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2020-01-21 Ex 01obvel is -2O) 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: i _, -;;249:20 Date Issued: Application No: 40 � YW' Date(s) & Times of Event: Friday, February 14, 2020 8am-2:30pm Information: Organization: Okeechobee Christian Academy Mailing Address: 701 S. Parrott Ave, Okeechobee, FL 34974 Contact Name: Melissa King E -Mail Address: Melissa.King@OkeechobeeChristianAcademy.org Telephone: Work: 863-763-3072 Home: Cell: Summary of activities: Students will participate in Field Day and will need to cross back and forth all day. Proceeds usage: Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 ❑ #4 o #5 o #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 1St & 3rd Tuesdays but subject to change) Address of Event: 70 � S Parrott Ave Street(s) to be closed: SE 2nd Ave from SE 6th Street to SE 7th Street Date(s) to be closed: Friday, February 14, 2020 Time(s) to be closed: 8:00am-2:30pm Purpose of Closing: Safety of children crossing the street Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closin ► Site Plan ► Site Plan ► Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee as additional insured. ► Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee and R.E. Hamrick Testamentary 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 property owner, if applicable.* ► State Alcoholic Beverage License, 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. o 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. /OS :out &ohm./ 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. iii Applicant Signature 1/7/2020 Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: Date: Date: / -110-0120 1 `f"' gt ►�i 1 ,, i �/ , i, ► i 1 }e( Building Official: Public Works: / /A----- Date: / 'c Police Department: Date: BTR De • artment: 4. L � P CM Date: / / � " 4.;12R0 City Administrator: Date: / 3 / )0 City Clerk: ...,e ' Cru tai 61n - Date: -15 --(910 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 • - ----•- ___--- ^....— rccviJluIN IVUMt$tK: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 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 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 ADOL INSR SUER WVD POLICY NUMBER POLICY EFF (MMIDDJYYYYt POLICY EXP (MM/DDrVYYYI LIMITS NAIC ft GENERAL X LIABILITY INSURED Okeechobee Christian Academy 701 South Parrott Ave Okeechobee, FL 34974 rnvCDA r_CO ..,-^-.....-.-" . _.- ..- •- --- INSURER B: Philadelphia Indemnity Insurance Company 18058 INSURER c : Philadelphia Indemnity Insurance Company 18058 EACH OCCURRENCE $ 1000000 INSURER E : Philadelphia Indemnity Insurance Company 18058 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500000 CLAIMS -MADE I X1 OCCUR MED EXP (Any ono person) $ 5000 A PHPK2000717 07/01/2019 07/01/2020 PERSONAL &ADV INJURY $ 1000000 GENERAL AGGREGATE $ 3000000 GEN'L AGGREGATE LIMIT APPLIES PER: RI PRODUCTS - COMP/OP AGO $ 3000000 POLICY n JEC7 I I LOC AUTOMOBILE LIABILITY COMRINED SINGLE LIMIT (Eaaccldentl $ 1,000,000.00 ANY AUTO ALL OWNED ^ BODILY INJURY (Per person) $ B AUTOS AUTOSSCHEDU�D NON -OWNED PHPK2000717 07/01/2019 07/01/2020 BODILY INJURY (Per accident) $ X HIRED AUTOS X AUTOS PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS X OCCUR EACH OCCURRENCE $ 1,000,000.00 C LIAB CLAIMS -MADE PHUB681884 07/01/2019 07/01/2020 AGGREGATE $ 1,000,000.00 DEO XI RETENTIONS 10,000.00 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- TORY LIMITS X OTH- FR D ANY PROPRIETOR/PARTNER/EXECUTIVE rY/N OFFICER/MEMBER EXCLUDED7 I N 1 N IA WFL 5042021 01 07/02/2019 07/02/2020 E.L. EACH ACCIDENT $ 1,000,000.00 (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000.00 E Professional Liability PHPK2000724 07/01/2019 07/01/2020 Directors & Officers $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACO120101, Additional Remarks Schedule if more space Is required) The City of Okeechobee & R.E. Hamrick Testamentary Trust is named as Additional Insured in regards to the General Liability portion of policy, rCDT1Cir ATC Lin, nein ,4K1L7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 01/06/2020 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 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 JDA Insurance Group 120 N Federal Hwy #301 Lake Worth , FL 33460 CONTACT Chris• tine Dewey PHONE Ext1• (561) 296-0373 I FAX No): 5612960392 AIL ADDRESS: Christine@thejdagroup.com INSURER(S) AFFORDING COVERAGE NAIC ft INSURER A: Philadelphia Indemnity Insurance*Company 18058 INSURED Okeechobee Christian Academy 701 South Parrott Ave Okeechobee, FL 34974 rnvCDA r_CO ..,-^-.....-.-" . _.- ..- •- --- INSURER B: Philadelphia Indemnity Insurance Company 18058 INSURER c : Philadelphia Indemnity Insurance Company 18058 INSURER D : Insurance Co Of The West 27847 INSURER E : Philadelphia Indemnity Insurance Company 18058 INSURER F : City of Okeechobee R.E. Hamrick Testamentary Trust 55 SE 3rd Ave Okeechobee, FL 34974 FL 34974 ACORD 25 (2010/05) NCELLATION 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 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • 13r 0 T3 (1.) IL LLI CC) SE 2.2d Ave _ SE (1) S Parrott Ave Gail Neu From: Sent: To: Cc: Subject: Attachments: Thank you, Melissa. Robin Brock Tuesday, January 7, 2020 9:23 AM Melissa King Gail Neu; Patty Burnette FW: Street closing Field Day closing 02142020.pdf Merry Christmas and Happy New Year to you as well. if - Ieiriea) Cetia(heCL `{ D tY16L-lid IS pDJt(tea - r� �I Croce oci )«dams 'fes Alba) ) v� ha1v (1.11k( tILL( Please allow me to introduce our new General Services Administrative Secretary, Gail Neu, who will be processing your temporary street closing application. Should you have any questions or need anything further regarding your application, please do not hesitate to contact Gail. See contact information below: 94et 72eu Administrative Secretary CITY OF OKEECHOBEE 55 SE 3RD Avenue Okeechobee, FL 34974 386-763-3372 Ext 9821 Fax # 863-763-1686 8neu@citvofokeechobee.com After the application is processed and submitted back to me, I will place it on the January 21st City Council meeting for approval. As always, if you have any questions, please let me know. Have a wonderful day. Robin C• Okeechobee FLORIDA, • F<_u,de.d 1415 Robin Brock Executive Assistant 55 SE 3rd Avenue Okeechobee, FL 34974 Phone: (863) 763-3372 Direct: (863) 763-9812 FAX: (863) 763-1686 Email: rbrock@cityofokeechobee.com Website: www.cityofokeechobee.com 1 09 qiC P51c,pd'i