HomeMy WebLinkAboutDocumentation_Regular_Tab 13_10/09/2014 VILLAGE CLERK'S OFFICE
AGEfVDA ITEM TRANSMITTAL FORM
Meeting Date: Meeting Type: Ordinance #:
October 9, 2014 Regular
Consent Agenda: Yes Resolufion #:
Originating Department: Community Development
AGENDA ITEM TITLE: (Wording form the SUBJECT line of your staff report)
SE-03-14 Special Event Permit Application from Palm Beach Roadrunners for the 14 Annual Run 4 the Pies
four mile road race. The event is planned to take place on November 27, 2014. It will start and finish at
Constitution Park. Alcohol will not be served. Projected number of attendees is 1,800 people.
BUDGET / FINANCIAL IMPACT:
Account #: Amount of this item:
Current Budgeted Amount Available: Amount Remaining after item:
Budget Transfer Required: Choose an Appropriate Fund Balance: Cncose an i�em.
item.
EXECUTIVE SUMMARY OF MAJOR ISSUES: (This is a snap shot description of the agenda item)
SE-03-14 Special Event Permit Application Special Event Permit Application from Palm Beach Roadrunners
for the 14 Annual Run 4 the Pies four mile road race. The event is planned to take place on November 27,
2014. It will start and finish at Constitution Park. Alcohol will not be served. Projected number of attendees is
1,800 people.
Sec. 78-561 (e) (3) "Any proposed special event whose attendance is contemplated to exceed 200 people in
total shall require final approval by the Village Council which, after considering the recommendations of the
Community Development Director, the P��lice Chief, and the Village Manager, may approve the application,
deny the application in whole or in part; or approve the application with conditions".
APPROVALS: SIGNATURE:
Department Head `�,� ✓,�. ��;;
_.: � _:-: _
Finance Director � _ ____. _. _ _ __
Reviewed for Financial Sufficiency 0 -� `�"� ��
No Financial Impact ❑ f� �
Attorney: (for legal sufficiency)
i age anager: -----
_ ---_
_ ---
Submit for Council Discussion: 0 -'
Approve Item: ❑
Deny Item: �
SPECIAL INSTRUCTIONS FOR CLERl�: (if you wish to have agreements signed, be sure to include the
number of copies you want signed and p�ace "Sign Here" sticker on them)
Form Amended: 10/20/11
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Monday, August 18, 2014 �' }�' �:' '-�
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Enclosed is the Event Permit Application, Certificate of Liability insurance and a map of the race course.
Please forward to the various departments for their approval and signatures and send me a copy once completec
Thanks....,,
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ViLLAGE OF TEQU�S ` �� �f�._�,.;�,.�,t-•. ,;
Department of Community Development PEFtl�ll�' #
345 Tequesta Dr
Tequesta Florida 33469
(561) 768-0450 fax (561) 768-0698
TEMPORARY OUTDOOR BUSINESS OR EVENT PERMIT APPLICATION
DATE OF SALE/EVENT: a� -L� \� �°-'� HOURS: FROM � ���"�`f0 \\ tio �`"-`
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SPONSORING ORGANIZATIOf� s�\ 4��.n.� � �� w�c�:�.�ti �-+ � �S
NAME & T1TLE OF PERSON
�1RECTiNG SALE / EVENT:�� �� �Q..--�QQ tb� ���,�-,-�
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MAILiNG ADDRESS� o`� �k � �v� PHONE NO.: ��\ —3L�_ �b ��
W � � �t\<,,.�''�1 ����� �--� FAX NO.:
33�� -�
PROCEEDS TO BE USED FOR: ��-� a s� `�--1
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LOCATION OF SALE/EVENT:��� i�=-,� -� ��.< � �-� ���z-� ��4 � � ���3ob�� �
DESCRIPTION OF SALEIEVEf�IT: \�; ```' ,�,,,.�.�, �, �,,. � `�$ �� �t�5
u �,.\e �a �C� �l �c.�
PROJECTED NUMBER OF ATTENDEES: \4� ov IS ALCOHOL BEING SERVED? � o
(If "yes", must obtain Div. of Alcoholic Beverages and Tobacco temporary aicohol license)
PROPERTY OWNER APPROVAL:
{if other than applicant)
**NOTE**
• Site Pfan required with each application accompanied with drawing indicating fayout for event_
• No fee shall be charged for said permit; however, not more than two (2) permits shafl be issued to
any one address, property, lega! description, property owner, or organization during any single
calendar year.
• Advertising signs are permitted ONLY on property having the sale.
• All sale sites shall be left in a clean and orderly manner upon completion of sale.
• Should the sale/event include the use of one or more tenis, there is a$35.00 Fire Inspection Fee
due at time of application and a cer�ificate of flame resistance is required for eaCh tent.
inspection to be done on the first day of event.
SlGNATURE OF APPLICANT: --� DATE: � -=. �
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APPROVAL S(GNATURES: r
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POLICE DEPT.: [ _- -- " �� - �� DATE: - �
FfRE/RESCUE: � �'
�-' " DATE: �i:-� . =�%Y
PARKS/RECREATIO[�l: �` 1�� � DATE: �
VILLAGE MANAGER: ~��,�--. ' . �-�
P & Z DIRECTOR: � -�.:; = :.- � ;. ��i.�''_- DATE: �-� ; > --r � �
---_----___ , .
A�c,.,,°R°� CERTIFICATE OF LIABILITY INSURANCE s;i2i2oi4 '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OtJLY 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 7HE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCEF2, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate hoider 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 NAMEACT J11dy WE8V2T
STAR Insurance - Fort Wayne Office PHONE ,(260) 467-5697 � C N : (260)467-5651
2130 East Dupont Road a °o R�ESS: 7udy.weaver@starfinancial.com
INSURER S) AFFORDING COVERAGE NAIC #
Fort Wayne IN 46825 iNSUaERANational Casual Com an 11991
INSURED iNSU�ReNationwide Life Insurance Co. 66869
Road Runners Club of America/2014 and Its INSURERC:
Mcm't� Clubs INSURERD:
1501 Lee Highway, Suite 140 INSURERE:
Arlington VA 22209 INSURERF:
COVERAGES CERTIFICATE NUINBER2014 -$1M A. x. 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. NOTWITHS7AND{NG ANY REQUiREMENT, TERM OR COND�TION 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.
�LTR TYPE OF INSURANCE A L U � POLICY NUMBER MM EFF MMlDD � LIMiTS
GENERAL LIABILITY EACH OCCURRENCE y' 1� OOO � OOO
DAMA E TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 500, O00
A CLAIMS-MADE �OCCUR O 000000 3937500 2/31/201312/31/2014 MEDEXP(Anyoneperson) $ 5,000
X Legal Liability to 2:01 A.M. 12:01 A.M. pERSONALBADVINJURY $ 1,000,000
Participant $1,000,000 GENERALAGGREGATE $ IINLIMITED
GEN'L AGGREGATE LIMIT APPLIES PER: use 6 Molestation pRODUCTS - COMP/OP AGG 5 1, 000 , 000
X POLICY PRa LOC ggregate $5, 000, 000 ABUSE 8 MOLESTATION $ 500, 000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $ 1 000 000
A ANY AUTO BODILY INJURY (Per person) $
ALLOWNED SCHEDULED O 000000 3937500 12/31/201312/31/2014 gODiLYINJURY(Peraccident) $
AUTOS AUTOS
X HIREDAUTOS X NON-ONMED 12:01 A.M. 12:01 A.M. PROPERNDAMAGE $
AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESSlIAB CLAIMS-MADE AGGREGATE $
DED RETEMION$ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y! N �'
ANYPROPRIETOR/PARTNEWEXECUTIVE❑ N � A E.L.EACHACCIDENT $
OFFICER/MEMBER EXCLUDED7
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L �ISEASE - POLICY LIMIT $
B EXCESS MEDICAI, & ACCIDENT P% 00000 26139600 2/31/2013 2/31/2014 �CESSMIEDICAL $10,000
($250 DEDUCTIBLE/CLAIM) 2:01 A.M. 2:01 A.M. AD & SPECIFIC LOSS $2 � 500
DESCRIPTION OF OPERATiONS / LOCATIONS / VEHICLES (Attach ACORD 10�, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSIIRED AS RESPECTS TFiE2R INTEREST IN THE OPERATIONS OF THE
NAMED INSIIRED. DATE OF EVENT: 11/27/14 Run 4 the Pies (4 mile Thanksgiving Day Race) INSURED
CLIJB/EVENT ME2�ER: Palm Beach Roadrunners, attn: Dianne Lavado; 401 N Flagler Drive, West Palm Beach,
EZ 33410
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIE� BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
11/27/14 Village of Tequesta
Attn : Special Events qUTHORIZED REPRESENTAl1VE
345 Tequesta Drive
Tequesta, FL 33469
John Lefever/JWE
ACORD 25 (2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025 r�mnn�i m Thn A(_[1R�1 namo �nrl Innn ��o �enic4urnei m��4c nf Af`(1RIl
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14 Annual Run 4 the Pies Race Course
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Start near Constitution Park gate on Dover Rd.
Right on Tequesta Dr. and over bridge
Through Tequesta Country Club gate and right on Yacht Club Piace
Left on Palmetto Way
Right on Fairview East, around U-turn which switches to Fairview West
Right onto EI Portal
Right onto Golfview Drive
Left onto Golf Place
Left onto River Drive
Veer right onto Point Circle and back on River Drive
Left on EI Portal to Tequesta Country Club gate
Straight onto Tequesta Drive and over bridge
Left onto Dover Rd. to the start/finish area.
Contact: Bob Anderson, Race Director -(561J 313-6099 - bob@palmbeachmarathontraining.com