First Baptist Church - Sports CampName of Applicant
First Baptist Church R.O.C.
Today's Date
4/3/2009
Address
310 SW 5th Avenue, Okee., FL 34974
Phone(s)
863 763 -2171
Fax No.
863 763 -8904
Name of Property Owner
City of Okeechobee
Address
55 SE 3rd Ave., Okee., FL 34974
Phone(s)
763 -3372
Street to be Closed
SW 3rd Street, 6th Avenue and 4 Street (re -route traffic)
Date to be Closed
July 13, 2009 through July 17, 2009
Time(s) to be Closed
4:30 p.m. 9:00 p.m.
Purpose of Closing
Sports Camp
Attachments
Original Signatures of all residents, property owners and business owners affected by the
street closing stating whether they approve or object. This can be done on one list. Make
sure if it is a business that the name of the business and the owner is legible. If it is a
resident make sure the name and address is legible. (Required of all applications).
Copy of proof of insurance. (Minimum $1,000,000.00, required of all applications).
If any items are being sold on City street or sidewalk then a Temporary Use Permit must be
attached for each business participating. Permits can be obtained from General Services.
State Food Service License if selling food.
State Alcoholic Beverage License. (You can only serve on private property. No alcoholic
beverages on City property, this includes streets and sidewalks).
Complete entire application with all applicable attachments and return to the Office of the City Clerk. The City
Departments will be contacted to sign the application. The application is then forwarded to the City Council. You will be
notified of the meeting date. Please note this application will cover both a City street and sidewalk. There is a separate
application should you request the sidewalk only.
TEMPORARY STREET AND SIDEWALK CLOSING
Clean up is required within 24 hours.
No alcoholic beverages can be consumed or taken out on City property, streets or sidewalks.
City of Okeechobee
55 Southeast 3 Avenue Okeechobee, Florida 34974 863- 763 -3372
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.
The City Public Works Department will deliver the appropriate barricades. The City Police Department will
set them out and take them down at the appropriate times.
Dumpsters and port-o -lets are required when closing the street for more than 3 hours.
r
CLERK'S
OFFICE
fY0q v //lotto. AkC`lZ ON
toa— P Iwo) Oi
cep
'PUBLIC WORKS
DEPARTMENT
Authorized. ignature
POLICE
DEPARTMENT
Denny Davis, Chief of Police
Authorized Signature
FIRE
DEPART
c
Fire Chief
thoi Signature
ADMINISTRATION
Auth "zed Si• ature
Donnie Robertson, Public Works Director
Date Typed Name Title
Date
Typed Name Title
Date Typed Name Title
Occupational and /or State License Verified:
cirs htab -69
Brian Whitehall, City Administrator
yped Name Title
Authorized Signature
npiac OCer) Lane Gamiotea, City Clerk
Date Typed Name Title
APPROVED /DENIED BY COUNCIL ON: 6/0?
Revised 8/05/03
n
r
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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSH
LTR
AUU
NSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
(MM/DDIYY
POLICY EXPIRATION
DATE MM /DD/YY)
LIMITS
A
INSURER B. AequiCap Program Admin Inc.
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
24CC13104130
06/07/08
06/07/09
EACH OCCURRENCE
1000000
LVNA HIat I U Ktr I tU
PREMISES (Eaoccure
1000000
CLAIMS MADE OCCUR
MED EXP (Any one person)
10000
PERSONAL 8 ADV INJURY
1000000
GENERAL AGGREGATE
2000000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PRO LOC
JECT
PRODUCTS COMP/OP AGG
2000000
C
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
06542854 -0
08/06/08
08/06/09
COMBINED SINGLE LIMIT
(Ea accident)
1000000
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EXCESS/UMBRELLA
LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION
EACH OCCURRENCE
AGGREGATE
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
CPW002624
01/01/09
01/01/10
WCSIAIU- 01H
TORY LIMITS ER
E.L. EACH ACCIDENT
100000
E.L. DISEASE EA EMPLOYEE
100000
E.L. DISEASE POLICY LIMIT
500000
A
OTHER
Property Section
24CC13104130
06/07/08
06/07/09
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID RD
FIRST -1
DATE (MM!DDIYYYY)
04/10/09
PRODUCER
Pritchards Associates, Inc.
1802 S Parrott Ave
Okeechobee FL 34974 -6179
Phone: 863 763 -7711 Fax: 863-763 -5629
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC
INSURED
First Baptist Church of
Okeechobee, Inc.
401 SW 4th Street
Okeechobee FL 34974
INSURER A. American States Insurance
19704
INSURER B. AequiCap Program Admin Inc.
NSURER C: Progressive Express Ins Co
10193
INSURER D-
INSURER E
OKEEC -4
SHOULD ANY OF THE ABOVE DESCRIBED
DATE THEREOF, THE ISSUING INSURER
NOTICE TO THE CERTIFICATE HOLDER
POLICIES BE CANCELLED BEFORE THE EXPIRATION
WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Okeechobee
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
55 SE 3rd Ave.
Okeechobee FL 34974
REPRESENTATIVES
AUTHOR! EPRES T
C
From:Rachel WI)iams FaxID:
Page 1 of 2
Date:4 /10/2009 10:19 AM Page:1 of 2
CERTIFICATE HOLDER
ACORD 25(2001/08)
CANCELLATION