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 Wt1""6 d ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserve. The ACORD name and logo are registered marks of ACORD SR ID: 18124719 BATCH: 1245736 Jackie Dunham From: Jackie Dunham Sent: Tuesday, June 18, 2019 8:23 AM To: Chief Herb Smith - City of Okeechobee (Chief Herb Smith); Chief Peterson; David Allen (dallen@cityofokeechobee.com); Jeffery C. Newell (jnewell@cityofokeechobee.com); Kay Matchett(kmatchett©cityofokeechobee.com); Kim Barnes (Kim Barnes); Lalo Rodriguez (Irodriguez@cityofokeechobee.com); Lane Gamiotea (Igamiotea@cityofokeechobee.com); Major Hagan; Stevie Cc: Patty Burnette; Robin Brock Subject: Short Notice for Park Use Attachments: Free Movie in Park.pdf The School Board contacted me yesterday to ask about using Park #3 to show a free movie on Friday evening, June 21St which is this Friday. They sent me the application just before 4:30pm last evening. I'm hoping you can review this and sign their application so I can get this issued by Friday. I know our Administrator will not be available after today but I'm not sure about the rest of your schedules. Please stop by my desk to review and sign asap. Thank you. I'm also attaching a copy of what they are sending so you can review it. Ja cki e. Dw'tha nv AcLvnim.i.:stratw&Secreta vy Cray of aceechobee 55 SE Th rd.Avevwce, Okeecho-b-e,e, FL 34974 863 -763 -3372 (Ma.wv) 863-763-9821 (Direct) 863-763-/686 (Fax.) jdunham@cityofokeechobee.com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1