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Park Use Permit - OCSB Free Movie for Community (2nd event)CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 e-mail: ldunham(Wcityofokeechobee. com Park Use Permit Permit Number: 010 Date(s) of Event: August 2nd 2019, 8:15PM — 10:30PM Permit Expiration August 2nd 2019 11:59PM Purpose of Request: Free Movie for Community (2nd Event) Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Okeechobee County School Board Phone Number: 863-462-5000 X1041 Current Zoning:P Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. Applicant's Address: 700 SW 2"d Avenue Address of Project: Park #3 FLU Designation: Public 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. ,_Tato1D July 16, 2019 Administrative Secretary/General Services, Date Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE . 0 004.: 55 SE THIRD AVENUE f�!! %., �y°0m* OKEECHOBEE, FL 34974 M. s; Tele: 863-763-9821 Fax: 863-763-1686 N.,<'„,.--,;',- ___ .,,.....;%` PARK USE AND/OR TEMPORARY STREET/ --.,;,i-W- ` SIDEWALK CLOSING PERMIT APPLICATION Date Received: (;. /1 t 11 4 Date Issued: 7-/4-/q Application No: I Ci _ p 10 Date(s) & Times of Event: -A - i 9 g ( $n1 - /0 ...44:' PM Information: Organization: 0l4.e-e.Cin,.k Co\An. 411 scl'.oa t °a-krl Mailing Address: 7 p 0 S (.4.7 2. --Not 444C. Contact Name: c.4.- M c Cati E -Mail Address: e C if ct P e o .e. • v-1 L•'FC • Lts Telephone: Work: 'cr, 3 -- Lice,).—SZOD Horne: Cell: '(T. !O'( Summary of activities: -- L -e -c. (kite. 0L2,- 44—e. Covt ivuur►. i i Proceeds usage: 0:44s '—n,,,;( LAS 4 t ( b t .¢ (( h, q wore s,t ' rla Please check requested Parks: Flagler Parks: o City Hall Park u #1 Memorial Park ❑ #2 #3 a #4 o #5 o #6 [Park 3 is location of Gazebo. Park 4 is location o an stand] (11' other private property used in conjunction with this Park Use Permit please provide the address and parcel number below along with notarized Ietter of authorization from property owner) Additional Addresses, if applicable Parcel ID: 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 Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick Testamentary Trust if closing streets or sidewalks. G (tr/f q Applicant Signatur- Date IL l •••• a i ICE USE ONLY"" Staff Review ./,/ � ' Fire Department:Date: // t Till j Building Official: ��` / Date: 7 63. 11 �� - Date: % ` 5 " i Public Works: Police Department: Date: ./.7 9 BTR Department: 11 6111.12.4) Date: x//0/9 City Administrator: Date: ?7c/ ' P City Clerk:,/cmoqatiu:0.0___ Date: r7/(p n 9, 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 #: /q -Di 0 Name Of Event: nCO APPLICATION FOR SPECIAL EVENT Date Submitted: -14- Permit #: Moo Le, zJ 31-F Address Of Event: 5 'e "=.4 SLA) ( �` • Description Of Event: e---- 4-1--et. Mb 0 LC ` y lolt e Of Sponsor/Organization: C ontact Number befo iliTng-event-9 + t P O Date(S) And T Date: Date: Date: 7 e(S) Starting Time: Starting Time: Starting Time: 'EA., ''394 Closing Time: 10 :3 0 Closing Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? NO LOCATION Will Emergency Apparatus (Fire and Ambulance) have access to area? IF NO, THEN EXPLAIN WILL ELECTRICI1BE USED? Locations: ° cty YES,( #v0 (provide alternatives): Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? YES I 1 NO D Type of Heating Equipment Used: WILL A TENT BE ERECTED? Tent Manufacturer: Tent have sides and how many? YES ❑ NO10 Size fire rating posted: P )ttia-, !'1�3s1 �\r��i�4 t+rj-flul rR>>(s�%.?trrn�l9i gfl ***ATTACH SITE MAP OF EVENT LAYOUT*** The following items to be completed by Fire Department only FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above) ro• y e rating cert[ t © Tpnt.Slze-require-life-safety inspectl..l 9AB-square-fenthr less thenrne-permit-is-requirecii E Floor plan / seating / setup drawing required showing exits, etc. ergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) CD --Fire extinguishers must have current tag, and be operational and readily accessible. O.. lecttical wiring exterior rated, not overloaded. Com.—Fire-Se Firefl.hter Ins•ecto FIRE DEPAR SIGNATURE: -amu Please call the FD at 863-467-1586 for any questions. 'NV*Is e en :.: vi eb t Page 1 of 1 '-----, to A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDlYYYY) 06/18/2019 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: PHONE1-877-995-7378 FAX 1-888-467-2376 IAIC No Ext) WC, No): E-MAIL certificates@wiIlis.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC8 INSURERA: Florida School Boards Insurance Trust D2772 INSURED Okeechobee County School District Attn: Chris Lawrence 700 SW Second Avenue Okeechobee, FL 34974 INSURER B : FSBIT19CAS7-1 INSURER C: 07/01/2020 ' INSURERD: $ 1,000,000 INSURERE: • $ Included INSURER F I VE AGES CERTIFICATE NUMBER: W11644258 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 AODLSUBR INSD WVD POLICY NUMBER POLICY EFF (MMIODIYYYYI POLICY EXP (MMIDDIYYYY) LIMITS A )( COMMERCIAL GENERAL LIABILITY Y FSBIT19CAS7-1 07/01/2019 07/01/2020 ' EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (Ea occu D nce) $ Included CLAIMS -MADE x OCCUR MED EXP (Anyone person) $ Excluded PERSONAL &ADV INJURY $ Included GENERAL AGGREGATE $ Unlimited GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT LOC OTHER: PRODUCTS - COMP/OP AGG $ Included AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY i - 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 w EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDEO9 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS f 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: August 2, 2019. Free Movie Night for the Community, Park #3, 8:15-10:30 pm. city of Okeechobee is included as an Additional Insured as respects to General Liability, CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016103) O 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 18125538 BAxcR: 124 604 8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Okeechobee AUTHORIZED REPRESENTATIVEI 55 SE 3rd Avenue Okeechobee, FL 34974 �' `'M • v3 WPtah ACORD 25 (2016103) O 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 18125538 BAxcR: 124 604 8 Page 1 of 1 AeQ%'i.r0' CERTIFICATE OF LIABILITY INSURANCE DA6/11 /2019 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 LISA CONTACTNAME: PHONE 1-877-945-7378 FAX /AIC, No, EM): (A/C, No): 1-888-467-2378 E-MAIL certificates@willis. corn ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Florida School Boards Insurance Trust D2772 INSURED Okeechobee County School District Attn: Chris Lawrence 700 SW Second Avenue Okeechobee, FL 34974 ----._. _ ---- --._ _ INSURER B : $ 1,000,000 INSURER C : INSURER D : $ Included INSURER E : _INSURER F:_.. ---- MED EXP (Any one person) CERTIFICATE NUMBER: W11644258 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 INSURANCEPOLICY ADDLSUBR INSD VP/YYYY) wvo NUMBER EFF (MM DDY POLICY EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY Y FSBIT19CAS7-1 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREMISES (Ea occurrence) $ Included - - CLAIMS -MADE I OCCUR MED EXP (Any one person) $ Excluded A 07/01/2019 07/01/2020 PERSONAL & ADV INJURY $ Included H'L GENERAL AGGREGATE $ Unlimited —I AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO -LOC PER: 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/EXECUTIVEN OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below �, / N / A I PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ — `-------TEL. 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: August 2, 2019. Free Movie Night for the Community, Park #3, 8:15-10:30 pm. City of Okeechobee is included as an Additional Insured as respects to General Liability. 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 (/ ,1r7 x ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD sa ID: 18125538 BATCH: 1246048 Jackie Dunham From: Jackie Dunham Sent: Monday, July 08, 2019 10:52 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 Patty Burnette School Board Free Movie Park 3 (Second Event) OCSB 2nd Free Movie Park 3.pdf Cc: Subject: Attachments: Please see the attached request for the use of Park 3 in August. Attaching copy for your review. If you approve, please stop by City Hall to sign. Thank you. 4 is Jacki,& Dtmaha vw AdiniAi4tratlive,Secsretary City of O keechobee/ 55 SE T rd'Avevwt.ei Okeechabeei, FL 34974 863 -763 -3372 (Ma ivv) 863 -763 -9821 (DCrect) 863-763-1686 (Fa40 j dunham(a,cityofokeechobee. com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure. 1 Page 2 of 3 Revised 3/5/19 • TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Meetings 1St & 3'a Tuesdays but subject to change) Address of Event: Street(s) to be closed: No o ane, Date(s) to be closed: No 4.e. Time(s) to be closed: IQ Ora. Purpose of Closing: fo,J 0 ea 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'ofrioii profit`status. ► 1(� _ �o lt' 1 C n ► i ,y OriginaI 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 froth 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. ❑ 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.