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Park Use Permit_OCSO_Candle Light Vigil �•O% oF,0KF��ti L CITY OF OKEECHOBEE `` o�m 55 SE THIRD AVENUE ••o ' o•` OKEECHOBEE, FL 34974 414 =a ‘4,��� Tele: 863-763-9821 Fax 863-763-1686 ••4'••� 91 , �06 e-mail: permitcityofokeechobee.com Park Use & Temporary Street Closing Permit Permit Number: 24-015 Date(s) of Event: August 30. 2024. 5:00 P.M. — 8:30 P.M. Permit Expiration: August 30, 2024 11:59 P.M. Purpose of Request: Candlelight Vigil 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 Current Zoning: PUB FLU Designation: PF Subdivision: City of Okeechobee Restrictions/Remarks: • Ail 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. 7ezed4 `70nde July 17, 2024 General Services Administrative Secretary Date Page 1 of 3 Revised 3/5/19 CITY OF OKEECHOBEE 55 SE THIRD AVENUE �. �� !a' OKEECHOBEE, FL 34974 `, Tele: 863-763-9821 Fax: 863-763-1686 ' PARK USE AND/OR TEMPORARY STREET/ :iip';0-0 SIDEWALK CLOSING PERMIT APPLICATION Date Received: 711012,024 ; Date Issued: 0`7 20 2/ Application No: 2 -I-01 j Date(s)&Times of Event: S 12 b12 se-se-t up $'/ fr I 5 00 — 1 i F:30prfi Information: / Organization: ,,� l� hob �'.� . �11r -j{ �Y't'�S ( Mailing Address: 5 L L k F Contact Name: R.>r t1 ► E-Mail Address: ( 17t.L4keco) Ct e 51sec;�� t r,(„ Telephone: Work: 13 -7zo - III'] Home: j Cell: k3- gen,;(.( Summary of activities: - � �c a � }L- C;k 4- r;`►d— Proceeds usage: Please check requested Parks: / Flagler Parks: o City Hall Park ❑ #1 Memorial Park o#2 n#3 #4 o#5 n #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 Id&3rd Tuesdays but subject to change) Address of Event: Pa( `t __ _ 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 Required for Street/Sidewalk Closings ► Site Plan ► Site Plan P. 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. P. 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 Insu . i. :.name City Okeechobee keechobee as Additional Insured as well as R.E.Hamrick Testamentary '.in: streets /'sidewalks. iiii �� —7/T/ Applicant Si 7.ture / , Date ••••OFFICE USE ONLY•••• _Staff Review n Fire Department: 44 • 0 In Date: 1 I �� I 24 Building Official: Aitglp Date: 7• I 1•Z4— ( ) 714 ° 1 Public Works: \J\J Vidi I Date: �t I. (--�� Police De artment: �/ I Date: ! 714 3( BTR Department: �J/��' _ Date: 7/D o�/ ONIIP _ i City Administrator: _ wj/ Date: //S/1 y City Clerk: ONWtL Date: 7/t 91a0 I 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) 4- Date � Temporary Street and Sidewalk Closing reviewed by City Council and approved 11/ k Date L a.,rna7r% r, , ..... '> . , ?,,cf.a_ g 49 / cu x / 04 /S -.. Fed o L -/„C5 .,' 7 A) p 0F�9 O'r I; s` 'Sr c7 1r.. 1r\ -.., 3 Q- 'L. f ooW1 �c / Cr . / ••7 4 ../` 0 AccpRE. ® DATE IMM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/2/2024 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 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 Florida Sheriffs Risk Management Fund CONTACT NAME: Mercedes Martin 2090 Summit Lake Dr. A/C,NNo,Ertl:8503206880 FAX No(: 850-320-6939 E-MAIL des.martin srmf.or Tallahassee, FL 32317 ADDRESS:merce 9 INSURER:Si AFFORDING COVERAGE NAIC# INSURER A: FLORIDA SHERIFFS SELF-INSURANCE PROGRAM INSURED Okeechobee County Sheriffs Office INSURER B: 504 N.W.4th Street INSURER C: Okeechobee, FL 34972 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSK YYVD POLICY NUMBER IMMIDDIYYYY, IMMIDD/YYYYI LIMITS GENERAL UABIDTY _ EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PRMMGE TO RENTED PREMISES Ea occurrence _S CLAIMS-MADE OCCUR MED EXP(Any one person) S PERSONAL 8 ADV INJURY Si GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY PRO- LOC JEC' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident. S ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident( S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS - WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN T ORY DMITS _- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED', N I A - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE. S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Special Events Liability $1,000,000 Per Occurrence 24-FSRMF-47 10101/2023 10/1/2024 S50,000 Per Occ.Damage to Rented Premises $1,000 Any One Person Medical Expenses DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CSO Co-sponsoring candlelight vigil-August 30th CERTIFICATE HOLDER CANCELLATION 10 DAY WRITTEN NOTICE and Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Okeechobee and RE Hamrick Testamentary Tru THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 55 SE 3rd Ave, Okeechobee, FL 34974 AUTHORIZED REPRESENTATIVE - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 0000275 05/27/2D DR-14 Consumer's Certificate of Exemption R.01/18 Issued Pursuant to Chapter 212, Florida Statutes FLORIDA 85-8012646245C-1 07/31/2020 07/31/2025 COUNTY GOVERNMENT Certificate Number Effective Date Expiration Date Exemption Category This certifies that OKEECHOBEE COUNTY SHERIFFS OFFICE 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. DR-14 Important Information for Exempt Organizations R.01/18 FLORIDA 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 organizatioh 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.