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Park Use Permit - Pregnancy Center Fish Fry ,of ooficiffo � 0„` 6b�: CITY OF OKEECHOBEE 55 SE THIRD AVENUE :° o.4 OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 �'IP 4- 91 * 400.- e-mail: jdunham(.cityofokeechobee.com Park Use Permit Permit Number: 014 Date(s) of Event: October 4, 2019 8AM-2:30PM Permit Expiration: October 4, 2019 11:59PM Purpose of Request: Fish Fry Fundraiser and Bake Sale Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Pregnancy Center of Okeechobee Applicant's Address: 808 NE Park St. Phone Number: 863-467-8748 or 863-634-1185 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. Comments/Concerns of Fire Chief: 1. Access to businesses in regards to the emergency vehicles in case of emergency. 2. Blocking of hydrants by vehicles or equipment 3. Any tent over 900 square feet requires inspections and the tent requires at the minimum one 2A rated extinguisher and possibly other items. 4. Participants should be familiar with the basic regulations(Fire Dept.gave the building dept.this sheet) 5. Electrical cords should be rated for outdoor use and in good condition. Do not plug extension cords into each other to lengthen. The greatest concern is accessibility by our firefighters and vehicles to address medical,fire,or any other hazard. We just need to make vendors and participants aware of these safety issues. H.Smith,Fire Chief/Marshal(863-467-1586) City of Okeechobee Fire Department `Taccia,eDutinhotivni August 23, 2019 Administrative Secretary/General Services Date Page 1of3 Revised 3/5/19 CITY OF OKEECHOBEE o& 4,:. �f• �•cy 55 SE THIRD AVENUE �o � 0; OKEECHOBEE, FL 34974 : - tw`. Tele: 863-763-9821 Fax: 863-763-1686 ` 04, � ', 0 PARK USE AND/OR TEMPORARY STREET/ ♦I'��I- lj r+,•• SIDEWALK CLOSING PERMIT APPLICATION Date Received: G•- L:--I g Date Issued: V -)-3 -i 4 Application No: /4-0,y Date(s) &Times of Event: Fri dt e% O P1" el ,20/6/ fi Anis - 1..3o Pr. . Information: /� Organization: frr n a.oC' e i'e� o/ OXeeichoJ2e e Mailing Address: ii /V� A , 2.Contact Name: /j d K./h AlJC /? E-Mail Address: 01<e epre5 ce er y� t d . 00/77 Telephone: `/ Work: '(G?3:3-- L/(7- g72/4" Home: Cell: g63(03 —//.r6 Summary of activities: rL-1 V,��i5 d rai ser- og1/int Fi Lsh d/nn erS , f.�affc 64/e 7 1 e. rya • Proceeds usage: al I pyo e e-e ds o o -/ e re nwC'e errLer- of 6Xce . Falx ra: i on, 7 mi n Qn ,9 d "movie-a / Please check requested Parks: Flagler Parks: ❑ City Hall Park o #1 Memorial Park ❑ #2 ❑ #4 ❑ #5 o #6 0 [Park 3 is location of Gazebo. Park 4 is location o .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: Street(s)to be closed: Date(s)to be closed: Time(s) to be closed: Purpose of Closing: Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closings ► Site Plan ► Site Plan E0 Copy of liability insurance in the amount of ► Copy of liability insurance in the amount of$1,000,000.00 $1,000,000.00 with the City of Okeechobee as with the City of Okeechobee and R.E. Hamrick Testamentary additional insured. Trust as Additional Insured. ►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 ► 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 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 itsofficers,: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. 01;02y42-&-X-1 App cant Signatu Date ••••OFFICE USE ONLY"" Staff Review � "'% (No .),.y;is wiolw I e Fire Department: Date: as_Au „r2D 10( Building Official: Date: • S" 1 Public Works: ' Date: CC.- 1J---/g Police Department: Date: g"--2-/-19 BTR Department: ( f niza Date: - 1619 City Administrator: Date: '' 1 ' y � ity Clerk: id •s Q r�U Q9 Date: 8' I5-6 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 FOR SPECIAL EVENT Application#: Date Submitted: O 1 1 if J 161 Permit#: /1 t7 i ei Name Of Event: f rainCin- -ex of O K e-et h o b e I 1 .5h Fv itA v Address Of Event: a tr AT K dor Description Of Event: 5e_ vin H ch c � l nn ers . (100(ir14-hQx) CfarK -x-31 .g J Name Of Sponsor/Organization: ��d Contact Number before/during event OF RESPONSIBLE PERSON: L 1 J a Li pki /o - X v e/ Date(S) And Time(S) Of Event: --i(rjC — ;237 r' Date: /0/1//47 Starting Time: S,J©ez-� Closing Time: -c3(� f/0 . Date: Starting Time: Closing Time: Date: Starting Time: Closing Time: 140 (fir to 01 ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? ' o -LOCATION, ' Will Emergency Apparatus(Fire and Ambulance)have access to area? IF NO, THEN EXPLAIN (provide alternatives): WILL ELECTRICITY BE USED? YES I I NO L(o) a J . P, ,s+�r+ Locations: bt Lii - gs -frsi d " Provided By: ���� Jskm..tr eeM ✓f.�✓aa0 WILL HEATING/OPEN FLAMES FOR�TjOOD BE PROV DED.`•��.yl■ O❑ t^ / " ~� Type of Heating Equipment Used: /'ro pa- 1 e- Ir y et s - .9 fire.- . xIi iigw5 ie S WILL A TENT BE ERECTED? YES 0'NO❑ `51)e1i.I/, ' Nei-. Tent Manufacturer: Size fire rating posted: Tent have sides and how many? (See Fire Department's checklist below to assist with expectations regarding safety) ***ATTACH SITE MAP OF EVENT LAYOUT*** The,following items to be completed by Fire Department only FIRy..-DEPARTMENT LIFE SAFETY&FIRE SERVICES REQUIREMENTS: (See above) Tents/canopy fire rating certificate required. (/Tent Size require life safety inspection (900 square feet or less then no permit is required) ? l Floor plan/ seating/ setup drawing required showing exits,etc. 0 Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) C9"-Fire extinguishers must have current tag,and be operational and readily accessible. Q---"Cooking requires LPG outside of tent pointing away from exposures. 7 0 Electrical wiring exterior rated,not o erloade . Fire Services inspection_required. V ,I O--Frfighter-/Ins-peeter-Amonnt. ( --Cather` FIRE DEPART - 1 Met CIAL(PRINT): M.A ) •L.fi SIGNATURE: /' 4' fr' Please call the FD at 863-467-1586 for any questions. 5 w �ti 4 vc (Y) C -, v .) i .--t--- i (7-1 _ 4- O b b ri:- til v24- /Zt ,' 1 1 7 I § r: --/ - . $ftl ono.:at 'e� l � r w W-(Qq1z-y5 ?Ail---/ - C AA etie ..„,,..... ' Certificate of Flame Resistance 1114ZE r i y ISSUED BY: Tent Renters Supply Reglstered Fabric or 5008 East Hanna Ave Concern Number Date treated or manufactured: 0 F-92001 Tampa, Florida 33610 November 2018 if his is b c `i;y that the materials described on the reverstide have been treated with a flame-retardant chemical or are inherently nonflammable, ' "` FOR: Okeechobee Co. Sheriff Office ''- '�*, '• ' ' ODOR ss• 504 N.W 4th St. Ockeechobee 4 ..�� •E +� : 4972 CITY: STATE: _ r,,. 1. Certification is hereby made that: (pierce'or"b") E (a) The articles desCtibed on the reverse side of this Certiflcate haveybeen treated with a flame-retardant chemical approved aria registered by the State Fire Marshal and the appiiaation of said cherikai:was done in conformance with,thesaws of the State of California and the Rules and Regulations o!the State Fire Marshal,;"� f- ,rt hi7!? �., Name of chemical used: Chemical Registration#: "' r Method'al/application: y • R iT r� . N41 "sk♦ �:. c Y v.... `,. •t ,..6.14 1 'Ftp.. 1x'f. � J. n § i F. ^ f (h).- •.;. The articles described on�`the reverse side pre made froma flame resistant fabric or material registered and approved `° by the State Fire Marshal for such use n • J.:---.3%-,•~:_.,._,.,74i:: ,.._ie '.:2 Yl 'Architect VT S/ ) m Re slra on#: F 0 Trade Name of frame-resistant fabric or material used: The Flame Retardant Process Used Will Not Be Removed By Washing (will or will not) Tent Renters Supply By: Matthew R.Pena President Name of Applicator or Production Superintendent Name 'line THIS REPRODUCIBLE ARTWORK IS FOR THE EXCLUSIVE USE OF STATE FIRE MARSHAL REGISTERED CONCERNS AND INDIVIDUALS FOR THE PRODUCTION OF REQUIRED FORMS FR-3(Revised 01103111) Page 4 of 2 i CONTROL NO. 44633 CUSTOMER ORDER NO: 44633 . CUSTOMER INVOICE NO. 44633 YARDS OR QUANTITY 1 (See Size Type) COLOR . SB White f SIZE/TYPE (1)20 x 40'1 piece Hip Roof Frame DATE PROCESSED November 2018 E may. nt . . , -- ` i , [ ' om. P ea k%- .'` 11 4 .. . . . 4. 400-: ,. :.. is on . t %-'.`'; l' '''-',L"-‘' .. ._ .4::-T.... : z - 7. kl- THIS REPRODUCIBLE ARTWORK IS FOR THE EXCLUSIVE USE OF STATE FIRE MARSHAL REGISTERED CONCERNS AND INDIVIDUALS FOR TUE PRODUCTION OF REQUIRED FORMS FR-3(Revised 01103/11) Page 2 of 2 AC RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 08/14/2019 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 NAME: Erika Hill Patriot Insurance Agency,Inc. PHONE .Ext): (520)455-9252 {n/c,No): (520)455-9358 PO Box 1298 E-MAIL ehill@patriot-insurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Sonoita AZ 85637-1298INSURERA: Spirit Mountain Ins Co RRG Inc 10754 INSURED INSURER B: Pregnancy Center of Okeechobee INSURER C: 808 North East Park Street INSURER D: INSURER E: Okeechobee FL 34972 INSURERF: _ COVERAGES . CERTIFICATE NUMBER: PKG 19/20 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 I POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) XI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ X PROF.LIAB.INCLUDEDMEDEXP(Anyoneperson) $ 0 A X DED:$2500 Y SMIC-LPP2019-CPP109 07/01/2019 07/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY JEo LOC PRODUCTS-COMP/OP AGG $ 1,000,000 X OTHER: RETRODATE:11/19/2010 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 LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 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 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVENT:Pregnancy Center of Okeechobee Fish Fry Fundraiser held on October 4,2019 City of Okeechobee and R.E.Hamrick Testamentary Trust are listed as Additional Insured. 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 and R.E.Hamrick Testamentary Trust ACCORDANCE WITH THE POLICY PROVISIONS. 55 Southeast 3rd Street AUTHORIZED REPRESENTATIVE Okeechobee FL 34974 _ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00004272 ,,,,,� LOC#: `-.." ACCRD ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Patriot Insurance Agency,Inc. Pregnancy Center of Okeechobee POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes CERTIFICATE HOLDER TO BE NAMED AS ADDITIONAL INSURED UNDER THE ABOVE POLICY BUT ONLY AS THEIR INTERESTS MAY APPEAR AND ONLY WITH RESPECT TO THE OPERATIONS OFTHE NAMED INSURED. NOTICE:THIS CERTIFICATE OF INSURANCE IS BASED ON POLICY COVERAGE ISSUED BY SPIRIT MOUNTAININSURANCE COMPANY RISK RETENTION GROUP,INC.,TO ALL MEMBERS OF THE INTERNATIONALASSOCATION OF THE COMMUNITY SERVICES ORGANIZATIONS.SPIRIT MOUNTAIN INSURANCE COMPANYRISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OFYOUR STATE.STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR SPIRIT MOUNTAIN INSURANCE COMPANY RISK RETENTION GROUP ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jackie Dunham From: Jackie Dunham Sent: Thursday, August 15, 2019 12:49 PM 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: Pregnancy Center Park Use Permit Attachments: Pregnancy Ctr Fish Fry 10-4-19.pdf Please see the attached request to use Park#3 on 10-4-19 for a Fish Fry from the Pregnancy Center. I have the original on my desk for comments and signatures. Thank you. Jackie' Ad4n 144, rattwe Secretary City of Okeechobee 55 SE Third/Avenue. Okeechobee', FL 34974 863-763-3372 (Haat v) 863-763-9821 (D%rect) 863-763-1686 (Fax) 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