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Temp. Use Permit - Christmas Tree Sales by GFWC Okeechobee Junior Women's ClubCity of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763-9821 Temporary Use Permit Permit Number: 19-006 Date(s) of Event: Nov 19 — Dec 19, 2019 9AM -9PM Permit Expiration: December 19, 2019 11:59 A.M. Purpose of Request: Christmas Tree Sales Property Owner: Downtown Okeechobee LLC Address: 205 SW Park St. City: Okeechobee State: Florida Zip Code: 34974 Applicant: GFWC Okeechobee Junior Women's Club, Inc. Address: 1800 SW 3rd Avenue Phone Number: 863-634-6322 Address of Project: SW Park St, Lot 6, Block 167 Current Zoning: Commercial Business District (CBD) FLU Designation: Commercial (C) Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 48 hours of expiratior date. Fire Department requests no wooden pallets are to be used as security fencing as in the past. Possible need for emergency lights due to enclosed tent. Inspection required to determine. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. I certif that I have examined this • ermit it is correct and I will abide b its re • uirements. -669.7(16te) A•plicant's gnature TctckCe' DIAA/ataivn/ Administrative Secretary REF:.ORD.716, Temporary Structures Date Revised 1/5/18 jd le,:do ., TEMPORARY USE PERMIT APPLICATION .1i OTHER TEMPORARY STRUCTURES (666) = City of Okeechobee - General Services Department `=L• ... ��� 55 SE 3rd Ave, Room 101, City Hall, Okeechobee, FL 34974 " opo Phone: (863) 763-3372 ext. 9821 DATE RECEIVED: ; i - i - i 9 DATE ISSUED: I i L1 kt 6 i / / APPLICATION NO.: i q „ t) 0 , EVENT DATE(S) & TIME: ///f 9 --49--h 9/, //V FEE: $175.00 is.t A T. on-Profit/Civic Organization DATE PAID: lid 494079- qp E Z Name of Property Owner(s): 3 vl D 1 6L-raJ 13e2.6 -&'Q s ° .. Address: r;()5 S� Bks , 44 307 ,,,,,a Telephone Numbers: „ �` .. Home: O . `e. i lcPsr 1bg2- el ')C�IIrnem t3 eJJName of Applicant: am,E 3 7i. S si,/p L a I� ,� Address: 1200 i) �/�11 -V.e 0-t 34 q% Telephone Numbers: ,,,n�. �n��� Home: Work: Uke hth 111 •frlt7�tk gi4 -63 63 ? Future Land Use Map Desigation: 1 `- 4T- Current Zoning Designation: .iJ D Legal Description of Property: ' (6- 37 35 . Ob(d - 010o- ©D(p 6 Address of Property: SPD &U Aix. d% V Vet C 0. q--/ 3 (eQ 7? Please Explain Type of Use: 01 f I lO-o '� Sates ,S � Briefly describe use of adjoining property North: ��j-�,0p_ 1A -.2J 1+3 .[ �D East: SIU P001,411e+610 A South: Una S U.I�Y�DI A� n� West: 1Jj �,� 51'1. ,r S Cj - Other temporary structures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated by a non-profit organizaiton. 2. Camival, circus, fair or other special event operated by a non-profit organization on or abutting their principal use. (*additional information required) 3. Commercial carnival, circus or fair in commercial or industrial districts. 4. Similar temporary structures where the period of use will not exceed 30 days a year. The Applicant shall: 1. Submit proof of liability insurance, paid in full covering the period for which the permit is issued, in the minimum amount of $1,000,000.00 per occurrence. 2. Have notarized written permission of property owner, if applicant is not the property owner. 3. Remove all debris within 48 hours of expiration of permit. 4. Submit Site Plan, State Inspection Certificates and submit State Annual Permit * City Staff (Please review the application, attach comments or special conditions). Occupational and.or State License Verification: 6 4,» J /.0 n cor Date: I —13 --I S311,,nem Fire Department Approval: Ae/ � C rnerb n�1 Li s Ve r I/ Date: / NOV- �,e,0 / , t o Police Department Approval: /� -��, Date: /Z-� F /� / N Public Works De.artment Al .rov��� I� iQ� - °cd-�° Date: - —/9 _ Building Inspector Approval: ".,*-a ',��' esar' IMllit.i . in this application Is for use by of up to thirty days and may Date: I (• i Z�• (i Date: 0 y'.5 the City of Okeechobee in processing my request. result In the ummary denial of this application. City Administrator Approval: �, I hereby I False -s- certi that the in ation on this ap • • n is correct. The information included or mi eading info ' : tion may be p • • - a e by a fine of up to $500.00 and imprisonment ignature o AP cant Date APPLICATION FOR SPECIAL EVENT Application #: ICI -00 (.,Q Date Submitted: 1 " 1 Z - 1 q Permit #: Name Of Event: 0SAo (JirtvMs I V i S Address Of Event: PO 61/0 a " I AA f, „� 3L( 3 i -! 7O Desch f Ever;..,, Lsolts Name Of Sponsor/Organization: &riA)6 0HS&th .! Wow/6 atiL Contact Number before/during event OF RESPONSIBLE PERSON:ava Date(S) And Time(S) Of Event: grime: Date: 1 1119 11 grime:QClosing Time: Date: Starting Time: Closing Time: Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? /00 LOCATION IF Will Emergency Apparatus (Fire and Ambulance) have access to area? 1J Q NO, THEN EXPLAIN (provide WILL ELECTRICITY BE USE ►' YES {. TO 0 Locations: , 4 Provided By: WILL HEATING/OPEN LAMES OR FO D BE PROVIDED? YES f T1' o Type of Heating Equipment Used: f1)r't alternatives): WILL A TENT BE ERECTED? YES [i'NO 0 Tent Manufacturer: A 1 TerrrSize t}� j )C I D 0fire ratin osted: Tent have sides and how many? — 21>F01-5. ,incl $ J ***ATTACH SITE MAP OF EVENT LAYOUT*** The folki toms to be comjeter:l >,- ; iro Doparttnent o.niy FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above) O Tents/canopy fire rating certificate required. 0 Tent Size require life safety inspection (900 square feet or less then no permit is required) 0 Floor plan / seating / setup drawing required showing exits, etc. O Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) 0 Fire extinguishers rnust have current tag, and be operational and readily accessible. 0 Cooking requires LPG outside of tent pointing away from exposures. O Electrical wiring exterior rated, not overloaded. Si Fire Services inspection required. O Fire watch or inspector(s) REQUIRED* FIRE WATCH Amount: O Firefighter/Inspector Arnount: O Ot 1 \ \ FIRE DEPARTM' O ' % ' RINT): SIGNATURE: Please call the FD at 863-467-1586 for any questions. N/A i dogs ATJed doaS friJi1QS MIM 9mota/ -en Aa Iv 44,14,a 11. II 9 r11 -3 -al HflQN >1IemopIS �aaa�s >�aed This Lease Agreement dates on the 19th of November, by and Between Downtown Okeechobee LLC/David Feltenberger (Landlord) and 1 Stop Party Shop LLC/Kimberly Hargraves (tenant). The parties agree to as follows: Premises: The Landlord in consideration of the Lease payment provided in this agreement agrees to lease the premises of: Vacant Lot #6, Block 167 of the City of Okeechobee, as recorded in Plat Book 1, page 10, plat book 5, page 5, Okeechobee Florida 34972, consisting of .162 Acres (Premises). Term/Payment: This Agreement shall be for a maximum of 1 month. The Lease terms shall Commence on November 19, 2019 until December 19, 2019. The Tennant Agrees to pay the Landlord 850.00 for the term lease above. Liability Insurance: The Tenant agrees to list the Landlord as Additionally Insured for said dates listed. Indemnify Regarding Premises: Tenant agrees to indemnify, hold harmless, and defend Landlord from and against all losses, claims, liabilities, and expenses, including reasonable attorney fees, if any, which the Landlord may suffer or incur in connection with Tenant's use of Premises. Landlord: Downtown Okeechobee LLC Tenant: 1 Stop Par David Feltenberger Kimberly Hargraves 863-447-6844 863-634-6322 As T' • lit ertificate of Flame Resistance CAL FIRE s7H3r7 3 -4174‘ *Regiete'red or Cbrideen Number .F-121.23 Issued By:: •Trivon.tage,.. LLC 1.831: NOTth Park.Ave. Glen:Raven, NC 27217 Date. treated or manufactured: 0911612013 • • . - Tigsqs fa -certify thatihe.17MtetiaV described fiddw ba.ve been trbatect llame-relardantr.heitiical toe-ale„it)herelitly. FOR: Ttivaritage, CITY: Glen -Raven CertifiCation is- hereby made that: (Chetk.!'a" Or"b!!) (a)' The Artidles. described at:the:bottom ofthis Certificate. hay.e been treated with. a -flame-retardant chemic,a1 • Opi-ovci.m-ici registered by the State Fire Marshal And the -application of'..said'chemical-was done in- Conformance 'WW1 the laws Of the. State Oftailfarnia and the Rules And. Regulations of the State -Fire Marshal ADDRESS: 1 831 North..Park.Ave, -TATE: NG 2721.7 X Narne if Cherilicataed: • • Chemical Registration ft:- . ••• •_ . . . • Method of application . (b)._.TheArticles .described::.at:themttompf this Certificate are made from a flamegesidtant-Tabac cr material,— regiateted. and approved by•theState Fire .Marshal for.such. use: . . Trade Nanie of:f.6iiio'ite"AAaht • • fabriC or ii-lateriar&ech 'RENTER.OHPICE-16.•,0:: Registration it! .F-12123. 1116.F101:0-Ret4dantl?rciOdtt Used Will Not Be Removed By Washing ALBERT E jOHNSOR • .. :Name of ApplicatOr or Production Superintendent VICE .PRESIDENT, BUS: •DEVELOPME Title RCN #. 106.:968340.16:103•968341Q16.79 CUSTOMER ORDER NO. FREE./ ROAD SAL CUSTOMER iNVOICE NO. 266852 )(AO:A.0R taipastriV. 10000' • pEscRtrriarst : Renter's .Choice. Blackout 61.". 16-..oz:White (Standard Pack100 :• • . • • • • • ••. " • • • " • • • • Wardsyr •-• • ITEM N MB Eik :".•':••• ••••'.908-3.40.'.. • • • • •-• • . „. •• • . ... • - • • We hereby deOfy.-.the above to accurately. reflect;the:infonnatiori contain0 within .a "pE.13TIFICATE:OFFLAME.13ESISTNCE" ittired:to Triventa0,.12.LC from the registrant set forth above .A copy athebriginal terfifi'd'afe,tif nailie. Resistance is available Upon ' request to Trlyentage',11C and the registration information faith above is. btiretord with the:Oefirciinia State Ore. Marshal, ..... . ... • . . : . ... ._. . . . . . .. ..... ,. . • . „ . . A 1 TENTS.ANIII:STROOTURE•8 . • - - • 234 'WEST M:IF1:81- mAILING.AptiRESS - . HIALEAR. FL. ...311111.() • T Certificate of Flame Resistance VNC FIRE Registered Fabric or Concern Number .F-12123 Issued By:. Trivantage,. £LC 1831 North Park Ave. Glen Raven, NC 27217 Date. treated or manufactured: 09116/2013 This is to certify that the material described belOw have been treated with a ffame-retardant chemical Or are inherently nonflammable. FOR: Trivantage, LLC ADDRESS: 1831 North..Park.Ave. crm. .Glen:-Rayen .STATE: NC 2721.7 Certification is -hereby made that: (Chetk.!'a" Or -"b7) (a) The :articles- described at:the bottom .6f -this Certificate. have been treated with. aflame -retardant chemical approved and registered by the State Fire Marshal and:the-application of saidt chemical.wasclonein-COnforMence with the of the State Of.dalifeenia and 0* RUlesatid.RegtilatiOrtS of the State..Fire Marshal, Name of chemical used: Method of application: Chemical Registration (b) Thearticies described -at-the bottom of this Certificate are made from a flame -resistant fabric or material . registered and apPreved by the State Fire Marshal for such use. Trade Name of:tianie-re0iptatit fabric or matefial uSed: • RENTERS CHOICE 16.0Z Registration #: F-12123 The Flame -Retardant Process Used Will Not Be Removed By Washing ALBERT. E.JOHNSON VICE PRESIDENT, BUS. DEVELOPME Name of Applicator or Production Superintendent Title RCN #- .1 op :968340 .16: 103.96834Q 16.79 CUSTOMER ORDER NO. FRED/ ROAD SAL. CUSTOMER INVOICE NO. 266852 YARDS OR QUANTITY 1000.60 DESCRIPTION Renter's .Choice.Blackout 61" 16-oz.White (Standard Pack 100 ITEM NUMBER 968340, We hereby Certify the abOve,to accurately. reflect;the. information. contained within a "CERTIFICATE:OF FLAME.RESISTANCE" issued.to Trivantage, LLC from the registrant set forth abeve. A copy of the:Origitial Certifidate.Of Flame Resistance is available upon request to Trivantage LLC and the registration information set forth above it on record with the Ooriforoid State Fire Marshal MAILING ADDRESS A 1 'TENTS AND STRUCTURES 234 WEST 24TH ST EAH. FL .33010 t S -Fr ertificate of lame esistance Registered Fabric Of Cbtiteen Number .F-12123 Issued By:: •Trivonpge;: LLQ 1831: North :P.ark.Ave. Glen Raven, NC 27217 Date. treated or manufadtured: 0911 61201 3 This4sta.cerlify thgt.ithejnateitale described below have been treatedwitha ffame-rdfardant-cheitiical bealkitiherelitly fiontigrritgdble, FOR:Trivantage, •LLC, ...... . . cn Glen.Raven Certification is hereby made th'at: (Chetk.!'a" Ormb7) (ay• 'The ArtiOles- described at:the:bottom .ot•this Certificate- have been treated with allame-retardarit chemical • gotovgd. god repiSteted bythe State Fire Marshal And the•application of --said 'chemical -was dorie'indOnfonnatice !Viitn'tholaWS of the State of California and the Rules and Regulations of the State Fire Marshal juitEss: 1831 North .Park.Ave. STATE: NG 272:1.7 Marne 'Of'dfiethical.USed: Chemical Registfatiori • • Method of application •• • .• ••• ..• ••. F:: (b)_ The:articles .describedAt:thetottomtif this!Certificate bre made from atfame-Tesistantlabric or material-- 'tepitteted. and approved 15y-theState• Fire.Marshal for:such:use: TrAsife Narife Off.aftiolfe'SiWnt 'fabric Or •••.. 'RENTER.CHOlCE 16 OZ- Registration # F-12123. The Flame -Retardant Process PrOdtt We'd. will Not Be Removed By Washing , . ALBERT E JOHNOU VICE .PRESIDENT, BUS, DEVELOPME :Name of ApplicatOr or Production Superintendent • Title • RCN it. 00.:968346.1 6103.96834A 1679 CUSTOMER ORDER No. FRED.I ROAD SAL CUSTOMERINVOICE N.O. • 266852 Y.ARD8.OR QUANTITY • 1000,60' pESCRIrrietilsi • . : Renter's .Choice. Blackout 61' 167oz:White (Standard Pack100 ••••—• " 'AfardS): "' • • • • ITEM.NOMBEft - : :•• • :• " . • .. . We hereby Ceilgy•the -abOve-to 'accurately. reflect:the. information. contained within .a npE.RTIElqAT..E:OF'FLAME.13ESIST6NCE" 'Mt:fed:to Tejtrgtitagb,Lt_C the registrant set fOrthAbOVe. ..A copy ciftherorigitial tOnifitAtA,Of Flame Resistance fe-'avAi:labte:dpOli- • request to Tily.Afita4etit_b And:the.'rebiAttatitirf information set forth above is. on record with. thA00:11fcirtiia State Tye- Mdfsba!, ... • . . A 1 TENTS:AND:STRUCTURES . . 234 WEST 24TH. ST . KnAiLING ADDRESS • I-PALE:AK •Ft... .33010 A'ET Rggistered he Chiltern Number Certificate of Flame ante .F-121= Issued By *Trivanfagef, LLC um: North :P.ark.Ave. • In :Raven, NC 27217 Date. treated or manufaCtur.ed: :0911612013 Thislstovegifr thitthejniffetillie adt dithed Heloge 1.1.4ve bee riltectwith.tffame•Watilantrhtcal Waikliffiereittly nVntlalyitObble., FOR: irtivaritagattO crni •Glen Raven Atoms: 18-31 Notth-Rark.Ave. STATE: NC 2:721.7 Cerillitatlun Is•bereby made that (Chetk`a" �r"131 • El• (ay 'The :articlesllescribed atinebottom fthis Certiffcate•hay.e been treated with. allame-retardarit chemical. • alitoVad. and tegitMtb0 byllie..qtate Fire Marshal .andlthe•applicalion otsalt chemical•was dolie'intbhtoltnattce Vittrthelayl Of. thO.Statiii Of -California tihtlihe Rtildataiiti.FiegUlatio.iS of ltie stAtafite tvigtglialf " • Nan: e tit tical. °bed:Chethical Registral101it• . . . • •- • •;• ••• • . • • Method ot!aprilication: • - • • • • • • • • ••• • -• - • • • • -•• • • - •• • • -:•• ThOlarticlesdescribetattheibottom 13T this:Certificate-tug made from affamo-tesistant:fabric or material..., ••• • Ie§igteted.arid apiirOvedl5y-the!State•Fire.Marshal for use; I'm& Nettie' ciiiiieIregopiit • " labriC br maferial'useck •-. - RENTERS CHO1C z.: • Reif:km(10 v.4: F-12123* Tht.P.Intili,34161*(1Ant•eroAett trdect Will Not Ile-RehivedByliVagriflig • ,. • • .• • ,. • .• %••••••., ALBERT EJOHNWISI •*) VICE .PRESIDE14., BUS, tptELOPME Name otApplicalir or Production Superintenderit • -Title ". 'RCN it• • 1 09.:968340. 18: 10316884P, le79 CUSTOMER ORDER NO. FRED ROAD SAL • dligTOMERINVOICE NO. • 266852 Y.A131)S•M QUANTITY. 10.Q0Alti. • DESCRIPTION :•• ••. • Renters Choice. Blackout 61". 16-oz:White (Standard P..ack 100. . • •Arards)..., • • ITEM. NUMBER b6-83140'"--1 :"- • ". • • " • • • ••• :•• Wehereby dettifttrie •abcive•to 'accurately reflecttheinformation ccintained.withInp "CERTIFICATE: OP FLAME.RES1STANCE! ittutoo trfliniti.tagb,.liC Wit the.rOdittraht set fOrth•tboue. A copy ofthegirigliial tartifiCafertif Flatlia;Kaigtahte is avabfeiib requesttbTrtVfltage. LLCartd thetb'dtirtititiminfOrrtiatiiiikset forthabOltdis.brile.tord W1th. thApoillbrnis4tett .,Fjte•Yfershal... • • !AMINOAPIIS6 Ai ;MNISIARD-T.KUOTUfteS . . • 1441NgST:4'TK:ST HIALEAH'. 1L .:33(11,1) RECEIVED 11/12/2019 10:22AM 8637638497 Nov 12 19, 10:22a Pritchards inc, Insurance DONS APPLIANCES 8637635629 p.2 AC o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 11/12/2019 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1S 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 Pritchard, & Associates, Inc 1802 S Parrott Ave Okeechobee INSURED FL 34974 NC.UNAME:IAt.I Taylor Padrick `PHONE aye N. at 8 63763 771 1 ADDRESS: taylor@pritchardsinc.com FAX (A1C, No): INSURER(S) AFFORDING COVERAGE NAIC INSURER A : OHIO SECIJRrrY INS CO COVERAGES 1 Stop Party Shop LLC 319 SW Park St Okeechobee FL 349?2 INSURER a : 24092 NSURER C: INSURER D: INSURER E INSURER F : THIS INDICATED. CERTIFICATE EXCLUSIONS -' — ..—... RtvISION NUMBER: IS TC CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING' ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, -THE INSURANCE AFFORDED BY THE POLICIES DESCR;BED HEREIN ;S SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIM:TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR L TYPE OF INSURANCE ilAuuNSD W5uBR VO POLICY NUMBER PULTLY EFF (MMIDOIYYYY) PDLIZ,Y EXP (MM1DOlYYYY) LIMITS xCOMMERCIAL GENERAL LIABILITY (CLAIMS EACH OCCURRENCE $ 1,000,000 K -MADE K SPC OCCUR IJ PREu SES (-a occurrence) S 300,000 MED EXP A (Any one person) S 15,000 BK557419072 06/30/2019 06/+0/2020 PERSONAL GEN'. & ADV INJURY S 1,000,000 AGGREGATE LIMIT APPLIES PER: 'OUCy 1 1 GENERAL AGGREGATE S 2,000,000 JECF I LOC JECT PRODUCTS - CCIlP.'OP hGG S 2,000,000 CTHER: $ AUTOMOBILE LIABILITY .1NY AUTO WM3INED S.NULE. LIMI I {Ea a:CidFXlt) $ - OVNJED — SCHEDULED BODILY INJURY iPer person) 5 AJTOS ONLY HIRED —"— AUTOS NON -OWNED BODILY INJURY (Per accc.'ent;: s AUTOS ONLY AUTOS ONLY P1tUP= TY UAMAGe (Per occident)S UMBRELLA LIAR EXCESS LIAR i OCCUR EACH OCCURRENCE S CLAIMS -MADE 1 !RETENTIONS AGGREGATE 5 WORKERS DED COMPENSATION $ AND EMPLOYERS' LIABILITY Y! N ANY PROPRIETOR/PARTNER/EXECUTIVE !STATUTE ER H. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N rA E.L. EACH ACCIDENT g 0 yes, descrbe under DESCR E.L. DISEASE - EA EMPLOYEE $ PTION OF OPERATIONS below E.L DISEASE -POLICY LIfd11 5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Addltionar Remarks Schedule, may be attached if more space is required) 17FRTIFIr`AT= unf nro ANCEL LATION City or0keechobee 55 SE 3rd Avenue ) Okeechobee FL 34974 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 I_Nrt:' H. PriJ aid, @ 1988-2015 AGGRO CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and Togo are registered marks of ACORD RECEIVED 11/12/2019 10:22AM 8637638497 DONS APPLIANCES Nov 12 19, 10:22a Pritchards inc. Insurance 8637635629 10.3 ACQR, Q 4.------ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODIYYYY) 11;12„019 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 holdor is art 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 Ptitchards & Associates, Inc 1302 S Parrott Ave Okeechobee FL 31974 CON IACt NAME: Taylor Padrick POLICI EH- (MMIDDIYYYY) ((PAHONI o E gk 063 763 77 1 1 1-AX NNo): AL ADIJDRDRESS: taylor@prilchazdsinc.com INSURER(S) AFFORDING COVERAGE NAIC it INSURERA : OHIO SECURITY ITIS CO 24082 INSURED 1 Stop Party Shop LLC 319 SW Park St Okeechobee FL 34972 INSURER e: INSURER C : EACH OCCURRENCE INSURER D INSURER E : CLAIMS -MADE X OCCUR INSURER F: E CERTIFICATE 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 CR OTHER DOCUMENT WTH 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. -1101.1LSulift INS K LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER POLICI EH- (MMIDDIYYYY) PUUCY EXP [MMIDOIYYYYI LIMITS K COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS -MADE X OCCUR U) MAt,e. IL, ITEM ED PREMISES (Ea orsurrerce) 5 300,000 K SPC MED EXP ;Any one person) S 15,000 A 13KS57419072 06130.2010 06/30/2020 PERSONAL & ADV INJL RY S 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE S 2,000,000 PRO - POLICY I IJECT LOC PRODUCTS - COUP/OP AGE $ 2,000,000 0 -HER: $ AUTOMOBILE LIABILITY LUMNINEU SINt,LE Ll.v I I (Ea accident) $ ANY AUTO — BODILY INJURY (Per person) $ OWNED AUTOS ONLY — SCHEDULED AUTOS BODILY INJURY(Peridt ae�en) 5 HIRED AUTOS ONLY _ NON -OWNED AUTOS ONLY NKiai-I tleY UAMAI,E fPeocnt) 5 5 UMBRELLA LIAB EXCESS UAB — OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DEO RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YiN ANY PROPRIETOR/PARTNER/EXECUTIVE DFFICERMEMBER EXCLUDE07 (Mandatory in NH) IF C0yes. SCRIRTION under CESCRI'T10N OF OPERAT ONS below NIA PER 611 -1 - STATUTE ER E.L. EACH ACCIDENT $ EL. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD lot, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION Downtown Okeechobee, LLC 320 SW Park Street okccchobcc FL 34972 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 L11weLL H. PrU 4t r, ACORD 25 (2016103) 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD