HomeMy WebLinkAboutDocumentation_Regular_Tab 13_09/08/2016 VILLAGE OF TEQUESTA �
PERMIT NO: `� � A � � � �
COMMUNITY DEVELOPMENT DEPARTMENT submittal �ate:_ '� "?'"
�- ''' 345Tequesta Dr. aepositAmounr`
Tequesta, Florida 33469
(561) 768-0450 Fax (561) 768-0698 " ,: � ' ;' � �_�;-'<� i�r-� �� �
SPECIAL EVENT PERMIT APPLICATION �} 3 � O1 �
Any Village resident, or any Village business holding a current Village business tax receipf�pursuant to�Chapte���/0, Article II, is eligibie
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 i� 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 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 typical►y 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:
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DATE OF SALE/EVENT: i�l .., �� Z...'`�„ '1._ i��� HOURS: FROM: \�'. v � t�.v� _ T0: \ u s,o (� r�
TYPE OF EVENT: `-� ,�... O Q�-�,� A,�� c p .a- ��'�< <�� < � v o -�. n�_:, ��l .r�., L-a
LOCATION OF EVENT:` g ,�-- �� �.�� �c �- `�� w�- 1-�`� �"�-'� s.-� ` � �
PROPERTY OWNER: ��\.\ A ��� r:.�. ��;-r �n (Attach written consent of property owner of record.)
Print Name
CONTACT INFORMATION
SPONSOR or PERSON(5) RESPON516LE FOR EVEN� � ,2,e.� �-a �'�. � m..���w- -� ° � ��"� �
`�'r.,t�:?�' dE \ n �, � d�-c � v�n t� �_ ^ t � v ..�:TC, J� ��.> , •� �� .
��+t�\�c_z � .�.�o__ :, EMAIL: �� v--.
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MA►LING ADDRESS� v c 2,�� - � .,'��', PNONE NO.: �-, L,L ''��� --��`��_
\ �: , °� �\ �,,.�1�'.i �►. � �e � `�,' �, � 1 'v � FAX NO.:
i PROJECTED NUMBER OF ATTENDEES: 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 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 reai or personai 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-PROFIT 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 FOLL�WING 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 a�d/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.
SPECIAL EVENT FEES:
• Under 200 attendees: $40.00
• Over 200 attendees: $100.00
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5lGNATURE OF APPLICANT• �`r�h� ^ ^ ����s-,��-. � k� � DATE: �-� ��_
Print Name Signature
*�***«******s****�**�.*****�****«ss*f**:*******�*::****s*s***�sx�******.*****��**�*«�**�*:**�*s
RECOMMEND FOR APPROVAL: 1)
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COMMUNITY DEV. DIRECTOR: ` U/� ,�--i.�-L'������� DATE: f�
__ _._._---,
BUILDING DIRECTOR: /�► , ` DATE:
POLICE CHIE . �'U L`�-- � DATE: � �� ��
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FIRECHIEF: DATE: ' ' �.�P
PARKS/RE ON: � � �. ! DATE: � �`� � �F�
APPROVED BY -
VILLAGE MANAGER: �i�' ��� ` ` ��'"^• DATE: j /�
Approval/Review Notes:
Page 2 of 2
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Course Proposal F: http://www.mappedometer.com/?maproute=293975
� Start near Constitution Park gate on Dover Rd.
Right on Tequesta Dr. and over bridge
Through Tequesta Country Club gate and right on Yacht Club Place �
Left on Palmetto Way
Right on Fairview East, around U-turn which switches to Fairview West
Right onto EI Portal
Right onto Golfview Drive
Left onto Golf Place
Left onto River Drive
Veer right onto Point Circle and back on River Drive
Left on EI Portal to Tequesta Country Club gate
Straight onto Tequesta Drive and over bridge
Left onto Dover Rd. to the start/finish area. •
Contact: Bob Anderson, Race Director- (561J 313-6099 - bob@palmbeachmarathontraining.com
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THIS CER7IFICATE !S 135UED AS A MATTER OF INFQRNIATION ONLY ANb CONFERS NO RIGiiTS UPaN THE CERTIFICATE tfQLDER. THFS
GERTIFICATE DQ�3 NOT AFFIRMATIVEtY OR NEGATNELY AMEND, EX'1'END OR ALTER THE COYERAGE AFFORDED BY 'fFiE POLlCIES
BELQW. THFS CERTIFlCATE OF IMSURANCE DQES NOT CUt�]STfTUTE A CONTRACT BETWEEN THE iSSU1NG IN$URE�2(3), AtlTHORIZED
REPRESENTATIYE QR PRODUCER, Al�ID'iHE CERTIFIGATE HQLOER.
IMPQRTANT: ff the certefPcate haider is an ADDITlONAL INSURED, the polFcy{iesj must be er�dorsed. N SUBROGATION 13 WAtVED, subj�ct bo
ti�e terms and conditlans of fhe poifcy, certain policies may require an endorsertierit. A statament on this certfficate does �wt confer rights to ihe
certificata hofder in lieu of such endorseme s.
PRODUC£R N� bLflr�J3t0� M Msyers
STAR insuraace - Fort �Payne BFfica �NE , (260)967-b689 F � �: (2603467
218p East Dupoat Road � _margaret.meyers@starfiaancial.cflm
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Fort Wayne IN 96825 �NSUrtE[tAl�Tational Casualt C 11991
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COVERAGES CERTI�ICATE MUMBER:2016 $iM A. i. REVISlON NUMBER:
THIS IS FO CERTIFY THAT THE POLICIES OF lNSURANCE �ISTEd BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOV� FOR TF1E POUCY PERIOD
INDICATED. NOTWITHS7AhDING ANY REQUiRElNENT, TERM OR CONDITION OF ANY COMTRACT OR OTHER �OCUMENT Wf7H RESPECT TQ WHICH THIS
CERTfFiGATE MAY BE tSSUED OR MAY PERTAW, THE INSURANC� APFORDED BY THE POLICIES DESCRBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS Of SUCH POLIGIES. LfMtTS SHOWN MAY HAVE BEEIV REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POI.ICY NUMBER POLIGY EFF M wLICY EXP LIMITS
X COMMERCIAL GENERAL LUiBILITY
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Participaflt $1,000,000 12:01 aM 12:01 ne! pERSUr�Al.aapvlrvruRY $ 1,000,000
GEN'L AGGREGAFE LIMITAPPCIE3 PER: GEt�RAL A(iGRE6ATE i Osilimited
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($250 Deductible/Claia) 12:oi Paf 12:01 AM ADSSpeoir�c�oss $2,500
DESCRiP'OtQN OF OPERATIONS t LOCATIOIi3 ! YEHICLES {A�RO 1D1. Additional Remarks Sehotlule, may 6o atael�d t/ mae Bpace � raq�tadJ
CERTIFICATS HOLDER IS NI►MED A3 AN ADBITIONAL INSI7RI;A A� R$3P8CT3 TO THEIR INTBREST IN THE O?SRATIONS O�'
TIiE NA�A INS�iRED. DATB pF EVSt3T(3) ; 11/24/i6 Race 4 tha 8ies Thanksgivit�q Day 4 Milc Run
INS[7RED RRCA CLLTS/EVENT D�'�ER: Palm 8each Roadzuaners, Att'n: Dianne I,avado, 2434i Tsvelyt� Drivc, Palm
Beach Qardens, iPi. 334i0
CERTiFICATE HOtOER CAl+10ELLATION
SHOULD ANY OF THE AB�1/E pESCRIBED POLICfES BE CANCELIED BEFORE
}.1/24J16 Village of Tequ�sts THE EXPIRATION DA7E THFRfOf, N07)CE WILI. 8� DELIVERED IM
345 T8c�13@Stsl 1}�7.V4 ACCOR�ANCEWiTH;HEPOLICYPR0VIS10NS.
Tequesta, FL 33469
At1THqRIZED REPRESEIiTAT1VE
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� 1988-2014 ACORD CORPORATtON. All rEghts reserved.
ACORD 25 (201AJ01) The ACORD name and logo are registered marks of ACdRd
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Gansumer's Cerfiificate af Exemption �. o�,,,t,
�l 1! Issued Pursuant to Chapter 212, Fbrida Statufies
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Uf KtVENUE _
� 85-8013958fiQ6C-3 � 12/31i2012 12/31/20i7 5D�(C)(3) �fiGAl*11ZAT10N
Certificate Number 6ffeciive Qate Expiration pate -. _ Exernption Gatec�orY_
7his certifies that � '-
PALtJI BEACM ROADRUNNERS 1lVC = _ _, � -:':-�; . .'.. : - .-; .. . : _ � - . - -
403 N FLAGLER aR • - _ �°.:�,`_', �-. .
�lVEST PALM BEACN Fl. 3340 l -43d5 � -- _ _ - ;
is exempt from the payment of Florida saies and use tax on rea! property rerzted, transient rental piQperry�rented, tangihte
p�rsonat proper#y purchased or rented, or services purchased.
Important Information fior E�cempfi 4rganizations � R�,;;
.,; .
O[PARTIAENT
OF REVEt�lUE
1. You must provide al( venciars and supptiers with an exemption certi�icate before making tax-exempt pur�chases_
See Rute 12A-1.Q38, Florida Administrative Code (F.A.C.).
2. Your Gonsumer's Certificate af Exemption is to be used solely by your organization #or your organixation's
customary nonp►'o�ii activities.
3. Purchases made by an individuaf on behalf of the flrganization are taxable, even ifi the individual wiU be
reimbursed by the arganization.
4. This exernption applies onEy ta purchases your organization makes. The ssle or tease to others oi #angit�le
��ersonai property, sieeping acco►nrr�odations, or other real property is tax�ble. Your organization must register,
ar�d co�le�t and remit sates and use tax on such taxable iransactions. iVote: Churches are exempt from this
requirement excepi_whsn ihey are the iessor of real property (Fiule i2A FA.C.}.
5, It is a criminal offense to fraudulently present th+s certificate to evade the payrnerri of safes tax. iJnder no
c'srcumstances 5houki #his certifiCate be used for the persanai benefit of any inclividual_ liio{atars wifl be tiable for
payment of the sales tax plus a penalty oi 20U9�o of the tax, and may be subjec# to canvictio[� of a fhird-degree
felony. Any violation wilt require #he revocation of this certi#icate_
6. if you have questions regarding your exemptio� certificate, pEease contact the Exemption Unit o# l�ccount
IVlart�gemer►t at 800-352-3671. From the available options, select "Registrattan af Ta�ces," then "Registra#ion
lnfom�atinn," and finaNy "Exernption Certificates and Nanprofit Entities.° The mai{ing addresS is F� Box 648fl,
Tallahassee, �L 323f 4-648Q_