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Park Use Permit - Free Community Dinner AHWC o CITY OF OKEECHOBEE LL``;' "• T 55 SE THIRD AVENUE 4 : o OKEECHOBEE, FL 34974 ate.+'� Tele: 863-763-9821 Fax: 863-763-1686 %.*791 01�� e-mail: jdunham(cityofokeechobee.corn Park Use Permit Permit Number: 011 Date(s) of Event: August 17th'2019 5:00AM — 3:00PM Permit Expiration August 17th, 2019 11:59PM Purpose of Request: Free Community Dinner Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Abiding Hope Worship Center Applicant's Address: 4550 US Hwy 441 N Phone Number: 863-763-3736 Address of Project; Park #4 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. Jacict,e/DtkighOLVIli July 31, 2019 Administrative Secretary/General Services Date Page 1 of 3 Revised 3-21-17 3-S i g CITY OF OKEECHOBEE '�k,, 'o�ar4.yo_ 55 SE THIRD AVENUE �•� ��,. OKEECHOBEE, FL 34974 .o � Tele: 863-763-9821 Fax: 863-763-1686 _6_s "�"•,a��•'' PARK USE AND/OR TEMPORARY STREET/ %9 sik 401' SIDEWALK CLOSING PERMIT APPLICATION Date Received: -t 4-i q Date Issued: 1 -30 i , Application No: 1,Q-v i i Date(s) & Times of Event:Say,,,,,,,/,,,,,,,,/, ,_9. /`7 e .; :tx k- ,y,_ 3 ;ov pi,n Information: Organization: 4/.-,,d,`✓[C1 mni- _. Wor.± ee-*-a--- Mailing Address: 4 o U S If-wi i 41/ N. C/eeePle) he e FL. 5 4-C'7 2 Contact Name: f `t0 r flj< j y"� E-Mail Address: /`d r'rl cj kpe e / Sft'^ gill ail. CO'rel Telephone: Work: ' 3 -'7(p. -3.734 Home: Cell: g63 -(x,9"7-3//vi, Summary of activities: — rooK;n and Sc-v-umY►g meals — TQJ- i-e's -Sc✓'t .tom le cut /0 K /0 1731/r1157 J1'1 t' Proceeds usage: AO pro C_e Ply /fl, 01'l t i----a .- h1 e Al(---_'12.1 Please check requested Parks: )Flagler Parks: o City Hall Park o #1 Memorial Park o #2 0/V3 #4 ❑ #5 o #6 [Park 3 is location of Gazebo. Park 4 is location of B andstan ]'. (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 rt & 3rd Tuesdays but subject to change) Address of Event: Street(s) to be closed: Date(s) to be closed: Time(s) to be closed: Purpose of Closin • Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closings ► Site Plan ► Site Plan ► Copy of liability insurance in the amount of ► Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee as $1,000,000.00 with the City of Okeechobee and R.E. additional insured. Hamrick Testamentary Trust as Additional Insured. Proof of non-profit status (IPS-Determination ► Original signatures of all residents,property owners and L-etter)-- 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 ► State Alcoholic Beverage License, if applicable.** property owner, 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. 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 TestamentaryTrust 'f closing streets or sidewalks. Applicant Signature Date ••••OFFICE USE ONLY"" Staff Review i 4 Fire Department: �%�91 / /P Date: -R6-ii Building Official: 01.10 '4.0/��� Date: II Public Works: ediM Date: % APPLICATION FOR SPECIAL EVENT Application#: q' 0// Date Submitted: 7-0- 19 Permit#: NAME OF EVENT: Cu u.r d 1 01L& h D,�'J ADDRESS OF EVENT: Rai ter � �� tr 4 (BAK13) 51-A- Q1))J DESCRIPTION OF EVENT: £?l Vi'it c a- /-x ajs' 4o 'iow loves of 670019a-�0 �OL v- Comrnunctz/ rE OF, SPONSOR ORGANIZATION: bid i 9 �p frJor Lp fifer Contact Number before and during event OF RESPONSIBLE PERSON: Pastor- Mai-4.ki! ' 8403 -(091-3// DATE(S) AND TIME""(S) OF EVENT: Date: SQJ-,Att9 /r/tStarting Time: "-:OO Aftf Closing Time: 3 • pr4 Date: Starting Time: Closing Time: Date: Starting Time: / Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? Aid LOCATION Will Emergency Apparatus(Fire and Ambulance)have access to area? t es IF NO, THEN EXPLAIN (provide alternatives): WILL ELECTRICITY BE USED? YES ❑ONO JX Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED?YES ❑LINO ❑ Type of Heating Equipment Used: SV)©k i Ptrrc. E. J*A1u i sj A gus. 3 a WILL A TENT BE ERECTED? YES Xl NO ig Tent Manufacturer: Size /0 Y/0 fire rating posted: Tent have sides and how many? ,S7.•7: ***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) O Tents/canopy fire rating certificate required. O Tent Size require life safety inspection (900 square feet or less then no permit is required) O Floor plan / seating/ setup drawing required showing exits, etc. O Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) O Fire extinguishers must have current tag,and be operational and readily accessible. O Cooking requires LPG outside of tent pointing away from exposures. O Electrical wiring exterior rated,not overloaded. O Fire Services inspection required. O Fire watch or inspector(s)REQUIRED? FIRE WATCH Amount: O Firefighter/Inspector Amount: O Other: FIRE DEPARTMENT OFFICIAL(PRINT): SIGNATURE: Please call the FD at 863-467-1586 for any questions. AC !� DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/16/2019 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 CONTACT Tonya Stamm NAME: Milton Carpenter Insurance,Inc. PHONE (863)824-0885 FAX 561 996-2601 (A/C,No,Ext): (AIC,No): ( ) 135 S.E.Avenue C E-MAIL tonya@miltoncarpenterins.com ADDRESS: P.O.Box 1270 INSURERS)AFFORDING COVERAGE NAIC a Belle Glade FL 33430 INSURERA: United States Liability Insurance Company INSURED INSURER B: Lloyds of London Abiding Hope Worship Center,Inc. INSURER C: 4550 HWY 441 N INSURER D: INSURER E: Okeechobee FL 34972 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1971101449 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP WLIMITS LTRINSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RETED CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A NPP1577766A 08/26/2018 08/20/2019 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO Included JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: Professional Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Building Limit $1,611,700 Property B 097590115353S01 08/26/2018 08/26/2019 Contents limit $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Okeechobee is listed as an Additional Insured in regards to the general liability policy. Event date 08/17/19 Feeding the community CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Okeechobee ACCORDANCE WITH THE POLICY PROVISIONS. 55 SE Third Avenue AUTHORIZED REPRESENTATIVE Okeechobee FL 34974 � rn I a ©1988-2015 ACORD CORPORATION. All rights reserved. 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I 111 1(111 11 f Il� 1�►I( �'I,�f l ! f ( 1 I , t _ ,, ;_ ;,r n , n rl I r i�,. , �, { f I I ti tx r 1 fl �i If I�1 7 - - ;i l ,11(1•,11 I, I �I}11!Il , ,II,i? f ,,,,,II .,:,;:,,,,,,,,ii.,,,,,-,,,,,„!;,. .,..,[ y„ir+ �� ,1 + I r I,1;f, 0,,....,..•„4:•,,,.,,,,,,., . Il1', 11 f ,1 ' ,1 I'I I 11 1 If q I 11 lye II I 11 :,1,,,,,,'.11,...,,,''+lf�r'! fl Ifi {I �,i+ ( 111 ff {1 L. BBQ Smoker li.'III1:1!1;1?1 i.. ! :(!'1111'!{ g • I. ! Il fi 1{111x.: „ 3 • } { ` I ` r1. +f €x 4!. 11 i 18'1 ri 1 !!,1111 f(�r ,1 f 1.1 , li 1i ,,f.. •f..• rifi ,, ;1,,1,11 h11II, III• l• Iti I l +',,. ''” '111'",:l:li>t1111 ir'':P 2019 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#709327 Mar 25, 2019 Entity Name: ABIDING HOPE WORSHIP CENTER, INC Secretary of State 5654169127CC Current Principal Place of Business: 4550 US HIGHWAY 441 N OKEECHOBEE, FL 34972 Current Mailing Address: P. O. BOX 813 OKEECHOBEE, FL 34973-0813 US FEI Number: 59-1095392 Certificate of Status Desired: No Name and Address of Current Registered Agent: WITT,MARK C 4550 US HIGHWAY 441 N OKEECHOBEE,FL 34972 US 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: MARK C.WITT 03/25/2019 Electronic Signature of Registered Agent Date Officer/Director Detail : Title PRESIDENT Title DEACON Name WITT,MARK C Name HINES,ROBERT L Address 4550 US HIGHWAY 441 N Address 9600 NE 272ND ST. City-State-Zip: OKEECHOBEE FL 34972 City-State-Zip: OKEECHOBEE FL 34973 Title DEACON Title DEACON Name OUTTEN-SMITH,LISA Name PADGETT,ROY VINCENT Address 2703 NW 5TH ST. Address 3494 NW 18TH ST. City-State-Zip: OKEECHOBEE FL 34972 City-State-Zip: OKEECHOBEE FL 34972 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 lam 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:MARK WITT PRESIDENT 03/25/2019 Electronic Signature of Signing Officer/Director Detail Date Jackie Dunham From: Jackie Dunham Sent: Friday,July 19, 2019 10:15 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 Subject: Abiding Hope Park Use Permit Attachments: Abiding Hope Park Use Permit.pdf I am in receipt of a new request to use Park#4 on August 17th for a free outreach dinner. I believe everything is attached that is needed. Please take a moment to stop by General Services to sign. The application is attached for your review. Jackie/Dw'.ha rry AolAttiA4ZstratOvei Secretary Ccty Okee,chabee' 55 SE Thi rd,Avevu e' Okeechobee', FL 34974 863-763-3372 (Ma.wv) 863-763-9821 (D(Kea") 863-763-1686 (Fav) jdunham@cityofokeechobee.com Website: http://www.cityofokeechobee.com NOTICE: Due to Florida's broad public laws, this email may be subject to public disclosure.