HomeMy WebLinkAboutDocumentation_Regular_Tab 06_2/12/2026 Agenda Item #6.
Regular Council
STAFF MEMO
�,lti S
Meeting: Regular Council - Feb 12 2026
Staff Contact: Wayne Cameron Department: Building
IMEW
Consider Approval of Special Event application for a Family Spring Festival event on March 7th, 2026
from 11:30 a.m. - 4:00 p.m. for -200 attendees by the Good Shepherd Church to take place on its
premises located at 402 Seabrook Rd. There will be activities such as bounce house, pumpkin patch,
etc.
SUMMARY:.i-j
Please consider approval of a special event permit application for Family Spring Fling Festival
scheduled for March 7th, 2026, from 11:30 a.m. to 4:00 p.m. at Good Shepherd Church, located at
402 Seabrook Rd. The event is expected to host approximately 200 attendees and will feature
activities such as a bounce house and pumpkin patch, along with a food trucks. The applicant has
provided proof of insurance.
Please find the attached permit application, which has been reviewed and approved by the Fire
Department, Police Department, Building Department, and Village Manager.
This document and any attachments may be reproduced upon request in an alternative format by
completing our Accessibility Feedback Form, sending an e-mail to the Village Clerk or calling 561-
768-0443.
BUDGET • - •
BUDGET AMOUNT N/A AMOUNT AVAILABLE N/A EXPENDITURE AMOUNT: N/A
FUNDING SOURCES: N/A IS THIS A PIGGYBACK:
❑ Yes ❑ N/A
DID YOU OBTAIN 3 QUOTES?
❑ Yes ❑ N/A
COMMENTS/EXPLANATION ON SELECTIONN/A
012026 - 402 Seabrook Road - Spring Festival Special Event Application - 03.07.2026
Page 74 of 325
Agenda Item #6.
J�V1* 11age �� Tequesta�� U[
s4sTmnumotaDrive 561'7e8'0700
Tequesta' FIL 3346e vv"vw.tequmsm-o,g
To: Jeremy Allen, Village Manager
From: Wayne Cameron, Building Director
CC: Honorable Mayor and Village Council
Date: January 9,uZOZ5
Re: Special Event Permit Good Shepard Church & School — March 7 th, 2026 Family
Spring Fling Festival (—ZOO Attendees)
This is a Specie/ Event permit application for a Family Spring Fling Festival at Good Shepard
Church on March 7 th, 2026 from 11:30arn~4prn at 402 Seabrook Road. There will be activities
such as a bounce house, face painting, live music etc (see attached letter). There also will be
food trucks and drinks available. Alcohol will be served (see attached site map)
The applicant, has provided proof of General Liability (see Certificate of Liability Insurance,
attached). The fee for the Special Event permit application will be paid at the time of permit
issuance.
Page 75 Of 325
Agenda Item #6.
�..........=
■
Village
Tequesta
* a / i
SpecialermiA- pplicat, ion
345 Toque-ta Delve
Teques,ta, FL 3 469
(561) 746,04:50 Fax: (561) 768-0698
Any village resident, or any village business holding a current village business tax receipt pursuant to Chapter
70, Article Ii, is eligible to apply for and obtain a special event permit pursuant to Sec. 7$-56�., Any such
resident or business that desires to conduct any type of special event within the village must obtain a permit
from the village in order that the village may adequately provide for the potential impacts created by the
proposed event, A maximum of four (4) such permits shall be allowed per address or per business in any
single calendar year. A special event that includes multiple addresses, for example within a shopping center,
shall count as one event for each address captured by the special event permit.
"Special Evert" Is any outdoor activity, gathering or group of persons, vehicles or both, organized and
having a common purpose, upon public or privato property, which is likely to inhibit the usual flow of
vehicular or pedestrian traffic, which is likely to create noise in excess of that typically associated with the
areas upon which the vent is to occur, or which is likely to preempt or restrict use of property typically
accessible by the general public. Examples of special events include, but are not limited to block parties,
parades, races or walks, grand opening events, charity fundraisers, anti other similar events not specifically
permitted by the Village-s zoning ordinance, Special Events that are sponsored by the village and held on
Village property shall be exempt from the provisions of this section.
Written application rust be submitted to the village Building Department at least forty five (45) days prior to
the date for which the special event is proposed; at the discretion of the Building department, an application
may be submitted less than forty five (45) days in advance If extenuating circumstance are present. The
application shall contain the following information;
Page 76 of 325
Agenda Item #6.
Event details
Gate of event: Ojcva�)
r
Hours of event: a41A D-D
Type of event: Ll snl-
-,- k0ok,
Location of event.
Property owner n4me; _
You must attach the written consent of the property a ner on ecord.
Contact Information:
Sponsor/persons responsible for events lyr
r
Wiling
• vI C.c�
Marling address: + __ ..
._ .��'� ... _._ -mar,.w.�--.-:f•.�..�. _ ..-__- _- -- -
Phone number. 1Y,
Fax number.
Email address. Lao._ _.._ -. sr _ YJ1
._—
0c)
Q�)DProjected number of attendees;M(
Is Village Council approval needed? Yeses No[]
Any proposed special event whose attendance is contemplated to exceed Zoo people in total shall require
final approval by the Village Council which, after considering the recommendations of the Building Director,
the Police Chief and the Village Manager, may approve the application, deny the application in whole or in
part; or approve the application with conditions,
Is alcohol being served?Yes[T NoF"
0 The service of alcoholic beverages at any special event shall require the issuance of the appropriate
state alcoholic beverage permit, a copy of which must be provided to the village in conjunction with
the special event permit application.The Village may require the use of physical barriers to define and
contain the outdoor area within which alcoholic beverages may beconsumed and/or the use of
security or off-duty law enforcement personnel at the special event. It is the applicant's responsibility
to monitor for and prevent excessive as well as underage consumption of alcoholic beverages at all
times.
Page 77 of 325
Agenda Item #6.
How many tents will be used at event? er-JJ&d%-C
or-
Will tents have sides?Yes o No n o
® Should the event Include the use of one or more tents,a $35.00 Fire Inspection Fee, due at time of
application, and a certificate of flame resistance Is required for each tent. Inspection to be done on the
first day of event,
0 By submitting a complete application, the applicant expressly agrees that it shall indemnify, defend and
hold the Village harmless from any and all damage to any real or personal property, and from any and
all injury or death SLIffered by any person directly or indirectly related to the consumption of alcoholic
beverages in conjunction with the special event,
Non-Profit Enterprises:
The Villa&Q may is-sue non profitpermits to any pet-son or organization for the conduct or operation of
occasional sales and/or fundraising projects field by non-profit enterprises, either regularly or
temporarily, when the applicant signs an affidavit that the applicant operates without private profit,
for a civic, public, charitable, youth, service, educational, literary, fraternal, or religious purpose.
A person making application under this section must comply with all rules and procedures for the
granting of special event permits as set forth In this section. All persons operating under a non-profit
permit shall operate their non-profit enterprise in compliance with this section and all other rules and
regulations of the. Village,
Required Documents
The following items must be submitted at the time of"application:
* Summary of event on official letterhead of organization, signed by the applicant
* Proof of insurance in amounts acceptable to the Village for the type of event. The Village shall be
named as additional insured on all liability insurance (not a certificate holder).
* Expected traffic, fire-rescue, and utilities impact, if any,and proposed mitigation plans.
* Copy of all required state and county permits If event will be held on or utilize state and/or county-
controlled property,
* A refundable deposit is required if the event Is held on any Village property.
o Site Plan required with each application accompanied with drawing Indicating layout for event.
o All event sites shall be left in a clean and orderly manner upon completion of event.
Special Event Fees
Under 200 attendees: $40.00
Over 200 attendees: $100.00
Pei-village Resolution 36-19, fees for property owners that. are 501(c)(3) non for profit entities shall be
reduced by 50%.
Page 78 of 325
Agenda Item #6.
Applicant Signature
Applicant name: �C�.- 1-�pp nt m G� �°
Applicant signature;"-,-
Date: --�]
Office Use Only
Permit number:
Submittal Date:
Deposit amount:
Cke.c'-.o rn r n e i-i d e.o' f o A p 1)r-o v a
Building Department:
Date: c,2.� .
Police Cb f:
Date: �' r p21 Go
Fire Chief:-----
Date: A.r•
Parks & Recreation:
.a.r*.r-.r+�-...-,-�..___ ��-.-r�.�r+�-.��v s- rr�s�ti tea++.,..3.4�.�,{.-�",t—�!�--�-•tee. _ __ -Lw.,,..+a++��ar+�-�.r-=r-�:
Date:
Appi-oved by
Digitally signed by Jeremy Allen
Jeremy enDate:2026.01.21 12:55:25-05'00'
11iIlage Manager _._.. �-_
Date;
Approval rotes:
'Ile VC
lie1►'1ar i
-56gya-MVE ER A eX--) A,)C-rd aO
AW o4 &IINESS f-C--Is A16.,
!�'�RM��.�41'wi:�Mti►^�/^. '^'.]�M�"1 .. JtS^'�+�R'tlR�T��YCd� - t�,�,_...�..__+.-��r...�.A....s��'b�+�.�IR+�Ti Ml.r..�'M�_.Ir� M� i 1 f�� Y_4.Y TM - .
Page 79 of 325
Agenda Item #6.
G.-OOD SHEPHERD
EPISCOPAL SCHOOL
January 7, 2026
Village of Tequesta Building Department
345 Teqtiesta. Drive
Tequesta, FL 33469
Special Event Permit Applicatim
Stinimary of Event
Good Shepherd Episcopal School Parent Association Spring Fling
Event Date: March 7, 2026 11:30ain—4:00pm
During our Spring Fling we plan to have the following activities:
Bounce house/Obstacle course
• Live music by Anthony James
Photo areas
Face painting,balloon artist and carnival games
• Silk flower crafts
Bake sale and cake walk
• Food Trucks: Chick Fil A,Food Shack and Kona Ice
For Good Shepherd Episcopal School
lq� 11 Z02(.0
Erin Ross Date
402 Seabrook Road - Tequesta,Florida 33469 - Phone 561-746-5507 - mvxv.goo dshepscho ol.com
Page 80 of 325
Agenda Item N.
TEQLIEFL002 LCAMPAIVIELLo
CERTIFICATE
DATE(MMJDDfYYYY�
OF LIABILITY INSURANCE E(MM/DD 6
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 1NSURER(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 License#957262 CONTACT
The Church Insurance Agency Corp PHONE gp0 293-3525 FAX 8QD 55�-�395
210 South Street,Suite 2 (A/C,No,Ext): (A/C,No):
ton VT 05201-2894 E-MAIL
Bennington,r ADDRESS:
INSURER 5 AFFORDING COVERAGE NAIL#
INSURER A:Church Ins Co of Vermont 1 0669V
INSURED INSURER B:
Good Shepherd Episcopal School LLC INSURER C:
402 Seabrook Rd INSURER D:
Tequesta,FL 33469-2685
INSURER E: f
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 1S 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 A013L SUBR POLICY EFI= POLICY EXP
LTR TYPE OF INSURANCE iu ❑ ❑ POLICY NUMBER MM D❑ MMJDD LIMITS
►41 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 110007000
CLAIMS-MADE OCCUR 31-CP-000002254-0 101112025 10/1/2026 DAMAGE TO RENTED 170007000
X PREMISES Ea occurrence $
IVIED EXP(Any oneperson) $ 15,000
PERSONAL&ADV INJURY $ 110007000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,O00,000
;�C POLICY PRO"- LOC PRODUCTS-COMPIOP AGG $ 130007000
JECT
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY Perperson) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident $
$
A UMBRELLA LIAB OCCUR EACH OCCURRENCE $ /70001000
X EXCESS LIAR CLAIMS-MADE X 31-CP-000002254-0 10/112025 1011/2026 AGGREGATE $ 110001000
DED RETENTION$ 1 0,600 $
WORKERS COMPENSATION PER STATUTE !ERH-
AND EMPLOYERS'LIABILITY Y 1 N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N J A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS 1 LOCATIONS J VEHICLES (ACORD 101,Additional Remarks Schedule,maybe be attached if more space is re aired)
All operations of the named insured including Spring Fling to be held 31712026 at 402 Seabrook Rd Tequesta F�.in connection with which the certificate holder
is named as an additional insured but only in connection with the actions and negligence of the named insured.
CANCELLATION:THE POLICY IS SUBJECT TO THE PREMIUMS,FORMS,AND RULES IN EFFECT FOR EACH POLICY PERIOD.SHOULD THE POLICY BE
TERMINATED,THE COMPANY WILL ENDEAVOR TO GIVE THE.ADDITIONAL INTEREST IDENTIFIED 30 DAYS WRITTEN NOTICE,AND WILL SEND
NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD EFFECT THAT INTEREST,IN ACCORDANCE WITH THE POLICY PROVISIONS OR
REQUIRED BY LAIN.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
uesta Village of Te THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
9 q ACCORDANCE WITH THE POLICY PROVISIONS.
345Teq uesta Drive
Tequesta, FL 33469
AUTHORIZED REPRESENTATIVE
r
ACORD 25(2016103) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Page 81 of 325
Agenda #6.
AC"R ® DATE(MMII]DIYYYY)
CERTIFICATE OF LIABILITY INSURANCE a 1/o612oz6
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 NAAMME: Tony Canni=aro
First Commercial Insurance Agency PHONE N (386)775--1781 FAX No):
P.O.Box 295 E-MAIL tony@firstcommfl.com
ADDRESS: y
INSURERS AFFORDING COVERAGE NAIC#
Cassadaga FL 32706 INSURER A: BEAZLEY 1 CERTAIN UNDERWRITERS AT LLOYD 37540
INSURED INSURER B:
JupiterBounce.com LLC INSURER c:
6671 W. Indiantown Road INSURER D:
Spite 50-271 INSURER E:
Jupiter FL 33458 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS 1S 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.
1NSR ADDL SUHR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY) (MM/DD= LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE FI OCCUR $
DAMAGE TO RENTED PREMISES Ea occurrence 300,000
( 3 Year Extended Reporting Peri❑ MED EXP(Any one person) $ 25,000
A X Retroactive Date:05/06/2018 X ZISMB0613 07 05/06/2025 05/06/2026 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY❑ PRO F-
JECT LOC PRODUCTS-COMPIOP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY EOMaBII NEeD SINGLE LIMIT $
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE I I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? F7N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required)
The Certificate Holder is named as Additional Insured as regard the General Liability policy when required by written contract subject to the terms,conditions,
and exclusions of the policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Good Shepherd Episcopal School ACCORDANCE WI1TH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
400 Seabrook Rd
Tequesta FL 33469
C 1988-2015 ACORD CORPORATION. All rights reserved.
AGORD 25(2016103) The ACORD name and logo are registered marks of ACORD
Page 82 of 325
Agenda #6.
AC"l7l—"f® IDDIY
■1L! /2026
CERTIFICATE OF LIABILITY INSURANCE DATE{MM����5IDDffYYYJ
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DO ES 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 endorsernent(s).
PRODUCER CONTACT Amie Turner
NAME:
Northern Kentucky Insurance A!C NN (859)586-858a AC Na+ (859)586-8616
5915 Centennial Circle EMAIL amie@cornerstoneinsllc.com
cornerstoneinsllc.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
Florence KY 41042 INSURER A: Great American Spirit Insurance Company 33723
INSURED INSURER B: Great American Alliance Company 26832
Kona Ice of Jupiter LLC INSURER C
990 SW Gardens Blvd INSURER D:
INSURER E:
Palm City FL 34990 INSURER F
COVERAGES CERTIFICATE NUMBER: 202.5-2026 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 CONTRACTOR 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 I ADDLSUBRI POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED 500,000
CLAIMS-MADE OCCUR PREMISES Ea occurrence $
MED EXP(Any one person) $ 10,000
A Y BOP2550763 01/1612026 01/16/2027 PERSONAL a.ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
X POLICY D JECT PRO- F-1 LOCO PRODUCTS-COMP/OP AGG $ 4,000,000
OTHER. $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED CAP2550764 01/16/2026 01/1612027 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
�D�ED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER
ANY PROPRIETORIPARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E,L,DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Certificate holder is listed as an additional insured with regards to the operations of the named insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Good Shepherd Episcopal School LLC ACCORDANCE WITH THE POLICY PROVISIONS.
400 Seabrook Rd
AUTHORIZED REPRESENTATIVE
Jupiter FL 33469
Q 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and loge are registered marks of ACORD
Page 83 of 325
Agenda Item #6.
LITTMOI-01 CGREITZER
DATE(MMfiIDlYYYY]
CERTIFICATE OF LIABILITY INSURANCE E(MMID /Y
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 endorsements).
PRODUCER CONTACT Genheve Lawrence
NAME:
Patriot Growth Insurance Services LLC PHONE FAX
2056 Vista Pkwy Ste 350 (A/C,No,Ext): (A/C,No):
West Palm Beach, FL 33411-6756 E-MAILADDRESS. rence�P GLaw atriot rowth.com
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:Southern-Owners Insurance Company 10190
INSURED Little Moirs Leftovers Inc,dba Leftovers Cafe Inc. INSURER B:National Union Fire Ins Co Pittsburgh PA 19445
MGWM Inc dba Little Moir's Foodshack INSURER C
Little Moirs LLC aka Hibiscus Street Eatery INSURER❑
5560 Old Mystic Court
Jupiter,FL 33458 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 TYPE OF INSURANCE AQDL SUBR POLICY NUMBER ~�Y POLICY EFF POLICY EXP LIMITS
IN SO WVL] MM DD MM QD
A }( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 17000,000
CLAIMS-MADE — OCCUR 7232'1156-26 1/11202+6 1/112027 DAMAGE TO RENTED 300,000
X PREMISES Ea occurrence $
MED EXP(Anyoneperson) $ 102000
PERSONAL&ADV INJURY $ 17000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 210007000
ROPOLICY a JPECT Lac PRODUCTS-COMP/OP AGG $ 210007000
OTHER: LIQUOR LIAB $ 1,0001000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY Perperson) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per acciden 0 $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident $
F_ $
B UMBRELLA LIAB OCCUR EACH OCCURRENCE J$ 53000,000
X EXCESS LIAR CLAIMS-MADE EBU 037085971 1/112026 111f2027 AGGREGATE $ 570007000
❑ __ RETENTION$ 0 Prods Comp Aggr $ 510001000
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y f N STATUTE I I ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $
OF'FICERIMEMBER EXCLUDED? Li N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
If required by written contract,the following apply in favor of: Good Shepherd Episcopal School
GL Blanket Additional Insured Lessor of Leased Equip/Manager or Lessors of Premises/Blanket WOS,per#65034(6-22)
Primary Non-contributory per form CG2001 0413
Umbrella Liability extends over General Liability
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Good Shepherd Episcopal School THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
402 Seabrook Rd. ACCORDANCE WITH THE POLICY PROVISIONS.
Tequesta,FL 33469
AUTHORIZED REPRESENTATIVE
_ T
I
ACORD 25(2016103) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Page 84 of 325
Agendantt6W#&-0642-00 Policy Number $4582-72321 s
65034 (6-22)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FLORIDA = COMMERCIAL GENERAL LIABILITY PLUS
COVERAGE = WITH LIMITED HIRED AUTO AHD
NON -OWNED AUTO LIABILITY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. EXTENDED WATERCRAFT LIABILITY This coverage does not apply to:
SECTION I -COVERAGES, COVERAGE A- (1) "Bodily injury" or"property damage"
BODILY INJURY AND PROPERTY DAMAGE expected or intended from the standpoint of
LIABILITY, 2. Exclusions is amended. Exclusion the insured. This exclusion does not apply
g.(2)is deleted and is replaced by the following to "bodily injury" resulting from the use of
exclusion. reasonable force to protect persons or
(2) A watercraft you do not own that is: property.
(a) Less than 50 feet long; and (2) Any obligation of the insured under a
(b) Not being used to carry persons or workers compensation, disability benefits or
property for a charge; unemployment compensation law or any
2. LIMITED HIRED AUTO AND NON-OWNED AUTO similar law_
LIABILITY (3) (a) "Bodily injury" or"property damage"
Coverage for"bodily injury" and "property damage" arising out of the actual, alleged or
liability provided under SECTION I-COVERAGES, threatened discharge, dispersal,
COVERAGE A-BODILY INJURY AND seepage, migration, release or escape
PROPERTY DAMAGE LIABILITY, is extended as of"pollutantsr':
follows under this item, but only if you do not have 1) That are, or are contained in any
any other insurance available to you which affords property that is:
the same or similar coverage, a) Being transported or towed by,
a. Coverage handled or prepared for
We will pay those sums the insured becomes placement into or upon, or taken
legally obligated to pay as damages because of from the "auto";
"bodily injury„ or"property damage"arising out b) otherwise in the course of
of the maintenance or use of an "auto"': transit by you or on your behalf;
(1) You do not own; or
(2) Which is not registered in your name; or c) Being disposed of, stored,
(3) Which is not leased or rented to you for treated or processed into or
more than ninety consecutive days upon the "auto";
and Which is used in your business. 2) Before such "pollutants" or property
b. Exclusions containing "pollutants" are moved
With respect to only LIMITED HIRED AUTO from the place they are accepted by
AND NON-OWNED AUTO] LIABILITY, the you or anyone acting on your behalf
exclusions Which apply to SECTION I - for placement into or onto the
COVERAGES, COVERAGE A- BODILY "auto""; or
INJURY AND PROPERTY DAMAGE 3) After such ""pollutants"' or property
LIABILITY, other than the Nuclear Energy containing "pollutants" are removed
Liability Exclusion Endorsement, do not apply. from the "auto"to where they are
The following exclusions apply to this coverage. delivered, disposed of or abandoned
65034 (0-22) Includes copyrighted material of Insurance Services office, Inc., with its permission. Page 1 of 6
Page 85 of 325
Agen Policy Number 184682-72321156
by you or anyone acting on your liability ina contract oragreement. This
behalf. exclusion does not apply go liability for
Paragraph (3)(a)1) does not apply to damages:
"pollutants"that are needed or result (a) Assumed ina contract oragreement
from the normal mechanical, electrical that isan "insured contnsct"' provided
or hydraulic functioning of the ^auto^ or the "bodily injury" or"property damage"
its parts, if the discharge, release, occurs subsequent Lo the execution of
escape, seepage, migration ordispersal the contract oragreement. However, if
of such ^poUutents^ is directly from a the insurance under this policy does not
part of the ^auto^designed tohold, apply ko the liability of the insured, it also
store, receive or dispose ofsuch does not apply to such liability assumed
^poUutants^ by the ^auto^ manufacturer. by the insured under an ^insured
Paragraphs (])(a)2)and (])(a)3) do not contract''
apply, ifasa direct result of (b) That the insured would have /nthe
maintenance or use of the "auLo^. absence of the contract oragreement.
~poUutants" or property containing (6) "Property damage"to:
^AoUutants^which are not inor upon the (a) Property owned or being transported by,
^auto^. are upset, overturned or or rented or loaned to any insunsd� or
damaged at any premises not owned by (b) Property)n the care, custody orcontrol
or leased toyou. The discharge, of any insured other than "property
release, escape, seepage, migration or damage"toa residence oraprivate
dispersal of the ~poUutants^ must be garage bya private passenger"auto
"
directly caused by such upset, overturn covered by this coverage.
or damage. (7) (a) "Bodily injury"to:
(b) Any loss, cost or expense arising out of 1} An ^employee^of the insured arising
any: out of and in the course of
1) Request, demand or order that any employment by the insured; or
insured or others test for, monitor, 2) The spouse, child, parent, brother or
dean up, rcmove, contain, beat, sister of that"emp/oyee^as a
detoxify or neutralize, orin any way consequence of paragraph (7)(a)~)
respond to, or assess the effects of (b) This exclusion applies:
^poUutants^; or 1) Whether the insured maybe liable
2) Claim or~suit' byoron behalf ofa as an employer or in any other
governmental authority for damages capacity; and
because of testing for, monitoring, 2) To any obligation to share damages
cleaning up, removing, containing, with or repay someone else who
treating, detoxifying orneutralizing, must pay damages because of the
orin any way responding to, or injury.
assessing the effects of^poUutanis^ (c) This exclusion does not apply to:
k/
(4) "Bodily injury" damage" 1) Liability assumed bythe insured
however caused, arising directly or under an "insured contnact^
indirect|y, out of: 2) "Bodily injury"to any"employee" of
(a) War, including undeclared or civil war, the insured arising out of and in the
(b) Warlike action bya military force, course of his or her domestic
including action in hindering or employment bythe insured unless
defending against an actual or expected benefits for such injury are in whole
attack, by any government, sovereign or orin part either payable orrequired
other authority using military personnel to be provided under any workers
or other agents; or compensation law.
(c) |nsurrection, rebellion, revolution, c- Who Is An Insured
usurped pom/er, or action taken by With respect to only this coverage. SECTION 11'
governmental authority in hindering or WHO IS AN INSURED is deleted and replaced
defending against any of these. by the following provision.
(5) ''Bodily injury' or"property damage"for SECTION |/-WHO IS AN INSURED
which the insured is obligated to pay (1) Each of the following is an insured with
damages by reason ofthe assumption of respect to this coverage.
65034 (6-22) Includes copyrighted material of Insurance Services Office. Inc., with its permission. Page 2 of
Page 86 of 325
Agendanttam#&-0642-00 Policy Number 184682-72321756
(a) You. "Auto business" means the business or
(b) Your partners if you are designated in occupation of selling, repairing, servicing' storing
the Declarations asa partnership ora or parking ^autos^
joint venture. e. Limits ofInsurance
(c) Your members if you are designated )n With respect to only this coverage, SECTION
the Declarations as a limited liability U|- L|YN[7S OF INSURANCE is deleted and
company. replaced by the following provision.
(d) Your"executive officers" J you are SECTION III-LIMITS OFINSURANCE
designated in the Declarations as an (1) The Limits of Insurance shown in the
organization other than a partnersh/p. Declarations and the rules be/ow fix the
joint venture or limited liability company. most we will pay regardless of the number
(e) Any person using the "auto" and any of:
person or organization legally (a) Insureds:
responsible for the use of an ^auto^ not (b) Claims made or^suits^ brought; or
owned by such person ororganization, (c) Persons or organizations making claims
provided the actual use is with your or bringing "suits'.
permission. (2) We will pay damages for"bodily injury" or
(2) None of the following is an insured: "property damage" up to the limits of liability
(a) Any person engaged in the business of shown in the Declarations for this coverage.
his or her employer with respect to Such damages shall be paid as follows:
"bodily injury"to any co-"employee" of (a) When Limited Hired Auto and
such person injured /n the course of Non-Owned Auto Each Occurrence
employment. Limit is shown in the Declarations, such
(b) Any person using the "auto" and any limit is the total amount of coverage and
person other than you. legally the most we will pay for all damages
responsible for its use with respect to an because oforarising out of all"bodily
"auto" owned or registered in the name injury'and ^pmperty damage" in any
of: one ^occumence^
1) Such person; or (b) When Bodily Injury Limited Hired Auto
2) Any partner or"executive officer" of and Non-Owned Auto Each Occurrence
yours or a member of his or her Limit and Property Damage Limited
household; or Hired Auto and Non-Owned Auto Each
3) Any"employee" or agent of yours Occurrence Limit are shown in the
who is granted an operating Declarations:
allowance of any sort for the use of 1) The limit shown for Bodily Injury
such "auto". Limited Hired Auto and Non-Owned
(c) Any person while employed in or Auto Each Occurrence is the total
otherwise engaged in duties in amount of coverage and the most
connection with an "auto business^. we will pay for all damages because
other than an "auto business"you of or arising out of all "bodily injury"
openste in any one ^occunence^
(d) The owner orlessee (of whom you are a 2) The limit shown for Property
sub-lessee) of hired "auto" or the Damage Limited Hired Auto and
owner of an ^auto^you do not own or Non-Owned Auto Each Occurrence
which is not registered in your name is the total amount of coverage and
which is used in your business or any the most we will pay for all damages
agent or employee of any such owner or because ofor arising out ofall
lessee. "property damage" in any one
(e) Any person or organization with respect occurrence
to the conduct of any current or past 3 BROADENED SUPPLEMENTARY PAYMENTS
partnership or joint venture that is not SUPPLEMENTARY PAYMENTS- COVERAGES
shown as a Named Insured in the AND B. Paragraph 1d. is amended
Declarations. The amount we will pay for the actual loss of
d. Additional Definitions earnings is increased from $250 per day to $400 per
The following definition applies to only this day'
coverage.
65034 (6-22) Includes copyrighted material of Insurance Services Office, Inc. with its permission- Page 3 of
Page 87 of 325
Agenftnft6M#(S2-0642-00Policy Number 1846e2-72321756
4. ADDITIONAL PRODUCTS-COMPLETED (f) Websites; or
OPERATIONS AGGREGATE LIMIT (g) Televisions.
If the endorsement, EXCLUSION PRODUCTS- (2) SECT|C:NV- DEFINITIONS isamended.
COMPLETED OPERATIONS HAZARD, CG 21 04` Paragraph 14^ "Personal and advertising
is not a�achedtoth�po/�y following i�u�" isde�ted and nep�cedbythe
pnzv�on � added to SECTION III- LIMITS OF following definition.
INSURANCE. 14. "Personal and advertising injuryrmeans
Commencing with the effective date of this policy, injury, including consequential"bodily
vve will provide one additional Products-Completed injury'. arising out of one or more ofthe
Operations Aggregate Limit, for each annual period, following offenses:
equal to the amount of the Products-Completed a. False arrest, detention or
Operations Aggregate Limit shown inthe imprisonment;
Declarations. The maximum Products-Completed b. Malicious prosecution;
Operations Aggregate Limit for any annual period c The wrongful eviction from, wrongful
will beno more than two times the original entry into, or invasion of the right of
Products-Completed Operations Aggregate Limit. private occupancy ofaroom,
5. PERSONAL INJURY EXTENSION dwelling or premises that aperson
a. |f the endorsement EXCLUSION PERSONAL occupies, committed byoronbehalf
AND ADVERTISING INJURY, CG 21 38. is of its owner, landlord or lessor;
attached to this policy, then this provision, 5- d Oral or written publication, inany
PERSONAL INJURY EXTENSION, does not manner, of material that slanders or
apply' libels person or organization or
b. /f the endorsement EXCLUSION PERSONAL disparages aperson'sor
AND ADVERTISING INJURY, CG 21 38. is not organize1ion's goods, products or
attached to this policy: services;
(1) SECTION |-COVERAGES, COVERAGE e Oral or written publication, inany
B- PERSONAL AND ADVERTISING manner, of material that violates a
INJURY L1AB|L[TY, 2' Exclusions is pecson's right of privacy,
amended. The following exclusion isadded. t The use ofenother'sadvertising
This insurance does not apply to: idea in your"adverbsemen�;
Americans With Disabilities Act(AD/\) g. Infringing upon encther'scopyright,
"Personal and advertising injug''arising trade dress or slogan inyour
directly or indirectly out of any action or "advert/sement^; or
omission that violates or is alleged to h. Dischm/nation, humi|iation, sexual
violate- harassment and any violation ofcivil
(1) The Americans With Disabilities Act rights caused bysuch
(ADA). including any amendment ofor dischminat/on' humiliation orsexual
addition to such ksvv� harassment.
(2) Any federal rule orregulation 6. BROADENED KNOWLEDGE 0FOCCURRENCE
promulgated to implement the ADA and SECTION K/'COMMERCIAL GENERAL
its amendments and additions; or LIABILITY CONDITIONS, 2- Duties Jn The Event
(3) Any federal, state, or local statute, Of Occurrence, Offense, Claim Or Suit is
ordinance or regulation, other than the amended. The following condition isadded.
ADA and its amendments and additions, Paragraphs a.and b.of this condition will not serve
that prohibits discrimination on the basis Lo deny any claim for failure to provide us with notice
of disability relating to the use of, as soon as practicable after an "occurrence^ oran
access to, or enjoyment of: offense which may result in a claim:
(a) Facilities used as, or designated or a' If the notice of new claim is given to your
constructed for use as places of "employee", and
public accommodation', b That~emp1oyee^falls to provide us with notice
(b) Facilities used as, ordesignated assoonaspracticab|e-
andconsiructedforuse as This exception shall not apply to you ortoany
commercial facility; officer,, dinector, partner, risk manager orinsurance
(c) Telecommunication systems; manager of yours.
(d) Telephones;
(e) Internet;
65034 (8'22) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of
Page 88 of325
Agendeftem #&-0642-00 Policy Number 184682-72327156
7- DAMAGE TOPREMISES RENTED TOYOU 20 Mud flow ormudslide;
a. SECTION | ' COVERAGES, COVERAGE a- 3) Volcanic eruption, explosion or
BODILY INJURY AND PROPERTY DAMAGE effusion;
LIABILITY, 2. Exclusions isamended. 4) Any earth movement, such as
(1) The last paragraph is deleted and replaced earthquake, landslide, mine
by the following paragraph. subsidence, earth sinking, earth
Exc/usionsc-throughn. donotapplyto rising or earth shifting;
damage by fire, Ughining, explosion. smoke 5) Regardless ofthe oause, flood,
or water damage to premises rented toyou surface water, waves,tides, tidal
or temporarily occupied by you with waves, storm surge, overflow ofany
permission of the owner. A separate limit of body of water, or their spray, all
insurance applies io this coverage as whether wind driven or not; or
described in7. DAMAGE TOPREMISES 6) Water under the ground surface
RENTED T<]YOU, b. Limits ofInsurance. pressing on, or seeping orflowing
(2) The following additional exclusions apply to through:
^'propeMydamage^ arising out ofwater a) Walls, foundations, floors or
damage to premises rented to you or paved surfaces;
temporarily occupied by you with permission b) Basements, whether paved or
of the owner. not; or
(a) "Property damage"to: c) Doors, windows orother
1) The interior of the premises caused openings.
byor resulting from rain orsnow, (d) "Property damage"for which the insured
whether driven by wind ornot; or is obligated to pay as damages by
2) Heating, air conditioning, plumbing reason of the assumption of liability ina
or fire protection systems, or other contract oragreement. This exclusion
equipment orappliances. does not apply to liability for damages
(b) "Property damage" caused byor that the insured would have inthe
resulting from any of the following: absence of this contract oragreement.
1> Mechanical breakdown, including o. Limits ofInsurance
bursting or rupture caused by SECTION .0 - LIMITS OF INSURANCE is
centrifugal force; amended Paragraph G. is deleted and replaced
2} Cracking, settling, expansion or by the following paragraph,
shrinking; 6. The most vve will pay under Coverage Afor
3) Smoke orsmog; damages because of"property damage" to
4) Birds, insects, rodents orother premises rented[o you ortemporarily
animals; occupied by you with permission ofthe
S) Wear and tear; owner arising out ofor caused byfire,
6) Corrosion, rust, decay,fungus, lightning, explosion, smoke and water
deterioration, hidden o/latent defect damage is the amount shown inthe
or any quality in property that Declarations under Damage to Premises
causes such property to destroy or Rented toYou.
damage itseff; or c. SECTION |V-COMMERCIAL GENERAL
7) Water that flows or leaks from any LIABILITY CONO|T|ONS, 4- Other|nsurance,
heating, air conditioning, plumbing Paragraph b. is amended. The word fire is
or fire protection system caused by amended to include fire, hghtning, exp|osion,
or resulting from freczing, unless- smoke or water damage.
a) You make a reasonable effort to 8. BLANKET ADDITIONAL INSURED-LESSOR OF
maintain heat in the building or LEASED EQUIPMENT
structure; or a- (1) SECTION ||-VVHO IS AN INSURED is
b} You drain the equipment and amended to include as an additional insured
shut off the water supply if the any person or organization with vvhorn you
heat is not maintained. have agreed:
(c) "Property damage" caused directly or (a) /n a written contract or agreement,
indirectly by any of the following: executed prior to loss, to name as an
1> Water that backs up from a drain or additional insured; or
sewer;
65034 (6-22) Includes copyrighted material of Insurance Services Office. Inc., with its permission. Page S of
Page 89 of 325
Age ndenftem#62.-0642-00 Policy Number 184682-72321156
(b) /nan oral contract oragreement, c SECTION III 'LIMITS C>F INSURANCE /s
executed prior io loss, to name asan amended. The following provision is added for
additional insured only ifaCertifioateof purposes of this endorsement only.
Insurance was issued prior ioloss The Limits of Insurance for the additional
indicating that the person or insured are those specified in the written
organization was an additional insured. contract or agreement between the insured and
(Z) This provision applies only with respect to the manager or lessor of the premises, not to
liability for: exceed the limits provided in this policy. These
(a) "Bodily inju��� limits are inclusive of and not in addition tothe
(b) "Property damage^; or Limits of Insurance shown /n the Declarations,
(c) "Personal and advertising injury" 10. NEWLY FORMED QRACQUIRED
caused in whole or/n part, byyour ORGANIZATIONS
maintenance, operation or use ofequipment SECTION U-WHO |SAN INSURED isamended.
leased to you by such person or Paragoaph3. is deleted and replaced bythe
organization. following paragraph.
b. With respect to the insurance afforded toan 3- Any organization you newly acquire orform,
additional insured, this insurance does not apply other than a partnership,joint venture orlimited
to any"occurrence^which takes place after-the liability company, and over which you maintain
equipment lease expires. ownership or majority interest, will qualify as a
c' SECTION III- LIMITS C>F INSURANCE is Named Insured if there isno other similar
amended. The following provision is added for insurance available to that organization.
purposes of this endorsement only. However:
The Limits of Insurance for the additional a. Coverage under this provision isafforded
insured are those specified in the written only until the 18Oth day after you acquire or
contract or agreement between the insured and form the organization or the end ofthe
the lessor, not to exceed the limits provided in policy period, whichever isearlier;
this policy. These limits are inclusive of and not b. Coverage A does not apply to "bodily injury^
in addition to the Limits of Insurance shown in or^property damage"that occurred before
the Declarations. you acquired or formed the organization,
9- BLANKET ADDITIONAL INSURED-MANAGERS and
OR LESSORS OF PREMISES c. Coverage B does not apply to "personal and
a' SECTION /|'WHO |SAN INSURED is advertising injur_V'arising out ofanoffense
amended to include esan additional insured any committed before you acquired orformed
person or organization with whom you have the organization.
agreed: No person or organization isan insured with
(1) Ina written contract or agreement, executed respect to the conduct of any current orpast
prior to loss,to name asanadditional partnership,joint venture or limited liability
insured; or company that is not shown asa Named Insured
(2) |nan oral contract or agreement, executed in the Declarations.
prior to loss,to name asanadditional 11. BLANKET WAIVER OFSUBROGATION
insured only ifa Certificate of Insurance was SECTION |V-COMMERCIAL GENERAL
issued prior to loss indicating that the LIABILITY CONDITIONS is amended. The
person or organization was anadditional following provision is added to8.Transfer Of
insured Rights Of Recovery Against Others ToUs.
but only with respect to liability arising out ofthe When you have agreed to waive your right of
ownership, maintenance oruse of that part of subrogation in a written contnac1, executed prior to
the premises leased to you. loss, with any person or organization, we waive any
b. This provision is subject to the following right of recovery w/e may have against such person
additional exclusions. or organization because of payments vve make for
(1) Any ^occuroence" which takes place after injury or damage arising out of your ongoing
you cease iobea tenant in that premises. operations or"your work" done under a contract with
(2) Structural alterations, new construction or that person or organization and included inthe
demolition operations performed byoron "products-comp1eted operations hazard^'
behalf of the additional insured.
All other policy terms and conditions apply.
65034 (5-22) Includes copyrighted material of Insurance Services Office, Inc., with its permission, Page 6 of
Page 90 of 325
Agent"ft&W#B?-064Z-00 Policy Number 1 84682-72321 1 56
COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance Condition (2) You have agreed in writing in a contract or
and supersedes any provision to the contrary: agreement that this insurance would be
Primary And Noncontributory Insurance primary and would not seek contribution
This insurance is primary to and will not seek from any other insurance available to the
contribution from any other insurance available additional insured.
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 01 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 1
Page 91 of 325
Agenda Item #6.
GOOD SHEPHERD
EPISCOPAL CHURCH&SCHOOL The Rev. Dr. Sanford H. Groff, Jr.
------......... .......
TEQUESTA, FLORIDA
January 9, 2026
Village of Tequesta
345 Tequesta Drive
Tequesta,, FL 33469
In regards to:Special Event Permit Application
For: Good Shepherd Episcopal School,Spring Fling
Event Date: March 7., 2026 11:00 am-5:00 pm
The Church of the Good Shepherd, property owner of 400-402 Seabrook Road,Tequesta,
FL, hereby gives permission to Good Shepherd Episcopal School to hold their Spring Fling
event on-site on March 7, 2026.
Sincerely,
The R v. Dr.Sanford H. Groff, Jr.
Rector
�P�(/ld�-Pi d�CP�67if'l�D�
400 Seabrook Road I Tequesta, FL 33469 1 (561) 746-4674 1 qoodsheponline.orq
Page 92 of 325
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Page 93 of 325
Agenda Item #6.
A
,--rory LaUr-% b9 lie L-Schuen a inn o Dub;el
Re- Fall Festival Special Event Appjica--;on
Izep 16, 2024 at 3:37:4" PM
Tc,-� Kase y Fy d a i ij e,
Kasen
Attached is a screenshot of the goo fy rnap view of the property. Yes., the food truck
is the only one that will Provide alcohol. !--L's the same vendor that we used last year.
More than 'nalf, the people attending are children so the number of cars is actually
9
MUch smaller than the number of guests. The school has two ark gig 'lots on the
,-,s + LLree-;- for
property. Addi-1--ionally, last year some gU(D'StS parked in the spots acro,"*, the street I
conStitu t
-ion Park. We also have many school fare*alies that live off ofSeabrook and
typically walk to school events. Please left nrie know if there is anythina else you
need.
Laura
lip
PW
ru
wr
�3 e a b ro o k oac.
w, nit
AN S
ME.
..........
Page 94 of 325
Agenda Item #6.
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