HomeMy WebLinkAboutDocumentation_Special Meeting_Tab 01_10/22/2015 .,
' ..� VlELAGE OF TEQUESTA ��T' �/
?ERMIT N0: -�S
�` COMMUNITY DEVELOPMEiVT DEPARTMEfV7 5ubmittal Date:
345Tequesta Dr . DepositAmount:
- Tequesta, �lorida 33469
(561} 768-045d Fax (561) 768-069$
SP�CIAI. EVENT PERiWtIT APPLICATlON
Any Village resident, or any �liage business holding a current Viilage business tax receipt pursuant to Chapier 70, Article II, is eligible
to apply for and ohtain 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 Vi!lage 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 aflowed per address or per
business in any single calendar year.
"5pecial Event" is any outdoor activity, gatherfng or group of persons, vehicles or both, organized and having a common
purpose, upon public or prlvate property, which is likely to inhibit the usual flow of vehicular or pedestrian traffic, which is
likely fio create noise in excess of that typica!{y associated with the areas upon whith the vent is to occur, or which is likely
to preempt or restrict use of property typicafly accessible by the general public. Examples o€ special events inciude, but are
nat limited to biock parties, parades, races or walks, grand opening events, charity fundraisers, and other similar events not
specifically permitted by the Viliage's zonfng ord3nance. Special Events that are sponsored by the village and held on village
property shall be exempt fram the prov(sions of this section.
Wrftten applicatian must be submitted to the Viliage Community Development Department at least forty five (45) days prior to the
da#e for which the specia! event is proposed; which apptication shalf contain the follow(ng information:
DATE Of SALE/EVENT: �.b 3 I�� S_ NQURS: FROM:. � P� T0: I��
TYRE OF EVENT: 1'���-- FES`�lV A�—
LOCATION OF EVENT �t�fi �A1PTf �t �R.K �a'"�'
PROPER'FY OWNER: F I�ST $AP� CHuK-G� {Attach written consent of property owner of record.}
Print iVame
CQNTACT INFORMATION
SPONSOR or AERSON(S) R£SPONSIBLE FOR EVENT; ���� �� 1
EMAIL: �AP�`Cr 24(�2S�-0.S Gkw°C� _ n+Z'[
MAfLING ADDRESS: ��-3 Te��gs�0. �'h,v� PNONE lVO 5�a t'1`fb �4 `F'�� .
�e�k�saa F�- 33�FC�g FAx No.:�S��� - r'�O -�tZ�(o
�
PRpJECTED NUMBER OF ATTENDEES: �n�� �b CQUNClLAPPROVAI REQUIRED: [ )YES �)NO
• Any proppsed spectal event whose attendance is contemplated to exceed 240 people in total shall require final approval by
the ViE(age Gouncil wf�ich, after considering the recommendations of the Corrimunity Devefopment Director, the Pollce
Chief and the Village Manager, may approve the appltcation, deny the applicatian in whole or in part; or approve the
application wit� condltlons,
IS ALCOHDL BEING SEftVED7 ( }YES {x}NQ
• The service oE alcoholic beverages at any special event shall require the issuance of the appropriate state atcoholic
bevera$e perrnit, a copy of which must be provided ta the vfllage in conjunct'son with the special event permit appl3cation.
s The Village may require the use of physical barriers to define and contain the outdoor area within which alcoholic
beverages rriay be consumed and/or the use of security or ofF-duty law enforcement personneE at the special event.
• It is the applicant's responsibility to monitor for and prevent excessfve as well as underage consumption of alcoholic
heverages at all times.
Page 1 of 2
. ' ,
• e submitting a com lete a lication, the a ficant ex ressf a rees that it shall indemni defend and hold the Viifa e
Y p pP pP P Y� fY, g�'':
harmless �rom any and at! damage to any real ar personal property, and from any and all injury or death suffered by any
person directly or indirectly related to the consumption of afcoholic bevera�es in conjunction with the special event.
NON-PROFIT ENTERPRlSES; .
• 7he Village may issue non-profit permi#s to any person or organ3aation for the conduct ar operatlon of occastonaf sales
and/or fundraising projects held by nan enterprises, either regularfy or temporarily, when the appllcant slgns an
affldavit that the applicant operates without private profit, for a clvlc, pabltc, charitable, youth, service, educaiional,
Ilterary, fraiernal, or religious purpose.
o A person making appllcation under thls section must tomply with all.rules and procedures for the granting of special event
permits as set forth in thts sectton. All persons operating under a non-profit permit shall operate their nan-profit enterprise
in compfiance with this section arid alf other rules and regulations of the �Ilage.
THE FQILOWfNG ITEMS ARE REQUIRED TO BE SUBMITTEb AT TIME 0� APPLICATION:
• Proof of insurance in amounts accep#able to the Viilage {or the type ofi event. The Vllage shalt 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 reqaired state and rounty permits if event will be held on or utillze state and/or county-controlled property.
• A refundable depos'st is requEred if the event is hetd on any Village property.
o Site Plan required with each application accompanled 'with drawing indicating layout for event.
a All seie sites s�all be left !n a clean and orderly manner upon completion of sa�e.
� Should the sale/event include the use of one or more tents, a$35.00 Ffre fnspectlon Fee, due at ttme of appltcation, and a
certfficate of flatne resis#ance is reqtaired for eac tent. (nspection to be done an the flrst day of event.
StGNATUREOFAPPLIGANT: !<<��K ����s DATE: !a IJ`�
, Print Name 5ignature
�
RECOMMEND FOR APPROVAL: �!
�
P01tCE CHIEF: DATF: �� � � �S�
�
FtRE CNIEF: DA7E: �I /
PARKS/RECREATI : DA7E:
COMMtJN1TY DE RECTOR: DA7E: D '
APPROVED 8Y
VILLAGE MANAGER: c ,�� DATE: � s'�f 6�
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ACC.?RU CERTIFICATE OF LIABILITY INSURANCE
�,,,,! 6J3D/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORRflAT10N ONLY ANR CONFERS NO RIGHTS UPON THE CERTfFiCATE HOLDER. TFttS
CERTlFlCATE dOES NQT AFFIRMATtVELY OR NEGATNEIY AMEND, EXTEND OR ALTER 7HE COVERAGE AFFORDED BY THE POLlCIES
BELOW. THlS GERTIFICATf OF- INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TNE iSSU1NG INSURER(S), AUTHORIZED
REPRESENTATtVE OR RRODUCHR, AND THE CERTIFICATE HOLLIER. '
IMPOR7ANT: If the certiflcake hoider is an ADD!'fIONAL INSURED fhe poliay{iesj must be endorsed. !f SUBROGATION IS�WAIVED, subJect ta
the terms and canditions of the policy, certain poticks may requfre an endorsement A stafement on th[s certificate does not confer rights to the
certificate fiolder in iieu ot such endorsement s).
PRO�lCER CONTACT
NAM£: $SwArd L Katz
Seitlin, A Marah&MeLennan Agency LLC Co. PNONE FAX
9850 NVP �lst Street t305} 591-0090 ArC No:(76b) 662-6227
Suite l0U E-MAIL
Miami FL 33178
IN5URER S AFFORDIIdC+ COVER!!GE NAiC 0
INSURERA:Philadel hia Znsuranee Com anies
INSUttEp � f561) 746-4447 �NSURERB:
First 8aptiak Church of Tequesta, Inc.
1N5URER C :
P. O. Box 3718 INSURE�tD:
Tequesta 8L 33469 INSURERE:
{NSURER F : �
COVERAGES CERTIFICATE NUMBER: �ert ID 47649 REVISlON NUMBER:
TNtS 1S TQ CERTiFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUGY PERIOD
tNDICATED. NOT1MTFiSTANDWG ANY REQUIREMENT, TERM OR CONpItION OF ANY GQNTRACT OR OTHER DOCUMENT WITH RESPECT TO ViMICH THIS
CERTIFICATE MAY BE fSSUED OR MAY FERTAtN, THE WSURANCE AFFQRGED BY THE POL{GIES �ESCRtBED NEREIN IS SUBJECT TO ALl THE TEitMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLfCIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
WSR TyPE OF INSURANCE ADO POLICY EPF POLJCY EXP LIMITS
L7R PQLICY NUMBER MM/DUtYYYY MRRAD
A X COMMERCiALGENERALUA6tU7Y EACHOCCURRENCE $ 1,000 ,000
ClAIMS-MADE � QCCUR PHPIC1370317 13/13/2014 13/13/2015 R � T E iED� g � 100, 000
MED EXP y one persan) S 5, 000
PERS6NAl bADV INJURY $�1, 000, 000
GEM'IAGGREGATELIMITAPPGESPER: GENERALACGREGATE $ 2,0�0,000
X POItCY � jE a � lOC PRODUCTS- COMPlOP AGG S 2, 000, 000
OTHER: Hired & Non Owned S 1,000,000
AtlTOWOBILE UA6)UTY 1 f COM91Nfi0 S�NGtE 11MiT S
I Ea acciden
ANY AUTO
I BODILY INJURY (Per person) 3
AIIOYVtdED SCHEDULEO BODILYINJUitV(Peraecidenq S
AUTOS AUTOS
HlREOAUTOS NpM1f-OWNED PROPERTYDAMAGE �
AUTOS .
S
A g UMBRELIALIAB X ppCUR PHB8483713 12/13/2014 S2/i3/2015 EAGHOCCURRENCE S 3,OQ0,000
EXCESSLIAB CIAIMS AGGREGATE S 3, 000, 000
OED X RETENTIONS 10,Q00 Pro3ucts S 3,000,000
WOkKERSCOMPEN5A7tON PER OTH-
ANO EPAPLOYERS' LIABIUTY Y � N T ER �._
ANY PROPRIETORIPARTNEWEXECUTtVE ❑ N � A E.l. EACH ACCIDENT $
pFFICERlMEMBER IXCWDED? `
(Mandatary in NH) E.L. DISEASE - EA EMPLOYE 5
It yes descnbeunder
DESCRIPiION OF OPERATIONS below E.L. DlSEASE - POLICY LIMIS 5
DESCR�P7tON OF OPERA7IOWSi LOCA770N3! VEHICLES (ACORD 191, Additionai Remarks Schedule, may be axtached if more space is requiredj
Proof of insurance Only
CERTiFiCATE HOI.DER CANGELLATION
SHOULD ANY OF THE ABOVE DESCRtBED POLICIES BE CANGELLED BEFORE
THE EXPIRATIUN OATE THEREOF, N07'ICE WILI. 6E pELIVEREQ IN
ACCQRDANCE WITH TNE POLlCY PROVISIt3NS.
Huilding Permit Coordinator
and Businesa Tax Official
'ViliBge oi Tequesta AUT� REPRESENTATIVE
345 Requesta Dr,
Teguesta FL 33469
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