Temp Use Permit_FCA_Chobee Wrestling Club BBQ FundraiserPermit Number: T-24-003
City of Okeechobee
55 S.E. 3 d Avenue
Okeechobee, Florida 34974
(863) 763-9821
Temporary Use Permit
Date(s) of Event: FRIDAY, APRIL 19, 2024
11:00 A.M. — 1:00 P.M.
Permit Expiration: APRIL 19, 2024 a, 11:59 P.M.
Purpose of Request: CHOBEE WRESTLING BB(
Property Owner: ARRANTS LLC
Address: 1600 S PARROTT AVENUE
City: OKEECHOBEE State: FLORIDA
Applicant: FELLOWSHIP OF CHRISTIAN ATHLETES
Phone Number: 863-634-9411
Current Zoning
HEAVY COMMERCIAL
Restrictions/Remarks:
Zip Code: 34974
Address of Project: 1600 S PARROTT AVENUE
FLU Designation: COMMERCIAL
PLEASE CONTACT THE CITY @ 863-763-9821 IF YOUR EVENT IS CANCELLED OR RESCHEDULED.
ALL DEBRIS MUST BE REMOVED WITHIN 24 HOURS OF EXPIRATION DATE.
Owner understands and agrees to the following:
X Issuance of a permit may be subject to other conditions and time limitations.
X Issuance of a permit is not authorization to violate public or private restrictions.
X Failure to comply with applicable regulations may result in withholding future permits.
74OW4 2114e 4-2-2024
Administrative Secretary Date
TEMPORARY USE PERMIT APPLICATION
OTHER TEMPORARY STRUCTURES (666)
City of Okeechobee - General Services Department
55 SE 3rd Ave, Room 101, City Hall, Okeechobee, FL 34974
Phone: (863) 763-3372 ext. 9821
DATE RECEIVED: 2-z2, 2,0 .4 DATE ISSUED:
APPLICATION NO.: y_ W3 EVENT DATE(S) & TIME: 2_4
FEE: $175.00 on-Profit/Civic Organization DATE PAID:
of Property Owner(s): u(�
Address: Cri ri0
Telephone Numbers:
IName
Home: Work: Cell: -b 9-7- (p "
Name of Applicant: of L..6,Li�e f
Address: Z2- alarce 47
Telephone Numbers:
Home: Work: Cell:
Future Land Use Map Desigation: Current Zoning Designation: 4[V
Legal Description of Property: t e 1:✓ i - 1-1
Address of Property: c�_(f&A-ve yule_
Please Explain Type of Use: �71 r C1 CU Pi(
Briefly describe use of adjoining property
North: keSk n a Ca nt
East: qqi I ComroeI Gt. L (_
South: U"
West:
Other temporary structures subject to the following regulations:
1. Christmas tree, fireworks and similar seasonal sales operated by a non-profit organizaiton.
2. Carnival, circus, fair or other special event operated by a non-profit organization on or abutting their principal use. (*additional information required)
3. Commercial carnival, circus or fair in commercial or industrial districts.
4. Similar temporary structures where the period of use will not exceed 30 days a year.
The Applicant shall:
1. Submit proof of liability insurance, paid in full covering the period for which the permit is issued, in the minimum amount of $1,000,000.00 per occurrence.
2. Have notarized written permission of property owner, if applicant is not the property owner.
3. Remove all debris within 48 hours of expiration of permit.
4. Submit Site Plan, State Inspection Certificates and submit State Annual Permit
City Staff Please review the ap licat' n, attach co ents or special conditions).
Occupational and.or State License Verific tion:
Date: j j>
Fire Department Approval:
Date: Z(, L
Police Department Approval:
Date: ,? 515
Public Works Department A oval:
Date: - - 2—
Building Inspector Approval:
Date:
City Administrator Ap royal:
Date: _L
1 hereby certify that the information on this application is correct. The information included in this application is for use by the City of Okeechobee in processing my request.
False or misleading information may be punjsha 16 by a fine of up t $ 00.00 and imprisonment of up to thirty days and may result in the summary denial of this application.
Signature of Applicallit Date Revised 3-55-19 jld
+cok lD
Application Number:
NAME OF EVENT:
APPLICATION FOR SPECIAL EVENT
-r-z(4- Qt,3
Date Received:
ADDRESS OF EVENT: 1 l co � QC,t ll� t ' 1
DESCRIPTION OF EVENT: eQ
NAME OF SPONSOR ORGANIZATION:
I
yen o ?S(o 3 (p -S4 Z3---7- 1
Contact Number before and during event OF RESPONSIBLE `PERSON: ( ) -
16(l tC e ,� O—K n C (
RESPONSIBLE PERSON'S NAME
DATE(S) AND TIME(S) OF EVENT:
Date: `-�— I —Z�- Starting Time: Z�} Ivt Closing Time: 3p AA
Date:
Starting Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? n Q LOCATION
Closing Time:
Will Emergency Apparatus (Fire and Ambulance) have access to area?
IF NO, THEN (provide alternatives):
WILL ELECTRICITY BE USED? YES M KNO 0 (circle)
Locations:
Provided By:
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YESA1 MNO 0
Type of Heating Equipment Used:
WILL A TENT BE ERECTED? (circle) ' YES 0 NO 0
Tent Manufacturer: Size 1(4- t= fire rating posted:
Tent have sides and how many? Z
Are there Fire Extinguishers accessible and ready for use? (circle) Yes No
..'*ATTACH SITE MAP OF EVENT LAYOUT***
FIRE SERVICES SHALL COMPLETE ITEMS BELOW:
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.
1�A 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.
P Electrical wiring exterior rated, not overloaded.
Fire Services inspection required.
Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount:
t:Np` Firefighter/Inspector Amount: O Other:
FIRE DEPARTMENT OFFICIAL (PRINT):
SIGNATURE:
ci
Seff1c(q SAJk r
Please call the FD at 863-467-1586 for any questions.
Revised 11-6-19
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
3/6/2024
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(ies) must be endorsed. If SUBROGATICIO 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:
James Greene & Associates, Inc.
______ _
PHONE
800-604-1401
275 West Kiehl Ave
c, No, Ext): 800-422-3384 No):
(A/C,
Sherwood AR 72120
E-MAIL
ADDRESS_ customerservice@4Lamesgreenelns_Com_ _
INSURER(S) AFFORDING COVERAGE _ _ NAIC # _
INSURERA: Brotherhood Mutual Insurance 13528
INSURED MOKANFO-02
INSURER B:
Fellowship of Christian Athletes
- - — - -
8701 Leeds Rd
INSURER C
Kansas City MO 64129
INSURER D:
INSURER E.
PERSONAL & ADV INJURY $ 2,000,000
INSURER F :
COVFRAGES CERTIFICATE NUMBER: 1500315255 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. _
INS ADDL SUBR' POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE p POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
24MEA0518584
9/1/2023
9/1/2024
EACH OCCURRENCE $2,000,000 _
] CLAIMS -MADE lxl OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)_ 1,000,000
_
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 2,000,000
GENT
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE _ $ 10,000,000
POLICY JE� [� LOC
PRODUCTS - COMP/OP A_GG$ 10,000,000 _
X
OTHER:
High Hazard Sports $ $1M Occ. $2M Agg
AUTOMOBILE LIABILITY
A
COMBINED SINGLE LIMIT $
La accidents_ _
ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
BODILY INJURY (Per accident) $
—
PROPERTY DAMAGE $
ccident)__A
Ler accident)--
A
UMBRELLA LAB
X
OCCUR
24MEA0518584
9/1/2023
9/1/2024
EACH OCCURRENCE $ 20,000,000 _
X
EXCESS LIAB__
CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
PER -
_ STATUTE _ ER -
EACH ACCIDENT _ $
OFFICER/MEMBER EXCLUDED? ElE.L.
(Mandatory in NH)
N / A
E.L. DISEASE_ EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT 1 $
A
Abuse /Molestation
24MEA0518584
9/1/2023
9/1/2024
Abuse /Molestation $1M Occ, $2M Agg
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
BBQ Wrestling Fundraiser, April 19, 2024
r'I=0TI9:lr_ATF HAI r1FR CANCELLATION
Arrants LLC
1600 S Parrot Ave
Okeechobee FL 34972
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
10$(2ED�REPRESENTATIVE
U 1985-204 AGUKU GUKYUKA I IUN. All rlgnis reserves.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
Consumer's Certificate of Exemption
Issued Pursuant to Chapter 212, Florida Statutes
FLORIDA
85-801794959OC-5 01/10/2020 01/31/2025
Certificate Number FHnnvc-� Oatr: r. tF�irttlon Date
This certifies that
FELLOWSHIP OF CHRISTIAN ATHLETES INC
FORT PIERCE
1312 S 33RD ST
FORT PIERCE FL 34947-6314
DR -14
R. 01/18
501(C)(3) ORGANIZATION
f-xernwion Cat.,r.,icny
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.
Q
FLORIDA
2
3
Important Information for Exempt Organizations
DR -14
R. 01/18
You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases.
See Rule 12A-1.038, Florida Administrative Code (FA.C.).
Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's
customary nonprofit activities.
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, F.A.C.).
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.
GRANTOFPROPERTYUSAGE&RELEAS EOFCLAI MS
GRANT OF USAGE
For the consideration of Lot Usage at 1600 S Parrott Ave, Okeechobee FL
(Movie Theater), for express usage of Fund Raiser, Parking, Food Preparation, General
Activities related to Fundraiser
GENERAL RELEASE
The undersigned, hereinafter the Releasor(s), for and in consideration of
Lot Usage at 1600 S Parrott Ave, Okeechobee FL, do, for ourselves and our respective
heirs, executors, administrators and assigns, do hereby completely and fully release
and discharge Lightsey's Fish Company & Restaurant INC, ARRANTS LLC, Lightsey's
Restaurant INC, and associated affiliates hereinafter the
Releasee(s), of and from any obligation, liability or responsibility arising out of the claim
and/or action of Wrestling Team Fundraiser occuring on or about
DATE OF EVENT.-
INDEMNITY
VENT:
INDEMNITY AND HOLD HARMLESS AGREEMENT
[It is further agreed and understood that the Releasor(s) will protect,
indemnify and save harmless the Releasee(s) from any valid claims or liens arising from
benefits provided to or on behalf of Releasor(s) which are related to the incident giving
rise to this claim
The undersigned acknowledges that he/she have/has read this Grant of Usage and
General Release and understand the terms outlined herein.
Signed this
l �
day of A I,
Releasee/ Grantor: Lightseys Fish Company & Restaurant INC
Releasor
2L2 .
Notary Public State of Florida
t, Christy Denise Schneider
q ; � My COMMISSlon HH 438471
Expires 8/28/2027
7Sti
L .- 2
Okeechobee County Property
Appraiser
Mickey L. Bandi, CFA I Okeechobee, Florida 1863-763-
4422
Owner & Property Info
Parcel ID: 3-28-37-35-0050-00290-0010 (36831)
Name
ARRANTS LLC
Site Addr
1600 S PARROTT, OKEECHOBEE
Mailing
399 SW 18TH ST
OKEECHOBEE, FL 34974
FIRST ADDITION TO SOUTH OKEECHOBEE (PLAT BOOK 1 PAGE 17) LOTS 1, 2, 3, 7, 8, 9 AND THE NORTH 9.00 FEET OF LOT
Description
10, BLOCK 29. TOG
3-28-37-35-0050-00290-0010
Bldg Item
Bldg Desc
Year Bit
Base S.F.
Actual S.F.
Bldg Value
Show Sub -Area Codea
1
AUDITORIUM (6000)
1974
12084
14208
$167,024.00
`Vs
zo7SR"� 2 US o
199 L393
L
90
1 &
69.9
SAS
1993
F13 2 13
+GAN
IBJ
au
FST 14
1393
40
54
F
13 CAN
1
�� 1993
11^
^^w .....
I W,
1
�1 dam i: I lo I xp�
"&po---B-BQ FUNDRAISER
Brahman Theater III
1600
April 19, 2024 ^* 11am till Ipm
PREPARED BY KLYE RENO
PULLED PORK -BAKED BEANS -SIDE -ROLL -COOKIE
$ 10*00
DELIVERY 5+ ! BUSINESS TOWN ONLYff