Park Use Permit_Hippie Dazes_Drum CirclePagel of 3
Revised 3/5/19
CITY OF OKEECHOBEE
Organization: "• na p �`fettzT _
Mailing Address: / 1 ' I Ll
Je,5 rY1Pr2
Contact Name: q i ej J 6LJ
E-Mail Address: c., o CeChe: ee I) nY . i ► a ca
I Work: I h'La3- _`�h�- G�:�y(,� I Home: I I Cell: I 3ml - CRS�?
of activities: 4 h
Proceed
Please check requested Parks:
Fller Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 X #4 ❑ #5 ❑ #6
[Park 3 is location of Gazebo. Park 4 is Iocation ofBandstandl
(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)
Additio I Addresses, if applicable
Parcel Ili:
Dates of Drum Circle presented by Okeechobee Main Street and Hippie Daze
2024 Every 3rd Sunday from Dusk for a 2 hour duration.
January, Fehm ar�v, Marcb, April,1VJav, Ame, JWv, Agvsl� September, October,,
November, December
July
2 i
N�rem►�-r
17
�.e im r
15
Page 2 of 3
Revised 3/5/19
TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION
(Street Closings require City Council approval. Meetings 1" & 3rd Tuesdays but subject to change)
Address of Event-. wo t4 (3,
Street(s) to be closed:
Dates 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.
► Proofof non-profit status
► Original signatures of all residents, property owners and
business owners affected by the closing.
► Stnt 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.
** Afcoftolic beverages can be served only on private property. Alcoholic beverages NOT ALLOWED in City
Parks, Cry 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 TemporarX
Use Permit 667 along with the Street Closing application.
Note:
► Clean-up is required within 24 hours.
1 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 ggvernmental 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, irVury, 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 applicnt a cashier's check or advance deposit in the sum approximated by the City to be incurred in providing
City ser+ces. 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 knowledge that I have read and completed this application, the attached Resolutions No.(s) 03-8 and
04-03, co -kerning the use and the rules of using City property, that the information is correct, and that I am the
duty aukh rized 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 fnsurance must name City of Okeechobee as Additionaf Insured as well as R. E. ffamrick
Testamentary Trust if closing streets or sidewalks.
I LM Qhh611( i,-) - 7
ant Signature Date
••••OFFICE USE ONLY••••
Staff Review
Fire Department:
Date:
ZI Z I ZJ
Building Official:
Date:
Public Works:
9JT7ADate:
% 2 - 7- 2-2
Police Department:
Date:
i
BTR Department:
Date:
City Administrator:
Date:
City Clerk:
Date:
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 N /4
'Vmupnrary Street and Sidewalk Closing reviewed by City Council and approved
Date
Date
Application Number:
NAME C_)F EVENT:
ADDRESS OF EVENT:
DESCRIPTION OF
CITY OF OKEECHOBEE FIRE DEPARTMENT
APPLICATION FOR SPECIAL EVENT
Date Received:
NAME OF SPONSOR ORGANIZATION: Q ctn ho eE 31-,etel
Contact Number before and during event OF RESPONSIBLE PERSON: &,121 - - / 3=_Lj-%
M MP /zioht W-Uslester i the Ie-
DATE(S) AND TIME(S) OF EVENT.- wee I -
Date: Starting Time:
Date:
Starting Time:
he d
Closing Time:
Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? QL LOCATION
Will Emergency Apparatus (Fire and Ambulance) have access to area? ir`L's
IF NO, THEN (provide alternatives):
WILL ELECTRICITY BE USED? YES 1fl 1fl 0 circle)
Locations:
Provided By:
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YES M (? NO
Type of Heating Equipment Used:
WILL A TENT BE ERECTED? (circle) YES M NO 0
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)
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)
k Fire extinguishers must have current tag, and be operational and readily accessible.
Cooking requires LPG outside of tent pointing away from exposures.
rd1� Electrical wiring exterior rated, not overloaded.
f FFire Services inspection required.
l* Fire watch or inspectors) REQUIRED? FIRE WATCH Amount-
* Firefighter/Inspector Amount: O Other:
FIRE DEPARTMENT FFI IAL (PRINT):
SIGNATURE:
f,SSiCG f6.1W
Please call the FD at 863-467-1586 for any questions.
Revised 11-6-19
INTERNAL REVENUE SERVICE
P0. BOX 2508
CINCINNATI, OH 4S201
Date: ojrv� 2 S 7,001
OKEECHOBEE MAIN STREET INC
III NE 2ND ST
OKEECHOBEE, FL 34974
Dear Applicant:
DEPARTMENT OF THE TREASUR
Employer Identification Number:
65-0887929
DLN:
17053329002014
Contact Person:
DEBRA jOHNSON 1D# 75126
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
September 30
Public Charity Status;
509(a)(1)
Form 990 Required:
me's
Effective Date of Exemption:
November 22, 2004
Contribution Deductibility:
Yes
Alvance 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 ar
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 c.ass ifiE,
as either public charities or private foundations. During your advance ruling
periodo you will he 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 exemc
organization.
Letter 1045 (DO/CC
OKEEMAI-01 MBUCHANAN
'4�oFzo CERTIFICATE OF LIABILITY INSURANCE
DATE 11/1/2/l/2DIYYYY)
023
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
Lawrence Insurance Agency, Inc.
P.O BOX 549
CONTACT
NAME:
PHONE g63 46 FAX
(A/C, No, Ext): ( ) 7-0600 (A/C No); (863) 467-5142
Mfiss: marlene@lawrenceins.com
Okeechobee, FL 34973
INSURERS AFFORDING COVERAGE
NAIC S
INSURER A: Mt. Vernon Fire Insurance Co
INSURED
INSURER B :
INSURERC:
Okeechobee Main Street
111 NE 2nd Street
Okeechobee, FL 34972
INSURER D:
INSURER E:
INSURER F :
COVERAGES r`FRTIFIrATF MIIMRFR• ociilelnNr r.rrre Elmo•
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
LTR
I TYPE OF INSURANCE
ADDL
I D
SUER
WVD
POLICY NUMBER
POLICY EFF
MM/
POLICY EXP
YY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
Directors 8: Officers
X
NBP2552460F
10l25/2023
10/25/2024
EACH OCCURRENCE
$ 1,000,000
DAMPREMISES (Ea occurrence)S TO RENTED
100,000
X
MED EXP An one son
$ 5,000
PERSONAL & ADV INJURY
S 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ JECT LOC
GENERAL AGGREGATE
$ 1,000,000
PRODUCTS - COMP/OP AGG
S
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY Perperson)
S
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY Per accident
S
PROS d f AMAGE
Pe
S
AUTOS ONLY AUTOS ONED
S
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
S
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED RETENTIONS
S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETgOR/PARTNER/EXECUTIVE
�R
(MFan.4(M In NH) CLUDED7
If yes, describe under
NIA
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
City of Okeechobee and RE Hamrick is included as additional insureds with request to General Liability Coverage
City of Okeechobee
55 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 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Patty Burnette
From:
info@okeechobeemainstreet.org
Sent:
Wednesday, December 13, 2023 10:57 AM
To:
Patty Burnette
Cc:
Marion Heddesheimer; Angie Griffin
Subject:
[EXTERNAL]Park 4
Attachments:
Screenshot (4).png
Good Morning,
I am attaching a Google map picture of Park 4 for the drum circle. The drum circle will be held in the triangle east
of the flagpole.
Please let me know if you have any questions.
Have a great day & Merry Christmas!
Jenna Stephens
Executive Director
Okeechobee Main Street Arts & Culture Alliance
OKMS Phone: 863-357-6246
111 NE 2nd Street
Okeechobee, Florida 34972
Email: i_nfo@okeechobeemainstreet.org
OKMS Website: www.OkeechobeeMainStreet.orq
Arts Website: www.OkeechobeeArts.orq
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