HomeMy WebLinkAboutDocumentation_Regular_Tab 07_02/12/2015 Print Form
� VILLAGE CLERK'S OFFICE '"�'�,
AGENDA ITEM ROUTING SHEET .�' ,i
Meeting Date: Meeting Type: Regular Ordinance #:
Feb 12, 2015 Consent Agenda: No Resolution #:
Originating Department: Community Development
� � • • • • - C - • • -�•
SE 03-15
Special event permit application for an informational and fund raising event at Hannah's Home of South Florida
located at 4390 County Line Road in Tequesta, Florida. The event is planned to take place on Saturday,
February 21, 2015 from 5-8pm.
, . .
Account #: Amount of this item:
Budgeted amount available: Amount remaining after item:
Budget transfer required: No Appropriate Fund Balance:
• •- .• . .- • . . ..- ..
SE 03-15 is a special event permit application for an informational and fund raising event at Hannah's Home of
South Florida located at 4390 County Line Road in Tequesta, Florida. The event is planned to take place on
Saturday, February 21, 2015 from 5-8pm. There will be one tent on the grounds of the property. The projected
number of attendees is 200 people. No alcohol will be served. Per 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
Police Chief, and the Village Manager, may approve the application, deny the application in whole or in part; or
approve the application with conditions".
-•
Department Head �7' �
'� tX/r'.�..� z,, � -
Legal (for legal sufficiency) �- �
Finance Director or Representative
Reviewed for Financial Sufficiency
No Financial Impact �
Village Manager:
__ _�. __ ___
1 .�-.°- -- -
Submit for Council Discussion: �' ..
Approve Item: �
Deny Item: 0
� • • ' • • . • — — — Ko��C-'(o.� �q( �.�:_�� � • � 4�K�'�1�7�K��
•— • •• — • • —• . • • . — • — • — _�� _
Form Amended: 10/30/14
VILLAGE OF TEQUESTA � �
PERMIT NO: , � r�-� ' I.
COMMUNITY DEVELOPMENT DEPARTMENT Submittal �ate: j-(,'?.—� ;
�. `'� � 345 Tequesta Dr. Deposit Amount:
Tequesta, Florida 33469
(561) 768-0450 Fax (561) 768-0698
SPECIAL EVENT PERMIT APPLICATION
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. 78-561. 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.
"Special Event" is any outdoor activity, gathering or group of persons, vehicles or both, organized and having a common
purpose, upon public or private 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, and 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 must be submitted to the Village Community Development Department at least forty five (45) days prior to the
date for which the special event is proposed; which application shall contain the following information:
l �
DATE OF SALE/EVENT: ��2��'���-�-L/ , /"�I'?l���l�u �S/' �I , .�L� � �HOURS: FROM: � . i�1'1� TO: � ;1�� � i'�
� � �
TYPE OF EVENT: � v� � n�v�i.:'� �� i; �1, c'..�,�� - w��C. r�cti �), P< <' � s i �..� �} •.�'�;1 �
I � � �
�`'� L' i/�:.t _°✓'� � S I'' ��e- t'1{ �i:�T" �t. ��C` ("d C� i,
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LOCATION OF EVENT: `� � r � � S L c?!���t'T - b �r�h (� I�t�� , ��'�; �t C 4: �t`° _} `> �� �/
.�- -
PROPERTY OWNER: � J b1d� ���� SC� t� (Attach written consent of property owner of record.)
Print Name
CONTACT INFORMATION
SPONSOR or PERSON(S) RESPONSIBLE FOR EVENT: ��`' f�� f i�� C �� X'e `- �•s-T� �^C �•� i F�e.0 �cJ �"
EMAIL: � 4` � {� �(cJ �i.(,il�htf.� S Yt 0Y+'� t S�.
MAILING ADDRESS: �� `/ U ��� L���K �'� I u►� � I"��>( PHONE NO.: �')(i.: I Z��- f �U �� a y
I� At.t.t'�".,�c F( �.i�/� % FAXNO.: '�C� �-7� -` �l��k� ,
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PROJECTED NUMBER OF ATTENDEES: �'# i- COUNCIL APPROVAL REQUIRED: (��' YES (�}NO
• 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 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 (�)NO
• 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 be consumed 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 1 of 2
/
• By �ubmitting 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 suffered by any
person directly or indirectly related to the consumption of alcoholic beverages in conjunction with the special event.
• NON ENTERPRISES:
• The Village may issue non-profit permits to any person or organization for the conduct or operation of occasional sales
and/or fundraising projects held 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.
THE FOLLOWING ITEMS ARE REQUIRED TO BE SUBMITTED AT TIME OF APPLICATION:
• Proof of insurance in amounts acceptable to the Village for the type of event. The Village shall be named as an additional
insured on all liability insurance.
• 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.
• Site Plan required with each application accompanied with drawing indicating layout for event.
• 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 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.
� �i� � /
SIGNATURE OF APPUCANT: � i`� � � ��(����� � bCd��- � �) ('-��� � �-����,� ' DATE: � �' � � — (
Print Name Signature
***********************************************************************************************
RECOMMEND FOR APPROVA ; �
POLICE CHIEF: -- t DATE:
o� ��' is
FIRE CHIEF: � DATE: ! w��
PARKS/REC � N: � � DATE:
COMMUNITY DEV. DIRECTOR: r �"-t�-���t� DATE:
_._ __ ..—._____�
APPROVED BY:
� �
VILLAGE MANAGER: DATE: / /� � j
Page 2 of 2
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� .,; � � �1390 S. County I.,ine Rd
' �/ Tequesta, I��l 33469
� � i-tNl�l�f\l-1� (561)277-9823
� O M � (56 l) 277-9826 f'ax
�ol SoUr�t ►IOR���n www.hannahshomesf.org
Information about event for Hannah's Home of South Floricla on 2/21/15
Hannah's Home of South Florida is a non-profit organization in the Village of Tequesta
that is applying for a permit to hold a special informational and fundraising event for 200
guests on Hannah's Home property at 4390 Countyline Road, Tequesta. This event will
take place on February 21, 2015 from 5:00 p.m. to 8:00 p.m. This will be a tented event
and Hannah's Home will provide special lighting along its driveway and walkways.
Hannah's Home will also provide police assistance for traffic direction.
Hannah's Home of South Florida, Inc. is a 501 (c) (3) not for profit corporation.
A COPY OF THE OFFICIAL REGISTRATION (CH30205) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE
DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE (800)435-7352. REGISTRATION DOES
NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE
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DATE (MMIDD/YYYY)
'`�� °� CERTIFICATE OF LIABILITY INSURANCE
12�8�2014
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 certiflcate holder 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 CONTACT
Seitlia, A Marah&MeLennan Agency LLC Co. PHONE FAX
9850 NW 41at Street Ex: (305) 591-0090 A/C No:(786) 662-6227
Suite 100 E-MAIL
Miami FL 33178 ADDRESS:
INSURER 3 AFFORDING COVERAGE NAIC #
INSURERA:Philadel hia lnBUranCe COm dn 18058
INSURED (561) 827 �NSURERB:
Hannah�s Home of South Florida Inc.
INSURER C :
P. 0. BOx 4512 INSURERD:
Teqttesta FL 33469 INSURERE:
INSURER F :
COVERAGES CERTIFICATE NUMBER: Cert tn 47181 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 7YPE OF INSURANCE ADDL SUBR pOLICY NUMBER MM/LDIDY EFF MM/DD EXP LIMITS
LTR
A X COMMERCWL GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000
CLAIMS-MADE �% OCCUR PHPK1260870 11/15/2014 11/15/2015 pREMSES Eaox $ 100,000
MED EXP (Any one person) $ 5, 000
PERSONAL&ADVINJURY $ 1,000,000
GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000
X POLICY ❑ PR � � LOC PRODUCTS-COMP/OPAGG $ 2,000,000
JECT
O7HER: �
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANYAUTO BODILYINJURY(Perperson) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCE33 LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY Y � N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED7 ❑ N!A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
S
S
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached if more space ts required)
Certificate Hoider as Mortgagee, is an Additional Inaured as reapects to General Liability, subject
to the terms, conditions, and excluaions 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
The Northern Trust Company I3AOA ACCORDANCE WITH THE POLICY PROVISIONS.
P O BOx 7060 AUT� REPRESENTATIVE
r=oy nsi 48007-7060
O 1988-2013 ACORD CORPORATION. All rights reserved.
ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD
�� 4390 S. County Line Rd
,� Teq�iesta, FI 33469
- ( V � HA�NAH'�� (561)277-9823
t L_j O M � (561)277-9826 fax
� 11 www.hannahshomesEorg
:/� ' ,," `� 1 CORtDA
December 31, 2014
Village of Tequesta
345 Tequesta Dr., Tequesta, FL 33469-0273
RE: Hannah's Home of South Florida, Property Owner Authorization
To Whom it may Concern:
Pursuant to the guidelines for submitting a request for special events in the Village of
Tequesta, I represent that the property located at 4390 County Line Road, Tequesta,
Florida is owned by the Board of Directors. As Chairman of the Board, I do hereby
authorize the use of the property for the special event scheduled on February 21, 2015.
Written communication can be sent to my address at:
Mr. jon Olson
221 Colony Way W.
Jupiter Florida, 33458
Email: jon@peacockandlewis.com
Please contact me should there be any questions,
Sincerely, / �
�
; �';; _.----�.--�
- ; --
jon'�D. Olson
Cha�;rman of the Board
�, File :'
,���,''
Hannah's Home of South Florida, Inc. is a 501 (c) (3) not for profit corporation.
A COPY OF THE OFFICIAL REGISTRATION (CH30205) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE
DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE (800)435-7352. REGISTRATION DOES
NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE
Affidavit
State of Floridc�
Palm beach County �
I, Jon Olson residing at 22.1 Colon� Way W. Jupiter Florida do herby represent that the entity
operating as Hannah's Home of Sout�i Florida is a"n.ot for profit" organization. Hannah's
Home of Soutli Florida is recognized by The S�tate of Floridc� zvitli a certificate # of 85-
8014764895G5
on Olson December 31,2014
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Chc�irnz�c�n of tlle Boc�rd
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Notc�ry Public
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On �� � / before me, �.,/C� ��lYIG�IC� ��S�i
personally appeared zvho proved to me on the basis of satisfactory evidence to be the person(s)
zvhose name(s) is/are subscribed to the zoithin �instrun�ent and acicnozvledged to me that J�e
e�ecuted tl2e same in his authorized capacift� and tlic�t by liis signa�ture(s) on the instrument tlie
person(s), or the entit�� upon behalf of zvltiich the perso�r(s) acted, executed tlze instrument
WITNESS my hand and official seal.
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% �' — / a +o+�"" "�� ANTHONV SANTELU
�/ � . .: Notary Public - State ol Florida
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00000�5 03/06/1•f
Consumer's Certificate of Exemption R 04M1
, l % Issued Pursuant to Chapter 212, Florida Statutes
DEPARTMENT .: -- � _
OFREVENUE -
85-8014764895C-5 06/30/2014 06/30/2019 501(C)(3);:QRGaN17.AT1QN
Certificate Number Effective Date Expiration Date . --_=E,�c�lr►jiti6� Cat�gory: .,�
This certifies that
HANNAHS HOME OF SOUTH FLORIDA INC � "� � �`.�. � � °' �- �' "' r•� _-'� ��1 '� ' .
4390 COUNTY LINE RD ,� '�''�' � • - - �`.��-':
TEQUESTA FL 33469-2174 ' ' '';';''`' - � . _- , `�` `. �
,� .
Q ,.>,;<:-
' . ' _ 'k.'. , :t.� �
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is exempt from the payment of Florida sales and use tax on real property rented, transient rental� property' "rerited, tangible
personal property purchased or rented, or services purchased.
Important Information for Exempt Organizations R 04N1
►f �
DEPARTMENT
OF REVENUE
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 wili 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, sieeping accommodations, or other real property is taxabie. Your organization must register,
and coliect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this
_ _ reguirement except when they are the lessor of real property {Rule 12A-1.070, FA.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 regarding your exemption certificate, please contact the Exemption Unit of Account
Management at 800-352-3671. From the available options, select "Registration of Taxes," then "Registration
Information," and finally "Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480,
Tallahassee, FL 32314-6480.
HANNAWS HOME OF SOUTH FLORIDA INC .
4390 COUNTY UNE RD
TEQt1ESTA FL 33469-2174
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