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2020-03-17 Ex 01Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE 55 SE THIRD AVENUE s ° OKEECHOBEE, FL 34974 ~ Tele: 863-763-9821 Fax: 863-763-1686 s PARK USE AND/OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: e Date Issued. Application No:Date(s) & Times of Event: Information: Organization: First Baptist Church Mailing Address: 401 SW 4th street Contact Name: Melanie Rooks E-Mail Address: mail@fbcokee.org melanie@fbcokee.org Tele one: Work: 863-467-7625 I Home: I I Cell: 772-633-9777 Summary of activities: Easter Egg hunt Proceeds usage: Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #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 I" & 3rd Tuesdays but subject to change) Address of Event: 310 SW 5th Avenue Streets to be closed: SW 4th Street between 5th Avenue and 6th Avenue Dates to be closed: Saturday, April 11, 2020 Time(s) to be closed gam -12pm Purpose Of Closing: Children walking to adjoining property 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. ► 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 ► 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 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. 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. 'utAZ144 Applicant Signature `, U'l.Ll/L(!v 2/25/2020 Date ••••OF W E USE ONLY090* Staff Review Fire Department: 0 o $$d` s Date: - - Building Official: Date: Public Works: Date: —2 7-2 Police Department: Date: I Z� BTR Department: Date: -01646 Ci Administrator: -- Date:I/ City Clerk: y ? Date: 0 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 APPLICATION FOR SPECIAL EVENT Application Number: NAME OF EVENT: ADDRESS OF EVENT: DESCRIPTION OF EVENT: 3 00 S tA; Lk -h , ` -+ U• A. –cm CDmvr��nl Date Received: NAME OF SPONSOR ORGANIZATION: -rlrsti RZqP-m.,-r Contact Number before and during event OF RESPONSIBLE PERSON: ctj-7-7 ast RESPONSIBLE PERSON'S NAME: / DATE(S) AND TIME(S) OF EVENT: Date: 4- 1 j 2-0222 Starting Time: to% -:50 Closing Time: Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? ✓ LOCATION f9W'MASk h Soh Iv�h Aum Will Emergency Apparatus (Fire and Ambulance) have access to area? .5 IF NO, THEN (provide alternatives): WILL ELECTRICITY BE USED? YES 0 circle) — ov V 5– Locations: Provided By: WILL HEATING/OPEN Type of Heating Equi] S FOR FOOD BE PROVIDED? (circle) YES Used: WILL A TENT BE ERECTED? (circle) YES IN Tent Manufacturer: Size fire rating posted: _ Tent have sides and how ma 7 Are there Fire Exti s ersaccessible and ready for use? (circle) Yes No '**ATTACH SITE MAP OF EVENT LAYOUT"-' FIRE SERVICES SHALL COMPLETE ITEMS BELOW: FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above) Tents/ (� 1 . e..4E 11 -----a r --------------- FIRE DEPARTMENT F W (PRINT): c T SIGNATURE Please call the FD at 863-40-1586 for any questions. Revised 11-6-19 FIRSB-1077 JHECKMAN . 40.--"'� ? 7 CERTIFICATE OF LIABILITY INSURANCE `0 DATE (M 2!26!/202202YYY) 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 Church Asset Management, Inc. 1500 Wall St. Saint Charles, MO 63303E CONTACT PHONEFAX (A/C, No, Ext): (800) 200-7257 1 (A/C, No)066) 608-0600 -MAIL - �gDDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:GuideOne Mutual Insurance Compal 115032 12/1/2019 INSURED INSURER B : Is 1'000'000 $ 1'000'000 INSURER C : First Baptist Church of Okeechobee _ INSURER D: 401 SW 4th St Okeechobee, FL 34974 INSURER E, I $ 10'000 INSURER F: _ PERSONAL & ADV INJURY $ 1'000,000 COVERAGES CERTIFICATE NUMBER: 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 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 TYPE OF INSURANCE ADDL SUBINSD p POLICY NUMBER POLICY EFF POLICY EXP _ LIMITS A X COMMERCIAL GENERAL LIABILITY J CLAIMS MADE OCCUR X 1423-828 12/1/2019 12/1/2020 EACH OCCURRENCE DAMAGE TO RENTED PREML$.E.S_.(Ea_44currn�e) Is 1'000'000 $ 1'000'000 MED EXP (Anyoneperson I $ 10'000 _ PERSONAL & ADV INJURY $ 1'000,000 AGGREGATE LIMIT APPLIES PER: POLICY L_ ] PECOT- D LOC GENERAL AGGREGATE $ 3'000'000 GEN'L (� PRODUCTS - COMP/OP AGG S 3'000'000 $ OTHER: AUTOMOBILE — LIABILITY ( COMBINED SINGLE LIMIT _(Ea asci I 1 $ _ ANY AUTO OWNEDSCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Perperson) BODILY INJURY Per accident -- —� $ _ $ HIRED NON -OWNED AUTOS ONLY I— AUTOS ONLY PROPERTY DAMAGE Per accident $ _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ is WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? n (Mandatory in NH) N / A I PER I OTH- __$TATUTE _.SER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Please see the attached CG2026 form for the additional inssured information for the event on April 11, 2020. City of Okeechobee 55 SE 3ed Ave 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NAMED INSURED: First Baptist Church of Okeechobee POLICY NUMBER: 1423-828 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following:: COMMERCIAL GENERAL -LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of Okeechobee 55 SE 3rd Ave. Okeechobee, FL 34974 The City of Okeechobee and R.E. Hamrick Testamentary Trust are named as an additional insured with respects to use of facilities at 310 SW 5th Ave, Okeechobee, FL 34974 for the Egg Hunt event on ;April 11, 2020. Information required to complete this Schedule, if not shown above will be shown in the Declarations ------- —1 Section If — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf. A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 2/26/2020 Detail by Entity Name Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Not For Profit Corporation FIRST BAPTIST CHURCH OF OKEECHOBEE, INC. Filing Information Document Number 718538 FEI/EIN Number 59-0948707 Date Filed 05/18/1970 State FL Status ACTIVE Principal Address 401 S.W. 4TH ST. ATTN: BEVERLY SHURLEY OKEECHOBEE, FL 34974-4240 Changed: 04/03/2001 Mailing Address 401 S.W. 4TH ST. ATTN: BEVERLY SHURLEY OKEECHOBEE, FL 34974-4240 Changed: 04/03/2001 Registered Agent Name & Address LEVINS, THOMAS C 8511 S.W. 2ND STREET OKEECHOBEE, FL 34974 Name Changed: 05/01/2008 Address Changed: 05/01/2008 Name & Address Title TD TURBEVILLE, JOI C 2198 N.E. 54th Trail OKEECHOBEE, FL 34972 DiviSION OF CORPORATIONS IN Excerpt of City Map with First Baptist Church property identified, a the portion of the street requesting to temporarily close. I than /.. ',: Gail Neu To: MAIL@FBCOKEE.ORG; MELANIE@FBCOKEE.ORG; David Allen; Chief Herb Smith; Robert Peterson; Marcos Montesdeoca; Stevie; Donald Hagan; Kim Barnes; Lane Gamiotea; Jeffery C. Newell; Lalo Rodriguez Cc: Kay Matchett; Sue Christopher; Patty Burnette Subject: Street Closing - Easter Egg Hunt - Hello Melanie — The City has approved your Street Closure request for your annual Easter Egg Hunt on Saturday, April 11, 2020 from 9:.00 a.m —12:00 p.m. Good Luck with your Event Q Have a GREAT day. - -gait-- Administrative Secretary 55 SE 3RD Avenue Okeechobee, FL 34974 863-763-3372 Ext 9821 Fax # 863-763-1686 gneu@cityofol<eechobee.com 1