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Park Use Permit - OHS Band Cards in the ParkPermit Number: 019 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 ext. 9821 Fax: 863-763-1686 e-mail: idunhamCcDcityotokeechobee.com Park Use Permit Permit Expiration: January 8, 2020 11:59 P.M. Date(s) of Event: Nov. 30, 2019 — Jan. 8, 2020 Purpose of Request: Display 4x8, 8x8 Cards for Individuals/Businesses Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: OHS Band OHSbandboostersl8CcDgmail.com Applicant's Address: 2800 Hwy 441 North Phone Number: 863-801-7673 or 863-447-5509 Address of Project: Park #6 (SE Corner) Current Zoning: P FLU Designation: Public Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. _Tal4 Administrative Secretary/General Services Date ll q Page 1 of 3 Revised 3/5!19 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: $63-763-1.686 PARK. USE ,AND/OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: r - �,- -/ a Date Issued: s A lication No: _ / Dates & Times of Event: Zp -- 2b r � Information: Organization: Mailing Address: 61106 V!5 - key ei'EL. 6q9-----f-Z Contact Name: y -p f �} E -Mail Address zOflS S-f+?r 5, 1`3 mci i - O�v1 ct h1 �1Ke� , �� Tele hone:0—h vt}- Lcpla ") �1PP-� W Cir id w Work: I R 6Z -10) - 410- Home: qG�3 ,qq4 ci, i n 9 ...... Cell; Surnmary of activities: Ja W-- e i arc i I s o e �Ct 'q r / Ol s d cd xroceeas usage: -To rai n r choo I bter, Please check requested Parks: Flagler Parks: ❑ City Hall Park o #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 2 of 3 Revised 3/5/19 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Meetings V & 3rd Tuesdays but subject to change) Address of Event: Streets to be closed: Date(s) to be closed: Time(s) to be closed: Pu ose of Closing; 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 $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. 0- Proof of non-profit status ► Original signatures of all residents, properly 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 Parkes, 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 kicense(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 regglatory 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 lzanxnless 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 sura not ixrc=ed skull be refunded to the applicant of this Park Use/Street Closing Permit. fPage 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 Trusst� if closing streets or sidewalks. Applicant Rignature Date ••••OF E S ONLY•••• Staff Review p in a Department: Date: Building Official- Date: 1117-19 Public Works: Date: Police Department: ' Date: BTR Department: Date: Ci Administrator: Date: City Clerk: Date: i 1—« 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 i 0 0 i : PPLICATIQN FQR SPECIAL EVENT Application #: I Date Submitted: I i ' 7 - / Name Of Event: _ 1 '61 / Address Of Event: r D / / Name Of Sponsox/Organization: S Contact Number before/during event OF RESPONSIBLE PERSON O r ID' "d •44 (�� Date(S) And T' aS) Of Event: Date: 2- I I Starting Time: Date: Starting Time: D ate: Starting Time: t ►'� L�►�la.�'�(a3' SOI .�-� Closing Time: Closing Timc: ���i Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? LOCATION Will Emergency Apparatus (Fire and Ambulance) Dave access to area? \l !e_ S IF NO, T14EN EXPLAIN I (provide alternatives): WILL ELECTRICITY BE USED? ` YES O F1 r 71% Provided By: i 'Lf I Ll Page 1 of 1 ® • 1 1 A�� o CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDlYYYYj 11/06/2019 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 poliay(ie6) 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 ehdorsament(s). PRODUCER Hillis Adlrtinistrativa sarvices corporation D>aA Willis Pooling c/o 26 Century Bl.rd GONTAOT' NAME: PHONE FAX 1-888-497-2378 �A1 1-877-995-7378 No : ADDRESS; certificates@wiliiS.com F.O. Box 305191 INSURERS AFFORDING COVERAGE NAICV xashvilla, TN 312305191 DSA 1NSURERA; Florida School Hoards Insurance Trust 1)2772 CLAIMS.MADE X OCCUP, INSURED Okeechobee County School District INSURER 6: Attn: Chris Lavronca MSURERC• INSURER O: 700 9N Second Awm7o - INSURER E:; Okeaohobea, FL 34914 INSURER INSURER F : COVERAGES CERTIFICATE NUMBER: W13768353 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 9ELOW HAVE SEEN 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 I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- City of Okeechobee 58 SE 3rd Avenue Okeechobee, FL 34974 CAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHDRIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ORID! 18784170 -1: 1443772 TYPE OF INSURANCE /Irisp 0.DDL =SUER POLICY NVMBER ywr MM/DD FxP MM/DO LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00C rLT CLAIMS.MADE X OCCUP, DAM G U 1ncl,adac PREM S occurrence $ MED EXP (Any onePerson) $ Excludec Y FSSITI9CAS7-1 07/01/2019 07/01/2020 PERSONAL B. ADV INJURY $ Tncludec GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ [77ilimitac PRODUCTS-COMP/OPAGG E InCludec POLICY ❑ JE° F7LOC $ OTHER: AUTOM08ILELIADILITYCOM6INED SINGLE LIMI I $ Es sccident BODILY INJURY (Per Pereon) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ Pers a $ UMBRELLAWAS HCLAIMS-MADE OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESSLWB DED I I RETENTION $ WORKERS COMPENSATION AN EMPLOYERS' LIABILITY YIN ANYPROPP.IETORIPARTNER/EXECUTIVE PER ER E,L. EACH ACCIDENT $ E.L, DISFASE. EA EMPLOYEE $ OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) N/A E.L. DISEASE - POLICY LIMIT $ It yea, dsscrlbe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS! LOCATIONS I VIEHI"r-$ (ACORD 101, Additional Remarks Schedule, may be attached Itmoro space Is requimd) For the General Liability policy, Genaral Aggrogate is Unlimited, R£: In evidence of coverage in respect to the Okeechobee High School Hand having Holiday,Stcoll in the Park from 11/30/2019-1/8/2020. Located: 9E corner of; park #6 City of Okeachobaa is included as an Additional Insured as respects to General Liability - City of Okeechobee 58 SE 3rd Avenue Okeechobee, FL 34974 CAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHDRIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ORID! 18784170 -1: 1443772 O"DADC6 '01121/19 jjE- Gq Certificates qqvitnerl* Corb-6 of Exemption Isbued PtfesUdnt twthap*r Mi Flialda-.8taiuies- Tbl�-cerfffi , as that 'OKEECHOBEE CQtJNTY-PUSLIO-SCHQQL'DISTf:uC,--T .�NDAVE bKXECHOSEE-A-3497-4-Mi? DR -1'4 R. OVIS 0.413012G23 -COUNTY- t5OVEANMENT ls,exempt'lrorp the payment,of Floridasalesand"use'tax on' real propd'itymtod,.ftnsientrental property rehteck tangible' persohO.pYopbrty'OuFchased"or'-re�rit6o, or - services -purchased, I. 2'. 1 mportant. 1hformation. f6t. -ExeMpt Organ-Wifio"S YOU must provide all vendors and suppliers with M exempilori certificate ljefbro MgkInd tax-exempt. pqrqhaws- See Rile 12A-1.030. Flarlda.-Adminr6trafive'Gode (RA.0j. Your Consume/'s Certificate of Exemptfon is to be used solely -by your otganization for -your orqanjzalion% ot.1stomary -nonprok activffies. Purch4tes madi) -bV an individual oh behalf of-th.e-arganfzatlon pre taxable; even If the i-no)VIF.Jdal. will be 4, Tbla-exemptionapplies ontjto*purchasesy.ouriorganl�ationmakes, The saW.or leage'to-oth6'S.df-tangible Peradnaf property, sloepIng accornmbdatl6nS. or other. mat prgperty is taxable- Your -arganizairion must maisiar, acid colibct -and remit.-801es and use taxon such -taxable transactions. Note: Churches are:exempt'fmm This peq0f%.mpt dx apt:When they are the lessor of real En3p S. If is a. crimirial offemle to ft ud ler.dry presbfft this• certltfc:aA4 to evade the paym entof gales tax- Under..rio . pAyrzlent of Abe -sales :tax plus -a -penalty of.' 200% of -the. taxi and mqy-besubl.ect, to corkVic-tiom-0- a. tblecpdegrxe felony Any vf6latfon will rqquire-the-revocdflon of-thiszortifiente. a. If yab.havd qWstions about your dxernpflon certificate, please. call Taxpayer'Eiervices 4t 850-468-6600. The mailihg Address Is, PO Bog 6480,.TalNhzisseo, FIL 32314-54$0.