2020-08-04 Ex 01Page 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:
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Date Issued:
A lication No:
Contact Name:
Dates) & Times of Event: q- F -lDU - -1 - ,D {
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Information:
Organization: }
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Mailing Address:L•
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Contact Name:
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E-Mail Address: ��
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Telephone:
Work: 22h�'j (S bi Le Home: r Cell: '` j�r,�0,
Summary of activities: i� V► 11.(11 JJ /Y � � �t .i��C)l�" 11,4-fO_rJ;12,0
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Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park �#3) -\\-P-'#-4 ❑ #5 ❑ #6
[Park 3 is location of Gazebo. Park 4 is locati 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 Add csses, 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:
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Streets
to be closed: �!' /L
Date(s) to be closed: rvi YtYi�
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Trust as Additional Insured.
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Time(s)
to be closed:
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Purpose
of Closing: ��� l; itX (, (y y k',l , rj ,' J
Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closines
► Site Plan
* Required if private propert
►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.*
y 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.
❑ Please check if items will be sold on City streets/sidewalks. Each busiress will need to apply for a' Tem orary
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 a eg ncies. 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
theissuance
must name City of Okeechobee as Additional Insured as well as R.E. Hamrick
clog ing streets or sidewalks.
Date
••••OFFICE USE ONLY••••
Staff Review
Fire Department:
Date:
Building Official:
Date:
Public Works:
'Date:
Police Department:
Date:
BTR De artment:
Date:
City Administrator:
Date:
City Clerk:
Date:
NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND
RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO
EVENT FOR PERMITTING.
I
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