2021-03-16 Ex 05Page 1 of 3
Revised 3/5/19
�,� _
.-�/
Date Received:
Anplication No:
Information:
vrganization:
Mailing Address:
Contact Name:
E-Mail Address:
Tele�
Work:
CITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tele: 863-763-9821 Fax: 863-763-1686
PARK USE AND/OR TEMPORA.RY STREET/
SIDEWALK CLOSING
PERMIT APPLICATION
Date Issued:
Date(s) & Times of Event:
Please check requested Parks:
Home:
Cell:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park Ar#2 �s'#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:
(s) to be closed:
�) to be closed:
Time(s) to be closed: / / �
Purpose of Closing: / t'
i
Attachments Required for Use of Parks
► Site Plan pu}j�� l,�Cr4�5 �-v �r�QnC��Q
► Copy of liability insurance in the amount of
$1,000,000.00 with the City of Okeechobee as
additional insured. 1� � �1-
► Proof of non-profit
�7
► State Food Service License if> 3 day,
► Notarized letter of authorization from
property owner, if applicable.* I����
Attachments Required for Street/Sidewalk
► Site Plan
► Copy of liability insurance in the amount of $1,000,000.00
with the City of Okeechobee and R:fi. Hamrick Testamentary
Trust as Additional Insured. %
► Original
business ov�
► State Fo�
► State ��i
idents, property owners and
if > 3 da
License, 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.
❑ 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 Severage 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 reguirernents of the City and other repulations
of other �overnmental re latory a e� 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.
�i ; J . ' Page 3 of 3
;\ \ ; � ;� ( � � 1,, ��--,�. I ��� �� �� � = j Revised 3/5/19
� �C.; _ �l_ �� / 1; i�_ � � , G'_.1 •li-. /�';_?
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 ruIes 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 welI as R.E. Hamrick
Testamentary Trust if closing streets or sidewalks.
�,�/� �/% �� �' , 7
��( .r ,!� !�� !1� r, :.�li�(�l/i(/,'-� c, )- � `�- c!� � l
Applicant Signatur�✓ ✓ Date
� ••••OFFIGE USE ONLY•••�
Staff Review /
; - -_i�,;'. ,� ,;> =;�_�;
FireDepartment: � ,<- ;�_,,,_,;.,,,, ��;. .' .
Building Official:
Public Works:
Police Department:
BTR Department:
City Administrator:
City Clerk:
j / -,
�
���,i
��.� :
���� "� . � ;i
' I ,--%;!, l ' f:�-_
,,
%
Date: ,-; _ :�-; . . - - ,
Date: •� • �
Date: r� � � Zj
Date: '' •_ _ - '
Date• :_; . �� ^� /
Date: � � `% /G r
� -
Date: � /� '�/I_�-/
NOTE: APPLICATION AND INSURANCE CERTIFICAT� MUST BE COMPLETED AND
RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO
EVENT FOR P�RMITTING.
Temporary Street and Sidewalk Closing submitted for review by City Council on �.111r-�
Date�
Temporary Street and Sidewalk Closing reviewed by City Council and approved e� liG�
. Darte