2023-11-07 V. B. OMS Temp Street Closure, Exhibit 5Exhibit 5
11 /07/2023
Page 1 of 3
OCT Q 9 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:
1 d G :3,0 A 7?
1 Date Issued:
Application No:
/aJ — X
Date(s) & Times of Event: Tf-cc rnr'e-r q , a.I) ;k 3 1 OCLM --Opr
Information:
Organization: C
III _ 't r C f 3491A
.MailingAddress:
Contact Name: � j S ' i1
E-Mail Address: 'm
J
Tele hone:
(Work: I kL,-,A ;,--)L-4i , Home: I Cell:
of activities:
Proceeds
Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park #2 p #3 �#4 ❑ #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:
3.-
Street(s) to be closed: SWr V e 1 t h C Jrk,+Wafl Vox'L_ iee
Date(s) to be closed: r q
Time(s) to be closed: f - rj L q "
Purpose of Closing: t-.% k
Attachments Required for Use of Parks Attachments Required for Street/Sidewalk Closings
► Site Plan
1 ► 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.
❑ 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.
L� IA12—j I c
licant SiNiature Date
••••OFFICE USE ONLY••••
Staff Review
Fire Department:
Date:
Building Official:
Date:-7.5
S,
Public Works:
Date:
1( ' 17- a
Police Department:
i
' l '
Date:
o /7
BTR Department:
Date:
Cgy Administrator:
Date:
lm //,,q -4
City Clerk:
Date:
U 0 3
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
Temporary Street and Sidewalk Closing reviewed by City Council and approved
It-;f-a.3
Date
Date
APPLICATION FOR SPECIAL EVENT
Application Number: Date Received:_` li 1)q -; a
NAME OF EVENT: Main �, "recf Ch(i<,J-mas Fc4'Val a.i1d 4ctrnde,
ADDRESS OF EVENT:
DESCRIPTION OF EVENT:
i_ r_ c.
NAME OF SPONSOR ORGANIZATION:
Contact Number before and during event OF RESPONSIBLE PERSON: (c,0 L?)`(
e. r)
S
DATE(S) AND TIME(S) OF EVENT:
Date: OeL . 3 Starting Time: aY) Closing Time:
Date: Starting Time: _ Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? -�— LOCATION -Sim ?)-M �Jand q 1h k4e,
Will Emergency Apparatus (Fire and Ambulance) have access to area? T
IF NO, THEN (provide alternatives):
WILL ELECTRICITY BE USED? YE! • NO M (circle)
Locations:—P I CA u J. r - Q y-y- S -
Provided By: .I n d 'e- f).
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YES 0 (ENO (J
Type of Heating Equipment Used: n 114
WILL A TENT BE ERECTED? (circle) YES 0 NO M
Tent Manufacturer: _ Size fire rating posted:
Tent have sides and how many? _
Are there Fire Extinguishers accessible and ready for use? (circle) Yes
No
IOx10 its otily
***ATTACH SITE MAP OF EVENT LAYOUT'}'t*
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.
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: O Other:
FIRE DEPARTMENT FFI L (PRINT): J 1 ca J ajkt'-
SIGNATURE: Peas call the FD at 863-467-1586 for any questions.
L11 Revised 11-6-19
C Alc4r.e
Zwalw. Inc
5D
q.
3p
14,17al
F.11 Bar.,:
Pawn-
0, iKhcl:lf
a—tOMd pe:k,�
z
of 0).�6-3e=
NW Park Si
US Hwy 98
NW Park St
NW Park sl
u
Zfz
rLg• n
ti
SW Park St swParkst
sw Park St
ark S(
SW Park St
SW Park
St SW Park St
ACORO'-
OKEEMAI-01
CERTIFICATE OF LIABILITY INSURANCE
OgTE (MMIDOIYYYY)
1 /6/2023
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 terfns 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
oendorsements .
PRODUCER J 59AIACT
Lawrence Insurance Agency, Inc. PHONE 467-0600 FAX 86
P.O BOX 649 (AX, No, Ext): (863 ) lac. No):( 3) 467-5142
Okeechobee, FL 34973 I `s. marlene@lawrenceins.com _ y_
I
INSURED
Okeechobee Main Street
111 NE 2nd Street
Okeechobee, FL 34972
Cf1VFOAf]FR
r 9zDTIFIr:ATF IJIIMRFR-
INSURER C
Insu
RFVICIrTAI NIIMRFR-
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 CONTRACTOROTHER 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 PAIDCLAIMS.
N_3 TYPE OF INSURANCE
AOOL
UBD
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A X
X
GEN'L
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ] OCCUR
Directors & Officers
X
BP2662460E
1012612022
10/26/2023
I EACH OCCURRENCE
$ 1,000,000
Do>a i� siEAENrED�et
S 100,000
MED EXP An one person)
S 6,000
PERSONAL 6 ADV INJURY
$ 1,000.000
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ %?i LOC
OTHER.
GENERAL AGGREGATE.
$ 1,000,000
PRODUCTS- COMPIOP AGG
S
Hired/Non Owned
S Included
AUTOMOBILE LIABILITY
-- ANY AUTO
OVMIED •SCHEDULED
AUTOS ONLY AUTOS
AUTO.SONLV AUTOSONLVOPER]Y�AMAGE
'T
COMBINED SINGLE LIMIT
(Ea aaodw+l�_
BODILY INJURY Lpocum)
S _
BCD
BODILY INJURY (Per accident)-
S
]1
UMBRELLA LIAB
EXCESSLUIB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
S
DIEDRETENTIONS
S
S5
ANDEEMPPLOYERS'LIABILLITY YIN
ANY PROPRIIETTORJPARTNER/EXECUTIVE
)CLUDED7
.F,IEgqIMnNHR
If yes, describe under
DESCRIPTION OF OPERATIONS below
N1A
I
_--10gym_Llflk.
E.L. EACH ACCIDENT
- - _----
$ -
-II;
S
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE • POLICY LIMIT -
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more span Is required)
City of Okeechobee and RE Hamrick is included as additional insureds with request to General Liability Coverage
City of Okeechobee
66 S.E. 3rd Avenue
Okeechobee, FL 34974
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 26 (2016103) O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACIDRD name and logo are registered marks of ACORD
INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date: APR 2 9 2335
OKEECHOBEE MAIN STREET INC
Ill NE 2ND ST
OKEECHOBEE, FL 34974
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
65-0887929
DLN:
17053329002014
Contact Person:
DEBRA JOHNSON ID# 75126
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
September 30
Public Charity Status:
509(a)(1)
Form 990 Required:
Yes
Effective Date of Exemption:
November 22, 2004
Contribution Deductibility:
Yes
Advance Ruling Ending Date:
September 30, 2009
We are pleased to inform you that upon review of your application for tax
exempt status we have determined that you are exempt from Federal income tax
under section 501(c)(3) of the Internal Revenue Code. Contributions to you are
deductible under section 170 of the Code. You are also qualified to receive
tax deductible bequests, devises, transfers or gifts under section 2055, 2106
or 2522 of the Code. Because this letter could help resolve any questions
regarding your exempt status, you should keep it in your permanent records.
Organizations exempt under section 501(c)(3) of the Code are further classified
as either public charities or private foundations. During your advance ruling
period, you will be treated as a public charity. Your advance ruling period
begins with the effective date of your exemption and ends with advance ruling
ending date shown in the heading of the letter.
Shortly before the end of your advance ruling period, we will send you Form
8734, Support Schedule for Advance Ruling Period. You will have 90 days after
the end of your advance ruling period to return the completed form. We will
then notify you, in writing, about your public charity status.
Please see enclosed Information for Exempt Organizations Under Section
501(c)(3) for some helpful information about your responsibilities as an exempt
organization.
Letter 1045 (DO/CG)
10/10/23, 11:42 AM Detail by Entity Name
DIVISION OF CORPORATIONS
„A.org
Department of State / Division of Corporations / Search Records / Search by Entity Name /
Detail by Entity Name
Florida Not For Profit Corporation
OKEECHOBEE MAIN STREET,
INC.
Filing Information
Document Number
N99000000045
FEI/EIN Number
65-0887929
Date Filed
01/05/1999
State
FL
Status
ACTIVE
Last Event
REINSTATEMENT
Event Date Filed
10/18/2000
Principal Address
111 NE 2nd Street
OKEECHOBEE, FL 34972
Changed: 10/30/2020
Mailing -Address
111 NE 2nd Street
OKEECHOBEE, FL 34972
Changed: 01/30/2013
Registered Agent Name & Address
Turgeon, Sharie
111 NE 2nd St
Okeechobee, FL 34972
Name Changed: 02/03/2022
Address Changed: 04/13/2021
Officer/Director Detail
Name & Address
Title President
Griffin, Angie
313 SW Park Street
OKEECHOBEE, FL 34974
https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=OKEECH... 1 /3
10/10/23, 11:42 AM
Detail by Entity Name
Annual Reports
Report Year Filed Date
Document Images
https://search.sunbiz.org/Inquiry/CorporationSearch/Search ResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=OKEECH... 2/3