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Temp Street Closing - Okeechobee Christian Academy Field Day� CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Tele: 863-763-3372 X9821 Fax: 863-763-1686 e-mail: pneu @citvofokeechobee.com STREET CLOSING PERMIT Permit Number: 21-001 Permit Expiration: February 12, 2021 Purpose of Request: Field Dav Property Owner: Citv of Okeechobee Address: 55 SE Third Avenue Date(s) of Event: February 12, 2021 8:00 a.m. — 2:30 p.m. City: Okeechobee State: Florida Zip Code: 34974 Applicant: Okeechobee Christian Academv Applicant's Address:701 S Parrott Avenue . Okeechobee, FL 34974 Phone Number: 863-763-3072 Current Zoning: P Subdivision: City of Okeechobee Address of Project: SE 2°d Avenue —(SE 6t�' Street thru SE 7�' Street FLU Designation: Public Restrictions/Remarks: All debris must be removed within 24 hours of expiration date. Ca� � N�.v ��c�;a�v 5, 2 02 Y Administrative Secretary Date General Services Department � � •.�t�t.�►.�:.� ''�� c� � 2G�:G/ , Page 1 of 3 Revised 3/5/19 � -,.._ �� Date Received: Ant�lication No: Information: 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 Issued: �''` :11' ��- �� L� 1 , Date(s) & Times of Event: Fr�day, February 12, 2020 8am-2:30pm �T arilZatlOri: Okeechobee Christian Academy Mailing Address: �o� s. Parron Ave, Okeechobee, FL 34974 Contact Name: Mei�ssa K�r,9 E-Mall f�ddTeSS: Melissa.King@OkeechobeeChristianAcademy.org Tele hone: WOI'Ic: 863-763-3072 of activities: Please check requested Parks: Home: Cell: 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 lst & 3rd Tuesdays but subject to change) Address of Event: 7� � S Pa rrOtt /�V@ Street(s) to be closed: sE 2nd Ave from sE 6tn street to sE 7tn street Date(s) to be closed: Fr�day, February 12, 2021 Time(s) to be closed: s:ooam-2:sopm Pu OSe Of CIOSIrig: Safety of children crossing the street Attachments Re uired for Use of Parks Attachments Re uired for Street/Sidewalk Closin s ► 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 da s. ► State Food Service License if > 3 da s. ► Notarized letter of authorization from ► State Alcoholic Beverage License, if applicable.** ro ert owner, if a licable.* * 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. ❑ 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 re�ulations of other governmental re ug latory a encies. 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 Olceechobee, 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. 1 /7/2021 Applicant Signature Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: Building Official: Public Works• Police Department: BTR Department: City Administrator: City Clerk: � �� i; Date: /�'t��'v2�� Date: � � Z•Z Date: j " %�� % Date: � �a a I Date: I � Z Zl Date: � / �. Date: � I i � �i�(i� NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO EVENT FOR PERMITTING. Tem orar Street and Sidewalk Closin submitted for review b Cit Council on �� lit°'�/ P Y g Y Y Date Temporary Street and Sidewalk Closing reviewed by City Council and approved �/�v L�� Date '�t"d ,��1 I. r I' i I C/a � i.0 --c --t d � D c� (�`•� �, � � I :,�� OV.�echu+�,e CVthsfiia.n .q-c�cxdQrn�u' , ) !. � 1 �' :; � �G�r�� Ikc��,�a��ii� �71��cFaok�� z ~� Clasing her� ;, � ._., �:f U,'� m ^• ; ��: �. :-�� r; �, �� .f �r �;;� C�t�� hGYe '��i �iE;ld �� • �-` `.;'i ,.,Ie �,� � �i .,. � � Gt��c1 C��r� ei4��{�i«c� �-�4►r --� .aco O� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YWY) �� 11 /05/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CER7IFICATE 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 CONTACT �ohn Duran NAME: JDA Insurance Group PHONE E:(561) 296-0373 ac No :(561) 828-0997 120 N Federal Hw Suite #301 E-MAIL info the'da rou com y� ADDRESS: G 1 9 P• INSURER 5 AFFORDING COVERAGE NAIC # Lake Worth FL 33460 iNsuRERA: PHILADELPHIA INDEMNITY INS CO 18058 INSURED iNsurtert s: INSURANCE CO OF THE WEST 27847 Okeechobee Christian Academy, Inc. 701 South Parrott Ave Okeechobee FL 34974 GOVERAGES 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 7ypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP L�MITS LTR POLICY NUMBER MM/DD/YYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $'I ,OOO,OOO CLAIMS-MADE �X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 5��,��0 MED EXP (Any one person) $ 5,��0 A PHPK2127332 O%�O'I IZOZO 07/01/2021 PERSONAL 8 ADV INJURY $'I ,OOO,OOO GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 3,000,000 X POLICY ❑ JECT � LOC PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY (Per person) $ A OWNED SCHEDULED pHPK2127332 �%/��/2�20 07/01/2021 BODILYINJURY(Peraccident $ AUTOS ONLY AUTOS � XHIRED V NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY �� AUTOS ONLY Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $'I,OOO,OOO /� EXCESSLIAB CLAIMS-MADE PHU6720513 07/01/2020 07/01/2021 AGGREGATE $ 1,00�,�� DED RETENTION $ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE �/�/FL 5042021 02 O7IOZIZOZO O%IOZIZOZ� E.L. EACH ACCIDENT $'I,OOO,OOO B OFFICER/MEMBER EXCLUDED? �N N� A (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ �,��0,�00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $'I ,OOO,OOO A Professional Liability PHPK2152616 07/01/2020 07/01/2021 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: With respect to field day events for the school The City of Okeechobee and R.E. Hamrick Testamentary Trust is named as an Additional Insured under the General Liability policy evidenced herein. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Okeechobee ACCORDANCE WITH THE POLICY PROVISIONS. R.E. Hamrick Testamentary Trust AUTHORIZED REPRESENTATIVE 55 SE 3rd Ave ,\ � ;�, • - Okeechobee, FL 34974 FL 34974-2903 - O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD