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Chobee Wrestling BBQ Fundraiser i�,,>�,, ,,-dam TEMPORARY USE PERMIT APPLICATION �1 ,. OTHER TEMPORARY STRUCTURES (666) r t ;ra City of Okeechobee -General Services Derartment -'A-—0 4% 55 SE 3rd Ave, Room 101,City Hall, Okeechobee, FL 34974 Phone: (863)763-3372 ext. 9821 •ADATE RECEIVED: 4 jig 73 DATE ISSUED: .'APPLICATION NO.: T..Z OD 2) EVENT DATE(S) &TIME: iti_j.1 3 J j - I ioy-k, FEE:S175.00 p\ion-ProfiUCivic Organization DATE PAID: Name of Property Owner(s): lC 22 a ri e=5_ GL,e riee-• p ` Address: /6.(TC% Li,0rrt=C E /9—Ve �, Telephone Numbers: Home: Work: Cell:(SS'((3) Vj--I- — ((- .),((`j Name of Applicant: re(A C. ','ii0 Ck (A; \(; t-)6eh (Q-f-NCIS ((7 0/ b (tit'nt ( t )) Address: T C i J_€,e( 5 KA kCAiLS(S en l Vl o Cy Li t I . Telephone Numbers: Home: Work: Cell: oily 3('/-(,o//2 ((�� Future Land Use Map Desigation: l� Current Zoning Designation: j,H Legal Description of Property: first Pc t tl tI t6 S b i t?C_ L.. 1-3,7--1 N Ct'0 f Lit) ZL LF1 t ( bL 14') Address of Property: I eg��1 (Xv t1 oath( i n U yz b t-s(4 ru S � r' vn�f-I- �v� vaatie Please Explain Type of Use: J36 :Etna vat S_C v Briefly describe use of adjoining property North:--fle.S10 ,;;cj f East: t?4t-I aidt, Pc-lb South: (rye`I ,arh West: f ectu't-` Other temporary structures subject to the following regulations: 1.Christmas tree,fireworks and similar seasonal sales operated by a non-profit organizaiton. 2.Carnival,circus,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 S 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 An I Permit' City Staff(Please review the applicat'ort;attach com s-or p_eci I conditions). Occupational and.or State License Verificati n- Date: /�y�3 Fire Department Approval: Date: 4 12- 3 Police Department Approval: i Date: /a'� ,3S Public Works Department Approval: pt�-- - Date: ,t ii L Building Inspector Approval: Date:ft ' !P' Z, City Administrator Approval: Date: //oZ®/Z--3 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 may 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. F Signature of Applicant Date is Revised 3-5-19 lId APPLICATION FOR SPECIAL EVENT Application Number: Date Received: NAME OF EVENT: Nake. )Re --41 3 )6 ADDRESS OF EVENT: /6(2 ) S Ariz-re- /N/- DESCRIPTION OF EVENT: en�Q eliriret/Sec NAME OF SPONSOR ORGANIZATION: Fed-, Contact Number before and during event OF RESPONSIBLE PERSON: ((o j - (P 3/-'N// RESPONSIBLE PERSON'S NAME: brace Jc-4-1"1-n , — 166 DATE(S) AND TIME(S) OF EVENT: Date: 'f-Z/- Z 3 Starting Time: '?1'y'n Closing Time: Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? Al(l LOCATION Will Emergency Apparatus (Fire and Ambulance) have access to area? L��.s IF NO,THEN (provide alternatives): WILL ELECTRICITY BE USED? YES E l LI (circle) Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED?(circle)YES I fNO M Type of Heating Equipment Used: •J i)1t- 'cam; WILL A TENT BE ERECTED? (circle) YES 0 NO Ii 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 SERVICF:S SI-IALl:.. COMPLETE ITEMS BELOW: FIRE DEPARTMENT LIFE SAFETY& FIRE SERVICES REQUIREMENTS: (See above) U Tents/canopy fire rating certificate required. 0 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. 0 Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) 0 Fire extinguishers must have current tag, and be operational and readily accessible. O Cooking requires LPG outside of tent pointing away from exposures. O 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: Other:FIRE DEPARTMENT OFFI IAL(PRINT): Tar CA- cJ r ab s-l/r- --DtpLAN Fa,e, Marshal SIGNATURE: Please call the FD at 863-467-1586 for any questions. Revised 11-6-19 01%13;20 DR-14o _ t% rConsumer's Certificate of Exemption R.01/18 Issued Pursuant to Chapter 212, Florida Statutes FLORIDA 85-80179495900-5 01/10/2020 01/31/2025 501(C)(3) ORGANIZATION Certificate Number Effective Date Expiration Date Exemption Category This certifies that FELLOWSHIP OF CHRISTIAN ATHLETES INC • FORT PIERCE 1312 S 33RD ST FORT PIERCE FL 34947-6314 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-14 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-'188-6800. The mailing address is PO Box 6480, Tallahassee, FL 32314-6480. ARD® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/20/2023 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 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 James Greene&Associates, Inc. PHONE FAX 275 West Kiehl Ave (A/C.No.Ext):800-422-3384 (NC,No):800-604-1401 Sherwood AR 72120 ADDRESS: customerservice@jamesgreeneins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Brotherhood Mutual Insurance 13528 INSURED MOKANFO-02 INSURER B Fellowship of Christian Athletes 8701 Leeds Rd INSURER C: Kansas City MO 64129 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1778825537 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 ADDL SUER POLICY EFF POLICY EXP/Y LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDYYY) A X COMMERCIAL GENERAL LIABILITY 24MEA0518584 9/1/2022 9/1/2023 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $10,000,000 OTHER: Sexual Abuse/Molest $$1 M Occ.S2M Agg AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS AUTOS NON-OWNED (Per accident) A UMBRELLA LIAB X OCCUR 24MEA0518584 9/1/2022 9/1/2023 EACH OCCURRENCE $20,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED'? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Arrants LLC 1600 S. Parrott Avenue AUTHO ED REPRESENTATIVE Okeechobee FL 34974 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PARKING AGREEMENT This Agreement entered into effect April 11th, 2023 by and between Lightsey's Fish Company/Arrants LLC. and 61r/`r4! -r-y j e1•I till April 22nd, 2023. Whereas, Lightsey's Fish Co./Arrants LLC. is the owner of the parking lot at 1600 S. Parrott Avenue,Okeechobee, Fl 34974; Whereas, occupant desires to use the parking lot on the terms and conditions set forth; Now,therefore, in consideration of the mutual promises contained herein and other good and valuable consideration the parties hereto agree as follows: Occupant agrees to indemnify and hold Lightsey's Fish Co./Arrants LLC. harmless, including attorney's fees from: any and all liability arising out of the use of the above described premises. In witness whereof,the undersigned parties have executed the Agreement as of April 11th, 2023.. /*., - - a s //,i Office Manager Date (�l�G/ .' ° .. ! G 4 �'�Tj�(� i i / / Occupant Date DATE(MM/DD/YYYY) ACE; D® CERTIFICATE OF LIABILITY INSURANCE 4/20/2023 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 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 James Greene&Associates, Inc. PHONE FAX 275 West Kiehl Ave (A/C.No.Extl:800-422-3384 (A/C,No):800-604-1401 Sherwood AR 72120 ADDRESS: customerservice@jamesgreeneins.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Brotherhood Mutual Insurance 13528 INSURED MOKANFO-02 INSURER B: Fellowship of Christian Athletes 8701 Leeds Rd INSURER C: Kansas City MO 64129 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1778825537 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 24MEA0518584 9/1/2022 9/1/2023 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $10,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $10,000,000 OTHER: Sexual Abuse/Molest $$1M Occ.$2M Agg AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ A UMBRELLA LIAB X OCCUR 24MEA0518584 9/1/2022 9/1/2023 EACH OCCURRENCE $20,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Arrants LLC 1600 S. Parrott Avenue Okeechobee FL 34974 AUTHO ED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CHOBEE WRESTLING PRESENTS 7th Annual BBQFundraiser Prepared by: Kyle Reno/ Brahman Theater Friday, April 21 , 2023 11am — 1 pm Dinner Includes: Pulled Pork, Baked Beans, Coleslaw, Roll, Cookie Free delivery for 5 or more for businesses in town Tickets only $ 1O . Wow ., � ,.....r..— ..+ry a/ yao4 J+ F ".'i144,.. .i° .i. N 'l.." :i,�. an^ °,; f3$" ' -G y, 9 yr. e r .y. �L k N b:Pi ..„, lir-tt , ,-„.; ...,,,, . .... ....„,..„., : 1" ,,, ' a a , _.„ . : ". Viz:•: <, :;,' €k' �, ,.. .. `,,. -It .t . .�, ,, .....,, ,,r,,,,,,, . , � .; l\ ate. E a4 , ,'.:. • 4+' $ tg , .: .. 1 E+ ip e $$ .ew , J air/IF sw.os OF•OKF�!`+_ CITY OF OKEECHOBEE `•`` �� 55 SE THIRD AVENUE " "` OKEECHOBEE FL 34974 o �. � ,�-y- a��••`�, Tele: 863-763-9821 Fax 863-763-1686 '�:.w;;;,.��' e-mail: permit@cityofokeechobee.com Temporary Use Permit Permit Number: T-23-003 Date(s) of Event: April 21-2023,11-1PM Permit Expiration: April 21, 2023, 2t3 (I 11:59 PM Purpose of Request: BBQ Fundraiser Property Owner: Arrants, LLC Address: 1600 South Parrott Ave City: Okeechobee State: Florida Zip Code: 34974 Applicant: Fellowship of Christian Athletes Applicant's Address: 8701 Leeds Rd Kansas_ Phone Number( 863-824-2287 - ' Address of Project: 1600 South Parrott Avenue_ gCurrent Zoning: Heavy Commercial e-- FLU Designation: Commercial (C) Subdivision: City of Okeechobee Restrictions/Remarks: • All debris must be removed within 24-hourspof expiration date. • Contact the Okeechobee County Fire Department at 863-763-5544 to schedule a final field inspection before event. 7lateee, 4 nevalte April 20, 2023 General Services Administrative Secretary Date ''1 OF O/CF�!`tiL CITY OF OKEECHOBEE `` "" ��a 55 SE THIRD AVENUE o•` OKEECHOBEE, FL 34974 r 416$•�� Tele: 863-763-9821 Fax 863-763-1686 :...do-��'� e-mail: permit@cityofokeechobee.com Temporary Use Permit Permit Number: T-23-003 Date(s) of Event: April 21,2023,11AM-1 PM Permit Expiration: April 21, 2023, @ 11:59 PM Purpose of Request: BBQ Fundraiser Property Owner: Arrants, LLC Address: 1600 South Parrott Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Fellowship of Christian Athletes Applicant's Address: 8701 Leeds Rd, Kansas City Phone Number: 863-824-2287 Address of Project: 1600 South Parrott Avenue Current Zoning: Heavy Commercial FLU Designation: Commercial Subdivision: City of Okeechobee Restrictions/Remarks: • All debris must be removed within 24-hours of expiration date. • Contact the Okeechobee County Fire Department at 863-763-5544 to schedule a final field inspection before event. 7k/dal 4 valdtate April 20, 2023 General Services Administrative Secretary Date