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Park use_Thank you for your service_Veterans Day 00.0�°F�°K-c4; CITY OF OKEECHOBEE z • 91� 55 SE THIRD A VENUE o o• OKEECHOBEE, FL 34974 1-4 a���` Tele: 863-763-9821 Fax 863-763-1686 i * 915* ���� e-mail: permit(a�cityofokeechobee.corn 003i11/I Park Use & Temporary Street Closing Permit Permit Number: 24-020 Date(s) of Event: November 11, 2024, 9 A.M — 3 P.M. Permit Expiration: November 11, 2024, 11:59 P.M. Purpose of Request: Thank you for Service-Veterans Day Property Owner: City of Okeechobee Address: 55 SE 3rd Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Thank You For Your Service Applicant's Address: PO Box 1856 Phone Number: 863-484-0170 Address of Project: Veterans Memorial Park Current Zoning: PUB FLU Designation: PF Subdivision: City of Okeechobee Restrictions/Remarks: Contact the Okeechobee County Fire Department at 863-763-5544 to schedule a final field inspection before event. • All debris must be removed within 24 hours of expiration date. 7 eneda 20 zde October 16, 2024 General Services Administrative Secretary Date Page 1 of 3 Revised 5/13/24 CITY OF OKEECHOBEE 55 SE THIRD AVENUE 's1�q.oF•OKFFcyo�` OKEECHOBEE, FL 34974 �LL \ Tele: 863-763-9821 Fax: 863-763-1686 �;.•'� PARK USE AND/OR TEMPORARY STREET/ %;;;��'' SIDEWALK CLOSING PERMIT APPLICATION Date Received: )0 CI 2_4 Date Issued: Application No: j2O' Date(s) & Times of Event: ri o d u a,b ' y 9 G - 3 pry Information: Organization: y u r Mailing Address: 1_ fe, b I`1 Sti D �„ < << ��! c C_ 3 y 9 7 3 Contact Name: r0.Ca E-Mail Address: Telephone: Work: Home: Cell: f63 ' / / �/ Summary of activities: I� r I , I°](• y p 1 v d, s,o v Proceeds usage: • Please check requested Parks: Flagler Parks: o City Hall Plaza d#1 Veterans Memorial Square 2r#2-Speckled Perch Square ❑ #3-Seminole Square o #4-Settlers Square o #5-Cattlemen's Square o #6-Butterfly Square [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 5/13/24 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Meetings 1st& 3rd Tuesdays but subject to change) Address of Event: V Y �.�, r j Pc,r k Street(s)to be closed: SW a d , Vat }AN en Werth P J St red5 Date(s) to be closed: Time(s) to be closed: 9 ,,, - 3 p Purpose of Closing: Attachments Required for Use of Parks Attachments Required 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.** 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 5/13/24 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. ./73 In/ // 1/ Applicant Signature Date "OFFICE USE ONLY" Staff Review Fire Department: Date: 10/ '. 12u Building Official: Date: 1l7 Public Works: Date: 10 Police Department: lit,_a041.4 i \j ,k. Date: rO 3 BTR Department: �� Date: /Q/j,2CG L City Administrator: Date: to/� City Clerk: C Date: CO �7 I acat/ 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 I J 15 I 2 Dat ,/ Temporary Street and Sidewalk Closing reviewed by City Council and approved I �l l Ib I Date kMb� Ac R D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) �� 03/172024 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Next First Insurance Agency,Inc. PHONE (855)222-5919 FAX PO Box 60787 INC.No.Ext): (A/C,No): Palo Alto,CA 94306 E-MAIL ADDRESS: pp su ort@nextinsurance.com INSURER(S)AFFORDING COVERAGE NAIC a INSURER A: State National Insurance Company,Inc. 12831 INSURED INSURER B: Thank You For your Service LLC 20155 NW 260th St INSURER C: Okeechobee,FL 34972 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:067053228 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 INSD WVD POLICY NUMBER I(MM/DD/YYYY) (MM/DO/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) 5100,000.00 MED EXP(Any one person) $15,000.00 A X NXTQL4L4DX-01-GL 01/27/2024 01/27/2025 PERSONAL&ADV INJURY $1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000.00 X POLICY ECOT LOC PRODUCTS-COMP/OP AGG $2,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Peraccident) AUTOS ONLY AUTOS $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is City of Okeechobee/ R.E.Hamrick Testamentary Trust.This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement.All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured, and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Okeechobee/ R.E.Hamrick Testamentary Trust LIVE CERTIFICATE 55 SE 3rd Ave +--., SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Okeechobee,FL 34974 Fj .` o• �: •.�❑ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN �•?+F '��s2 ACCORDANCE WITH THE POLICY PROVISIONS. •r *t�. b• ,'� r# ) AUTHORIZED REPRESENTATIVE it ‘qP---. I Click or scan to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r , INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: Date: DEC 0 3 2017(� 84-3434602 DLN: 26053718001079 THANK YOU FOR YOUR SERVICE Contact Person: PO BOX 1856 CUSTOMER SERVICE ID# 31954 OKEECHOBEE, FL 34973-0000 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December 31 Public Charity Status: 509(a) (2) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: January 1, 2018 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501 (c) (3) . Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c) (3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard) . If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 -2- THANK YOU FOR YOUR SERVICE Sincerely, -. errata Director, Exempt Organizations Rulings and Agreements Letter 947