2021-10-26 Ex 03Page 1 of 3
Revised 3/5/l9
Date Received:
Application No:
Information:
-O
CITY OF OKE�CHOBEE
55 SE THIRD AVENUE
OK�ECHOBEE, FL 34974
Tele: 863-763-9821 Fax: 863-763-1686
PARK US� AND/OR TEMPORARY STREET/
SIDEWALK CLOSING
PERMIT APPLICATION
Date Issued:
Date(s) & Times of Event: �- t� - 202
Please check requested Parks:
Flagler Parks: o City Hall Park ❑ # l Memorial Park ❑ #2 ❑ #3 ❑ #4 ❑ #5 ❑ #6
[Park 3 is location of Gazebo. Park 4 is location of Bandstand]
(If otl�er private property used in conjunction with this Park Use Permit please provide the address and
parcel numUer below along witli notarized letter of authorization from property owner)
Additional Addresses, if applicable
Parcel ID:
�-�,�� � 0
�( w a �' �
s � s�
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%.�I�� /�( w �(��' S� �' /U (,J
i ete none:
Work: _ Home: Cell:
Page 2 of 3
Revised 3/5/19
TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION
(Street Closings require City Council approval. Meetings IS` & 3�d Tuesdays but subject to change)
Address of Event: ��� /�i ) s'� ,s�-
:(s) to be closed:
s) to be closed:
;s) to be closed:
�se of ClosinQ:
�
Attachments Re uired for Use of Parks Attachments Re uired for Street/Sidewal losin s
► Site Plan ► Site Plan
► Copy of liabi(ity insurance in the amount of ► Copy of liability insurance in the amount of $1,000,00�.00
$1,000,000.00 with the City of Okeechobee as with the City of Okeechobee and R.E. Hamrick Test�mentary
additional insured. Trust as Additional Insured. �
► Proof of non-profit status ► Origina! signatures of all residents, propert}� �.vners 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.* N
* Required if private property used in conjunction witl� 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 tlie 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 �overnmental re ulator� 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.
Pabe 3 of 3
Revised 3/5/19
I hereby acknowledge that I liave read and completed this application, the attached Resolutions No.(s) 03-8 and
04-03, concerning the use and the rules of usinb City property, that the information is correct, and that I am the
duly authorized agent of the organization. [ a�ree to conforni with, abide by and obey all the rules and
regulations, wliich may be lawfully prescribed by the City Council of the City of Okeecl�obee, 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.
_ ���—
Applicant Signature Date
Staff Review
Fire Department:
Building Official:
Public Works:
Police Department:
BTR Department•
City Administrator:
City Clerk:
'•••OF]
,
USE ONLY••••
�
U�—
Date: '�f'•�� %��?,2'
�.+2•2�
llate:
Date: !(i'' 13`z�
Date: d 3 a I
Date: /l� �� �-
Datc:
Date: ��' �����
NOTE: APPLICATION AND I1�ISURAI�'CF.. CERTIFICATE MUST BE COMPLETED AND
RETURNED TO THE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO
EVENT T'OR 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
Datc
. �'r---�- . . --,.. , .; � .. .-o. ___.�_ - - , �r- - - - - - - �-
C� OF OKEE �FiOBE` u^ EP�RZ'M�NT p 'l ��
, .y.,, _,. . �d.., .� _. _ . _ _. _ .. �.�....�:.._. �..�_ .___.,.,��..�_ - ._._.......�__ _ , ..�._ _
APPLICATION FOR SPECIAL EVENT
Application Number:
NAME OF EVENT:
Date Received:
ADDRESS OF EVENT: __/Q�� (� S�i`—�' S%'
DESCRTPTION OF
NAME OF SPONSOR ORGANIZATION:
v ��9�. �L
Contact Number befare and during event OF RESPONSIBLE PER�ON: �ry� ) �6?� -��� p�_
5 NAME:
DATE(S) AND TIME(S) OF EVLN1`: �
Date: _f/-Q�f —;.2! Starting Time: (0 f'%yj Closing Time: �' %�i'y')
Date: Starting Time: Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? � LOCATION I�UL�i �� v�U�c rc�1`we.�/1 /I(l.v �i� i� �� l�(LtJ
Will Emergency Apparatus (Fire and Ambulance) have access to area? �Q.S g—�`�
IF N0, THEN (provide alternatives): �
WILL ELECTRICITY BE USED? YES � NO 0 ircle)
Locations:
Provided By:
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? circle) YE � �NO �
Type of Heating Equipment Used: (�.�iui• c1 t�� ��r ; l
W[LL A TENT BE ERECTED? (circle) ES NO �
Tent ManuFacturer: Size aU fire rating posted:
Tent have sides and how many?
Ace there Fire Extinguishers accessible and ready for use? (circle) Yes
No
'���'�ATTACH SITE MAP OF EVENT LAYOUT'��'�'�
[�fRf: SERVIC[•�.S SHALL COi��IPL�'CG ITE�b1S [3I:LC�\1�':
FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above)
� Tents/canopy fire rating certificate required.
`; Tent Size require life safety inspection (900 square feet or less then no permit is required)
- Floor plan / seating / setup drawing required showing exits, etc.
:_, Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT�
IJ Fire extin uishers must have cur P
g rent tab, and be operational and readily accessible.
� Cooking requires LPG outside of tent pointing away from exposures.
-.'. Electrical wiring exterior rated, not overloaded. y�.
,_; Pire Services inspection required. � ; -�
`f :
�; Fire watch or inspector(s) REQUIRED? ,,- `FTR'E"WATCH Amount:
�i Firefi hter/Ins ector Amount: ��� �' �
g P _ �—�: .� �' Other:
FIRE DEPARTMENT
S[GNATURE:
Please call the FD at 863-467-1586 for any questions.
Reviscd 11•6-19
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9/23/21, 3:26 PM
Okeechobee County Property Appraiser
Okeechobee County Property Appraiser
Micicey L. Bandi, CrA
Parcel: «; 3-15-37-35-0010-01260-0010 (33840) » :
Owner & Property Info Result: 1 of 1
OKEECHOBEE CO FARM BUREAU
Owner 401 NW 4TH ST
OKEECHOBEE, FL 34974-2550
Site 401 NW 4TH ST, OKEECHOBEE
Description* CITY OF OKEECHOBEE LOTS 1 8 2 BLOCK 126
Area 0.344 AC S/T/R 15-37-35
Use Code** OFFICE BLD 1STY (1700) Tax District 50
'The Descriplion above is not to be used as the Legal Descriplion for this parcel in any
legal transaction.
"The Use Code is a Dept. of Revenue code. Please contact Okeechobee County
Planning & Development at 863-763-5548 for zoning info.
Property & Assessment Values
2020 Certified Values 2021 Preliminary Certified
Mkt Land $66,750 Mkt Land $66,750
Ag Land $0 Ag Land $0
Building $130,337 Building $135,098
XFOB $2,100 XFOB $2,100
Just $199,187 Just $203,948
Class $0 Class $0
Appraised $199,187 Appraised $203,948
SOH/10% $� SOH/1o% ��
Cap [?] Cap [?]
Assessed $199,187 Assessed $203,948
Exempt $p Exempt $0
county:$199,187 county:$203,948
Total c�ri:$199,187 Total city:$203,948
Taxable otner:$199,187 Taxable ocner:$203,948
scnool:$199,187 scnool:$203,948
Note: Property ownership changes can cause the Assessed value of the property to
reset to full Market value, which could result in higher property taxes.
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' Sales History
Sale Date Sale Price
5/1/1969 $4,000
Book/Page � Deed � V/I � Qualification (codes) � RCode
0113/0359 QC I Q
'' Land Breakdown
Code Description Units Adjustments Eff Rate Land Value
067NP8 I NO SIDE ST (MKT) 100.000 FF (0.344 AC) 1.0000/.8900 1.0000/ / $668 /FF $66,750
� Building Characteristics
Bldg Sketch Description* Year Blt Base SF Actual SF Bldg Value
Sketch OFFICE SFR (4700) 1972 3540 3730 $135,098
*Bldg Desc determinations are used by the Property Appraisers office solely for the purpose of determining a property's Just Value for ad valorem tax purposes
and should not be used for any other purpose.
Search Result: 1 of 1
� Okeechobee County Property Appraiser I Mickey L. Bandi, CFA I Okeechobee, Florida I 863-763-4422
by: GriulyLogic.com
2021 Preliminary Certified
updated: 9/16I2021
Aerial Vewer Pictometery Google Maps
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www.okeecho6eeoa_com/ais/ � i�
CERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION aNLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
COMPANIES AFFORDING COVERAGES:
FLORIDA FARM BUREAU INSURANCE COMPANIES
P.O. BOX 147030 Company
Letter A:
GAINESVILLE, FLORIDA 32614-7030 �
Florida Farm Bureau General Ins. Co.
NAME AND ADDRESS OF INSURED: Company
OKEECHOBEE : OUNTY FARM &UREAU Letter B:
4G1 NW 4TH ST
OKEECHOBEE FL 034972 Florida Farm Bureau Casualty Ins. Co.
The policies ol insurance listed below have been issued to the insured named above and are in (orce at this time. Nohvilhstanding any requirement, term or condition ol any contract or
oiner oocumen� wnn respec� �o wnicn cnis cenmcate may oe issuea or may penain, the insurance anortled by ine poliaes tlescnbed herefn is subject lo all the lerms, exclusions and
conditions o( such palicies.
C0. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
LTR (MMlDD1YY) DATE (MM;DDIYY�
General Liability:
General Aggregale $ j Q Q Q
Produc�s-comple;ed 1Q00
�XCommercial General Liability ope�ahons aggregaie �
(Occurrence Form)
A Personal 8 Adverlisin In ur � 5 0 0
C�F 9�21659 0'0/24/21 06/29/22 91Y
'.._! Owner's & Contractor's Each Occurrence $ 5 Q Q
Protective
F�re Damage (Any one liie� $ 5 Q
�. J Farmer's Personal Liabiliry
Medical Ezpense �Any one person) � °
Automobile Liability: Combined
�__� Any auto Single Limit $
!_� All owned autos Bodily InjUry $
(Per Person)
� Scheduled autos
Bodily Injury $
� ''; Hired autos (Per ACCident)
_� Non-owned autos PrOperty $
Damage
Excess Liability: Each Aggregate
Occurrence
�_'. Umbrella Form
f. ' Olher Ihan Umbrella (orm �S �
Employers Llabi�ity: $
I__! Farm Employer's Liahiliry IEach Ocanencel
�. _J Farm Employee's Medical �
�Each Employ=ei
Other:
�
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES:
ME�BERSHIP / INSURANCE ORGANI7,P.TION
CANCELLATION: Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to
mail 10 days written notice to the below named certificate holder, but failure to mail such notice shail impose no obligation or liability of any kind
upon the company.
NAMEANDADDRESS OF CERTIFICATE HOLDER: COUNTYCODE q� DATE ISSUED a��07/21
CI'lY OF OKEECHOBEE .�-,ND R.E. HAMRICK TESTAI`�]ENTARY OI<GECHOIIEE
TRUST AS AI Serviced by County Farm Bureau
ATTA1: GARY' R�TTE° TIMOTHY M CRAIG, I.LC
55 SE THIRD AVENUG
OF{EECHdBEE, FL 39 97? AUTHORIZED REPRESENTATIVE
93-7-692 (Rev. 5l93)
CERTIFICATE OF INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.
FLORIDA FARM BUREAU INSURANCE COMPANIES COMPANIES AFFORDING COVERAGES:
Company
P.O. BOX 147030 �etter,4:
GAINESVILLE, FLORIDA 32614-7030 Florida Farm Bureau General Ins. Co.
Company
NAME AND ADDRESS OF INSURED; ���}���;
l; —
OKEECHOBEE COUNTY FARM BUREAU . - Florida Farm Bureau Casualty Ins. Co.
,� �` :
401 NW 4TH ST
OKEECHOBEE, FL 34972-2550
i ne oiicies or insurance iistea oeiow nave oeen issuea to tne insurea namea above and are in force at this time. Notwithstanding any requirement, term or
con ition 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.
CO. POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/Yl� DATE (MM/DD/Y`� ALL LIMITS IN THOUSANDS
GENERAL LIABILITY: GENERALAGGREGATE $ 1 � O O O
X❑ LIABIUTY (OCCURRENCE OPEFlAT ONS AGGR GATE � 1- � O O O
FORM)
PERSONAL & ADVERTISING rj O O
INJURY �
A ❑ P OTECTI&E ONTPAGTOR�s C P P 9 5 216 5 9 14 0 6/ 2 4/ 2 0 21 0 6/ 2 4/ 2 0 2 2 EACH OCCURRENCE $ 5 0 0
FARMER'S PERSONAL FIRE DAMAGE (Any one fire) � 5 O
❑ LIABILITY
MEDICAL EXPENSE d� 5
(Any one person) `P
AUTOMOBILE LIABILITY:
COM6INED Q
� ANY AUTO SINGLE LIMIT �P
�ALL OWNED AUTOS BODILY
INJURY (Per �
Person)
� SCHEDULED AUTOS 80DILY
INJURY �Per $
Accident
� HIRED AUTOS
� NON-OWNED AUTOS PROPERTY �i '�.'
DAMAGE w � �-��
EXCESSLIA6ILITY: EACH AGGREGATE���
I OCCURRENCE
� UMBRELLA FORM
❑OTHER THAN UM6RELLA � �
FORM
EMPLOYERS LIABILIiY:
❑FARM EMPLOYER'S ' (� ch Occurrence)
LIABILITY �� �
� FARM EMPLOYEE'S MEDICAL ' Each Employee)
OTHER:
,$
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES:
SEE FORM CG 20 26 11 85
MEMBERSHIP / INSUR.ANCE ORGANIZATION
�Hivut�uii iuiv: �nouia any ot tne aaove aescnaea policles be cancelled before the expiration date thereof, the issuing company will endeavor to
mail 10 days written notice to the below named certificate holder, but failure to mail such notice shall impose no obligation or liability of any kind
upon the company.
NAME AND ADDRESS OF CERTIFICATE HOLDER:
CITY OF OKEECHOBEE AND R E HAMRICK
TESTAMENTARY TRUST
ATTN: GARY RITTER
55 SE THIRD AVE
OKEECHOBEE FL 34974
County Code 4 7- 0 Date Issued 0 9/ 2 8/ 2 0 21
Serviced by QKEECHOBEE County Farm eureau
T MOTH M CRAT ,, T�T� _
AUTHORIZED REPRESENTAT�VE
POLICY NUMBER: CPP 9521659 14
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-DESIGNATED PERSON 4R
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
CITY OF OKEECHOBEE
AND R E HAMRICK TESTAMENTARY TRUST
ATTN: GARY RITTER
55 SE THIRD AVE
OKEECHOBEE FL 34974
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSUREQ (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you.
CG 20 26 11 85 Copyright, Insurance Services Office, Inc., 1984 �