Park Use Permit_Ed Foundation_Jail & BailCITY OF OKEECHOBEE
55 SE THIRD AVENUE
OKEECHOBEE; FL 34974
Tele: 863-763-9821 i^ax 863-763-1686
e-mail: permit((Dcityofokeechobee.com
Park Use Permit
Permit Number: 24-010 Date(s) of Event: May 17, 2024, 8:00 A.M. -3:00 P.M.
Permit Expiration: May 17, 2024, Cad 11:59 P.M.
Purpose of Request: Fundraiser for the Okeechobee Education Foundation
Property Owner: City of Okeechobee
Address: 55 SE Third Avenue
City: Okeechobee State: Florida Zip Code: 34974
Applicant: Okeechobee County Sheriff's Office Applicant`s Address: 504 NW 4th Street
Phone Number: 863-763-3117 Address of Project: Park 4/Settler's Square
Current Zoning: PUB FLU Designation: PF
Subdivision: Citv of Okeechobee
Restrictions/Remarks:
• 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.
44.4 N 74na!e May 17, 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 Fax: 863-763-1686
PARK USE AND/OR TEMPORARY STREET/
SIDEWALK CLOSING
PERMIT APPLICATION
Date Received
2-V;2 q
Date Issued: Z L:-2.
Application. No:
214 - 1 G
Dates & Times'of Event: Ma 17 2024 0800-1500(8am-3 )m
Information:
Organization: I
Okeechobee County Sheriff's Office
Mailing Address:
504 NW 4th St Okeeshobee Florida 34972
Contact Name:
Sergeant Jack Nash (863)-763-3117 Ext 5018
E -Mail Address:
jnash@okeesheriff.com
Telephone:
Work: 863 763 3117 Ext 5018 Home: Cell: 1863 634 9108
oI activities:
rroceeas usage:
Education Foundation of Okeechobee 100%
Please check requested Parks:
Flagler Parks: ❑ City Hall Park ❑ #1 Memorial Park ❑ #2 ❑ 43'0197)" ❑ 45 ❑ #6
[Park 3 is location of Gazebo. Park 4 is location of Sandst
(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:
1
Page 2 of 3
Revised 3/5/19
TEMPORARY STREET AND SIDEWALh CLOSING INFORMATION
(Street Closings require City Council approval. Meetings 1st & V1 Tuesdays but subject to change)
Address of Event: Hader Park #4
Street(s) to be closed:
Date(s) to be closed:
Time(s) to be closed:
Purpose of Closing:
Attaclunents Required for Use of Parks Attachments Required for Street/Side-,valk 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 remilatory agencies. The applicant will be responsible for costs associated with the event,
including damage of property. By receipt of this pen -nit, 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.
W -
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 conforni 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. Hann ick
Testamentary Trust if closing streets or sidewalks.
Se-gM4-vt`- .lack J. Nays #,2 6.5- 25 April 24
Applicant Signature Sergeant lack Nash #265
Staff Review
Date
""OFFICE USE ONLY9966
Fire Department:
Date:
L Z�
Building Official:
Date:
�' 13 ' Z`i
Public Works:
Date:
5
✓ Z
Police Department:
Date:
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 reAew by City Council on
Temporary Street and Sidewalk Closing reviewed by City Council and approved Date
Date
q1A
Re
APPLICATION • • SPECIAL EVENT
Application Number:
NAME OF EVENT: Jail and Bail
ADDRESS OF EVENT: Park 4
Date Received:
DESCRIPTION OF EVENT:
We will have a makeshift Jail set up in the park, bringing particpants there for photos. Raising monies for
the Okeechobee Education Foundation
NAME OF SPONSOR ORGANIZATION: Sergeant Jack -Nash - Okeechobee CourztSheriff's Office
Contact Number before and during event OF RESPONSIBLE PERSON: ( ) 863 634-9108
RESPONSIBLE PERSON'S NAME:
O.C.S.O. - Sergeant Jack Nash
DATE(S) AND TIMES) OF EVENT:
8:00 a.m.
Date: May 17, 2024 Starting 'Time: Closing 'Time:
Date: _ Starting Time: _ _ Closing Time:
ARE ANY ROADWAYS TO BE BLOC ICE D/CLOSED? No LOCATION
Will Emergency Apparatus (Fire and Ambulance) have access to area? Yes
IF NO, THEN (provide alternatives):
WILL ELECTRICITY BE USED? YESk!.NO � (circle)
Locations:
Provided By:.,,
WILL HEATING/OPEN FLAMES FOR FOOD BE PROVIDED? (circle) YES' NO D '
Type of Ileating Equipment Used:
WILL A TENT BE ERECTED? (circle) YL 11 NOD
Tent Manufacturer: Indust. Inc Size 12X12 fire rating posted: YES
Tent have sides and how many? None
Are there Fire Extinguishers accessible and ready for use? (circ e) Yes) No
3:00 p.m.
*,r**ATTACH SITE MAP OF EVENT LAYOTJ'I'* **
FIRE SERVICES SHALL. COMPLE'IT I'ITMS BELOW:
FIRE DEPARTMENT LIFE SAFETY & FIRE SERVICES REQUIREMENTS: (See above)
O Tents/canopy fire rating certificate required.
O Tent Size require life safety inspection (900 square feet or less then no permit is required)
O Floor plan / seating / setup drawing required showing exits, etc.
O Emergency access must be maintained. (REFERS TO VEHICLES AND EQUIPMENT)
O 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.
O Fire Services inspection required.
O Fire watch or inspector(s) REQUIRED? FIRE WATCH Amount:
O Firefighter/Inspector Amount: O Other:
FIRE DEPARTMENT OFFICIAL, (PRINT):
SIGNATURE Please call the FD at 863-467-1586 for any questions.
Revised 11-6.19
t.
r 1.
,acoRo CERTIFICATE OF LIABILIT`� INSURAN I DAT5/71:DD:
5/7/2024
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 I
I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS). AUTHORIZ=C
I REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE= HOLDE,P.
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 NAMercedes Martin
Florida Sheriffs i�isDc Management Fund NAME: ME:
2090 Summit Lake Dr. (A/CNo, Ext): 8503206880 - - -- - ----- F No): ___850-320.6939
E-MAIL cedes.martin rmf.o
Tallahassee, FL 32347 ADDRESS: mer
_ -- __-� _-_rg _--..- -- _..---
INSURER(S�AFFOROING COVERAGE - NAIC!
INSURER A : FLORIDA SHERIFFS SELF-INSURANCE PROGRAM
INSURED Okeechobee County Sheriff's Office INSURERS: __--
504 N.W. 4th Street _INSURER C :
Okeechobee, FL 34972 INSURER 0:
INSURER E:
r r_nr-- -c wn ianor_M- RFVISICIAI AMI IMRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR -1 HE POLICY PERIOD
INDICATED. NOTIAITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TIME 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.
R Y ADDL SUBR - POLICY EFF ' POLICY EXP LIMITSLTR
TYPE OF INSURANCE NSR •iPOLICY NUMBER MM/DD1`.'YYY IMMlDDlY
GENERAL LIABILITY
EACH OCCURRENCE
I----
-UAMAGE TO RENTED—
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PRFMI_SESLEaoouarertce) S .-
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GENERAL AGGREGATE Is
PRODUCTS - COMP/OP AGG 5
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AUTOMOBILE LIABILITY -..
acc-id-
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BODILY INJURY (Per Person) S
ANY AUTO I
- -_-..— - _-_-- --
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ALL OWNED SCHEDULED
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(alsicierY) S
URY (Peer
BODILY INJURY
-- AUTOS AUTOS i
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PROPERTY DAMAGE — S
HIRED AUTOS AUTOS
$
I UMBRELLA UAB_ _ OCCUR
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_EACH OCCURRENCE..........._... $_. _. ._—.._.._—....
EXCESS LLIAB I_ CLAIMS4AADE
AGGREGATE —
DED I {RETENTION $
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$
WORKERS COMPENSATION
VMC STATU- OT'H-
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AND EMPLOYERS LABILITY YIN
ANY PROPMETOR/PARTNERIEXECUTIVE
EACHACC�ENT--- S _---_-- _
OFFICERPdEMBER EXCLUDED? F-1E.L
(Mandatory in NH)
N / A
E.L.DISEASE - EA EMPLOYE S
- ---.--__--____-`- - -
If yes, describe under
DESCRIPTION OF OPERATIONS below
EL DISEASE -POLICY LIMIT $
A Law Enforcement Profession?I LiabI tY
I
$5.000.000 each occurrence:
including Premises Liability
V 24-17
/�
10/01/2023 10/1/2024
$10.000.000 annual aggregate;
S1,000.000 additional insured limit
DESCRIPTION OF OPERATIONS] LOCATIONS !VEHICLES (Attach ACORD lot, Additi(xmi Remarks Schedule, it move space is required)
i
iEvent: ",Dail and Bail"
Date: May 17th, 2024
_ s�rtr.�ar ���uura��•a•r�ur•savr.ea��u�
City of Okeechobee
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
55 SE 3rd Ave,
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE IVITH THE POLICY PROVISIONS.
Okeechobee, FL 34974
AUTHORIZED REPRESENTATIVE
lyil tf-ZUIU RL.VKU VLJKYtJKN I IUI`1. /ill r[gnts raserveu.
ACORD 25 (2010105) The ACORD name and logo are registered inar7<s of ACORD
0000028 12/06/22
- -- DR -14
Consumer's Certificate of Exemption R. 01/18
Issued Pursuant to Chapter 212, Florida Statutes
FLORIDA
85-8018937591C-6 12/02/2022 12/31/2027 501(C)(3) ORGANIZATION
--- - - - - - --- -- - — - -- - -- - --
Certificate Number Effective Dat - e Expirat-i on Date —Ex e-m-Ttion Category
This certifies that
OKEECHOBEE COUNTY SHERIFF'S OFFICE I/C/O
SKIP BRYANT MEMORIAL FUND INC
504 NW 4TH ST
OKEECHOBEE FL 34972-2502
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.
_a
FLORIDA
Important Information for Exempt Organizations
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, FA.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.