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Community Outreach (2) CITY OF OKEECHOBEE s`` ' ���: 55 SE THIRD AVENUE .o OKEECHOBEE, FL 34974 0. �=� ao'��� Tele: 863-763-9821 Fax 863-763-1686 .. .�4—91 *id" e-mail: permitcitvofokeechobee.com Park Use Permit Permit Number: 23-018 Date(s) of Event: November 11, 2023 Time: 3:00PM - 6:00PM Permit Expiration: November 11, 2023, @ 11:59 P.M. Purpose of Request: Outside Church Service Property Owner: City of Okeechobee Address: 55 SE 3rd Avenue Okeechobee, FL 34974 Applicant: Iglesia de Dios Pentecostal Movimiento Internacional Contact: Nancy or Sonia Cabrera Applicant Phone Number: (772) 209-'1264 or(772)530-1695 Applicant Address: 2935 Suite #2941 SW 3rd Terrace, Okeechobee, FL 34974 Current Zoning: PUB FLU: PF Subdivision: City of Okeechobee Restrictions/Remarks: • Contact the Okeechobee County Fire Department at 863-763-5544 to schedule a final field inspection before event. • All debris must be removed within 24 hours of expiration date. 7 ezeda 7oi de October 24, 2023 General Services Administrative Secretary Date Page 1 of 3 M Revised 3/5/19 CITY OF OKEECHOBEE 5�Opoky7=4 55 SE THIRD AVENUE . °,);� OKEECHOBEE, FL 34974 Z. o 4 Tele: 863-763-9821 Fax: 863-763-1686 '_,� a .0 PARK USE AND/OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: Q a18-A3 Date Issued: Op-.424'.QD Application No: r 3,-� ( a Date(s)&Times of Event: November 11, 2023 @ 3pm -6pm Information: Organization: Iglesia de Dios Pentecostal Movimiento Internacional INC. Mailing Address: 2935 Suite#2941 SW 3rd Terrace, Okeechobee, FL, 34974 Contact Name: Nancy Cabrera , Sonia Cabrera E-Mail Address: (772) 209-1264 , (772) 530-1695 Telephone: Work: Home: Cell: 772)209-1264 , (772) 530-1695 Summary of activities: We are planning to do an outside church service with live music and finish off the evening with small sermon and prayer. Proceeds usage: We would like use this Dark/locations because it is close proximity to our church. We would only require the park itself and the electricity from city, we will provide everything else included to sound system. Please check requested Parks: UI LaqiCUI Skru1S1(. Flagler Parks: o City Hall Park ❑#1 Memorial Park o #2 DK#3 ❑ #4 )o #5 ❑#6 [Park 3 is location of Gazebo. Park 4 is location of Bandstanilr (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: 55 SE 3eAve Okeechobee FL 34974, Park#'(Flag Pole+ Gazebo) Street(s)to be closed: N/A 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. ► 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. a8kelq L 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 closin streets or sidewalks. -62 -,1 lo/15 Ap ica Signature Date ••••OFFICE USE ONLY•••• Staff Review Fire Department: 'i Date: �( � i01111 Building Official: Date: IC,—1$-23 Public Works: ( C..� Date: t(2 f, 13 Police Department: it Date: f 003 BTR Department: — — L . Date: /U -)-34 City Administrator: Date: j0 4.3), City Clerk: (f (�_(,,� Date: 101 lib 193 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 r\ire la Date APPLICATION FOR SPECIAL EVENT Application Number: A3. Date Received: NAME OF EVENT: Community Outreach -�, (lb RIA4 SJy(4 ADDRESS OF EVENT: 55A. 3rd Ave, Okeechobee, FL 34974 II Park#Y 4 DESCRIPTION OF EVENT: Community Outreach NAME OF SPONSOR ORGANIZATION: Ilgesia de Dios Pentecostal Movimiento Internacional Contact Number before and during event OF RESPONSIBLE PERSON: (772)209-1264 - RESPONSIBLE PERSON'S NAME: Nancy Cabrera Reyes DATE(S) AND TIME(S) OF EVENT: Date:November 11, 2023 Starting Time: 3:00 PM Closing Time: 6:00 PM Date: Starting Time: Closing Time: _ ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? No LOCATION Will Emergency Apparatus(Fire and Ambulance)have access to area? Yes IF NO,THEN(provide alternatives): WILL ELECTRICITY BE USED? YES RI ONO[I (circle) Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED?(circle)YES 0 LINO ta Type of Heating Equipment Used: WILL A TENT BE ERECTED?(circle) YES E NO IX 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. Cl 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. O Cooking requires LPG outside of tent pointing away from exposures. O Electrical wiring exterior rated, not overloaded. O Fire Services inspection required. U Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount: O Firefighter/Inspector Amount: �e`Ir Li Other: (' f r� FIRE DEPARTM T OFF CIAL(PRINT): �J 1 O c1 a`I J 'r SIGNATURE: Please call the FD at 863-467-1586 for any questions. Revised 11-6-19 DATE(MWDD/YYYY) . ACORO® CERTIFICATE OF LIABILITY INSURANCE `...----- 04/11/2023 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 NOLAN JACKSON JR. &ASSOCIATES, INC. NAME:CT Nolan Jackson C NN �• (770)788.79ti0 _(A/C,_Not�770)788-9010 1455 River Cove Rd Social Circle, GA 30025 E-MAIL ADDRESS:_ njackson@npins.com License#: 531001 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: GuiideOne Insurance Company 15032 INSURED INSURER B: IGLESIA DE DIOS PENTECOSTAL MI INSURERC: 2310 SE Bordeaux Ct INSURERD: Port Saint Lucie, FL 34952 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00005549-128365 REVISION NUMBER: 11 THIS IS TO CERTIFY TI4 T TUL roI IciCs or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INL11l P,1 tU Nt11 Lvi i f-t`,I HnH.ANC A'i Y 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 CONiDI I IONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AUDL'SUBR MI POLICY EFF ' POLICY EXP LTR I I IN180 VYVD POLICY NUMBER (IRM/DD/YYYY) (MDD/YYYY) LIMITS A I XI COMMERCIAL GENERAL LIABILITY I Y I 1910035810 12131r2022 12f31!202S E_ACHOCCURRE:CE I$ 1,000,00 0 rX 1 I I OAMAGE TO RENTED 111${ I CLAIMS-MADE i i OCCUR I I i_'LLrviiSr+iia uiw.u[ncice) 1 5,000 I I 1 i i MFD FXP(.Any one person) { $ 1 0,000 I I I I ! I A AAA Ann i Y_t—KJVNHLe UV INJUIs 1,Y I,VVV,VVV GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000 000 X POLICY JET L__J LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ __ (Ea accident ANY AUTO BODILY INJURY(Per person) $ -- OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 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 $ r 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 CITY OF OKEECHOBEE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVEPj�j_ 0— vY" . / / (NLJ) ©1988-2015 ACORD CORPORATION. All rights reserved. Arnon nc I9111R/f'5' r-... Arnon.......•..,.,.1 I................:c.r.•....•+.......t,e..e Arnon o.I..+...-Y.,,nu 1.,..nn,i 1 Pon', s iT1nOn.- 0000207 .o/16/z1 °m DR-14 t. Consumer's Certificate of Exemption R.01/18 Issued Pursuant to Chapter 212, Florida Statutes FLORIDA 85-8015784594C-4 12/02/2021 12/31/2026 501(C)(3)ORGANIZATION 1 Certificate Number Effective Date Expiration Date Exemption Category This certifies that IGLESIA DE DIOS PENTECOSTAL MOVIMIENTO INTERNACIONAL INC 12621 BALCOMBE RD ORLANDO FL 32837-6219 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 "Pie ; 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, FA.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. ...�. .... ..........__ - ... .__a..b.. a !_ i i • R" LJt- t_. I s • , �. �_ ' • . may, 1 ( b. ' 1 31. Irrt iya..,-., 9■ (• +fir _ 5m-Ft A, Y -W7= �7 /'+ f , 1 n y . , i i IL Y� sa- _•d .l� i Cirr`:_ �enll0t ifs, 'mil C.(,6i C:/ 11-e- a$ CF .) 3 k*P kc915. . iD(0 6)(Nik - Vl.kdk 4-0) \AWA- No\i • L6b