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2024-02-06 V. B. OCA Field Day Temp Rd Closure, Exhibit 2• •Exhibit 2 02/06/2024 Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE o�� 55 SE THIRD AVENUE OKEECHOBEE, FL 34974 r Tele: 863-763-9821 Fax: 863-763-1686 PARK USE AND/OR TEMPORARY 'ST -E— SIDEWALK CLOSING PERMIT APPLICATION Date Received: k0--ZC2 Date Issued: Application No: �4 -GC�� Date(s) & Times of Event: Friday, March 8, 2024 8am-2:30pm Information: Organization: Okeechobee Christian Academy Mailing Address: 701 S. Parrott Ave, Okeechobee, FL 34974 Contact Name: Melissa King E-Mail Address: Melissa.King@OkeechobeeChristianAcademy.org Telephone: W ork: 863-763-3072 Home: I Cell Summary of activities: Students will participate in Field Day and will need to cross back and forth all day. rroceeas 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: 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: 701 S Parrott Ave Street(s) to be closed: SE 2nd Ave from SE 6th Street to SE 7th Street Date(s) to be closed: Friday, March a, 2024 Time(s) to be closed:8:00am-2:30pm Purpose of Closing: Safety of children crossing the street Attachments Required for Use of Parks Attachments Reauired 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.** -propertyowner, 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. �z&"�4f Applicant Signature Staff Review 1 /10/2024 Date •"'OFFICE USE ONLY•••• Fire Department: _ Date: a 12,(4 -Building Official: Date: v "Z Public Works: Date: Police Department: /' Date: BTR Department: _ ?_ Date: /c.- Administrator: C,. Date: -City 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 A- � - dq Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date • U Application Number: CITY OF Ois$=CHOBEE FZRE AEPARTMENT APPLICATION FOR SPECIAL EVENT Date Received: NAME OF EVENT: _Okeechobee Christian Academy Field Day ADDRESS OF EVENT: 701 S Parrott Avenue Okeechobee, FL DESCRIPTION OF EVENT: Annual Field Day event where students will participate in sports and games on both side of the road. NAME OF SPONSOR ORGANIZATION: Okeechobee Christian Academy before and during event OF RESPONSIBLE PERSON: (863) 610-1268 - RESPONSIBLE PERSON'S _,_Melissa King DATE(S) AND TIME(S) OF EVENT: Date: 3/8/2024 Starting Time: 8:00am Closing Time: 2:00pm Date: Starting Time: Closing Time: ARE ANY ROADWAYS TO BE BLOCI ED/CLOSED? des LOCATION SE 2nd Ave from SE 6th Str to SE 7th Str Will Emergency Apparatus (Fire and Ambulance) have access to area? yes IF NO, THEN (provide alternatives): _ WILL ELECTRICITY BE USED? YES 0 (circle) Locations: Provided By: WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YES i7 ©NO [a Type of Heating Equipment Used: WILL A TENT BE ERECTED? (circle) YES M `NO Tent Manufacturer: Size _ fire rafing 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 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) Fire extinguishers must have current tag, and be operational and readily accessible. Cooking requires LPG outside of tent pointing away from exposures. MN Electrical wiring exterior rated, not overloaded. Fire Services inspection required. OR Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount: 4��Firefighter/Inspector Amount: O Other: FIRE DEPARTMENT OFFI IAL (PRINT): SIGNATURE: l_ Please call the FD at 863-467-1586 for any questions. Revised 11-6-19 41 U— GO 4- "0 Ave- S to O LL 0 O 01 S Parrott Ave ti ME E E A� 7 ® OF LIABILITY INSURANCE 1/2024 YY)CERTIFICATE 701�11/11/2024 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(les) 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. Astatement on (his certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT MarcCri3pino NAME: JDA Insurance Group PHONE EX , (561) 296-0373 INC No ; (561) 828-0997 E-M IL mars@lhejdagroup.com ADDRESS: 120 N. Federal Hwy., #301 INSURER(SI AFFORDING COVERAGE NAIL N INSURERA: Philadelphia Indemnity Insurance Company 1805B Lake Worth FL 33460 INSURED INSURER B : Insurance CO Of the West 27847 Okeechobee Christian Academy, Inc. INSURER c : INSURER 701 South Parrott AVa INSURER E Okeechobee FL 34974 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2381704086 REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSIANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IN R LTR TYPE OF INSURANCE AUUL INSO Suuh: `. 'O POLICY NUMBER PO IGY EFF MMIDDlYYYY POLICY EXP MMIDDIY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 CLAIMS -MADE a OCCUR PR�EIAISES Ea occurrence)_ S 500,000 MEO EXP (Any one person) S 15,000 PERSONAL aAOVINJURY S 1,000,000 A Y PHPK2572515 07JO112023 07/01/2024 GEN1 AGGREGATE UMITAPPLIES PER: AGGREGATE S 3,000,000 PRO- LOC X POLICY JECT _GENERAL PRODUCTS-COMPIOP AGG S 3,000,000 OTHER: Abuse 8r Molestation _ $ AUTOMOBILE LIABILITY COMBINED 5INGLELIMIT jEe eccldenq S 1,000,000 BODILY INJURY Per person) S ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS PHPK2572515 07/01 f2023 07/01/2024 1�5 BODILY INJURY (Per accident) 5 PROPERTY DAMAGE fPor occid ent__ s HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S U MBRELLA LIAB OCCUR EACH OCCURRENCE s AGGREGATE 5 A EXCESsLIAB CLAIMS -MADE PHUB870809 07101/2023 07/01/2024 OEn RETENTION 5 I S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOIWARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ (Nendelory In NH) NIA WFL5042021 05 07102/2023 07(0212024 �/ v X PER /� ER — E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 It Yes, describe under DESCRIPTION OF OPERATIONS below I I I E.L. DISEASE -POLICY LIMIT S 1,000,000 Each Claim $1,000,000 A Professional Liability PHPK2672517 07/01/2023 0710112024 Aggregate $1,000,000 Retention $1,000 DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached II more space Is required) When required by contract or agreement, the certificate holder(s) shall be Included as additional Insured(s) as respects the General Llabllity. Re: With respect to a field day event forthe school, l9HCA1Iak"11L7 iLJ91;li1 The City of Okeechobee R.E. Hamrick Testamentary Trus 55 SE 3rd Ave Okeechobee 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 FL 34974-2903 I �►t� @ 198B-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD