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2023-02-07 V. C. Exhibit 2 xhibit.2 02/07/2023 Page 1 of 3 Revised 3/5/19 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 Date Received: Pie Date Issued: Application No: 1 3--Q 5 Date(s) & Times of Event:Friday,February 24, 2023 Sam-2:30pm Information: Organization:Okeechobee Christian Academy Mailing Address:701 S.Parrott Ave, Okeechobee,FL 34974 I Contact Name:Melissa King I E-Mail Address:Melissa.King@OkeechobeeChristianAcademy.org Telephone: IWork: 1863-763-3072 Home: - 1 Cell: 1_ Summary of activities: Students will participate in Field Day and will need to cross back and forth all day. I Proceeds usage: Please check requested Parks: Flagler Parks: o City Hall Park o #1 Memorial Park ❑ #2 o#3 ❑ #4 o #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 1st& 3rd Tuesdays but subject to change) Address of Event: 70� S Parrott Ave Street(s)to be closed:SE 2nd Ave from SE 6th Street to SE 7th Street Date(s) to be closed:Friday,February 24,2023 Time(s)to be closed:8:00am-2:30pm Purpose of Closing:Safety of children crossing the street Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closings O. 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. IIamrick 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. ► 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 jlimited 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 Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E. Hamrick Testamentary Trust if closing streets or sidewalks. 1/23/2023 Applicant Signature Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: Date: Building Official: Date: Public Works: Date: Police Department: — Date: 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 APPLICATION FOR SPECIAL EVENT Application Number: Date Received: "LO")3 NAME OF EVENT: field U= -- GSA ADDRESS OF EVENT: 701 S. N2l/YC't+ 14 ) DESCRIPTION OF EVENT: c>tuArn-L. arslfyi h;cr K JFcf-i-h a-1 i C10 f NAME OF SPONSOR ORGANIZATION: ' 11, - ? Pica cfc nl Y Contact Number before and during event OF RESPONSIBLE PERSON: ( ) /(v 3 -30 RESPONSIBLE PERSON'S sct N- DATE(S) AND TIMF(S) OF EVENT: Date: Starting Time: Q,to Closing Time: a9; 3u f m Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? LOCATION SF '9flQ � " ' �i� 5E (Q+h fa 7tkS(K fs Will Emergency Apparatus (Fire and Ambulance)have access to area? IF NO,THEN (provide alternatives): - WILL ELECTRICITY BE USED? NO (] (circle) Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED?(circle)YES (l <1:lNQ.C1 Type of Heating Equipment Used: —_ WILL A TENT BE ERECTED?(circle) YES 0 (NO J u) 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) O Tents/canopy fire rating certificate required. O Tent Size require life safety inspection (900 square feet or less then no permit is required) O Floor plan / seating/ setup drawing required showing exits, etc. O Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) O Fire extinguishers must have current tag, and be operational and readily accessible. 0 Cooking requires LPG outside of tent pointing away from exposures. 0 Electrical wiring exterior rated,not overloaded. 0 Fire Services inspection required. 0 Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount: O Firefighter/Inspector Amount: Other: FIRE DEPARTMENT OFFICIAL (PRINT): SIGNATURE: Please call the FD at 863-467-1586 for any questions. Revised 11-6-19 ® I DATE(MMIDDIYYYI) ACORD CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE �------ 01/25/2023 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 Christine Dewey NAME: JDA Insurance PHONE (561)296-0373 I V No): (561)828-0997 (A/C,No.FA: 120 N.Federal Hwy.,#301 E-MAIL christine@thejdagroup.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N Lake Worth FL 33460 INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: Insurance Company of the West 27847 Okeechobee Christian Academy,Inc. INSURER C: 701 South Parrott Ave INSURER D: INSURER E: Okeechobee FL 34974 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2312503353 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 NUDE SUER POLICY NUMBER POLICY E/F POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ DAMAGE TO rED CLAIMS-MADE n OCCUR PREMISES(EaEoccurrence) $ 500,000 MED EXP(Any one person) $ 5,000 A - Y PHPK2416971 07/01/2022 07/01/2023 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY n JEt° n LOC PRODUCTS-COMP/OPAGG I $ 3,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED PHPK2416971 07/01/2022 07/01/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ .X AUTOS ONLY X AUTOS ONLY (Per accident) $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A —)EXCESS DAB CLAIMS-MADE PHUB815898 07/01/2022 07/01/2023 AGGREGATE $ 1,000,000 I DED XI RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY X STATUTE OTH- ER Y/N 1 B ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA PHPK2416971 07/01/2022 07/01/2023 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 10 ,00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Each Claim $1,000,000 Professional Liability A PHPK2435608 07/01/2022 07/01/2023 Aggregate $1,000,000 Retention $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required) Re:With respect to field day events for the school The City of Okeechobee and R.E.Hamrick Testamentary Trust is named as an Additional Insured under the General Liability policy evidenced herein. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Okeechobee R.E.Hamrick Testamentary Trust ACCORDANCE WITH THE POLICY PROVISIONS. 55 SE 3rd Ave AUTHORIZED REPRESENTATIVE Okeechobee FL 34974-2903 4S11' .‘ '.''* I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD _ 4" 0 C., _:..- .,... .-6.-... '7--- a b (.0 = _. = 77-- _. ,0 TS ,.--.. ._ L -z...-_-. _c- LL ..... — .-. _. — ..c...: 0 a .- . :.:;-7- '''''..'•d i-,.'..,:.I L7-,--_-_ :::-...! ,i'...•i:f - -k.•,-', 4.- ,.... . .".1($. rg 2 C..) [ 7.. , --- o 5 o — , c.) 0 LI- • .--• :'...) ..7...:7) __.C.,., t .5 Z;•T' L.... 0 0 • S Parrott Ave -7.. -.. .._,._ .-- A: