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2019-08-20 Ex 01Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE of 0/(4' 55 SE THIRD AVENUE Jay Q �..z. OKEECHOBEE, FL 34974 1, ! -;co, Tele: 863-763-9821 Fax: 863-763-1686 ,-- .,oa���' PARK USE AND/OR TEMPORARY STREET/ "'-=.,;,;,�'� SIDEWALK CLOSING PERMIT APPLICATION Date Received: v �G(C) Date Issued: Application No: if 'L -c i ). Date(s) & Times of Event: i41, .6 i r c r, - ='c',a �_�`a' (i 71, , ,- Information: Organization: 0 K.€2ecV p4�2€ i"Yl a,t; v 5 -hv� !- • Mailing Address: S , Po rro4- /we ., D 1.,-eech D bit, -F-L- 31-1q 7--/ . 2J Contact Name: i.--Nt vloLQL Po Lv S E -Mail Address: 1 \Iv- ct a_, p o ;,r j 1-1 §rat 1, • Com . Telephone: Work: S lr 723 ?j "5-7, (Q 2)L 1p Home: Cell: q(A LL 7 Lei D-1 Summary of activities: l I.CI0C( DCu fZi:liVo P !- 52) G -I (Q�l e-Vdr if) l_C �� �'1 i CJ-( (.1 Q i i I Lc$4 e ( j(C(�, -e:+•1e'.f '- Py�s . � Y,C{ Cra,i1 1-5/ °yid o vp,i-vjv✓S f -H J i Ce -vi sed cold i 1 ✓15 1,.. t --P aI a .i,(,: Y'�,co des -/- ) v- vh - r rr► t 1'1 q L) ,S )i 6 OJ S '-Pei v�a h .4 -he z� ,_ "� v,i; i z: -h'- (..c.4:-,35 v t c>�e I< J r1 I cu -g_ 2sc �:�-e� �z 1 i� c'n� th h c ' 0-r au -t am'-epiervi,l�ev- 1Y- Iv1 ft�k 2 /4--1 S D ct%& e- (J,t - ern cd ' l,,t_ lam, s Irl &) 1 -re__ will bLi._111, ' \‘ c +h_ oc..S 0 --e i +- f-' PC4-411( 7 . J Proceeds usage: 1 r0 G-eS . --khks 6u-e/rvi- Gt o 40 PRI- 0-ymyGtJ 6wS el, wh- tAitku1 \ Pj-VQ(k-\ (F OK,e) olO-e,c 111,11)A93tYe-d- •--t-, Q1it�ka..4 (L c)6-voy<<j17td'l cin a'rcts cl_s�1 t 1ikeLr1-� oJ- u— �Mmi'vt,c u a i Please check requested Parks: Flagler Parks: o City Hall Park o #1 Memorial Park ed'•2 3 4 o #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is location of andstand] (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 3/5/19 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings �require City Council approval. Meetings 1st & 3rd Tuesdays but subject to change) Address of Event: -�Q) ( ljOUT K r &/ 4- Street(s) to be closed: j'41; %yel. Pde 0,,;(0 9v 'Th/�,/e 8�t va —ec- n ►�crth ...5,;.a. Date(s) to be closed: ' W ti �- } �, '�,� ; JAh 6TAeet.S Time(s) to be closed: G3 qi, ' '��. - yy� • .� '�;.� Purpose of Closing: ID a,•I.;,� ,:. 5e,4- u. ( V 41 ; 'YS (►t31C1 1,c DV '-i-i S'ke-€' 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. IN- Proof of non-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 Depaitinent 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 depaitmental 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 Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick me ' ru . sing streets or sidewalks. RR f� A� imckeA 01',3 -,g-00 A�pp i . _ - - Date • • 0 FFICE USE ONLY•••• • Staff Review o , P_Il _ r til G••••Date: Liv /1U�.,a�' FireDepartment: -., � Building Official: � Date: 7.25.t5 Public Works:/ Date: 7 3D "' % Police Department: OfgIe j Date: 7/ tJ i 1 BTR Department: / Date: c/i/i9 City Administrator: Date: 4/2—'7(7 City Clerk: % C(i{i_ di)/I Date: g1 l lam NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO EVENT FOR PERMITTING. ��11� 61? Temporary Street and Sidewalk Closing submitted for review by City Council on — 14 _�" Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date t iiagier ram - uoogie iviaps Google Maps Flagler ParkL-( Lok_loG(rDc-1`e_34- vete S L. "Ri f. qrr ,t ✓e a l..yK�v '�ti -i . • C1JgAgl • •• AT f iaKlt7;rt •li'I,'FIIJ1,! _ 11 ,!if rinmtltuf::S ��f1 e�Y MR. C� tJ1�.l _, A: till 7I t .' l"'+, a, tYfiiY aGt3"iP7 il;apaFt,i :i�rl 1 r •-141-7....'% Ak .t. , . - C r'7 C _ - r,:, -.,-;is , 04 I �' 'I/' ; �.(G+* • � � ., � .I r,, -I -4-02,;-9,4m.., tv' ' at ., W 0. , r, g.,iiici,4111,:liiI4PM, r +' PlilOiifltliggifU - . ,-•- 1 � - r - i ' 1 n •} i p J --. _R_+ fi'Z3-@il -- :ow .c.'�—nQi%t t ✓lt u3 lgifiif '.-�' y' } ir G79ytrI +;+ :tfiMl l Yis -r, firi +�l , I — 6J ,,J%�wSZ ��4" - n iLt`. ',''itf3(t J �+; UII ( .' _m1t 1 1 ^� r '�' �rf��,fjit'ql�: •- ( I4--. ,.,.- �. t!nt. 4pte.;1;4!ih-F,-, a.G 4. _y t'fl 3; ..;:.....t ;...0 j ii i. -'"1.,71-�.i5:,- 7. P+ r ! f ,ti M� H -:-..,;„4' e < i y • Nt=i 1r+ _a` - - '�i9K (71.91 -�`:'•.—moi ery ©2017 Goo e, Map data ©20 • ._'1 If >v CV 1 .4 -- el C's •( =C Ima 4( 7 Google United States 200 ft v ?Mt_ •Pyk 3 IA -a Nit) jo'r5 ;\/e 'S aly4,S i�v1/ 7 pJ /r� APPLICATION FOR SPECIAL EVENT Application #: Date Submitted: 1 - Cy Permit #: Name Of Event: V Kk.cho looe O Sh.Ludcx Address Of Event: e 9-U ? .l K ' j 1 - _! Description Of Event CCLr 5‘• -)Vi kte -PS-hV' _ Lo/ 'f -I J V Actors`` off( -er and i11�e� G �s4 f�(�frs�' Name O p ns�or/Organization: 1 C 1 bete. 1 on fact N -1 bre/during event OF RESPONSIBLE PERSO ii Date(S) And Time(S) Of Event �' '� L k" ' ``It`' ' she,- Date: GL c Starting Time: jpvh Closing Time: 3-6— u MI 1y Date: 'r . Starting Time: J G DO Closing Time: 5',if D ' Date: 7irli "►'2- Starting Time: 1 V DO Closing (Time: ',DU ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? LOCATIO j), -Ci ' qv - Will Emergency Apparatus (Fire and Ambulance) h ve access to area? f' ' , IF NO, THEN EXPLAIN 1 (provide WILL ELECTRICITY BE USED? YES [O Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? YES 1 1 ANOV Type of Heating Equipment Used: 6tita' end �� alternatives): WILL A TENT BE ERECTED? YES NO ❑ Tent Manufacturer: i G' f1 -1171c14 E.,L) Size lc' .c 4 c Tent have sides and how many? N o fire rating posted: OBD i:1):)?iirli,11s-; ril:;c,lc�l: .)i7lc) / Ili, ,1f1i[1)(l:3 it! t1).! i.l'f `�.'/) ***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) L ',Tents/canopy fire rating certificate required. ent Size require life safety inspection (900 square feet or less then no permit is required) r plan / seating / setup drawing required showing exits, etc. mergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) Fire extinguishers must have current tag, and be operational and readily accessible. -9—Eooking req i es L ?G-eutside-of-tentiaiating-away from -exposures. tric 'Fire Service s. ection re . aired. J/5( D ,firefighter/hnsgrera—Amountther:= Please call the FD at 863-467-1586 for any questions. • • f L i w• 1 a r6• a 'sr 1 t 1. F 14 L" ^ Tr P.()?k)q) • C 1F-419.01 i 4411 i nate bre-area or i )11)1 r... �. �... .._ r 4 ,.t�'f Lir "s' I August 2011 \Jl�r r+ iii r,,: , ;1.-itrz;.:ir #29261 ° �� 5008 1- Hanna /we. f ampa. t1 33ti10 800/865-5064 inV 813/740-8370 i c c;t lA.<{_. r �: s. •r f 411+? `.`�• ni r i i';3a at -ire -ate .r C f a !r! fiit}�ablE: an804-AN viwiiii:sc t o. Vic,` �keec"hobee Geo Sh'eriffs`Office ;,l 1t� �i h� E: T s/ S. Okeechobee TAT : f;a+rlrlit; .fiofr t;. hwetiy rn th tit rf; 1,4 The articles described on this Ger trftcc ,tte have been treated with a flan -le -retardant approved chemical and t. at the application .of chemical was done- it conformance withFederal (CT N= 701 rSpecification e(e Method oappication: nherntly Fiame resistant Trade n:47.r3r=: of ;tante-resisj int 1;31)6 c nr maiert. r :'sed Hi -Gloss _._. 1:,k. C.hi m. Rog. No. F-419.01 ..._ ... (It will not_ ? 'the Flame Retardant Proles; Useti- o -------o----_... e Removed By Washing {;vitt or wfft not_ Be is good for the lite of the fabric. Renewal Certification unnecessary. Sunblock White 15-16 oz. pay f� Color and weight of fabric: _........- _ ..- t�escriptinn at item certified: 1 2Q_.. ._4Q_...rame--- ent__.....0 Thomas Sciortino Production Supervisor Narnt of Appfrt tot �r f-trndartuarr Suptr:rHrndcnr Kt y /die -✓'._ 4:4 , zz...��_��, --i... \./.-,.. •y!"'•.✓ . �,.:' ..,�."�. ter... y . -.....--- '�..��� /.'�_ .....0 y../�ti.._ J Jn -.+j i*- -tl�uC• "'G .F"1✓ ` �S - i¢ 4' 6.Ji."x"�v. � � Lir i_ , J, �J \_i' , • J_`1..., f. ` r ^\� .. - / �' -\1 \`l �%-'-..:/'-4=!\`./\=J`�_/'a"\�/'-:.,, -y cc, tity this to We; ;t. trot. copy of Ui i original "CERTIFICATE OF FLAME VAESI 1"i'f4NCE" Iax:uati to trip, "otitflnal copy" of which has boon Iliad with the California c tl�iu l=ira Martihird. Lori Walker stymied by • 't%R� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 08/09/2019 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 863-467-0600 ISU Lawrence Insurance Agency PO Box 549 9 y Okeechobee, FL 34973 Heath Lawrence CONTACT Heath Lawrence NAME: (,vCO3NN Ext): 863-467-0600 I (NACX, No): 863-467-5142 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Mt. Vernon Fire Insurance Co COMMERCIAL GENERAL LIABILITY INSURED Okeechobee Main Street 55 S Parrott Ave Okeechobee, FL 34974 INSURER B: NBP2552460 INSURER C : 10/25/2019 INSURER D : $ 1,000,000 INSURER E: INSURER F : X COVERAGES CERTIFIC • 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMInn1YYYY) POLICY EXP jMMInn1YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X NBP2552460 10/25/2018 10/25/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PREM SES (GE TOEa occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 X Directors & Offic PERSONAL & ADV INJURY $ 1,000,000 GE X 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- PRO- JECT PER: LOC GENERAL AGGREGATE $ 1,000,000 PRODUCTS-COMP/OP AGG inc $ $ 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' LIABILITYYIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER STATUTE OTH- 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) Re: Labor Day Festival. August 31, Sept 1 & 2, 2019 City of Okeechobee & RE Hamrick Testamentary Trust is included and additional insureds with respect to the General Liability CERTIFICATE HOLDER CANCELLATION City of Okeechobee RE Ham rick Testamentary Trust 55 S.E. 3rd Avenue Okeechobee, FL 34974 ACORD 25 (2016/03) CTYOKEE 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 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2019 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT DOCUMENT# N99000000045 Entity Name: OKEECHOBEE MAIN STREET, 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: 65-0887929 Name and Address of Current Registered Agent: POWERS, LYNDA M 55 S. PARROTT AVE OKEECHOBEE, FL 34972 US FILED Apr 22, 2019 Secretary of State 0710899077CC 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: LYNDA M. POWERS 04/22/2019 Electronic Signature of Registered Agent Officer/Director Detail : Title Name Address City -State -Zip: Title Name Address City -State -Zip: PRESIDENT GRIFFIN, ANGIE 313 SW PARK STREET OKEECHOBEE FL 34974 SECRETARY BRAGEL, PAULETTE 55 S PARROTT AVE OKEECHOBEE FL 34972 Title Name Address City -State -Zip: Title Name Address City -State -Zip: VP HEDDESHEIMER, MARION P.O. BOX 2338 OKEECHOBEE FL 34973 TREASURER AUSTIN, ASHLEY 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: ANGIE GRIFFIN PRESIDENT 04/22/2019 Electronic Signature of Signing Officer/Director Detail Date