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2020-11-17 Ex 03Page 1 of 3 Revised 3/5/19 CITY OF OKEECHO EE ,1 ' ple:63-�G�3-��23 a: '63-763-16r PAR, X USE AND/0-R TEMPO, S�35, \T, �L, X CT 03 1 IN s ER�WHIT Date Received: JDate Issued: Application No: z;)ci--Ci) _ E�ate(s) & Times of Ev -t-- T FiefyHY (_- 1 h�N J Ot7� Information:?`�- Organization: Mailin Address: g ! ! 51 2cF7' 6bpE-hev, EL 349 , Contact Name: IV ' E-Mail Address: 1\jU <<� HC f'1G h i �� ( 2 'E7 : CPC Telephone: Work:3 - `� - (, : ;�� `� l Dome: I Cell: Summary of activities: E f AN> Fcc?) (Nb laS 1)/L' � %%US / C' cur -S c b 111flF'C_ S �7 S kfl Proceeds usage: , N; oF i s r Ul HFt`nzb 1 i H. Fe tr: Nth r\%L i C1 iJti,N Please check requested Parks: F'lagler Parks: ❑ City Pull Park ❑ #1 Memorial Park ❑ #2 !k #3 )(#4 ❑ #5 ❑ #6 [Park 3 is location of Gazebo. Park 4 is location of Bandstand] (R'•m Oth. O1 Jl I'✓c`1tG'. TDMTOelt J used In co i1j1'13Ildlon wKiL 3 th, is ---;"-,7k Use 1[ e2-TnIIiS-plense pl mvide the zd&ress 2n.d ?J-ac6'I unnabear iD6 lcv,, along -w!, t1 is cmiz- Lem lie ex of nnuthm izn'tion horn propeyn�' ovin, :-) Additional Addresses, if applicable Parcel ID: Page 2 of 3 Revised 315119 (Street Closings requi_ =y Council approval. Meetings V �, 3`a Tuesdays but subject to change) Address o f Event: Sireet(s)-to beclosed: ") &; 7 __362o1/}le w, Sr,.! 7 Lh Ave Dates) to be closed:L'!-:, P,? ,1 0.1cl- ! 1. l_l, Ti.-ne(s) to be closed: j ir,"r) ;`C_ 1 1 i-F i 'r; i ? - 1 r) l,1,>> ClIi Purpose of Closing: (`ha '-I ',)I r: �� 1 v�; i �� ') ;� .1,; D C-' \�i 1 1t :!` � A zichm—eras ReQia rred Ioi, use At-2cliaments IRenu bred C(�Imsiilvc, > 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. Truest as Additional Insured. >Proof of non-profit stags > 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 ftom > 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 AL LOV` IED in City Parks, City streets or City sidewalks. See additional note below. ❑ 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. 1Jmte: > 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 p roperty/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 depart rental expenses. The City reserves the right to require f.om 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 vM1111 ns R.E. ! a�ricPs Testamentary Trust if *sing streets or sidewalks. jo Applicant Signature J v Date 0000®J 111CiJ SE (0)r1r Y 0 0 0 0 Sta'ReWevv Eire De p al tment: Z I Date: Bui &n 9 O Mal: Date: P'10C `;i 70zfts: S Date• P©T-he D epaL•'Ment: Date: T R. e arC ,eat: ate: �� C9 -2 1 City Adm, hals'urn"La •: ^I Date° City Cie ?-': DDate: MOTE: AP LLCAT 701�1 AJ�110\TS i L .1q\ CE CERT 1!i CATE 1 'i JST EE COPUTPLETED A1\'TD R 1T'TUR,T` EED TO THE O:A:PM ii SERI/TiCES DEPART Pk=' 11TTi T 11 i � i1 .T (30) a A1'S PRIT' OR To EVE NT FOR PEL�.P211TT UNTO. Terre®rats, Sheet and Srdetiv�!AP� Cl©si�aa sr�l�rni�eed ©r r•eview ray Cagy C©uciIl on, Ternper•aLy Street, arc SMeyvnRk- CRosing revievieel by City CouncH nrd approved Date Date Application Number: APPLICATION FOR SPECIAL EVENT Date Received: NAME OF EVENT: t�.� l �r� 77 ADDRESS OF EVENT: N DESCRIPTION OF EVENT: r /�l1Pj�► t�v r�si l�„?� +hl?T r NAME OF SPONSOR ORGANIZATION: Chap hi-,bec, f^ii- i i\1 .-S P-6c' T' Contact before and during event OF RESPONSIBLE PERSON: QL,) ; /Vo i e- Cje1 4+1 r\1 DATE(S) AND TIME(S) OF EVENT: Date:--T),---(L_ (! 00,'�G Starting Time: fY) Closing Time: / Date: ire'(- ( Starting Time: Y71 Closing Time: I r7 ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? LOCATION r Will Emergency Apparatus ():ire and Ambulance) have access to area? V IF NO, THEN (provide alternatives): WILL ELECTRICITY BE USED? YES 0 N0i d (circle) Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YES M � O Type of Heating Equipment Used: WILL A TENT BE ERECTED? (circle) YES 0 te 0 6. Tent Manufacturer: Size fire rating posted: Tent have sides and how many? Are there Fire Extinguishers accessible and ready for use? (circle) Yes No ***ATTACH SITE MAP OF EVENT LAYOUT*- �SE''>=CESS: r'i? C1;''?at'±g�iVaSd�€: C'i\'f: FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above) O Tents/canopy fire rating certificate required. ❑ Tent Size require life safety inspection (900 square feet or less these no permit is required) ❑ Floor plan / seating / setup drawing required showing exits, etc. ❑ Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) O Fire extinguishers must have current tag, and be operational and readily accessible. O Cooking requires LPG outside of tent pointing away from exposures. ❑ Electrical wiring exterior rated, not overloaded. O Fire Services inspection required. O Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount: O Firefighter/Inspector Amount: O Other. FIRE DEPARTMENT FFIr-z�� : SIGNATURE: Please call the FD at 863-467-1586 for any questions. Revised 11-6-19