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Park Use Permit - Memory Flags Child Abuse VictimsPermit Number: 20-004 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 e-mail: pneu@cityofokeechobee.com Park Use Permit Date(s) of Event: April 10 — 17, 2020 Permit Expiration: April 17, 2020 @ 11:59pm Dedication: April 14, 2020 Purpose of Request: Memory Flags Child Abuse Victims Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: C.A.S.T.L.E. (clopresto@castletc.org) Applicant's Address: P.O. Box 12908 Ft. Pierce, FL 34979 Phone Number: 772-465-6011 X225 Address of Project: City Hall Park Current Zoning: P FLU Designation: Public Subdivision: City of Okeechobee Restrictions/Remarks: All debris must be removed within 24 hours of expiration date Please call 811 prior to installation of flags for all line and utililty locates. Public Works will mark sprinkler heads with flags to enable you to locate them. They will also advise our lawn maintenance contractor to mow prior to your weeklong event. 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. 9a,(1p. New Administrative Secretary February 4, 2020 Date Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE '.0F•ok4 55 SE THIRD AVENUE ,1``{�.oF•okFFryo� _6 �, OKEECHOBEE, FL 34974 S� Tele: 863-763-9821 Fax: 863-763-1686 -- :' PARK USE AND/OR TEMPORARY STREET/ ..... „.,,0 SIDEWALK CLOSING PERMIT APPLICATION Date Received: j-.�1-2C 2'C Date Issued: '., Dlf.�� % Application No: s_ Date(s) & Times of Event: t t f1 io 14, ; 0 Cr ( + ' Information: Organization: (., I'1 S 7 -Le Mailing Address: f-'. 0. Ros /a `%C78 . 1-...-0a, p, Epee ► ( 3 `I el -7 9 Contact Name: c ,ten,/ f Q Pk F `iT - E -Mail Address: CL c j'rr s -i0 (^/7STLE -1z ..arc? J Telephone: Work: -1-1,3 _ ,46S- 6,0t / Home: Cell: Summary of activities: rni.n.76uY F t 1,4 - 1.1 fi ,IGS Pi -AC L6 ciq PPR lc. I04 -L azo 70. -1,7; FL / /=02 fPPR .co,c,rvta-rE(Y r..)w6 44-4 44. %ax©1Cnrro..i ",1., y,,:•.'y ,-,:e (lee IL ltill, ,-20.2D '17lov AL -F FI -J -16s oN &Pie_ I 74 . 2 0c20 f4.EHaE: l,.,,'s,eArc _ /IY1Ilk'K rt lc Lce14r/cAi r /,_4.!lCaAr10A/ /S'P,, fAief 4k' 5N/ Sl /WS o AVL7, () G 14041911E FROM FL fi C_i P°L C .-S . Proceeds usage: Please check requested Parks: Flagler Parks: G' ity Hall Park ❑ #1 Memorial Park o #2 ❑ #3 o #4 o #5 o #6 [Park 3 is locationof 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: 1 -..;21-,...20.10 r;F-.e v- e 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: ( / ,/ //ht. t /-)talo Street(s) to be closed: /v /It' Date(s) to be closed: Time(s) to be closed: Purpose of Closing: Attachments Required for Use of Park ► 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. 10- 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 pnvate 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. n 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. - - .1 - -d- .. - - "---- .—Page 3 of 3 P age • M / '9. h 0 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. is ,v ti ; ,- , / ;�.c_ ,k ) I l /', J' r)L:.c.- Applicant Signature Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: /44,‘j(i....,„t 05.'l Date: /—C9C4:16' Building Official:;1` Date: ) '2.2. Z b Public Works: 1 — Z7 _ 2 C Date: Police Department: Date: j'?I Z74''-'' BTR Department: ‘ LZ,7ri / Date: -2�- City Administrator: ' Date: / 3/ —07/52.:24 - City Clerk: l )1A1 oT Date: ' jg Jci o 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 L� R. e@e a ----P-1 j • _ 1 ,t✓ 0000C?5 07/15/19 FLORIDA Consumer's Certificate of Exemption Issued Pursuant to Chapter 212, Florida Statutes DR -14 R. 01/18 85-8012614831C-1 Certificate Number This certifies that 09/30/2019 09/30/2024 501(C)(3) ORGANIZATION Effective Date EXCHANGE CLUB CENTER FOR THE PREVENTION OF CHILD ABUSE OF THE TREASURE COAST INC TREASURE COAST INC 3525 W MIDWAY RD FORT PIERCE FL 34981-4962 Expiration Date Exemption Category is exempt from the payment of Florida sales and use tax on real property rented, transient rental property rented, tangible personal property purchased or rented, or services purchased. Important Information for Exempt Organizations FLORIDA DR -14 R. Ol/18 1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. See Rule 12A-1.038, Florida Administrative Code (F.A.C.). 2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property, sleeping accommodations, or other real property is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property (Rule 12A-1.070, F.A.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions about your exemption certificate, please call Taxpayer Services at 850-488-6800. The mailing address is PO Box 6480, Tallahassee, FL 32314-6480. L i .)1?/7rn 4Lf. t • 3 • '4 Ro. CERTIFICATE OF LIABILITY INSURANCE EXCHCLU-04 KSOUTHWARD DATE (MMIDD/YYYY) 03/08/2019 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 Stapleton Insurance & Risk Mgt P. O. Box 1118 Sylvania, OH 43560-0118 INSURED The Exchange Club Center for PO Box 12908 Fort Pierce, FL 34979 COVERAGES CERTIFICATE NUMBER: NaMEACT NE (Arc, No, Ext): AX (419) 720-6446 ( , No): (419) 882-3911 E•MAIL ADDRESS: INSURERS) AFFORDING COVERAGE INSURER A : Philadelphia Insurance Company INSURER B . NAIC 0 23850 INSURER C INSURER 0 : INSURER E INSURER F 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 POLIC ES 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 ADDL INSD SUER WVD POLICY NUMBER POLICY EFF IMMIDDIYYYYI POLICY EXP 1MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LUU31LITY EACH 1,000,000 1 CLAIMS -NUDE X OCCUR PHPK1797913 03/26/2019 03/26/2020 OCCURRENCE PIsEESTO(ErNwrencel.__.._$._..__......_..—...___.100,000 $ MED EXP (Any aria $ 6,000 Person PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIESjPER: GENERAL AGGREGATE $ 3,000,000 POLICY Li JEL [._._J LOC PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER. $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ee accident) $ 1,000,000 ANY AUTO AUTOS ONLY SCHEDULED SE PHPK1797913 03/26/2019 03/26/2020 BODILY INJURY (Per person) _ BODILY INJURY (Per accident) $. _ ------ $ x_ AUTOS ONLY X . AUTOS ONLY PgacEc,dentDAMAGE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLWB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERSCOMPENSATIONPER AND EMPLOYERS' LIABILITY OTH- 1 STATUTE R YIN ANY PROPRIETOR/PARTNER/EXECUTIVEI J FFICER/I/MBgE�I EXCLUDED? NIA E.L. EACH ACCIDENT $ Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ ayes. describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT $ A A Professional Llab Sexual Abuse PHPK1797913 — PHPK1797913 103/2612019 03/28/2019 03/2612020 03/26/2020 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) City of Okeechobee Is an additional insured ATMA per form CG2026 7104. CERTIFICATE HOLDER City of Okeechobee 55 SE Third Avenue Okeechobee, FL 34974 ACORD 25 (2016/03) CANCELLATION 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 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Gail Neu From: Cindy Lopresto <CLopresto@castletc.org> Sent: Tuesday, January 21, 2020 10:18 AM To: Gail Neu Subject: Park Use/Permit Application Memory Field Attachments: [U ntitled].pdf Good morning Gail, I hope you had a wonderful long weekend! I've attached the Park Use/Permit Application along with the Tax Exempt form for CASTLE and the layout of what we have planned for Memory Field at the City Hall Park in April. If you need anything else, please let me know. Thank you! Best Regards, Cindy £oTresto Executive Administrative Assistant HH Program Coordinator CASTLE P.O. Box 12908 Fort Pierce, FL 34979 772-465 — 6011 ext. 225 CLooresto@castletc.orq Learn More about CASTLE at www.castletc.org Follow Us on Facebook: https://www.facebook.com/castletc/ Follow Us On Twitter: @Castletc 1 Gail Neu From: Cindy Lopresto <CLopresto@castletc.org> Sent: Thursday, January 9, 2020 10:02 AM To: Gail Neu Subject: RE: 2020 MEMORY FIELD Hi Gail, I had no idea that Jackie retired from the City of Okeechobee, I look forward to working with you this year. I did receive the form, I will get it filled out and sent back to you next week. Yes, we will need the same as last year including the irrigation & sprinklers flagged. We do not want to damage anything in this process. Have a wonderful day! Best Regards, Cindy LoPresto Executive Administrative Assistant HH Program Coordinator CASTLE P.O. Box 12908 Fort Pierce, FL 34979 772-465 — 6011 ext. 225 CLopresto@castletc.org Learn More about CASTLE at www.castletc.org Follow Us on Facebook: https://www.facebook.com/castletc/ Follow Us On Twitter: @Castletc 4)))*(,, LE From: Gail Neu [mailto:gneu@cityofokeechobee.com] Sent: Wednesday, January 08, 2020 4:15 PM To: Cindy Lopresto <CLopresto@castletc.org> Subject: 2020 MEMORY FIELD Hi Cindy — Gail Neu From: Sent: To: Subject: Cindy Lopresto <CLopresto@castletc.org> Monday, January 6, 2020 4:57 PM Gail Neu 2020 Memory Field Hi Jackie, I hope you had a wonderful holiday season and the new year is off to a great start! We are planning our Memory Field flags this year and I wanted to reach out and see if April 10th through the 17th (with a dedication ceremony on the 14th), would work for having it in the same location as last year? Best Regards, Cindy LoPresto Executive Administrative Assistant HH Program Coordinator CASTLE P.O. Box 12908 Fort Pierce, FL 34979 772-465 - 6011 ext. 225 CLopresto@castletc.orq Learn More about CASTLE at www.castletc.org Follow Us on Facebook: https://www.facebook.com/castletc/ Follow Us On Twitter: @Castletc 1 gad- skeet daj-es 5 poi& hctei(- I n-hroctuee Libre 1F In pine 0-r^ Jackie So She is W U? We usual{ i re eel ye. his requ.e.1.+ Q tigni ye Mail LS