Park Use Permit_Hospice_Butterfly release/Bereavement CampPermit Number: 24-009
CITY OF OKEECHOBEE
55 SE THIRD A VENUE
OKEECHOBEE, FL 34974
Tele: 863-763-9821 Fax 863-763-1686
e-mail: permit(d)-cityofokeechobee.com
Park Use Perinit
Permit Expiration: APRIL 5, 2023 (a)_ 11:59 P.M.
Purpose of Request: HOSPICE BUTTERFLY RELEASE
Property Owner: CITY OF OKEECHOBEE
Address: 55 SE THIRD AVENUE
City: OKEECHOBEE
Applicant: HOSPICE OF OKEECHOBEE
Phone Number: 863-484-4966
Current Zoning: PUB
Subdivision: CITY OF OKEECHOBEE
Restrictions/Remarks:
Date(s) of Event: APRIL 5, 2024, 2:30-
Q•Qn ID nn
State: FLORIDA
Zip Code: 34974
Applicant's Address: 411 SE 4T" STREET
Address of Project: PARK 6
FLU Designation: PF
a All debris must be removed within 24 hours of expiration date.
• Contact the Okeechobee County Fire Department at 863-763-5544 to schedule a final field
inspection before event.
74cw" 7aide April 2, 2024
General Services Administrative Secretary Date
Page 1 of 3
Revised 3/5/19
CITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE, FL 34974
Tele: 863-763-9821 Fag: 863-763-1686
PARK USE AND/OR TEMPORARY STREET/
SIDEWALK CLOSING
PERMIT APPLICATION
Date Received:
202
Date Issued: Z 2p
Application No:
- pp
Date(s) & Times of vent: 14 ' S :3 o - 3:3 U
Information:
Organization:
Mailing Address: _ y- lq
Contact Name: rP a
E -Mail Address:
Telephone:
Work: Kjn g. i.{ q D Home: Cell: 1-1 7 1 _ Ci T7 - 1 LI (--I
Summary of activities:
E' l cl
rroceeas usage:
Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ #3 ❑ #4 ❑ #5 X#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" & 3rd Tuesdays 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 Reauiredfol�Street/Sidewalk Closings
to, 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.
10, 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 Date
11000OFFICE USE ONLY'••®•
Staff Review
Fire Department:
0
Date:
Z(F N
317(,f
Building Official:
Date:
Public Works:
Date:
(j Z
Police Department:
Date:
BTR Department:
Date:
City Administrator:
Date:
City Clerk:
Date:
NOTE: APPLICATION AND INSURANCE CERTIFICATE MUST BE COMPLETED AND
RETURNED TO TIDE GENERAL SERVICES DEPARTMENT THIRTY (30) DAYS PRIOR TO
EVENT FOR PERMITTING.
Temporary Street and Sidewalk Closing submitted for review by City Council on
Date ,
Temporary Street and Sidewalk Closing reviewed by City Council and approved
Date
APPLICATION FOR SPECIAL EVENT
Application Number:
NAME OF EVENT:
ADDRESS OF EVENT:
DE C TI N OF EVENT:
NAME OF SPONSOR OlkGANIZATION:
Contact Numbe-. before and during event
'S i\11A
DATE(S) AND TIME(S) OF EVENT:
Date: 4, 5-'a i Starting Time:
Date:
Starting Time:
vove.-
Date Received: 312(12-6-24
Closing Time:
Closing Time:
ARE ANY ROADWAYS TO BE BLOCKED/CLOSED? LOCATION
Will Emergency Apparatus (Fire and Ambulance) have access to area?
IF NO, THEN (provide alternatives):
WILL ELECTRICITY BE USED? YES R0 (circle)
Locations:
Provided By:
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YES 0 O .
Type of Heating Equipment Used:
WILL A TENT BE ERECTED? (circle) YES E NO ?
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 SHALT. COMPLFTC. ITEMS BELOW:
FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES RE UIREMENTS: (See above)
!J 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)
t Fire extinguishers must have current tag, and be operational and readily accessible.
Cooking requires LPG outside of tent pointing away from exposures.
Electrical wiring exterior rated, not overloaded.
Fire Services inspection required.
b Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount:
Firefighter/Inspector Amount: O Other:
FIRE DEPARTMENT OFFI L (PRINT):
SIGNATURE:'
�J
Please call the FD at 863-467-1586 for any questions.
Revised 11-6-19
Client#: 1652281 CHAPTHEA2
ACORD CERTIFICATE OF LIABILITY INSURANCE DATEIYYYY)
31222/202/2024
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 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 any rights to the certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER NAME: Brittany Boucher
USI Insurance Services, LLC I PHONE 813 321-7500 FAX
(Ai C. No, Ext). (A/C. No):
2502 N Rocky Point Dr Ste 400 E-MAIL boucher u.
ADDRESS, brittan y• sicom � _
Tampa, FL 33607-1421 INSURER(S) AFFORDING COVERAGE NAIC #
813 321-7500 Ironshore Specialty Insurance Cc 25445
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN
INSURER A:
-
TERM OR CONDITION OF ANY
INSURED
INSURER B :
Endurance American Specialty Ins Co
41718
Chapters Health System, Inc.
12470 Telecom Dr Ste 301
Temple Terrace, FL 33637-0904
INSURER C :
INSURER D :
INSURER E
Hartford Fire Insurance Company
P y
RLI Insurance Company
P y
19682
13056
INSURER F
POLICY NUMBER
POLICY EFF POLICY EXP LIMITS
(MMIDD/YYYY) (MMIDDIYYYY)
r0 VFRAr;FS CERTIFICATE NUMBER:
HC7AACG4PRO02
REVISION NUMBER:
S1,000,000
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN
1 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 ADDL SUBR
LTR INSR WVD
POLICY NUMBER
POLICY EFF POLICY EXP LIMITS
(MMIDD/YYYY) (MMIDDIYYYY)
A X COMMERCIAL GENERAL LIABILITY X
HC7AACG4PRO02
08/26/2023 08/26/2024 EACH OCCURRENCE
S1,000,000
X CLAIMS -MADE OCCUR
RENTED
E TO RENTED
DAMAGE
PREMISES
5100,000
_
X BI/PD Ded:25000
NIED EXP (Any one person,
55,000
PERSONAL & ADV INJURY
S1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
s3,000,000
PRO-
POLICY JECT LOC
PRODUCTS - COMPOP AGG
- -- -
53,000,000
- -
_
5
OTHER
-
_ _ _ _ _ _ _ _ _ _
D AUTOMOBILE LIABILITY
_
CAP9509223
08/2612023 08/26/2024 (Ea icI,,der, SINGLE ur,nT
51,000,000
X ANYAUTO
BODILY NJUPY +,Per perscn)
S
OWNED SCHEDULED
BODILY INJURY IPer accident)
S
AUTOS ONLY AUTOS
_ _ _
HIRED NON -OWNED
X X
PP,OPERTY DAiYIAi;E
S
AUTOS ONLY AUTOS ONLY
iPer accident)
5
A X UMBRELLA LIAB X OCCUR
HC7AACG4P1002
08/26/2023 08/26/2024 EACH OCCUP.RE,CE
$10,000,000
B X EXCESS LIAB _ X_CLAINISAIADE
HAF10015040502
08/26/2023 08/26/2024 AGGREGATE
310,000,000
DED X RETENTION $10000
_
3
_ _
WORKERS COMPENSATION
_
PGP. OTH-
ST.4TUTE ER
AND EMPLOYERS' LIABILITY Y I N
_
ANY PROPRIETOR/PAR TNERIEXEC UT IV E --
E EACH ACCIDENT
S
OFFICER, MEMBER EXCLUDED? N I A
(Mandatory in NH) - - -
F . DISEASE - EA EMPLOYEE
S
If yes. describe under
DESCRIPTION OF OPERATIONS below
. E1. DISEASE - POLICY LIMIT
S
A Professional Liab
HC7AACG4PRO02
08/26/2023 08/26/2024 1 M Claiml3M A99 100kded
C Crime
21FA0252605
06/02/2023 06/02/2024 3M 50k ded
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
** Excess Liability Information **
B HAF10015040502 Eff Date: 08/26/2023 Exp Date: 08/26/2024
Excess Liability Retention: 10000
(See Attached Descriptions)
CERTIFICATE HOLDER k AINt. tLLA IJUN
Cit of Okeechobee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
55 SE 3rd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Okeechobee, FL 34974
AUTHORIZZEED� REPRESENTATIVE
U 1966-ZU15 AOUKU GUKYUKA I JUN. All ngn[s reserved.
ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S44133477/M41264638 CISZP
,W005 96 6 17/24
DR -14
Consumer's Certificate of Exemption R. 01/18
Issued Pursuant to Chapter 212, Florida Statutes
FLORIDA
85-8017734086C-3 03/13/2024 03/31/2029 501(C)(3) ORGANIZATION
Certificate Number Effective Date Expiration Date Exemption Category
This certifies that
CHAPTERS HEALTH FOUNDATION INC
12470 TELECOM DR STE 410
TEMPLE TERRACE FL 33637-0904
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.
[important Information for Exempt Organizations
FLORIDA
DR -14
R. 01/18
1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases.
See Rule 12A-1.038, Florida Administrative Code (F.A.C.).
2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's
customary nonprofit activities.
3. 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.).
5. 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.
RESOLUTION NO, 03-8
• A RESOLUTION OF THE CITY OF OKEECHOBEE, FLORIDA TO
ESTABLISH GUIDELINES FOR USE OF PUBLIC PARKS OR OTHER
LANDS OWNED BY THE CITY OF OKEECHOBEE FOR CERTAIN
CHARITABLE OR BENEVOLENT ORGANIZATIONS; OR THE GENERAL
PUBLIC; PROVIDING FOR AUTHORITY TO REVIEW SUCH
APPLICATIONS; PROVIDING FOR STANDARDS FOR REVIEW;
PROVIDING FOR GUIDELINES FOR SUCH ORGANIZATIONS TO
FOLLOW; PROVIDING FOR INSURANCE REQUIREMENT; PROVIDING
FOR AN EFFECTIVE DATE.
WHEREAS, there are located within the City of Okeechobee certain public parks and other
areas owned by the City of Okeechobee that are intended for, and open for use by,
the general public, with certain restrictions; and
WHEREAS, these functions range from large gatherings which attract many participants,
to very small groups, which may or may not cause traffic control problems, and vary
in intensity; and
WHEREAS, current regulations require the same liability insurance coverage for any such
group authorized to gather in the parks or on city lands, which creates a hardship
on the smaller gatherings;
NOW, THEREFORE, be it resolved and adopted by the City Council for the City of
Okeechobee, Florida the following resolution:
1. THAT permission for charitable or benevolent organizations, or non profit
groups, to engage in certain activities in City parks or on City lands, is
govemed by Article IV, Sections 14-141 to 14-149 of the City Code of
Ordinances, which regulations and restrictions shall be considered by
General Services whenever an application or request for use of public areas
is made, and followed accordingly.
2. THAT for any permit or permission granted by the Department of General
Services for such activities on public lands, such permit shall be also
executed by the City Administrator, prior to such event taking place.
3_ THAT most applicants for use of parks and public lands are charitable or
civic groups, who stage large events and attract many people. However,
smaller groups for prayer meetings; weddings; boy and girl scouting; and
similar type events are also authorized in parks and in public places, but are
also subject to the requirements of Article IV of the City Code.
4. THAT current regulations require the applicant for an event to procure
liability insurance in the sum of $ 1 million; the cost of which is or may be
prohibitive for smaller and more informal groups.
5. THEREFORE, for any application wherein it appears to the Department of
General Services that the participants thereof may be 100 or fewer persons,
the liability insurance requirement shall be waived. The City reserves the
• right to require the participants to execute a hold harmless agreement,
depending upon the nature and impact of the event.
Page 1 of 2
•
INTRODUCED AND ADOPTED this 5" day of August., 2003.
y
f. James. E. Kirk, iVtayor
ATTEST:
.r
Lane Gamiotea, City Cleric
REVIEWED FOR LEGAL SUFFICIENCY:
l
o Cook, Cit �ey
Page 2 of 2
RESOLUTION NO. 04-03
A RESOLUTION OF THE CITY OF OKEECHOBEE, FLORIDA
SUPPLEMENTING RESOLUTION NO. 03-08; GUIDELINES FOR USE OF
PUBLIC PARKS OR OTHER LANDS OWNED BY THE CITY OF
OKEECHOBEE FOR CERTAIN CHARITABLE OR BENEVOLENT
ORGANIZATIONS; PROVIDING FOR AUTHORITY TO REVIEW SUCH
APPLICATIONS; PROVIDING FOR STANDARDS FOR REVIEW;
PROVIDING FOR GUIDELINES FOR SUCH ORGANIZATIONS TO
FOLLOW; PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, there are located within the City of Okeechobee certain public parks and other
areas owned by the City of Okeechobee that are intended for, and open for use by,
the general public, with certain restrictions; and
WHEREAS, these uses change from time to time, and problems arise by certain uses that
are not anticipated, but should be the subject of regulation and control by the City
of Okeechobee for the safety and welfare of its citizens, and which requires
supplementing existing rules as necessary;
NOW THEREFORE, it is resolved before the City Council for the City of Okeechobee,
Florida; presented at a duly advertised public meeting; and passed by majority vote
of the City Council; and properly executed by the Mayor or designee, as Chief
presiding Officer for the City:
THAT permission for charitable or benevolent organizations, or non-profit
groups, to engage in certain activities in City parks or on City lands, is
governed by Article IV, Sections 14-141 to 14-149 of the City Code of
Ordinances, which regulations and restrictions shall be considered by
General Services whenever an application or request for use of public areas
is made, and followed accordingly.
THAT for any authorized use of the public parks or rights-of-way within the
City, the following regulations shall be followed, as applicable:
a. The organization or permit holder, or their designee, shall be
responsible to completely clean up the public area used by the permit,
within two days of completion of the event, unless otherwise
designated in the permit.
b. No trailers unattached to a motor vehicle shall be parked along any
street or avenue or public right-of-way, or in a marked parking spot,
unless the right-of-way is closed for the event, not otherwise blocked
off by the City. No other motor vehicles or trailers will be allowed to
park or remain on the Park grounds unless prior written approval is
obtained from the City Public Works Director or their designee, or
such vehicle or trailer is participating in an event such as a permitted
activity or car show. Any motor vehicle or trailer parked in violation of
this section may be towed by the City at the owner's expense, who
shall be liable for all towing and storage fees.
C. Golf carts, 4 -wheelers or other vehicles not licensed for use on public
rights-of-way, will not be permitted on the Park grounds without prior
written approval of the City Public Works Director or their designee.
• d. Certain events, such as but not limited to parades, or those which
draw a large number of people, require significant incurring of costs
Page 1 of 2
by the City, for traffic control, crowd control, fire safety, paramedic
service, or general policing, which often requires adding personnel,
and incurring overtime labor expense. For any such event, the City
may require the organization or permit holder to be responsible for
40 these additional costs, including property or personal injury damages
that may occur during the event. There will be a mandatory inspection
meeting between the Public Works Director or their designee and a
representative from the permit holder prior to and after each event.
Any additional expenses as stated above, will be billed to the
organization or permit holder, who shall pay such sum to the City.
e. For activities in Flagler Park, the use of generators for power is
encouraged, as electric outlets are limited and subject to the right of
the City to deny their use. When generators or extension cords are
used, the applicant shall cause a U.L. approved extension cord of
proper gauge to be safely attached, and routed so as to not interfere
with any pedestrian path, or in such area as may pose a risk of harm
to the public or other participants.
INTRODUCED AND ADOPTED this 16"d day of March, 2004,
L�
James. E. Kirk, Mayor
,, ATTEST:
21.
,
La'e Gamiote , City Clerk
REVIEWED FOR LEGAL SUFFICIENCY:
John R. Cook, City Attorney
0
Page 2 of 2