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American Legion Free Fair CITY OF OKEECHOBEE �m•� 55 SE THIRD AVENUE 10 r"• `` OKEECHOBEE, FL 34974 _- ao-', Tele: 863-763-9821 Fax 863-763-1686 ,' ,;,.il'�, e-mail: permit@cityofokeechobee.com Temporary Use Permit Permit Number: T-23-001 Date(s) of Event: January 20-31, 2023 (5P — 12A Weekdays; 12P — 12A Weekends) Permit Expiration: _ February 2, 2023 @ 11:59 PM Purpose of Request: American Legion Free Fair Property Owner: American Legion Post 64 Address: 501 SE 2nd Street City: Okeechobee State: Florida Zip Code: 34974 Applicant: American Legion Post 64 Applicant's Address: 501 SE 2nd Street Phone Number: 863-610-1742 Address of Project: 501 SE 2nd Street Current Zoning: Residential Multiple Family (RMF) FLU Designation: Commercial (C) Subdivision: 1st Addition to City of Okeechobee Restrictions/Remarks: All debris must be removed upon final completion date. PLEASE CONTACT THE CITY @ 863-763-9821 IF YOUR EVENT IS CANCELLED OR RESCHEDULED. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. NO SET UP OR TEAR DOWN BETWEEN THE HOURS OF 12 MIDNIGHT AND 7:00 A.M. 48 HRS AFTER FAIR CLOSING, PROPERTY MUST BE VACATED. TRA MUST BE PICKED UP DAILY IN PARKING LOT AT CITY HALL.. I c i that I have xamined this permit, it is correct and I will abide by its requirements. 4,f4 t. C2�f n�- -c.kn Q0, a003 Applicants Signature ' Date "Vdtee# 4 % u January 20, 2023 General Services Administrative Secretary's Signature Date fit,00( ci,„ /( -7 _ 1"6 I' jvi Revisey 1/5/18 jd kr,fOF•Ok Fc+ TEMPORARY USE PERMIT APPLICATION �w` . _ y°' OTHER TEMPORARY STRUCTURES (666) ao -,1 sR City of Okeechobee-General Services Department '' =- , `�, 55 SE 3rd Ave,Room 101,City Hall,Okeechobee,FL 34974 yam""",,;,4 Phone:(863)763-3372 ext.9821 DATE RECEIVED: (7 fi iv, I) DATE ISSUED: Jai. 4014O3 APPLICATION NO.: `Ta 3- 00 1 EVENT DATE(S)&TIME: a 0 3--AA) .-3/ ,Z FEE:$175.00 Von-Profit/Civic Organization DATE PAID: I _ti_dl3 Name of Property Owner(s): i d .G i Address: 'ri _5'ra 1,k56 S'j (9K e e C,4 0)e r✓ 6:- 3 zl CY ,, Telephone Numbers: i,,c 1 o 1) Home:if 6 It;7 - 9L+4,/ Work: ic6J.1�,9_,-SO Cell:, 6:7- '/D- 17111 E Name of Applicant:.' j'`he iz. j G/i-,tU ,Le , cA) /1eiy't>k1A 1 'c� C/�` 1'�� s `� I`�7f Address: �� 0 i -5'p 9._ NC, s l 0 e ,et,J 7 , e„, ' 9'�'f vTelephone Numbers: tHome:.f 4 L -7 1167 eit/ / Work: g(, _74,3 . q co Cell: 63 -Lib /7/41— 4--) Future Land Use Map Desigation: Current Zoning Designation: Legal Description of Property:t r 14' — /it)c- : 4_C-3 f,*T/-5-e 2%z r3,e) Address of Property: Please Explain Type of Use: Briefly describe use of adjoining property North: /--j is tr✓-5 t1J'rie A) East:N 2 ' . u T/-, e_- 1 ? South: L &et' e.,5' West: R�,,5" )}-o/y e, - Other temporary structures subject to the following regulations: 1.Chri tree,fireworks and similar seasonal sales operated by a non-profit organizaiton. 2 amival,lcircus,fair or other special event operated by a non-profit organization on or abutting their principal use.(*additional information required) 3.Commercial carnival,circus or fair in commercial or industrial districts. 4.Similar temporary structures where the period of use will not exceed 30 days a year. The Applicant shall: 1.Submit proof of liability insurance,paid in full covering the period for which the permit is issued,in the minimum amount of$1,000,000.00 per occurrence. 2.Have notarized written permission of property owner,if applicant is not the property owner. 3.Remove all debris within 48 hours of expiration of permit. 4.Submit Site Plan,State Inspection Certificates and submit State Annual Permit* City Staff(Please review the application,teach corn e is or s•ecial conditions. Occupational and.or State License Verification: " , A'_ Date: 1-;��- Fire Department Approval: fir' '' Date: 04�. ,),3Police Department Approval: Date: 07 7/3; Public Works Department Approves' �- Date: /"c2 5 - Building Inspector Approval: p ,deDate: l'l D'Z3 City Administrator Approval: Date:1i.l.a/A3 I hereby certify that the information on this application is correct.The information included in this application is for use by the City of Okeechobee in processing my request. False or misleading information r ray be punishable by a fine of up to$500.00 and imprisonment of up to thirty days and may result in the summary denial of this application. J/' J 1 / /gJ09�23 Signature of Applicant Date Temporary Use Permit Application Process for the City of Okeechobee, used by American Legion Post #64 501 SE 2nd Street Okeechobee, FL 34974, January 20th through January 31 st, 2023. Commander of Post #64: Carl Gaiser can be reached via Donna (his wife's cell) (863) 610-9416 or at the American Legion (863) 763-2950 Hildebrand Amusement Rides, Inc. 233 Commerce Ave #16 Sebring, FL 33876, Owner, Harland Bast (954) 415-1160 Mr. Bast's employee/assistant Joey Richardson (954) 868-9959 Angie Wagoner, Food Manager (229) 602-8670 Julie, Food Manager (Bingo Hall) at the American Legion during event (857) 417-3501 Julie (Am Legion) has agreed with (Event) owner, Mr.. Bast to get City Hall required signed documents from the state on Friday no later than 4pm HILDAMU-01 MCHUA ACORE DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1/13/2023 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 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 NAME: Johnson, Kendall&Johnson,Inc. PHONE 215 968-4741 F 215 968-0973 109 Pheasant;Run (euc,No,Ext) ( ) IA►c.�Y� ) Newtown,PA'I 8940 ADDREss:info@ jkj.Com INSURERS)AFFORDING COVERAGE NAIC INSURER A:Everest National Insurance Company 10120 INSURED INSURER B: Hildebrand Amusement Rides,Inc. INSURERC: - 233 Commerce Ave#16 INSURER D: Sebring,FL 33876 INSURER E: 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. NSR TYPE OF INSURANCE ADDL SUER, POLICY NUMBER ! POLICY EFF POLICY EXP LIMITS LTR INSD VIVO (MMVDO/YYYY) swDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S18GL01504-221 6/4/2022 6/4I2023 DREMISES AMAGE TO(Ea RENTEDoccurcenoe) 500,000 P E MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY jPa X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITYfEs COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO SI8CA00208-221 6/4/2022 6/4/2023 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS���� ONLY _ AUTOSl/yy BODILY INJURY(Per accident) $ X AIUTOSONLY X AUTTOSONLY PRrac DAMAGE _ per ru) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S A ,WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N SI8WC00768221 4/16/2022 4/16/2023 E.L EACH ACCIDENT $ 1,000,000 FFI CER/M in BE EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY UMIT $ ' ' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space is required) American Legion Post#64;the City of Okeechobee,Florida;and John and Joyce Richardson are named as Additional Insureds with respects to the operations of the Named insured where required by written contract. Event:American Legion Post#64 Free Fair Event Dates: January 20-30,2023 SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE American Legion Post#64 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. 501 S.E.2nd Street Okeechobee,FL 34974 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:HILDAMU-01 MCHUA LOC#: 1 ACORL7 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED ohnson, Kendall &Johnson,Inc. Hildebrand Amusement Rides,Inc. 233 Commerce Ave#16 POLICY NUMBER Sebring,FL 33876 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEEP 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: Dates on Premises: January 16-20,2023(includes set up and tear down) Relationship: Providing Rides, Food and Games for Collier Fair ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SE 5TH AVE SE 5TH AVE SE 5TH AVE RV PARKING RV PARKING AM LEGION KR KR KR KR KR KIDDIE RIDE KR KR G GENERATOR KR KR T PORTABLE TOILETS T TTTT CITY FOOD 'RIDES [ I RIDES FENCE RV A GAMES A FOOD A d �s��� yr fA yi A GAMES A GAMES 2ND k :fir 7t y��, a,� PARKIN. L AND L L > .�5.Ad � „�Ate'} ,1 L AND L AND STREET ,+ aja 15r � s CITY L CONCESSIONS L GAMES L 2 5 ryf 1" > L CONCESSIONS L CONCESSIONS FENC: E E E RIDES A a E E RV Y GAMES Y FOOD Y s °+,$a„,, f4'� Y GAMES Y GAMES PARKING AND r` 7k t in c s'+"its s,'Ist4A; AND AND CITY A CONCESSIONS A GAMES Ass af^ Ti-I12JD w A CONCESSIONS A CONCESSIONS 2ND FENC: L L L 1a� ,'t:1� �. 'e .. L L STREET RV L FOOD L FOOD L �i `' � �,F„"�r �`s �"� L GAMES L GAMES � Y t} r1 PARKING E GAMES E E RIDES g ` "i� ; E AND E AND CITY Y AND Y GAMES Y ± V Y� ,4c} Y CONCESSIONS Y CONCESSIONS FENC: CONCESSIONS RV FOOD fY 2ND PARKING RIDES RIDES RIDES STREET FOOD&GAME FOOD,GAME&CONCESSION R R (G) R R 3RD AVENUE 3RD AVENUE 3RD AVENUE AMERICAN LEGION:FAIR LAYOUT 2023 ,-2(dAtvrt- t, . . i\ 74 , .. /Clks- ktPD/r.A/PE 6. 6 ' Womb A hc- 0 , , - r . - retrAsitrolears. ac . .., , 0 . 1,31 A: 1111.11101111119110 Q [i•1 . . a r".... , te. 2$ , a 3 44 t.s Xifi V t it & 6 It 0 Call'46./ 10, t i kt i 73 g. e - 1k w ! • R ( . ti 4r A. , 1, - ,1 c . - • — - - --- - ' - . ".,. ... msm .......... •• rAlifi,59907 /11/%14,+' -00.4 i - 30) 405 ..---cc... L'>'-'-' • . . _. .,, . , 1 , \ . . 1 , ! i ! 1 I \ . i , 1 . . k ..----- ( --,-. .--- -N-.) _ , , ,". 31 il ((I „ t e . 7",415."44 -. ..ram HyD i @ j 4. «ki< i r t1STED DO NOT REMOVE .i,* .. . , 4 k BY ORDER OF THE STATE FIRE MARSHAL ir 4�09‘ :1. FOR CITY, STATE AND FIRE INSURANCE INSPECTION 154 CkVUI�'SS.,n2 1 ; �r1;s„I , .., .. „.,. SERIAL NUMBERlo ! ,. , „,,,,,,,',....:\__, .„---....; OF EXTINGUISHER: !!I e . ...... . ,.,. _,,... ... SERVICED B i,' n •„ , PERMIT N0 i y. a , — t 0.„\t,,,,. \,r;\ ' i - .6 r.r., O Q r u '' (: T''' m i u m EL/ m B*1,1, SUMMIT ��a6. °Ga qoe, ^'r -gyp • .?3 SUS s LJv� W Q .,_„,.. c W e . FIRE & SECURIT '' c' ,gam Z Cy 4e ur, rn 37 v' �"m—� �.� `'44� h rn A - �. .. 3a• 0 4009 N.E.6TH AVENUE m p p 'W `''-+a5n y'S - _ `'""pan„, m ,-.,z FORT LAUDERDALE, FL 33334 a5 • _ m m IMMEDIATELY AFTER -+ _ u. °� a USE,CALL: O 954•566.543 ,' ��, � ----C p A SUMMITFIRESECURITY.COM < O S ,' x , m ,; 1 x — b +€ rn < ,._ 9 x 4 .. `.ant' 411 m F w •#' fL _ i x' h 11 m I c 'c I p 1 1 _ ,. r f : 41 ti 0 1th �� i Florida Department of Agriculture and Consumer Services ;o:isota To;4 Division of Consumer Services/Bureau of Fair Rides Inspection , = m EVENT REPORT y��"`y' Phone 1-800-435-7352;Fax(850)410-3797 `;i...NguM Eft 5 _i FairRides@FreshFromFlorida.com WILTON SIMPSON COMMISSIONER INVOICE#: 3740157 PURPOSE: Reinspection HILDEBRAND AMUSEMENT RIDES, INC. EVENT NAME: AMERICAN LEGION 226 COMMERCIAL COURT EVENT ADDRESS/LOCATION: 501 SE 2ND AVE SEBRING, FL 33876 EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE OPEN DATE: 01/20/2023 INSPECTION#: 2301-01760 #Rides: 2 #Rides Passed: 0 #Rides Failed: 0 #Rides Not Ready: 0 #Go Karts: 0 #Go Karts Passed: 0/ #Go Karts Failed: 0 #Go Karts Not Ready: 0 USAID Theme Name Status IC/RT# Deficiency OST# Unit 05514 HIMALYA pass with R301-0176CStructural-Pins/Bolts/Keys:Bolt loose 16582 10 Installation-Fencing/Gates/Guarding:Not Secured 18286 12 Attachments-Restraints:Latches damaged/not working 16848 14 Attachments-Restraints:Shocks worn 18441 17 11654 ALIBABA pass with RE301-0176CAttachments-Restraints:Improper 16552. 2 I acknowledge that all identified rides issued a stop operation order(RT#)and/or carriers or components issued an out of service (OST#) are not in compliance with Florida Statute 616.242 and/or Rule Chapter 5J-18, F.A.C. Further deficiencies may still exist and ride(s) shall not operate unti�'t passes a subsequent inspection by the Department. { / --------- Inspe or's Na e y hi 1 i' —.)7.� Owner/Manager tl Date Run Date: January 25, 2023 12:32 PM viCI',C d I 510 3 Page: 1 of 1 Florida Department of Agriculture and Consumer Services -,,,jMENi-o ;. Division of Consumer Services/Bureau of Fair Rides Inspection ;.o G `�•,T ° INVOICE R o�"` .% Section 616.242(8),F.S.Rule 5J-18.0012,F.A.C. V. MERr Phone 1-800-435-7352;Fax(850)410-3797 WILTON SIMPSON FairRides@FreshFromFlorida,com COMMISSIONER INVOICE TO: INVOICE#: 3712528 PURPOSE: Scheduled HILDEBRAND AMUSEMENT RIDES, INC. EVENT NAME:AMERICAN LEGION 226 COMMERCIAL COURT EVENT ADDRESS/LOCATION: 501 SE 2ND AVE SEBRING, FL 33876 EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE OPEN DATE: 01/20/2023 INSPECTION#: 2212-30889 COMPANY INSPECTION FEES AND COUNTS-001142 FAIL TO CANCEL LATE NOTICE GOKARTS 4 - $400.00 0 - $0.00 0 - $0.00 PERMIT FEES-002060 INSPECTION FEES-001142 RIDE TYPE USAID PERMIT NO. IC NO. RIDE LOST USAID RIDE 1 HOLIDAY TOTAL K 10418 2212-30889-10418 2212-30889-10418 $150.00 $100.00 $250.00 K 16559 2212-30889-16559 2212-30889-16559 $150.00 $0.00 $150.00 NK 01791 2212-30889-01791 2212-30889-01791 $200.00 $0.00 $200.00 NK 05514 $200.00 $0.00 $200.00 NK 08273 2212-30889-08273 2212-30889-08273 $200.00 $0.00 $200.00 NK 08338 2212-30889-08338 2212-30889-08338 $200.00 $0.00 $200.00 NK 10423 2212-30889-10423 2212-30889-10423 $200.00 $0.00 $200.00 NK 11654 $200.00 $0.00 $200.00 NK 12359 2212-30889-12359 2212-30889-12359 $200.00 $0.00 $200.00 NK 14476 2212-30889-14476 2212-30889-14476 $200.00 $0.00 $200.00 NK 14723 2212-30889-14723 2212-30889-14723 $200.00 $0.00 $200.00 NK 15336 2212-30889-15336 2212-30889-15336 $200.00 $0.00 $200.00 NK 16319 2212-30889-16319 2212-30889-16319 $200.00 $0.00' $200.00 NK 16558 2212-30889-16558 2212-30889-16558 $200.00 $0.00 $200.00 NK 16584 2212-30889-16584 2212-30889-16584 $200.00 $0.00 $200.00 NK 16628 2212-30889-16628 2212-30889-16628 $200.00 $0.00 $200.00 NK 17057 '2212-30889-17057 2212-30889-17057 $200.00 $0.00 $200.00 NK 17622 2212-30889-17622 2212-30889-17622 $200.00 $100.00 $300.00 SR 11512 2212-30889-11512 2212-30889-11512 $300.00 $0.00 $300.00 SR 13104 2212-30889-13104 2212-30889-13104 $300.00 $0.00 $300.00 SR 17652 2212-30889-17652 2212-30889-17652 $300.00 $0.00 $300.00 TOTALS: $4,400.00 $0.00 $200.00 $0.00 $4,600.00 DTN:3712528 Org Code:42101002000 Object Code: 002060 $4,400.00 .(i i ---4' Object Code: 001142 $600.00 / Insp or's Grand Total: $5,000.00 oV 02 3 Check Number: Own r/M ger Dat FDACS-03401 Rev. 01/09 Run Date: January 20,2023 4:32 PM Page: 1 of 1 Florida Department of Agriculture and Consumer Services pSMENT,i ,• Division of Consumer Services/Bureau of Fair Rides Inspection °' EVENT REPORT :.:,1yo A",��y' Phone 1-800-435-7352;Fax(850)410-3797 :CONSUMER`'l- 3 FairRides@FreshFromFlorida.com WILTON SIMPSON COMMISSIONER INVOICE#: 3712528 PURPOSE: Scheduled HILDEBRAND AMUSEMENT RIDES, INC. EVENT NAME:AMERICAN LEGION 226 COMMERCIAL COURT EVENT ADDRESS/LOCATION: 501 SE 2ND AVE SEBRING, FL 33876 EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE OPEN DATE: 01/20/2023 INSPECTION#: 2212-30889 #Rides: 22 #Rides Passed: 17 #Rides Failed: 2 #Rides Not Ready: 1 #Go Karts: 0 #Go Karts Passed: 0 #Go Karts Failed: 0 #Go Karts Not Ready: 0 USAID Theme Name Status IC/RT# Deficiency I OST# Unit 01791 TOMB OF DOOM Pass '?212-30885 05514 HIMALYA Fail ?212-3088 Structural-Pins/Bolts/Keys:Bolt loose 16582 10 Installation-Fencing/Gates/Guarding:Not Secured 18286 12 Attachments-Restraints:Latches damaged/not working 16848 14 Attachments-Restraints:Shocks worn 18441 17 Attachments-Carrier/Tubs:Primary latches not working 17339 20 Structural-Pins/Bolts/Keys:Bolts/Nuts missing 08273 SEA RAY Pass 2212-3088E 08338 SUPER SLIDE Pass ?212-30885 10418 GO GATOR Dass with Re212-30885 10423 TEMPEST Pass ?212-30885 11512 EXPO WHEEL Pass ?212-30885Attachments-Carrier/Tubs:Damaged 18034 4 11654 ALIBABA Fail ?212-30889Operation-Controls:Improper operation of control switches 12359 HURRICANE Pass ?212-30885Attachments-Carrier/Tubs:Damaged 17294 4F Attachments-Carrier/Tubs:Primary latches not working 17333 5 13104 CICLONE/STREET FIGHTER Pass 2212-30885 14476 TORNADO Pass ?212-3088rAttachments-Restraints:Latches damaged/not working 18284 #3/1 Attachments-Restraints:Latches damaged/not working 18283 #8/1 Attachments-Restraints:Latches damaged/not working 18858 #8/2 Operation-Brakes:Inoperable 16759 2 Operation-Brakes:Inoperable 18288 7 14723 ROCK N TUG Pass 2212-30885Attachments-Carrier/Tubs:Primary latches not working 17345 #2 15336 SCOOTERS Pass ?212-30885Attachments-Carrier/Tubs:Other 18386 14 Attachments-Carrier/Tubs:Other 17216 5 Attachments-Carrier/Tubs:Other 17218 6 Attachments-Carrier/Tubs:Other 18385 7 Attachments-Carrier/Tubs:Other 18716 8 16319 FUN HOUSE Pass 2212-3088S 16558 ROUND UP Pass ?212-30885 16559 PIRATES POND RIDE Pass 2212-3088cttachments-Restraints:Latches damaged/not working 18287 4 Attachments-Restraints:Latches damaged/not working 16584 6 16584 LASER JET Pass 2212-30885 16628 WIGGLE WORM Pass ?212-30885 17057 SPINNER Pass ?212-30885 17622 JUMPING JUMBO ass with Rce212-30885Attachments-Restraints:Latches damaged/not working 17343 2 17652 SUPER SHOT Pass ?212-30885Attachments-Carrier/Tubs:Padding missing/damaged 18860 12 Attachments-Restraints:Interlocks not operational 18859 4 x I acknowledge that all identified rides issued a stop operation order(RT#)and/or carriers or components issued an out of service (OST#)are not in compliance with Florida Statute 616.242 and/or Rule Chapter 5J-18, F.A.C. Further deficiencies may still exist and ride(s)shall not operate until it passes a subsequent inspection by the Department. /// ' Arid Inspe.? rs :tea 4_71 4) Owne ♦ 1P er DatRun Date:January 20, 2023 4:32 PM Page: 1 of 2 Florida Department of Agriculture and Consumer Services Division of Consumer Services/Bureau of Fair Rides Inspection EVENT REPORT Phone 1-800-435-7352;Fax(850)410-3797 FairRides@FreshFromFlorida.com INVOICE#: 3712528 PURPOSE: Scheduled HILDEBRAND AMUSEMENT RIDES, INC. EVENT NAME:AMERICAN LEGION 226 COMMERCIAL COURT EVENT ADDRESS/LOCATION: 501 SE 2ND AVE SEBRING, FL 33876 EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE OPEN DATE: 01/20/2023 INSPECTION#: 2212-30889 USAID Theme Name Status IC/RT# Deficiency OST# Unit 17828 SAMBA I Not Ready Run Date: January 20, 2023 4:32 PM Page: 2 of 2 Florida Department of Agriculture and Consumer Services vv'v(�'p,, Division of Consumer Services �I`'' FAIR RIDES STOP OPERATION ORDER � °�Ns 5��`°=" Section 616.242,Florida Statutes u�Ea=` Rule 5J-18.0012,Florida Administrative Code WILTON SIMPSON COMMISSIONER 2005 Apalachee Parkway,Tallahassee,FL 32399-6500 TO: HILDEBRAND AMUSEMENT RIDES, INC. DTN#: 3712528 (Legal Name of Company) INSPECTION#: 2212-30889 OPEN DATE: 01/20/2023 226 COMMERCIAL COURT, SEBRING, FL 33876 PHONE#: 954-415-1160 (Company Address) Pursuant to§616.242(19), Florida Statutes, each amusement ride, carrier, and/or ride component identified below is considered an immediate serious danger to public health, safety, and welfare, and may not be operated for patron use until it has passed a subsequent inspection by or at the direction of the Department. Theme Name USAID Number Affected Component and Deficiency Identified HIMALYA 05514 Structural-Pins/Bolts/Keys: Bolts/Nuts missing ALIBABA 11654 Operation -Controls: Improper operation of control switches WARNING: Operating the identified amusement ride(s), carrier(s), and/or component(s)for patron use or removing the order and/or tags attached to them without authorization of the Department is a violation punishab e under§616.242, Florida Statutes, and r)ale chapter 5J-18, Florida Administrative Code. f (In or, i sion of Consu er Services) ( ig re of Person s�lUhom This Order was Issued) (Printed Name to venom This Order was Issued) estions: (850)410-3838 Administrative Hearing Available. If you wish to contest the Departments action, you have the right to request an administrative hearing to be conducted in accordance with Sections 120.569 and 120.57, Florida Statutes, and to be represented by counsel or other qualified representative. Your request for hearing must contain your name, address, and telephone number, and facsimile number (if any); the name, address, and telephone number, and facsimile number of your attorney or qualified representative (if any) upon whom service of pleadings and other papers shall be made; a statement that you are requesting an administrative hearing and dispute the material facts alleged by the department, in which case you must identify the material facts that are in dispute (formal hearing), or that you request an administrative hearing and that you do not dispute the facts alleged by the department(informal hearing); and a statement of when (date)you received this Notice and the file number on this Notice. Your request for a hearing must be received at the address shown on this Notice within twenty-one(21)days of receipt of this Notice. If you fail to request an administrative hearing within twenty-one (21) days, you waive your right to a hearing, and the Department may enter a Final Order imposing up to the maximum penalties as authorized by Florida law. FDACS-03437 07/19 Patty Burnette From: Patty Burnette Sent: Friday,January 20, 2023 4:38 PM To: Gary Ritter; Bettye Taylor; Belen Reyna;Jeff Newell;Justin Hazellief (jhazellief@co.Okeechobee.fl.us) Cc: Keli Trimnal;Jacqueline Boer Subject: American Legion Fair FYI State inspectors have passed all the fair rides with the exception of the two listed below. They will be re-inspected on Monday. • Music Express (known as the Himalayan) • Alibaba Patty 24. Burnette general Services Coordinator City of Okeechobee 55 SE 34 Avenue Okeechobee, PI 34974 Phone: (863) 763-3372 ext. 982o Direct: (863) 763-9820 Tax: (863) 763-1686 e-mail:yburnette@cityofo1eechobee.com website: www.cityofoIeechobee.com ie a Under Florida law, email addresses are public records. If you do not want your email address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing, Florida Statute 668.6076. CITY OF OKEECHOBEE ELECTRONIC DEVICE DISCLAIMER: Florida has a very broad public records law. Most written communications to or from local officials regarding city business are public records available to the public and media upon request. Your correspondence via e-mail, text message, voice mail, etc., may therefore be subject to public disclosure. I. Florida Department of Agriculture and Consumer Services ,; 01,7 of=:< Division of Consumer Services/Bureau of Fair Rides Inspection A'i 'LL� ro—_0 A?:; INVOICE m ' Y v o�"`�.`-' Section 616.242(8), F.S.Rule 5J-18.0012,F.A.C. ''.cONSUM ER SF?P ,. Phone 1-800-435-7352;Fax(850)410-3797 WILTON SIMPSON FairRides@FreshFromFlorida.com COMMISSIONER INVOICE TO: INVOICE#: 3740157 PURPOSE: Reinspection HILDEBRAND AMUSEMENT RIDES, INC. EVENT NAME:AMERICAN LEGION 226 COMMERCIAL COURT EVENT ADDRESS/LOCATION: 501 SE 2ND AVE SEBRING, FL 33876 EVENT CITY/COUNTY: OKEECHOBEE/OKEECHOBEE OPEN DATE: 01/20/2023 INSPECTION#: 2301-01760 COMPANY INSPECTION FI=ES AND COUNTS-001142 FAIL TO CANCEL LATE NOTICE GOKARTS 0 - $0.00 0 - $0.00 0 - $0.00 PERMIT FEES-002060 INSPECTION FEES-001142 RIDE TYPE USAID PERMIT NO. IC NO. RIDE LOST USAID RIDE HOLIDAY TOTAL NK 05514 2301-01760-05514 2301-01760-05514 $0.00' $500.00 ' $500.00 NK 11654 2301-01760-11654 2301-01760-11654 $0.00 $500.00 $500.00 TOTALS: $0.00 $0.00 $1,000.00 $0.00 $1,000.00 DTN: 3740157 Org Code:42101002000 �/ Object Code: 002060 $0.00 / Object Code: 001142 $1,000.00 I ? '�.�/ Inspek a ` )' L:' Grand Total: $1,000.00 ` i t ! [—s S j'� Check Number: C r S'S, Owner/Manager` Date FDACS-03401 Rev. 01/09 Run Date: January 25,2023 12:32 PM 1,eG C� ( a 3 Page: 1 of 1