RSCA 3rd Annual Love Run aatitS USIOUJILC-.
AL) woe `
� `Pag�elof3
Revised 3/5/19
CITY OF OKEECHOBEE
�,,�,��'oF oKFF`� 55 SE THIRD AVENUE
Osi y° ; OKEECHOBEE, FL 34974
;z7: Tele: 863-763-9821 Fax: 863-763-1686
a'+,e�� PARK USE AND/OR TEMPORARY STREET/
:wNN�'' SIDEWALK CLOSING
PERMIT APPLICATION
Date Received: I- f 7.&.3 Date Issued:
Application No: a 3- 0 03 Date(s) &Times of Event: Z. j ( gI2.3 7: 30 - 11:bO akA
Information:
Organization: 'R 004 c50 ld, („h r i Pr ad Zm
Mailing Address: 1.401 SW L,]t Sr-Yp,Q,t Qie _f L p_ f, 314 q )l
Contact Name: Y1 \,t �,K,c I a(1 ,P,C
E-Mail Address: '\�(1� CA S(�1 Ul eicc. corn Oxr a,n4 a,c,6 r t I di err.c co,
Telephone:
Work: , 1.0'b-7(6?_o 1 (Q Ll Home: Cell:
Summary of activitie :
m� nuo9 5 k ov-P. ?u.rt Pund.v7i s-e - ) K6 cis 1 -mil >
ruin -Fa d diet- GO y arm- k-h. (co, yd.cla4h is OYI r v e p doer ,
Proceeds usage: {� ��
r 1v G C_ School 1'uilr_Irc ur
Please check requested Parks:
Flagler Parks: o City Hall Park o #1 Memorial Park o#2 o #3 o#4 o#5 o #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 1s`& 3rd Tuesdays but subject to change)
Address of Event: See_ ?G« V-0 lam-
Street(s) to be closed: t,(
Date(s)to be closed:
Time(s)to be closed:
Purpose of Closing:
Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closings
► 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 days. ► State Food Service License if> 3 days.
► Notarized letter of authorization from ► 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 ALLOWED in City
Parks, City streets or City sidewalks. See additional note below.
o 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.
O. 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 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 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 Okeechobee, or its officers, for
the issuance
Certifi t of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick
Testa tary rust if losing streets or sidewalks.
117 2.3
plicant Si ure Date
••••OFFICE USE ONLY""
Staff Review
Fire Department: Date:
Building Official: Date:
Public Works: ��� Date:
Police Department: 1` Date: 001
i
BTR Department: Date:
City Administrator: Date:
City Clerk: Date:
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
aoacttn---
the race will start in RSCA east parking lot.The runners will then run south on sw 3rd ave towards the freshman
campus then head EAST down sw 6th street then turn and head SOUTH down sw 2nd AVE. then WEST down sw 8th
strer i, Mien SOUTH down sw 3rd AVE then WEST down sw 21st street then NORTH on sw 5th ave,then EAST on sw
park str=et,then SOUTH on sw 3rd ave and back into Rock Solids east parking lot.
,
APPLICATION FOR SPECIAL EVENT
Application Number: Date Received:
NAME OF EVENT: S < WO./ ?NW b01- Annk.kc&
ADDRESS OF EVENT: LA Q ' .Yr V " stmt. i- Y L Ft-34504 - Alan -I\MIS
nut rou,Vc,
DES RIPTI N OF EVENT:
5� K Sex -Dr Fnnusd &ilk-GUS-Cr M010
NAME OF SPONSOR ORGANIZATION: `QJ(j< Ql, 14h,0 Stlam A PIMA
Contact Number before and during event OF RESPONSIBLE PERSON: eta �p j i4 - LQg
RESPONSIBLE PERSON'S NAME: �" Vi .
V C R-i nut pl
DATE(S) AND TIM (S OF EVENT:
Date: L I $ 12,�j Starting Time: __ �'•,30 Closing •Time: l 'U U Can
Date: N H Starting Time:
Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? 0 LOCATION
Will Emergency Apparatus(Fire and Ambulance)have access to area?
IF NO,THEN(provide alternatives): _
WILL ELECTRICITY BE USED? YES iJ X 0 (circle)
Locations:
Provided By:
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED?(circle)YES El O
Type of Heating Equipment Used:
WILL A TENT BE ERECTED?(circle) YES 010 Al
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"*'*
FIRE SERVICES SHALL COMPLETE ITEMS BELOW:
FIRE DEPARTMENT LIFE SAFETY&FIRE SERVICES REQUIREMENTS:(See above)
0 Tents/canopy fire rating certificate required.
O Tent Size require life safety inspection (900 square feet or less then no permit is required)
0 Floor plan/seating/setup drawing required showing exits,etc.
0 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.
0 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 OFFICIAL(PRINT):
SIGNATURE: Please call the FD at 863-467-1586 for any questions.
Revised 11-6-19
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