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Park Use Permit - Small Business SaturdayCITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 X9821 Fax: 863-763-1686 e-mail: lduriham(a)cityofokeechobee. com Park Use Permit Permit Number: 018 Date(s) of Event: November 30, 2019 8AM — 2:30PM Permit Expiration: November 30, 2019 11:59AM Purpose of Request: Chamber of Commerce Small Business Saturday Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Chamber of Commerce of Okeechobee Applicant's Address: 55 S Parrott Ave Phone Number: 863-467-6246 Current Zoning: P Subdivision: City of Okeechobee Address of Project: Park #3 FLU Designation: Public Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. The Public Works Director requests 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. 4 Talo . November 7, 2019 Administrative Secretary Date General Services Department 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/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: MIA 1 y Date Issued: I t • 1 -t 9 Application No: 141 -o 19 Date(s) & Times of Event: Saturday, November 30th 8 - 2:30 Tnformation: Organization: Chamber of Commerce of QKeechobee County Mailing Address: 55 S Parrott Ave. Contact Name: Mariah Parriott E -Mail Address: info@okeechobeebusiness.com Work: 1 863-467-6246 1 Home: I I Cell: 1 863-801-5324 1 Gummary of activities: vendors for Small Business Saturday, children's crafts rroceeas usage: P -- Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 *3 ❑ #4 ❑ #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is location of Bandstand] (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 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. Mariah Parriott Applicant Signature Staff Review 10/24/2019 Date CE USE/ONLY•••• Fire Department: Date: 0 y- - / Building Official: �. Date: V •Z$ •% Public Works: Date: Police Department: Date: BTR Department: Date: wq / 9 City Administrator: Date: or < City Clerk: j Date: p ( q 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 Temporary Street and Sidewalk Closing reviewed by City Council and approved Date Date Application #: Name Of Event: Address Of Event: Description Of Event: Name Of Sponsor/Organ: Contact Number before/during APPLICATION FOR SPECIAL EVENT Date Submitted: Permit #: Date(S) And Time(S) Of Event: Date: Starting ime: Closing Time: Date: Startinge: Closing Time: Date: Starting T Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/ Will Emergency Apparatus (Fire and IF NO, THEN LOCATION have access to area? _ \ EXPLAIN WILL ELECTRICITY BE USED? YES [ Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? S ®40 ❑ Type of Heating Equipment Used: WILL A TENT BE ERECTED? Tent Manufacturer: Tent have sides and how many? YES ❑ NO ❑ I\ Size fire rating posted: ***ATTACH SITE MAP OF EVENT LA allowing items to be completed by Fire C FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See O Tents/canopy fire rating certificate required. O Tent Size require life safety inspection (900 square feet or less then no O Floor plan / seating / setup drawing required showing exits, etc. O Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIP 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): (provide alternatives): is required) SIGNATURE: Please call the FD at 863-467-1586 for any questions. APPLICATION FOR SPECIAL EVENT Application #: IR - 01 g Date Submitted: Pernut #: _____ Name Of Event: Address Of Event: Name Of Sponsor/Organization: 'lam 'Yl r— (A' Y f YY--'( ' Contact Number before/during event OF RESPONSIBLE PERSON:,mwo i "� Date(S) And Time(S) Of Eve : QQ Date:Starting Time: Closing Time: O Date: Starting Time: Closing Time: Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? f)n� LOCATION 1 V/,A Will Emergency Apparatus (Fire and Ambulance) have access to area? w `3 IF NO, THEN EXPLAIN (provide alternatives): WILL ELECTCI BE USED? YES x,10 9, F e,E [_ x r; ,,t G6t_i6 A e. --:s iW' t� Locations: Provided By: 6e- A U A► t i C. WILL HEATING/OPEN FLAMES FOR FnO�O. BE PROVIDED? YES BYO Type of Heating Equipment Used: / V% WILL A TENT BE ERECTED? Tent Manufacturer: Tent have sides and how many? YES ❑ NO Size fire rating posted: ***ATTACH SITE MAP OF EVENT LAYOUT*** The following items to be coMLhIeted 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 FI WATCH Amount: O Firefighter/Inspector Amount: O Other: FIRE DEPARTMEINT NT):4L SIGNATURE: �, /t //VW Please call the FD at 863-467-1586 for any questions. Park # 3 OKAAS Site l.,,tap State Rd 70 Tree 40 Trash Can ■ Light Post 351 350 349 348 347 346 333 332 335 9 m 345 f 4 0 Park i ui:ies nch i Trash Can 0 m 340 341 Trik e 337 OKIAS 326 Trit:u 325 F 6 4D Light Pcst Park Tables C Bench F3115 314 1 [316] 313 317 312 311 Bench 3zz 318 q ower 328 Power 0 Bench 331 330 329 Trash Can Park Tables 323 324 Park Tabli 0 310 1 349 1 348 1307 10 1 11 306 305 344 I 303 303 301 Bench Park Street =1 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 DEPARTMENT OF THE TREASURY Dear Applicant: We are pleased to inform you that upon review of your application for tax- exempt status we have determined that you are exempt from Federal income tax tinder section 501(c)(6) of the Internal Revenue Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Please see enclosed Publication 4221 -NC, Compliance Guide for Tax -Exempt Organizations (Other than 501(c)(3) Public Charities and Private Foundations), for some helpful information about your responsibilities as an exempt organization. Sincerely, Lo G. Lerner Director, Exempt Organizations Enclosure: Publication 4221 -NC Letter 948 (DO/CG) Employer Identification Number: Date MAY 1 2 2 Oti 27-4426593 DLN: 17053102368021 BUSINESS DEVELOPMENT BOARD OF Contact Person: OKEECHOBEE COUNTY INC JEFFERY A CULLEN Ill# 31215 C/O CHAMBER OF COMMERCE OF OKEECHOBEE Contact Telephone Number: 315 NW 4TH AVE (877) B29-5500 OKEECHOBEE, FL 34972 Accounting Period Ending: December 31 Form 990 Required: Yes Effective Date of Exemption: January 1, 2011 Contribution Deductibility: No Dear Applicant: We are pleased to inform you that upon review of your application for tax- exempt status we have determined that you are exempt from Federal income tax tinder section 501(c)(6) of the Internal Revenue Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Please see enclosed Publication 4221 -NC, Compliance Guide for Tax -Exempt Organizations (Other than 501(c)(3) Public Charities and Private Foundations), for some helpful information about your responsibilities as an exempt organization. Sincerely, Lo G. Lerner Director, Exempt Organizations Enclosure: Publication 4221 -NC Letter 948 (DO/CG) ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F 10/28/2019 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 GONIACT NAME: Sandy I -lines N itchards & Associates, Inc A/O No, Ext): NE 863763771 1 (A/e, No): ADDRESS: shinesCpritchardsinc.cont ] 802 S Parrott Ave INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Insurance 18058 Okeechobee FL 34974 INSURED INSURER B: ZENITH INS CO 13269 INSURER C: Business Development Board of Okeechobee County, Inc. INSURER D: 55 S PARROTT AVE INSURER E: OKEECHOBEE FL 34972 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 UULZ�UbK INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y PHPK1992448 07/20/2019 07/20/2020 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑PRO JECT F—]LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY OMBINEL (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROFIER I Y DAMAGE$ (Per accident) S UMBRELLA LIABOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB HCLAIMS-MADE DED I I RETENTION $ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 2134078203 03/03/2019 03/03/2020 - STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 D&O 1,000,000 A D&O PIISDI452847 07/20/2019 07/20/2020 EPLI 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Okeechobee is listed as Additional Insured in regards to the General Liability Policy. rGRTIGIr ATG 1-Irll nF=P rAKlr`I=1 1 ATIr1N © 1988-2015 ACORD CORPORATION. All rights reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 3rd Avenue AUTHORIZED REPRESENTATIVE Okeechobee FL 34974 �0-W k H. Pr0r+4rdV © 1988-2015 ACORD CORPORATION. All rights reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD