Mike Vinson Medical Expense Benefit Page 1 of 3
Revised 3/5/19
�/ CITY OF OKEECHOBEE
rI'ry''y''. THIRD 55 SE AVENUE
��`44 OKEECHOBEE, FL 34974
., Tele: 863-763-9821 Fax: 863-763-1686
v PARK USE AND/OR TEMPORARY STREET/
"'=';. 0 �+ SIDEWALK CLOSING
PERMIT APPLICATION
Date Received: -(G_d3 Date Issued: ,e`. /< 'G(,3,J
Application No: 3- ON„Q Date(s) &Times/of Event:
3J,'l 1a6a3 3:00an-) fi/ apT)
Information:
Organization: N AC, L'ic5... 6erv'ce
Mailing Address:
Contact Name: j � ��d i tick
E-Mail Address:
Tele hone:
Work: — Home: Cell:
Summary of activities:
r e6►Ca1 TXpen R ` ;ene(frk-
m 1\P \'v' /5Or "
e\`ir-y‘\ porgy ci.VC)nW'S
Proceeds usage:
Please check requested Parks:
Flagler Parks: o City Hall Park o #1 Memorial Park o #2 o #3 r, #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 1st&3rd Tuesdays but subject to change)
Address of Event:
Street(s)to be closed:
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 i ' ► 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
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
Certificate of Insurance must name City of Okeechobee as Additional Insured as well as R.E.Hamrick
Testamentary Trust if closing streets or sidewalks.
3._6
Ap icant Signature Date
`•!:!OFFICE ONLY••••
Staff Review
I d
Fire Department:
Date: 70 j
Building Official: Date: 3 • �
Public Works: _ Date: -6- 23
Police Department: Date: /7
BTR Department:
Date: 77: 3—
City Administrator: Date: 3
City Clerk: 1 r a, Date: (L?/ 7/.9
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 t .
Date
Temporary Street and Sidewalk Closing reviewed by City Council and approved d - I
Date
CITY OF OKEECHOBEE FIRE DEPARTMENT
APPLICATION FOR SPECIAL EVENT
Application Number: Date Received:
NAME OF EVENT: (Ved%CQ►.\ EE(c)er3. It(►� 1 1 IA
ADDRESS OF EVENT: 9
DESCRIPTION OF EVENT:
Se11 l r 6€:)Q
NAME OF SPONSOR ORGANIZATION: lie. LtQQ Cyr v�Ces
Contact Number before and during event OF RESPONSIBLE PERSON: (563 63,9 664
RESPONSIBLE PERSON'S G?�1
1410,-1-hr-the V tir t%Or'N
DATE(S) AND TIME(S) OF EVENT:
Date:Date: 3l�*1'20 3 Starting Time: $ � a,•.
Oa! Closing Time: op1,,m Starting Time: Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? (V 0 LOCATION
Will Emergency Apparatus(Fire and Ambulance)have access to area?
IF NO,THEN(provide alternatives):
WILL ELECTRICITY BE USED? YES H N n (circle)
Locations:
Provided By:
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED?(circle)YES[7 ENO E
Type of Heating Equipment Used:
WILL A TENT BE ERECTED?(circle) YES p p
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.
❑ 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.
❑ Electrical wiring exterior rated,not overloaded.
0 Fire Services inspection required.
O Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount:
0 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
II Consumer's ( ertit'icate of l xemptlon�I R.01/18
Issued Pursuant to Chapter 212, Florida Statutes
FLORIDA
85-8018520448C-7 11/12/2021 11/30/2026 501(C)(3)ORGANIZATION
Certificate Number Effective Date Expiration Date Exemption Category
This certifies that
RITELIFE SERVICES INC
5029 SE EBBTIDE AVE
STUART FL 34997-3164
is exempt from the payment of Florida sales and use tax on real property rented,transient rental property rented, tangible
personal property purchased or rented, or services purchased.
DR-144
Important Information for Exempt Organizations R.01/18
FLORIDA
1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases.
See Rule 12A-1.038, Florida Administrative Code(F.A.C.).
2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's
customary nonprofit activities.
3. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be
reimbursed by the organization.
4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible
personal property, sleeping accommodations, or other real property is taxable. Your organization must register,
and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this
requirement except when they are the lessor of real property(Rule 12A-1.070, F.A.C.).
5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no
circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for
payment of the sales tax plus a penalty of 200% of the tax,and may be subject to conviction of a third-degree
felony. Any violation will require the revocation of this certificate.
6. If you have questions about your exemption certificate, please call Taxpayer Services at 850-488-6800. The
mailing address is PO Box 6480,Tallahassee, FL 32314-6480.
Patty Burnette S63:-532.-IDO/Co
From: Kathrine Vinson <kathrine@ritelifeservices.org>
Sent: Monday, March 6, 2023 1:54 PM
To: Patty Burnette
Subject: Mike Vinson
Attachments: benefit info.pdf; dads flyer.pdf
Kathrine Vinson
772-233-7872
RitichiLiarv.
CAW 11.4
What behavioral health needs is more unashamed conversation.
i
Please Join us in helping
MIKE VINSON
WITH MEDICAL EXPENSES & TRIP TO CALIFORNIA FOR THE SURGERY
4y �r.h `i� ``�
k
Vg - Kii..AJt74,. ' :
[i, -4 .-.. e ,...,:,t,..,,•„.._
ri,_,),..t.::.„0„:.,.,,: ,,„1,,. :.,,i, „::. {t
y e
f e ‘
4.
47. V;^ •. 1'7 'A . 4 - Kai
V 06
1. h _•. '.(1
.,4l4 �,` f o..ATE,
1'i• S \ip �
44 :00..0..0 ; .,} a�'Ii
Mike is going to be having Pulmonary Thromboendarterectomy Surgery(PTE) on April 3RD, 2023. Mike has blood
clots in his pulmonary arteries. PTE is a complex surgery that removes deadly chronic blood clots from major
blood vessels in the lungs that cannot be treated with medication. Without treatment, these clots block off
blood flow to the lungs, cause damaging vascular changes and pulmonary hypertension. This condition can
lead to heart failure and death. The surgery will be an 8-10-hour procedure and 6 weeks to recover. Mike and his
wife Julie will be flying out on March 26th to San Diego California. Mike will be staying in the hospital for about 3 weeks
after the surgery to make sure he will recover as he needs to. We are throwing this benefit to help with all medical bills
that will be accumulating while they are there.
We will be having a BBQ Pork Lunch on March 17,2023 for $12.00
BBQ Sandwich, Coleslaw, baked beans, and a roll with a sweet tea.
We will deliver 5 or more plates. We will start delivering at about 10:30 am.
If you would would like to help the family you can send money to his wife
Julia Vinson with Cashapp or Venmo
Venmo @Julia-Vinson-92
Cash APP @$juliavinson92
Please contact:
April at 863-801-9696 - Food Plates on 3/17/2023
Kathrine at 863-532-6016 - Cooler w/alcohol Raffle on 3/24/2023
Sierra at 863-623-7514 - Silent Auction Raffle on 3/24/2023