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2021-10-26 Ex 02Page 1 of 3 Revised 3/5/19 -�.,.. :. �► . _;, == � 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 Telephone: Work: (863)467-7625 Home: Cell: (772)633-977 Proceeds usage: Free event - No charge except for food trucks 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 lst & 3rd Tuesdays but subject to change) Address of Event: 509 SW 4th Street Attachments Required for Use of Parks ► Site Plan ► Copy of liability insurance in the amount of $1,000,000.00 with the City of Okeechobee as additional insured. ►Proof of non-profit status ► State Food Service License if> 3 day ► Notarized letter of authorization from aronertv owner, if applicable.* 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.E. Hamrick Testamentary Trust as Additional Insured. ► Original signatures of all residents, property owners and business owners affected by the closing. ► State Food Service License if> 3 days. ► State Alcoholic Beverage 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 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 �overnmental regulatory 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 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. �� r�,� 10/5/21 Applicant Signature Date .. Staff Review Fire Denartment: Official: Public Works: Police Denartment: I BTR Department: Administrator: :� � Date: � City Clerk: ( ,�,�� ,,�,� � Date: I � ` � � � 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 USE ONLY'••• Date: Date: � -�< �,�Z�Zf � �� Date: %�'/ ' Date: / o / 3 a I ' � � D�� Date: /�i�.Z - -.- ;, _ ~ ' � TY OF OKEECHOBEE`�FI.RE DEP:ARTMENT _��- � � � �'� CI_ APPLICATION FOR SPECIAL EVENT Application #: Name Of Event: �ofS�Zl Date Submitted: �� h,�_ Permit #: Fall Festival (1st Baptist Okeechobee Children's Ministry) Address Of Event: Ball Field located south of the ROC 310 SW 5th Ave Description Of Event: Fall Festival in our ball field with game booths, free candy & refreshments. Inflatable's will be set up by the rental company & operated with multiple adult supervisors. Tents will not be larger than a 10 x 10. Name Of Sponsor/Organization: F��St aapt�sc cn��n or okeeonobee Contact Number before/during event OF RESPONSIBLE PERSON: Melanie Rooks 467-7625 or 772-633-9777 Date(S) And Tiine(S) Of Event: Date: �oi3�i� Za� 1�tarting Time: 5:0o PM Closing Time: ��oo Pnn Date: Startinb Time: Closing Time: Date: Starting Tiii�e: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? YES LOCATTON SW 4th ST belween 5th & 6th Avenue's Will Emergency Apparatus (Fire and Ambulance) have access to area? vEs IF NO, THEN EXPLAIN (provide alternatives): WILL ELECTRICiTY BE USED? YES �IO ❑ L,OCSilO11S: �n the center of the ball field Provided By: �oei eass Eieccr�o WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? YES mV0 � Type of Heating Equipment Used: WiLL A TENT BE ERECTED? vEs � No ❑ NO LARGER THAN 10-FT X 10-FT Tent Manufacturer: N/q Size 10'X10' or smaller fire rating posted: Tent have sides and how many? N/A �.. .. _,-, �._.. _ �part�nent's checklist below to assist �vith expectations regarding safery)' _.._ _ ***ATTACH SITE MAP OF EVENT LAYOUT*** The followin� items to be completed by Fii-e Department on1X FIRE DEPARTMENT LIFE SAFETI' & FIRE SERVICES REOUIREMENTS: (See above) O Tents/canop�� fire rating certificate required. O Tent Size require life safety inspection (900 square feet or less then no permit is required) ❑ Floor plan / seating / setup dra�ving required showing exits, etc. O Emergenc}� access must be maintained. (REFERS TO VEHICL�S AND EQUIP1��fENT� O Fire eatir `�uishers must ha�Te current tag, and be operational and readily accessible. O Coolung reqtures LPG outside of tent pointin� awa}� froin elposures. O Electrical �viring e�:terior rated, not overloacicd. � i O Fire Services inspection requiied. ,, / O Fire watch or inspector(s) REQUI.��D? l� FIRE WATCH Amount: �� O� Firefighter�Inspector Aino�uti"t:�. ° i� ""� O Od7er: � .n_ _, , FIRE DEPAR (PRINT): SIGNATURE: � f�' Please call the FD at 863-467-1586 for any questions. Page 2 of 3 Revised 3/5/19 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Meetings lst & 3'�d Tuesdays but subject to change) Aaaress ofE�ent: Ball Field south of the ROC 3� 0 SW 5th Ave Street(s) to be closed: sw atn st, between SW 5th & 6th Avenue's; if needed & at the Police DepYs discretion: the 400 block of SW 5th Ave Date(s) to be closed: o�tober a�, zo� Z'1ffie�S� t0 be CIOSed: 3:00 to 9:00 PM (Event time is approximately 5-7 PM) PUT'pOSe Of ClOslllg: Pedestrian crossing into the Fall Festival Attachments Required for Use of Parks Attachments Re uired for Street/Sidewalk Closin ► Site Plan ► Site Plan Attar.hPri ► 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 Olceechobee as with the City of Olceechobee and R.E. Hamricic Testamen�ry additional insured. Trust as Additional Insured. n� ► Proof of non-profit status ►-State Food-Ser-viee License if > 3 day ► Notarized letter of authorization from owner, if anulicable. * ► Original signatures of all residents, property owner�� business owners affected by the closing. N/A ► State Food Service License if > 3 days. NIA ► State Alcoholic Beverage License, if applicable.��* N/A � Required if private property used in conjunction with a Parlc Use application. ** Alcoholic beverages can be served only on private property. Alcoholic beverages NOT ALLOWED in City Parks, City streets or City sidewallcs. See additional note below. ❑ Please check if iteins will be sold on City streets/sidewallcs. Each business will need to apply for a TemporarX Use Permit 667 along with the Street Closing application. Note: ► Clean-up is required within 24 hours. ► No alcoholic beverages pei7nitted on City property, streets or sidewallcs. ► No donations can be requested if any type of alcoholic beverages are served on private property/bttsiness unless you possess a State Alcoholic Beverage License. Please note there are inside consumption and outside constui�ption licenses. You ulust have the appropriate license(s). ► The Departu�ent of Public Works will be responsible far 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 �oven�i�leiltal re. ttg lator� eig Zcies. The applicant will be responsible for costs associated with the event, including damage of property. By receipt of this perinit, 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 indeinnify 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 liinited 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 Parlc Use/Street Closing Pennit. ,� - _ — 51N PARK ST ��`N i. � "--"''_r p.r � �,,1- i 7 r � � � -� •� ,� , . ., � , �, . - ,- . .M , ' i� � t., x �� . i;"i � � ��. '.�..� ��". �... . 'iT �'�;Qc�Y.(ws �11 �1 � r� ';',�i' .:f R � ,._ ...�!��iru'/�'.,4 ' . 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N � Temp '�--. = ' Closing ��'�' SW 4�h ST �'11 `• �� . � ''.-�-: , Jj � �� .� •: ,._-,.:-i �',, • a,-,-, ,i , _.. ,. ;, � , T � � � � � �� ' �� _�.�i � 1 ��', sr `� -� � /�;.. ei. - -�� •�, �c+_ '.� - � , � , . . !i+ � � �1 , ' - . _ '_'• � � � • : � �•�.r' � � � • • � ' � _,�..., C . + ,, , : , 1 ._ .. .. _. . . . :. . . . a . . . . . . _.. 5W 3RD ST � SYV 3RD SWT � SW 3RD ST -+ � x 'A. �+y � w 7 - � - �� y -�r ._ - � - �� i '_{ ��t= FBC _� G ...� ' -^V� � , w o ' _ � The A Mission > �, ROC "i : V I ' �. `�'�'� rn House ; -' � f�"-i°°'-� i � �` :: - � -.._ 1 � i �q • � Parking -^� " � .- � e r '� i m ��• .�1 1 '�1 -� M,�..� u � 1 �� SW 4THiST �. Between ,r ?` c,�� 5�n & 6�h Ave '�' � Ball Field � _ ��-.—_ � �� ' � y My / � I ^ '�..!.Y. 1 F' M _ � , . _ ,� 'r .� : 1 �,� �� SW STN�ST _ �; � � � ' � �R � , � -� �-=., � e��;r � �� ei� , � i :•11,'� �1 ,r � ! � N � �� ' � ,fi '�,r �..- r y� �� . ' :; • �}.�-� . �� sw sTH sT - r-- i �� ;s� � -�- — - '� � '�,�� 1�1�� tN .�.�� _ �� ' fl � I/!� � �,��_ ` ':. ♦ :�,f_._� .Ui � � � �1 ~! � �_�a/�'/L�t � .� .�. , �' _ . �� __ � r � • � - _'i . . ;�I, , [� � ::i . : � � � I i "��.i9 - , � . r I � Il�.� ��F��_ .�..I.q_ i .� T � x� t . � �f `^�� .� � � I� `�'� ��r;,�� :T ,j ; Y ;� , '.� 1Z+ },, � SW STfi.S1 �� +;,�,' � � .,.s'y�t� � ,'�-3-311 q . ✓ .w^�.. "-��:R -�� i �� i' !i � �i- :�.�ii � � , � - R%��. ' � � �' �� ' �' `.- � .� � F' , ♦ � � �� ry.� � \Y � ' � j �-,�� n � , . ,,�, . , ,. . R t G��;` ' � � , I �� I .1 •. � + , ' 1 ' . '`lY�" �. . . _"1� • isl FBC Okeechobee Fall Festival, Temporary Street Closing Saturday, October 31, 202� Event Time (approximately): 5:00 to 7:00 PM Street Closing (approximately): 3:00 to 9:00 PM The portion of the street to be temporarily closed is SW 4th Street between SW 5t" and 6th Avenues for pedestrian safety. Should the Police Dept find it necessary, the portion of SW 5th Avenue between the ball field and FBC main campus may need to be temporarily closed due to amount of pedestrian traffic. ► Barricades are requested to close off both ends of 4t" Street from Public Works. ► The Fire and Police Departments are invited to participate by having a booth/tent within the ball field during the event. ► Requesting the Police Department to assist with traffic at the intersection of SW 4tn Street and SW 5t" Avenue during the event times. CERTIFICATE REQUEST FORM Name of vour church: First Baptist Church of Okeechobee Guideone Polic,� 001423828 Phone: 863-763-2171 Contact person from �ur organization: Melanie Rooks TVpe of event: Coinmunity Fall Festival Aetivities iiival�ed: Games - - Event address: 310 SW St'' Avenue Ball Field Date (sl of event: 10/31 /2021 Approxiinate nuinber of people attendin .g • 200+ ___ _ � Organization requiring the certificate: (not your church) Naine: City of Olceechobee Address:5_5 SE_3d_Avenue _ _ _ _ _ City:Okeechobee FL 34974 Email or Fax#:gneu@cityofokeechobee.com Is the requesting organization asking to be listed as "an additional insured"? Yes No City & R.E. Hamrick Testamentary Trust as additional insured �� ACORO ' �� FIRSB-1077 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/5/2021 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 BYTHEPOLICIES 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 riphts to the certificate holder in lieu of such endorsement/sl. PRODUCER Church Asset Management, Inc. 1500 Wall St. Saint Charles, MO 63303 INSURED First Baptist Church of Okeechobee 401 SW 4th St Okeechobee, FL 34974 Mary Hyde 200-7257 4259 �Itcam.com INSURER F : 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 SUBR pOLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR NSD WVD MM DD MM DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 'I,OOO,OOO CLAIMS-MADE � OCCUR 1423-828 12/1/2020 �2/7/2021 DAMAGETORENTED �,��,000 PREMISES (Ea occurre ce 5 MEDEXP An one erson $ ��,�� PERSONAL 8 ADV INJURY $ �,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY � jE � � LOC PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident $ ANY AUTO BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ 3 UMBRELLALIAB OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- I AND EMPLOYERS' LIABILITY Y � N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N � A � (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is rey uired Certificate holder is listed as Additional Insured re: Community Fall Festival on 10/31/2021, 509 SW 4th Ave & 310 �W 5th Ave Activities: Carnival type games, music & food City of Okeechobee & R.E. Hamrick Testamentary Trust 55 SE 3rd 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 ' /N//U.G��''^'/'�"'' ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD