Temp. Use Permit - American Legion Free FairCity of Okeechobee
55 S.E. 3rd Avenue
Okeechobee, Florida 34974
(863) 763-3372
Temporary Use Permit
Permit Number: 20-001 Date(s) of Event: FEBRUARY 5 - 16, 2020
(5P - 12A Weekdays; 12P - 12A Weekends)
Permit Expiration: FEBRUARY 16, 2020 @ 11:59 PM
Purpose of Request: American Legion Free Fair
Property Owner: American Legion Post 64
Address: 501 SE 2nd Street
City: Okeechobee State: Florida
Zia Code: 34974
Applicant: American Legion Post 64 Applicant's Address: 501 SE 2nd Street
Phone Number: 863-763-2950 Address of Project: 501 SE 2nd Street
Current Zoning: Residential Multiple Family (RMF) FLU Designation: Commercial (C)
Subdivision: 1st Addition to City of Okeechobee
Restrictions/Remarks: All debris must be removed upon final completion date.
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.
NO SET UP OR TEAR DOWN BETWEEN THE HOURS OF 12 MIDNIGHT AND 7:00
A.M.
48 HRS AFTER FAIR CLOSING, PROPERTY MUST BE VACATED.
TRASH MUST BE PICKED UP DAILY IN PARKING LOT AT CITY HALL.
certify that I have examined this permit, it is correct and I will abide by its requirements.
pplic [nt's Signature, -. Date
AElministrative Secretary
"'REF:.ORD.716, Temporary Structures
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570/-4(//-62R3
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Revised 1/5118 jd
`\,,/onok£Ecy TEMPORARY USE PERMIT APPLICATION
r.i'-'''' gyr,:,4 OTHER TEMPORARY STRUCTURES (666)
sz 2$ City of Okeechobee - General Services Department
iii.` a, 0 55 SE 3rd Ave, Room 101, City Hall, Okeechobee, FL 34974
Phone: (863) 763-3372 ext. 9821
DATE RECEIVED: 1 - 027- 020Q:20 DATE ISSUED:
APPLICATION NO.: ao--CDJ_ EVENT DATE(S) & TIME: . J 5-- / ;2I:)02-6) •
FEE: $175.00 1-1-5;37cf3 on-Profit/Civic Organization DATE PAID: �? - (1- -a6,;2Dc. (5 -p -r) -1.20,y) Az
fg Name of Property Owner(s): ,t✓ i lrAl )E<-; 71-i',:2- - l cUle,-W. C
Address:, •y Lt / ,3 f %,6
Et o Telephone Numbers: _
Ed Home: T(,-,...3 -7 3.._ °1..7t - Work: g6 3, _ ,t93( Cell:
Name of Applicant: v 111-,,j
t` Address: t ( -fie
a Telephone Numbers: -
Home: S 4, 3- 7&.3 :15 Work: Cell:
B
Future Land Use Map Desigation: d L %y /y0,2 j l t'y�- _ Current Zoning Designation: )v J
Legal Description of Property: I,," .T a. 3C, t3 ! o c.k J. r57 � ,j' i' /' O
Address of Property: SC) / S "6' ,2 A,tee STJ' t i I< € e c /7 c:' (, t_' e. L"74 3 ,t r%
Please Explain Type of Use: G'- `i 4k; ,(, `!.f /e4 -f //? t- C '-4 i R
Briefly describe use of adjoining property
North: l^ ! ti,., �_S 774 -ft o iCd
East: C. h i f a QJi -- . 5 713 6,i l4- r e 1,,T.
South: 1-4- e fl C. S
West: 0'r, ..,, /-/ 0> 1'1 e-5
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 camival, 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: V) Cat \i {J 11,1V- --`
Date: 0 -1 -90 .,IC
Y
Fire Department Approval: C Z �C-'
Date: 9t,
Police Department Approval: /
Date: - 5` `e>
_
Public Works Department Approval::la-
Date: 1 - 7 5... - Z (
Building Inspector Approval: �(� .
Date: z.3•
City Administrator Approval:
Date: 11- >iti
I hereby certify that the information on this application is correct. The information included in this application is for use by the City of Okeechobee in processing my request.
False or misleading information may be punishaabbte7 a fine of up to $500.00 and imprisonment of up to thirty days and may result in the summary denial of this application.
I
Sig • re of • ° plicant Date
Y
(
RX Date/Time
01/27/2020 10:48 2159680973
JKJ Inc --- Phone: 215-968-4741 Fax: 215-968-0973
P.001
AO/2b CERTIFICATE OF LIABILITY INSURANCE
�•.�---
DATE(MM/DDIYYYY)
1/27/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY QR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER
Johnson, Kendall & Johnson, Inc,
109 Pheasant Run
Newtown, PA 18940
CONTACT
NAME:
ac NN t 215 968W4741 FAx
t ? ) lac, Nn):(215) 968.0973
X-Mtba; Info( jkj.cam
INSURER($) AFFORDING COVERAGE
NAIL 0
INsuwFR A - Everest National Insurance Company
10120
INSURED
Megerle Shows, LLC and Robbie Monello dba Megerie's
12555 Biscayne Blvd. #923
North Miami, FL 33181
INSURER a :
.—.. ,
SI8ML01757-1111
INSURER :
$ 100,000
INSURER 0 ;
S
INSURER E :
_..--PERSONAL
INSURER F:
$ 1,000,000
•
•
THIS 1S 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,
'NSR
LTR
TYPE OF INSURANCE
ADDL
ItL@0„JIVVQ
BURR
POLICY NUMBER
POLICY EFF
.LMtdl9ii
4/1/2019
POLICY EXP
liY�llkgiYGYYI
41112020
LIMITS
_ ,
EACH OCCURRENCE
$ 1,000'000
A
X
--...__......
......,....,,..,.,,.....,...,....,.......,...,.....,....
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
.—.. ,
SI8ML01757-1111
DAMAGE TO RENTED
PREMISES IES occurrence
$ 100,000
MED EXP (Any one person)
S
_..--PERSONAL
& ADV INJURY
$ 1,000,000
GE
'I_ AGGRFGATE
POLICY
OTHER'
I_......._
IJ�MpIIT.. APPLIES PER:
JE CT [.:X.1 LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMP/OP AGO
S 2,000,000
$
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
OWNED
AURT�S ONLY
EO
aLIT08 ONLY
X
SCHEDULED
AUTOS
�y
AUOTOS ONLYY
S18ML01757-191
4/1/2019
4111/2020
COMBINED SINGLE LIMIT
IFa accident)
1,000,000
$
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
$
fregce e i AMAGE
$
A
X
UMBRFa.LA LAD
EXCESS LAB
X
OCCUR
CLAIMS -MADE
SI8EX01109.191
4/1/2019
4/1/2020
EACH OCCURRENCE
$ 9'000'000
AGGRFGATg
$ 9,000,000
DED X RETENTION $ 0
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE jY'/' 1
OQF�FIGpER/MEMS�g EXCLUDED?
Imilnd noYy In NM)
It yea, describe under
DESCRIPTION OF OPERATIONS below
N / A
111,6TE
oTH.
ER
F.L. EACH ACCIPFNT
$
E,L, DISEASE - EA EMPLOYEE
3
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION or OPERATIONS / LOCATIONS i VEHICLES (ACORD IU1, Additional Remarks Schedule, may be attached It more apace Is required)
American Legion of Okeechobee and The City of Okeechobee are named as Additional Insureds with respect to the operations of the Named Insured where
required by written contract for General Liability.
Ci3TIFICATE HOLDER ,,,..,...........,...,......,....,......,...,..,....,....,...........,............,............,.,,.,..........,.,..,..,..,,.,. CA_NQE.LLATIQN
American Legion of Okeechobee
501 SE 2nd St
Okeechobee, FL 34974
-7c3---&8/;”
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
1988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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FLORIDA DEPARTMENT OF AGRICULTURE
AND CONSUMER SERVICES
COMMISSIONER NICOLE "NIKKI" FRIED
www. FreshFromFlorida.com
BRAD YOUMANS
FAIL: RIDES INSPECTION
DIVISION OF CONSUMER SERVICES
sc'- Z51- 613145- ce+L
TERRY RHODES BUILDING
2005 APALACHEE PARKWAY
TALLAHASSEE FLORIDA 32399
(850) 410-3838 Phone
(850)410-3797 Fax
FairRides@FreshFromFlorida.com
MEGERLE SHOWS
PO BOX 310
GIBSONTON, FL 33534-0310
Int of Agriculture and Consumer Services
Dr Services/Bureau of Fair Rides Inspection
EVENT RECAP
e 1-800-435-7352; Fax (850) 410-3797
FairRides@FDACS.gov
INVOICE #: 3305808 PURPOSE: Scheduled
EVENT NAME: MARGATE CARNIVAL
EVENT ADDRESS/LOCATION: 501 SE & 2ND STREET
EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE
OPEN DATE: 02/06/2020 INSPECTION #: 2001-02314
# Rides: 16
# Rides Passed: 16
# Rides Failed: 0
# Rides Not Ready: 0
# Rides No Data: 0
# Go Karts: 0
# Go Karts Passed: 0
# Go Karts Failed: 0
# Go Karts Not Ready: 0
# Go Karts No Data: 0
USAID
Theme Name
Status
IC/RT #
Deficiency
OST #
Unit
07699
OCEAN TRIP
Pass
213198
Attachments - Restraints: Latches damaged/not working
15174
#3
08211
PARATROOPER
Pass
213199
Structural - Pins/Bolts/Keys: Keys Missing
1
08356
BEAR AFFAIR
Pass
213200
Operation - Brakes: Inoperable
15702
#2
Attachments - Restraints: Latches damaged/not working
15759
3
08357
COMBO
Pass
213201
09818
SWING CAROUSEL
Pass
213212
Structural - Hydraulics/Pneumatics: Hydraulic leaks
09826
SUPER SHOT (DROP TOWER)
Pass
213202
10939
CIRCUS TRAIN
Pass
213213
12172
ROCK -N -ROLL
Pass
213203
Attachments - Restraints: Latches damaged/not working
15660
#10/R.
Attachments - Restraints: Latches damaged/not working
1
13810
MINI JETS PETER PAUL
Pass
213205
13891
SKY WHEEL
Pass
213214
14339
FUN SLIDE
Pass
213206
14704
HAMPTON DUNE BUGGY
Pass
213207
14792
SCOOTERS
Pass
213208
Attachments - Restraints: Shocks worn
11824
#13
Operation - Rpm Check: Operational check not performed (ride
won{ t run)
11825
#2
Attachments - Carrier/Tubs: Other
15782
1
Attachments - Carrier/Tubs: Other
15745
14
Attachments - Carrier/Tubs: Other
15780
16
Attachments - Carrier/Tubs: Other
15777
5
Attachments - Carrier/Tubs: Other
15758
7
15034
MOTORCYCLES
Pass
213209
Attachments - Restraints: Latches damaged/not working
7
15035
GO GATOR
Pass
213210
15087
GONDOLA WHEEL
Pass
213211
❑I acknowledge that all identified rides issued a stop operation order (RT #) and/or carriers or components issued an out of service
(OST #) are not in compliance with Florida Statute 616.242 and/or Rule Chapter 5J-18, F.A.C. and shall not operate until it passes
a subsequent inspection by the Department.
Inspeor's ame
Owner/Manager Date
Run Date: February 5, 2020 1:45 PM
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