Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Park Use Permit_Dots Pots LLC_MLK Ceremony & March
Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 Li Q Tele: 863-763-9821 Fax: 863-763-1686 PARK USE AND/OR TEMPORARY STREET/ SIDEWALK CLOSING PERMIT APPLICATION Date Received: Date Issued: Applicatio Date(s) & Times of Event: -- ` �• Information: Organization! Mailing Address: p ; Contact Name: -7`•-. E-Mail Address: Telepho* mot( Work: - (og Home: Cell: "- Summary of activities: Proceeds usage: Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #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: I e Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE '` 1fQ 7ij �''�F•�KF�- 55 SE THIRD•0.60 F� AVENUE � Qm OKEECHOBEE, FL 34974 Tele: 863-763-9821 Fax: 863-763-1686 ` A` �,.•'� PARK USE AND/OR TEMPORARY STREET/ ••�..%��' SIDEWALK CLOSING PERMIT APPLICATION Date Received: j 2_Ct_ Date Issued: Application No: 24-CT?y Date(s) & Times of Event: I 5 0=ys - /O e o) c Information: Organization:` 04 'S -pois — Mailing Address:c 7 0 E.; N' s'-}. Contact Name: 7"7 ,ii« • n r. E-Mail Address: / Q Jyu' (0< (-.4)9 i Telephoned ACJK- Work: cA to by t Home: Cell: ?Cc-3 kI o"i'1 ` 3 ©s Summary of activities: rOM Mat 02 C. -1 -,-gin Proceeds usage: 1 Please check requested Parks: Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 Y#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 I" & 3`d 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 ► 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. Applicant Signature .1 Date ••••OFFICE USE ONLY**** Staff Review Fire Department: Date: 1 Z'j L 11 Z,3 Building Official: Date: 12 Public Works: Date: j2- dq- z.3 Police Department: ,� Date: _ s y BTR Department: Date: City Administrator: - Date: City Clerk: '� i Date: r v `--- - . - 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 Date Date APPLICATION FOR SPECIAL EVENT Application Number: NAME OF EVENT: M LL ADDRESS OF EVENT: �ar� L+ DESCRIPTION OF EVENT: M 0 r L,h Date Received: NAME OF SPONSOR ORGANIZATION: 6 1 G � lSuniness Contact Number before and during event OF RESPONSIBLE PERSON: R(a �RQ I ',)(.&LI (,i RESPONSIBLE PERSON'S NAME: 1Z�-n,ej i U 5 0,cL-r t)r✓- DATE(S) AND TIME(S) OF EVENT: Date: Starting Time: Closing Time: Ao l 5 6C?� Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? LOCATION. Will Emergency Apparatus (Fire d Ambulance) have access to area? IF NO, THEN (provide alternatives): Z� WILL ELECTRICITY BE USED? 'YES M ONO M (circle) Locations: I Provided By: WILL HEATING/OPEk FLAMES FOR FOOD Type of Heating Equipment Used: —IV PROVIDED? (circle) YES 0 ONO WILL A TENT BE ERECTED? (circle) YES 0 NO 0 Tent Manufacturer: Wk Size J), fire rating posted: 0140 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 ITEM_ S BELOW: FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above) O Tents/canopy fire rating certificate required. ❑ Tent Size require life safety inspection (900 square feet or less then no permit is required) ❑ Floor plan / seating / setup drawing required showing exits, etc. ❑ Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT) ❑ 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. ❑ Fire Services inspection required. ❑ Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount: O Firefighter/Inspector Amount: O Other: FIRE DEPARTMENT OF ICIAL (PRINT): SIGNATURE: Please call the FD at 863-467-1586 for any questions. Revised 11-6-19 AlrNc Vx All/ F 11 j , t : J Ah. o CERTIFICATE OF LIABILITY INSURANCE DATEmfl8/2 23 lL� 12/18/2023 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 NAME: ACT Program Support Veracity Insurance Solutions, LLC. IM.�e�EXt) (844}520-6991 FAIIX No): (801)-763 1374 260 South 2500 West, Suite 303 E'MAL ADDRESS: info@actinsurance.com Pleasant Grove UT 84062 INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: Great American Alliance Insurance Company 26832 INSURED INSURER B: INSURER C: Dot's Pots LLC 570 East Village Street NE INSURER D: Okeechobee FL 34974 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADDI: LTR SUBFt '., POLICY EFF POLICY EXP POLICY NUMBER MMIDD/YYYY ". MMIDD/YYYY I I LIMITS i GENERAL LIABILITY EACH OCCURRENCE 5 1 000,000 X DAMAGE TO RENTED - -- ' --"-- --- --- 300,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea urrence) S CLAIMS MADE X OCCUR - MED EXP (Anyone person) S 5,000 A -,, PLE860914-AA231783 04/21/2023 04/21/2024' _._ 1,000,000 PERSONAL aADVINJURY S GENERAL AGGREGATE :S 2,000,000 _ GE_N'L AGGREGATE LIMIT APPLIES PER: (_PRODUCTS-COMP/OP AGG 5 2,000, DOD X POLICY j PRO LOC ANIMAL BAILEE _ 5--- �- -� AUTOMOBILE LIABILITY AGINEO SINGLE LIMIT (E. Ea accident ANYAUTO BODILY INJURY(P., person) S 'ALL OWNED SCHEDULED AUTOS ' AUTOS BODILY INJURY (Per accident) 5 ,NON -OWNED _ PROPERTY DAMAGE S HIRED AUTOS �i AUTOS 1Per accidenn _ _ I S UMBRELLA LIAB OCCURI EACH OCCURRENCE S _. EXCESS LIAB Imo''.. CLAIMS -MADE '', AGGREGATE S DED 1i RETENTIONS 5 WORKERS COMPENSATION WC STATLI- ". OTH-: AND EMPLOYERS' LIABILITY YIN I ?CRY LIMITS''. ER -. AN YPROPRIETORIPARTNERIEXECUTIVE E. L. EACH ACCIDENT '', S OFF] C EIMEMBER EXCLUDED? NIA ❑ _ (Mantlatary in NM) E.L. DISEASE - EA EMPLOYEE S Il yes. descrihe under " _ _ E L DISEASE- POLICY LIMIT S FIF DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 107, Additional Remarks Schedule. it more space is required) Certificate holder had been added as additional insured regarding the above mentioned policy per attached Additional Insured - Designated Person or Organization (CG 20 26 Ed. 04 13) CERTIFICATE HOLDER CANCFLI ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Okeechobee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 55 Southeast 3rd Ave Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and ]ago are registered marks of ACORD IN5025 (201401) 1* co cr in d je►wg w uis-a" OC r z O t= 0 N o Z Q O c� CL o O a c� m x U w CD LO r_r) Cat o c`s o ce) C[J C. o u., if) 6 I � pp OD CY) Go O 00 u� C7(1 U z w U Ly- U) U ~Ca Q 't W M cr N F— r'- � C3: 0 M _! Lu LL F Q -- W =Pm p �o O (z 1)W W J o Y m(n0 CD O cu x 70 U W W o CU70 7 o U - O O C � N U Q D Q L � E Q O p Q Q ro E C X �O Q) -T r c o� t O E O i Electronic Articles of Incorporation For BLESSED HANDS OUTREACH SERVICES INC N20000006310 FILED June 12 2020 Sec. Of hate tscott The undersigned incorporator, for the purpose of forming a Florida not -for - profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: BLESSED HANDS OUTREACH SERVICES INC Article II The principal place of business address: 907 NE 30TH TERRACE OKEECHOBEE, FL. 34972 The mailing address of the corporation is: 907 NE 30TH TERRACE OKEECHOBEE, FL. 34972 Article III The specific purpose for which this corporation is organized is: TO BE AN BE A POSITIVE OUTREACH FOR YOUNG LADIES IN UNDER PRIVILEGE AREA OF THE COMMUNITY Article IV The manner in which directors are elected or appointed is: AS PROVIDED FOR IN THE BYLAWS. Article V The name and Florida street address of the registered agent is: KANTRELL SMITH 907 NE 30TH TERRACE OKEECHOBEE, FL. 34972 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: KANTREL SMITH ZIIIIII Wj FILED June 12 2020 Article VI Sec. Of ttate The name and address of the incorporator is: tscoft KANTREL SMITH 907 NE 30TH TERRACE OKEECHOBEE, FL 34972 Electronic Signature of Incorporator: KANTREL SMITH I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January I st and May I st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article V11 The initial officer(s) and/or director(s) of the corporation is/are: Title: P KANTREL SMITH 907 NE 30TH TERRACE OKEECHOBEE, FL. 34972