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Temp Use Permit_Hospice of Lake Okeechobee_Butterfly Release 10r oF�oKe 0cs tio�� CITY OF OKEECHOBEE 55 SE THIRD AVENUE •o _ -•` OKEECHOBEE, FL 34974 `=� :� a����, Tele: 863-763-9821 Fax 863-763-1686 '4' * 91 4`40 is e-mail: permit(c�cifyofokeechobee.com Park Use Permit Permit Number: 25-005 Date(s) of Event: April 4, 2025, 3 PM - 4 PM Permit Expiration: April 4,2025 11:59 P.M. Purpose of Request: Butterfly Release Property Owner: City of Okeechobee Address: 55 SE Third Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: Hospice of Lake Okeechobee Applicant's Address: 411 SE 4th Street Phone Number: 863-610-2662 Address of Project: Butterfly Square 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. 7eezeda 7o'rde April 1, 2025 General Services Administrative Secretary Date Page 1 of 3 Revised 5/13/24 CITY OF OKEECHOBEE loos OKFFC. 55 SE THIRD AVENUE ��r�\ y°cT` OKEECHOBEE, FL 34974 :a Tele: 863-763-9821 Fax: 863-763-1686 =_� ` `.;'. PARK USE AND/OR TEMPORARY STREET/ 10.0 SIDEWALK CLOSING PERMIT APPLICATION _Date Received: [ 12712.5 Date Issued: LI i I /20 25 Application No: 2 -00'4 Date(s)&Times of Event: Ftii do. /- ri 14:14% 3pm-+pm Information: Organization: Hospice of Lake Okeechobee Mailing Address: 411 SE 4th Street Contact Name: Magi Cable or Marie Culbreth E-Mail Address: cable.magi@gmail.com or marie@gilberthasit.com Telephone: Magi's cell or Marie's cell Work: Home: Cell: 863-610-2662 or 863-610-0264 Summary of activities: P Rainbow, a bereavement camp run by Chapter's Hospice. We will have the Chobee Steelers providing music, an invocation by the mayor, a few remarks from our Board Chair Marie Culbreth and a few words from Chapter's Hospice. At the end of the remarks, we will release butterflies that are native to Florida into the park. Proceeds usage: This is a free event. Please check requested Parks: Flagler Parks: o City Hall Plaza o#1 Veterans Memorial Square o#2-Speckled Perch Square o #3-Seminole Square a#4-Settlers Square o#5-Cattlemen's Square rX#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 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 Trus if closing streets or sidewalks. g/375/200.26— Applicant gnature Date ••••OFFICE USE ONLY•••• Staff Review 1 Fire Department: Date: 3)311 Z S Building Official: ti Date: 3yt 2-5 Public Works: r/441 Date: Police Department: / - Date: 3 NM BTR Department: / �� Date: s/'i p�� Ci Administrator: .�� , j� r �111; Date: 3A kr- "Pr z44-i City Clerk: U WO-Akk- ,i lL& Date: 4 ( ') 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 Date Temporary Street and Sidewalk Closing reviewed by City Council and approved Date Page 2 of 3 Revised 5/13/24 TEMPORARY STREET AND SIDEWALK CLOSING INFORMATION (Street Closings require City Council approval. Meetings I' &3rd Tuesdays but subject to change) Address of Event: /V fri- 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 ► 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 O. 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. o 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. DATE(MM/DD/YYYY) ACORO� CERTIFICATE OF LIABILITY INSURANCE 3/3/2025 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 Marsh &McLennan Agency LLC PHONE FAX 5500 Cherokee Avenue, Suite 300 (A/C,No.Extl:800-274-0268 (A/C,No): Alexandria VA 22312 ADDRESS: certificates@MarshMMA.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ironshore Specialty Insurance Company 25445 INSURED CHAPTHEALT INSURER B:RLI Insurance Company 13056 Chapters Health System, Inc. 12470 Telecom Drive INSURER C:Hartford Casualty Insurance Company 29424 Suite 301 INSURERD: Temple Terrace FL 33637 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:524289818 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY HC7AACG4PR003 8/26/2024 8/26/2025 EACH OCCURRENCE $1,000,000 X CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 X 25,000 X MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ _ OTHER: $ B AUTOMOBILE LIABILITY CAP9509224 8/26/2024 8/26/2025 COMaccidenU BINED SINGLE LIMIT $1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A UMBRELLA LIAB _ OCCUR HC7AACG4P1003 8/26/2024 8/26/2025 EACH OCCURRENCE $10,000,000 X EXCESS LIAB X CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? n N/A - — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liab HC7AACG4PR003 8/26/2024 8/26/2025 $1M Claim/$3M Agg $100k ded perciaim C Crime 21FA0252605 6/2/2024 6/2/2025 $3M Limit $50k ded DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) "Excess Liability Information`* HAF10015040503 Eff Date:08/26/2024 Exp Date:08/26/2025 Excess Liability Occ Limit:$5,000,000 Excess Liability Aggregate Limit:$5,000,000 PPX0000086 Eff Date:08/26/2024 Exp Date:08/26/2025 Excess Liability Limit:$5,000,000 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Okeechobee 55 SE 3rd Ave Okeechobee FL 34974 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0000586 01/17/24 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. 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 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. Okeechobee County Property 1 updeted.3/20/2025 H Record Search Search Results POMO DOI& .0100 . ' ' W ''. . , ri:, 1. 1 TOOLS .. , v .,.., , (.3 I) Hi 4A, 5 ' ' '''. W . ,,•s.ure OtttpLIt 10 ,,. Amex ,--, t Ei snow rnap ean or ilk Hi Paper Size: -..:„:,...L...._—. Paper Onentatlen , — ' f - , . 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