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HomeMy WebLinkAboutDocumentation_Regular_Tab 08_01/12/2017 VILLAGE OF TEQUESTA COMMUNITY DEVELOPMENT DEPARTMENT PERMIT N0� ld Submittal Date: �`� � 345 Tequesta Dr. �epositamount: _ -�Lf�� Tequesta, Florida 33469 (561) 768-0450 Fex (561) 768-0698 VfLlAGE OF'(��i�r;ST SPECIAL EVENT PERMIT APFLICATION DEC 2•- ?Q1F HUI�DING uEF'/�R7M � f'. Any Village resident, or any Village business holding a current Village business tax receipt pursuant to Chapter 70, Art►cle�l, 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 spetiai event within the Village must obtaln a permit from the Village in order that the Viltage may adequately provide for the potential impacts created by the proposed event, A maximum of four (4j such permfts shall be allowed per address or per buslness in any single calendar year. A special event that includes multipie 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 Ilkely to create noise in excess of that rypically associated with the areas upon which the vent is to occur, or which is likely to preempt or restrict use of properry typically accessible by the general public. Examples of special events include, but are not Ilmited to block parties, parades, races o� walks, grand opening events, charity fundraisers, and other similar events not specifically permitted by the �{tage's zoning ordinance. Speclal 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 feast forty five (45) days prior to the date for which the special event is proposed; whlch application shall contain the following information: DATE OF SALE/EV T: �C� e..-�,, �k-> >� �� � HOURS: FROM: , . TO: � t1n �_ TYPE OF EVENT: C�� '�'� � � �l G...lt k or� `� LOCATION OF EVENT, �2 "'e-.S � PROPERTY OWNER: �1 l v (Attach written consent of property owner of record,) Print ame CONTACT INFORMATION: SPONSOR or PERSON(SJ RESPONSIBLE FOR EVENT: vv��� ��'��� EMAII: 5���� � � ��S-�,�Q� - MA�LING ADDRESS: `t� e s��- PHONE NOSIo (�— 3�1-�O7�o� � � � �t�' FAX NO.: '? E�, ^� �-(, .� 770 � PROJECTED NUMBER OF ATTENDEES:� � COUNCIL APPROVAL REQUIRED: � j YES { )NO • Any proposed special event whose attendance is contemplated to exceed 200 peopie in total shall require flnal approva( 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? ( jYES �NO • The service of alcohofic beverages at any special event shall require the issuance o�i 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. • tt is the applicanYs responsibility to monitor for and prevent excesslve as well as underage consumption of alcohollc beverages at all times. Pa e1of2 6 • By submitting a complete application, the applicant expressly agrees that It shall indemnify, defend and hold the Viila�e harmless from any and all damage to any real or personai property, and from any and all injury or death suffered by any person directly or indirectly related to the consumption of aicoholic beverages in conjunction with the special event. NON ENTERPRlSES: • The Village may issue non-profit permits to any person or organization for the conduct or operation of occaslonal 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 compiy 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 shail operate their non-profit enterprise in compliance with this section and ali 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 Ilability insurance. • Expected traffic, �re-rescue, and uiilities 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 applicatlon, and a certificate of flame res(stance is required for e ch tent. Inspection to be done on the first day of event. SPECIAL EVENT fEES: • Under 200 attendees: $40.00 • Over 200 attendees: $100.00 SIGNATURE OF APPLICANT: v� �r �""" n C��� DATE; `, � ltD Print m� (� Signature r"�"'� ��" �s t'f �S W+k#*M�kt#�k�k#�k*�kM�k+k+k##i�t+Y�M�k�k�kk*#��kW�k�Kt�k*�k#+k�Y##I�Wk�k*##M��K�F�k##*#+k�k*t�kM�M+R+kM�k�k�k�k�K�k+k+F+k+k#�M��k RECOMMEND FOR APPROVAL COMMUNITY DEV. DIRECTOR: � ' DATE: IZ�'Z//� DATE: ____ POLICE CHi : � DATE: �a � �6 FIRE CHIEF: ' DATE: ' 7" l� PARKS/ CREATI DATE: APPROVED BY: �� /� � VILLAGE MANAGER: DATE: I � Approval/Review Notes: Page 2 of 2 , . , , . ; ° ., ,;, , . . ; ' - , : ` �ACO � DATE �MMIDO�YYYY) �:, . CERTIFICATE Of LIABILITY 1NSURA[VCE P age l_ o f ?__ 1?�z2�zo __._ . �' ' 1'HIS CERTIFICATE ISISSUED�A3A M%1TTER OFiNFORMATION ONLY AND NO RIGWTS UPON THE CERTIFIGATE MOLDER THI3� � ' CERTIFICATE DOES NOT AFFIRMAT.IVELY..OR NEGATIVELY AMEND;_EXTEND OR ALTER THE COVERAGE AFFORDED ; BY THE POUCIES , ,,. ,,,, .,_.. BELOW. THIS GERTIFICATE OF INSURANCE DOE�IQfO�$���.&ONTRAGT BETWEEN THE ISSUING INSURER(S), AUTHORIZED� � --------REPRESENTATIVE-QR-PRODUGER;AND.THE-CERTIFICATE•MQLDER.- _ _ .,, . ._--�--=. .. _ :. __._. , . _�,. _ . . , - . . � `. , _ . - . , ;, , . ..- .. �, .: �. >. .. - 1MPORT_ANl': If the,certificate tiolder:is an ADDITIONA'l�I��CI�ED,��e��olicy(ies)must lie,endorsed if SUBROGATION IS JNAIVED, sub�ect ta the terms and conditions of•ttie policy, cectain policiestriay, requice.art endorsement. A statement on this certificate does nof,confer rights to the certiflcate,:holder in: lieu of':such°endorsement��iLDfNG.O� ' � -. : . � . . PRODUCER . . ' TAGT ..,. . . ... =`,Willie o.f Ohio.�2nc.: ` PH�ONE ;. _ FAX � . , . c/o -26 Century eixd; ' . - . 877-945-7378 . .' . . 8`66. 217,-7737 P. o: sox 305i9i -��� certificatesewillis.com � Nashville, TN 3723_0-51'91 ' INSORER(S)AFfOR01NGCOVERAGE . NAIC�: . t - , . "' INSURERA; Lexington Inauiaiice Compariy� 19437.=002" 1NSURED . ° � .' - " ' ' - 1NSU � Natio'nal Uaion Fire. Tne.: Co. 'of Pittsburg 19445=001' , (0000003983)'= First Presbyterian Churah of Teques _ 482 Tequee£a.Drive � , , INSURERC: ' Tequesta, FL 33469 . ' , . . :. _ .. , : . � . . � . . � - ' �'INSURERD: �.: __. .' _ � : � .. � � -' .. . . , . . . � ; �. . , _ . _. ; . .. . . . � , .. , . �. ,,. . , . . . �..; � . �. . . :. _ . . .. .. ,.. , � , • ,' `1NSURERE: � ' ' . . . _ _ .. INSURER-Fi • ,- . , . : COVERAGE$ CERTIFICATE NUMBERs 24029342 REVISION NUMBER: : ., ' THIS �S TO CERTIFY THAT THE POLIGIES OF IN$URANCE LISTEQ BELOW HAVE BEEN ISSUED T0 THE�INSURED NAMED ABOVE.FOR THE BOLICY.PERIOD INDICATED: ANY REQUIREMENT, TERM OR CONDITION OF'ANY CONTRACT ORATHER DOCUMENT WITH RESPECT TO WHICH 7HIS '- CERTIFICA7E MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLIGIES DESCRIBED NEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES: IIMITS SHOWN MAY MAVE BEEN REDUCED BY PAID CLAIMS. - , INSR � "' DDL SUB ' . POUCYEFF POLICYEXP - TYPEOFINSURANCE POLICYNUMBER .,.. , .. . LIMIT5 _ _ A �X COMMERCIALGENERAI.LIA8ILITY y 11449743 � 048909'888 l/Y/2016 ;l•/1/2.017 EACH"OCCURRENCE � 3' 2. 000 OOA CLAIMS-MADE❑X OCCUR, ��EMISES�CaocaErenceJ S 500. 000 - - MED.EXP(Anyaneperson) S 10 �000 � �PERSONAL�ADVINJURY� . $� 2 OODi000• - GEN'LAGGREGATEIIMiTAPPLIESPER: GENERALAGGREGATH S 4 OOO�ODO X POLICY � PR �' � LOC � PRODUCTS-COMPlOPAGG. .$� 4� OAO UOO JECT om�: " s _ _' . A AUTOMOBILELWBIUTY Y 11449743 & 048409888 1/1�2016, 1/1/2017 EaaBci�deDSINGLELIMIT' $. 2,000,000 ANYAUTO BODILYINJURY(Perperson) ' S ALLOWNED SCHEOULED AUTOS � AUTQS " � � � � - � BODIIY INJURY(PeraccidenQ � 5 � - . X HIREDAUTOS X A� P $ $ $ UMBRELIALIAB X OCCUR y 3464U86 1%1/2016 �1/1/2017 EACHOCCURRENCE S 5 000 0.00. . X EXCESS LIAB CLAIMS-MA�E. . AGGREGATE S 5 000 � O . DED. � RETENTION$ " $ _ � WORKERSCOMPENSAT�ON ' , �- � ANDEMPLOYERS'LIABIUTY "Y/N � - � ANYPROPRIETOR/PARTNER/EXECUiiVE❑ N �� A E.L.EACHACCIDENT 5 O � ffMesd�escd�eun� E,L.OISEASE-EAEMFLOYEE 3 y er DESCRIPTIONOFOBERATIONStielaw E.L.�DI$EASE: S DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLE5 (ACORD 101, Addito�al Remarks Schedule, may be attached It more space Is requlretl) � Re: The Annual Strawberry Feetival. Pleaea contact you"r Agent for questions regarding your Certificate of Insurance. If you do not know your Ageat's contact inforatation you can call the Insurance•B.oar.d at 800-437-8630. The Village of Tequeata ie:an Additional Ineured with.respecte to.General Liability, Auto Liability, and Umbrella/Excees Liability as required by written contract. CERTIFICATE HOLDER � CANCECLATION SHOULD ANY OF THEABOVE DESCRIBED POLIGIES BE.CANCELLED BEfQRE THE EXPIRATION DATE THEREOF, NOTICE NIILL BE DELIVERED W. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Villaga of Teguesta 345 Tequeata Drive Tequesta, FL 33469 CoT1.:4823172 Tp1:2022306. Cert: 40 934 01988-2014ACORDCORPORATION:Alirightsreserved. ACORD 25 (2014/01) Tfie ACORD name and logo are registered marks of ACOR� , , . . , : . , , ; . ., . , .. ;:.,. ... � . : . . , . . , ... � AGENCY GUSTOMER ID: 7'2 0 9 3. _ .. . _ . , .. _. _ . _ ... _ ._ . .. :._ .:.. , . _ . � ,. .. ___ .., =.LOC#c _ _ _ _ _ _.__ ._ . _ . . ,. / � 1 � , .: , . . . . , :4COR0� ' _ _ ' , �" .. . , - � � - ADDI,TIONAL REMARKS :SCH'EDULE " � pa � : .__�__ _ACiENCY. _ _ _ - - , ,. .. .- - . _ . . .. _ _ , _ _ . . . ... _. � . , '_ .- , . _ . .... ,NAMED IN9URED : . ; � . .. : '_ . . . - - _ .. _ ," (00000039:83) -. First.;Presby;terian� C2�ureh of� Te es". , , , .. :'. ., :,� _ . Will<is of-=Ohio,`" Tnc. � 482' Tequesta Drive' .� ,� `. voucvNUMeER. . .: :, Tequesta,. FL 334.6 :. . . , See FirsE,.Page_ , -, ,. .: - .,. , . .._ ; _ ` . ' CARRIER. _. . ,.: � . . ; .. . . NAIC;CODE ; : • . � , . , , . SH'0 FJ�,Y`St, Pd e . .. EFPECiNEDATE'," g . ,_ - . • . ee First' Pa �e . ADDITIONAC REMARKS - • � - " � J � - � � . . _. . .._ . _ . . THI$,ADDITIQNAL'REMARKS.FORMIS,A"SCHEDULETQAC.QRD.FORM;'+. .:�. � • � . f :�� . . FORM NUMBER. 2 - 5 °��- FORM TITLE: CERT3FICATE -OF LIABILIT:Y INSURANCB, ,. -.. .. . ,. Gerieral Liability�,policy,shall be Pr`imar.y and Non�=ddntributbr� with any a�her insurarice in.force� for .or wYiich. may.be purchased• by :Additional "2nsured when requ�red by wri.tten_ contract,: ,. .� �' � , Umbrella/Sxceas �`Foll:ows Forin . : � , : V ILLAC�j p�. , , , . � . , . rcQ��sra � _ . . ,., . . . .. : . , . � DE� 2 „ ` � - � . , Z01� . . 8U11:b11�G�pEP�iFITP�iFN:7:. 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' 345 Tequesta Dr ' -� ,� ; � . �<# �.�� o e Te ue5ta, Flonda 33469-D273 � . � :..�@ R t� .. ,._�_ — _ — +r—^r . .; � � .� .� �� �t . �. � . � ,� _ , 5C1) 7 8=0450 AX (561)768-0698 �� .. r ., . - . .. _ C P r : _;.. : -:; , . � � , . � ,. - r: tNVOtCE - December 02, 2016: ;� � v � Perm�t{#, �= SEP16 000017 - ., � ' : . : : : .. � k :. �t '. A�ddress - 482 TEQUESTA DRIVE � : � � ._. . . _.�.:,,.. ..., � . , - , ,., � _ - ,. :. �. � � Co:ntractor : PRESBYTERY OF`�TROPICAL: FLORIDA lNC . .. .. - � h - _ t 440 E SAMPLE RD 5TE;208 ` � , : POMPANO BEACH FL - 33Q64 ' s ' � , .: , . � � , , ,. ,. . :t:. � ;, .. : .,, ,.,., � _ _. , . .�, : .._;� �. , : . . . . � � .. . . .� : . .. -, . . T _ ,,._, .:... ....... .. . _- � , . � FEES. :.:_ . `- : ,� � . Description a . Total Cost , . ' ��'�~ _ ` - � � ` . Over200.Attendees": , ,. � . . �.> � . ;�. ; :� , . _ .'� 1Q000 : : . . ' • � . .: " . . . . ... _'. - . :. -. . �,� �.fi � , - . . . . : . . � ' . Total Perrnit Amounf: 100..Q0.: - ,. . � , ` ,'. . ' _. . _ , '�.Total Amounf Paid 0:.00.: , . .. . - . . ' ` _ � � `� � ��Remaining �Balance: 100.Q0: : � Cindy:Morabito � . il � . � .. . � � � - ; . .. . . - - ' ���� � � . � � � . , :� � . - - _ � ������� �� �������