HomeMy WebLinkAboutDocumentation_Regular_18_04/13/2017 'pE " -- Tfc VILLAGE OF TEQUESTA ) (W UV
. y a " t C OMMUNITY DEVELOPMENT DEPARTMENT PERMIT NO: e: �' "� �� U U
Submittal Da te: -�` 1/
ii • ) 345TequestaDr. Deposit Amo unt: ( !,T
t �, ? Tequesta, Florida 33469
° e 9� •N s;:� (561) 768 0450 Fax (561) 768 0698 VILLAGE. 0;" i::`i.; +_: .• TE Q U ESTA
SPECIAL EVENT PERMIT APPLICATION . .1'..; I) ;> ?01i MAR 7 2017
Any Village resident, or any Village business holding a current Village business tax receipt, pursuant to, Chapter Nltei
to apply for and obtain a special event permit pursuant to Sec. 78 -561. Any such resident or business that desires to coif c
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. 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 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:
IL DATE OF SALE /EVENT: �` - k- ..\\ -, �\ \-e HOURS: FROM: Th , %u M TO: \. '»
TYPE OF EVENT: ' „- �\ 2 t -7\\„ A A \ \ice Qt 't- \• w \4 t., -
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LOCATION OF EVE NT: "�qo 2= 1� r �.c a... c,� Cc ... „,� �c ,,..1,....,..1,...., ts..e
PROPERTY OWNER: V , - \\ ,p, A , > . - 7 a- iii_.. ... 4 (Attach written consent of property owner of record.)
Print Name
CONTACT INFORMATION:
SPONSOR or PERSON(S) RESPONSIBLE FOR EVENT` �„ \, (�—, ,,.._,,,._,
�'1� ,.__.-7.__ EMAIL:
'\ \ � S "i < Q.c NL--1/4. 1t\IVD,2 +Y' k o ,.. .. ¢ a , . -, t. q
MAILING ADDRES�>: 7i, '?-, v, \c. \ PHONE NO.: 1 5 , \ --,1 U.1
,...7, ., c. \.; - RDG w;..\ - \ �ti ' - o \ FAX NO.:
PROJECTED NUMBER OF ATTENDEES: ■ •, COUNCIL APPROVAL REQUIRED: ( 7) ( )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 1of2 �o/ci��_ �w \. ^b��c,�eM ra_s c.�v�
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• 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 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 - 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 operAt @th@IFrten4100flt- erfterprise
in compliance with this section and all other rules and regulations of the Village.
i 1
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!bg!narned:asan
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 dean 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 eac h 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 APPUCANT et" r. Q.,o45.«..sw. DATE: -t \ii l\ - 1
Print Name Signature
RECOMMEND FOR APPROVAL:
COMMUNITY DEV. DIRECTOR: DATE: 3/y/7
BUILDING DIRE OR: DATE: -4732.
POLICE CHIE : • DATE: 3 / 7 / z "/
7
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FIRE CHIEF: ' U kik
' DATE: •
PARKS / , • d N: � ar DATE: 5 151
-
i
APPROVED BY:
VILLAGE MANAGER: DATE: 0 ~ r
Approval /Review Notes:
Page 2 of 2
t<
VILLAGE OF TEQUESTA
BUILDING DEPARTMENT
345 Tequesta Dr.
ti ; ` Tequesta, Florida 33469 -0273
s i + (561) 768 -0450 FAX (561) 768 -0696
INVOICE
March 02, 2017
Permit #: SEP17 000002
Address:
Sponsor: BOB ANDERSON
Property Owner:
FEES:
Description Total Cost
Over 200 Attendees 100.00
(P
Total Permit Amount: 100.00
Total Amount Paid: 0.00
Remaining Balance: 100.00
Maureen McGuinniss
* * *fir
kilit 2017 SPONSORSHIP LEVELS
• RUN 4 FREEDOM I TEQUESTA, FL I JULY 4T" 2017
'FREEEciV1 Benefiting Lyette Reback's 501(c)3 organization
B elieve With Me to support Gold Star Families
T 7Zua 11 ' * o � `° �hvp�ona 2f - �� , n�� 3 "' ABOUT THE RACE AND THE BENEFICIARY
EQUESTA. FL ILLY 4 m 2017
* * * l'II_l_tG OFTIEOLJE3TA run4freedom.pbrace.com
To Our Community,
We are reaching out to you to ask for donations and support for the inaugural Run 4 Freedom which will
take place on July 4th, 2017 at 7:15AM in Tequesta, FL. Proceeds from the race will benefit Lyette Reback's
501(c)3 organization Believe With Me.
Run 4 Freedom will be a family friendly event that includes a race distance for all ages: the Run 4 Freedom
4 -mile race for youth, adults, and senior sneakers on a scenic course through Tequesta; the Firecracker
Mile for children 8 -12; and the Cupcake Dash for 7 and under. After the race there will be food, music, local
vendors, and other activities in Constitution Park for everyone to enjoy.
Believe With Me is a 501(c)3 nonprofit charitable organization dedicated to support American Gold Star
Families, those whose loved ones died in service to their country. The project list is extensive: An American
Gold Star Christmas - where the organization gives Christmas gifts to the orphans of our war on terror,
An American Sweetheart- where volunteers craft Valentine's Day bouquets for the widows of our nation's
military. And then there's The House That Love Built, where the organization renovates the home of a Gold
Star family in an extreme make -over style. Believe With Me also generously helps Gold Star Families
needing financial assistance through their darkest times and meets as many needs as possible.
In order to make this a success and to raise funds for Believe With Me, we are reaching out to our
community to ask if you will become a sponsor for the Run 4 Freedom. No donation is too small. Your
donation will be recognized at the event in several ways that have been mapped out in the sponsorship
menu.
We are grateful for any support and greatly appreciate your consideration.
Sincerely,
Believe (With. Tie
a 501(c)3
organization
CUED SfAII FAMIUIs'S
Bob Anderson those whose loved ones died
Race Director in service to their country
bob @palmbeachmarathontraining.com 1 561 313 6099
PALMBEACH
Palm Beach Marathon Training MARATHON
PO Box 1073 TRAINING.COM
PACE MANAGEMENT SERVICES
West Palm Beach, FL 33401
ABOUT THE RACE: run4freedom.pbrace.com
Believe With Me is a non - profit 501(C)3 organization. Race Management Services by Palm Beach Marathon Training
• :: ._.. _ ;s-"' ? 'u£a i'Fs;u. is sa,....a_ a., ' s r+t.:.._ I ,11 • _ _ __ .. _ _ .1 7
V
INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY
• 1 P. O. BOX 2508
CINCINNATI, OH 45201
Employer Identification Number:
Date: NOV 0 3 2015 47 3192165
•
DLN:
17053280337045
BELIEVE WITH ME INC Contact Person:
11420 US HWY 1 PMB 122 JASON T SAMMONS ID# 31616
NORTH PALM BEACH, FL 33408 Contact Telephone Number:
(877) 829 -5500
Accounting Period Ending:
December 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990/990 -EZ /990 -N Required:
Yes
Effective Date of Exemption:
February 20, 2015
_ Contribution Deductibility: v'I ='=
Yes
Addendum Applies:
No
•
Dear Applicant:
We're pleased to tell you we determined you're exempt from federal income tax
under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct
contributions they make to you under IRC Section 170. You're also qualified
to receive tax deductible bequests, devises, transfers or gifts under
Section 2055, 2106, or 2522. This letter could help resolve questions on your
exempt status. Please keep it for your records.
Organizations exempt under IRC Section 501(c)(3) are further classified as
either public charities or private foundations. We determined you're a public
charity under the IRC Section listed at the top of this letter.
If we indicated at the top of this letter that required to file Form
990/990 -EZ /990 -N, our records show you're required to file an annual
information return (Form 990 or Form 990 -BZ) or electronic notice (Form 990 -N,
the e- Postcard). If you don't file a required return or notice for three
consecutive years, your exempt status will be automatically revoked.
If we indicated at the top of this letter that an addendum applies, the
enclosed addendum is an integral part of this letter.
For important information about your responsibilities as a tax - exempt
organization, go to www.irs.gov /charities. Enter "4221 -PC" in the search bar
to view Publication 4221 -PC, Compliance Guide for 501(c)(3) Public Charities,
which describes your recordkeeping, reporting, and disclosure requirements.
Letter 947
-2-
BELIEVE WITH ME INC
Sincerely,
•
A /
Jef y I. Cooper -
Director, Exempt Organizations
Rulings and Agreements
_ _ _ • _ . . .
Letter 947
* * * ** lik
7ua;, COURSE MAP
/FREEDOM RUN 4 FREEDOM I TEQUESTA, FL I JULY 4TH 2017
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� ..: : ;c5) rr Tequesta c
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Na
• 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 El 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 El Portal to Tequesta Country Club gate
Straight onto Tequesta Drive and over bridge
Left onto Dover Rd. to the start /finish area. 0 PALMBEACH
MARATHON
Distance: miles TRAINING.COM
RACE MANAGEMENT SERVICES
Race Director: Bob Anderson
bob @palmbeachmarathontraining.com
561 313 6099
PRINT DATE: i 3/2P2017
CERTIFICATE OF INSURANCE
CERTIFICATE NUMBER: 20170301503633
AGENCY:
ESIX, a division of Integro USA Inc. yi' ,; ,.:'; •, ,';;''; fr'. : THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
I
d/b/a Integro Insurance Br CONFERS NO RIG HTS UPON THE CERTF FIOL THIS C ERTI F ICA TE DOES
2727 Paces Ferry Road, Building Two Slate 1500 : NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
Atlanta, A 30339 , . (f . BELOW.
678- 324 -3300 (Phone), 678-324-3303 (Fax)
NAMED MSURED: [ , i :INSURERS AFFORDING COVERAGE: • USA Track 8 Field, Inc. Palm Beech Marathon Trolnin INSURER A: Philadelphia Indemnity Ins. Co. NAIC #:1 8058
132 East Washington Street, Suite 800
Indianapolis IN 48204 INSURER B: Philadelphia Indemnity Ina. Co. NNC #: 18068
•
' EVENT INFORMATION:
:Run 4 Freedom (7/4/2017 - 7/5/2017)
POUCY/COVERAGE INFORMATION:
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 TIE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE ;
' UMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS.
' INS TYPE OF INSURANCE: I POLICY NUMBER(8): I EFFECTIVE: j EXPIRES: : UMITS: f
A !GENERAL LIABILITY i
X Occurrence PFiPK15t�818 1 1 1/1/2016 11/112017 GENERAL AGGREGATE (Applies Per Event) $3,000,000 I
.. 12:01 AM 12:01 AM ....
: X Participant Legal Liability � EACH OCCURRENCE $1,000,000
1 ! DAMAGE TO RENTED PREMISES (Each Occ.) $1,000,000
MEDICAL EXPENSE (Any one person) EXCLUDED
PERSONAL 3 ADV INJURY $1,000,000
• .
i PRODUCTS- COMP/OP AGG $3.000,000
i B ' UMBRELLA/EXCESS LIABILITY
X Occurrence PHUB581340 11/1/2016 • 11/1/2017 EACH OCCURRENCE $10,000,000
112:01 AM ;12:01 AM
AGGREGATE (Applies Per Event) $10,000,000
DESCRIPTION OF OPERATIONS /LOCATIONBNEHICLES/EXCLUSIONS ADDED BY ENDORSE/SE
NDORSEMENT/SPECIAL PROVISIONS:
Coverage applies to USA Track & Field sanctioned events and registered practices, Including any directly related activities, such as event set-up and tear -down,
partidpant check-In and award ceremonies.
The certificate holder Is an additional Insured per the following endorsement: Additional Insured - Certificate Holders (Form PI-AM-002)
The General Liability policy is primary and non - contributory with respect to the negligence of the Named Insureds (Form CG 00 01)
The General Lability policy contains a blanket Waiver of Subrogation as required by contract per Waiver of Transfer of Rights of Recovery Against Others (Form CG
24 04).
•
•
Excess pOIICy Idiows form of underlying General Liability,
CERTIFICATE HOLDER: !NOTICE OF CANCELLATION:
Village of Tequesta/ Attn: Special Events ; Should any d the above desabed ponies be cancelled before the expiration date thereof,
345 Tequesta Drive ; notice will be delivered la mom:lan a with the policy provisions.
Tequesta FL 33469 i AUTHORIZED REPRESENTATIVE •
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Ilk 4TH OF JULY AT 7F1SAM 4 110
TEQUESTA. FL
BEAUTIFUL 4 MILE COURSE
litediachei, Aide & Cutzake Vak
FINISHER MEDALS
RED. WHITE AND BLUE
SHIRTS FOR MEN & WOMEN
CERTIFIED COURSE
ACCUCHIP TIMING
AGE GROUP AWARDS
FUN FOR THE ENTIRE FAMILY
FOOD MUSIC SURPRISES
Benefiting Lyeffe Rebacks non - profit organization
Believe With Me dedicated to bringing hope and help to
America's Gold Star Families.
FOR MORE INFORMATION AND TO SIGN UP
RUN4FREEDOM.PBRACE.COM
VILL.AGE: O - 1 ,-,. 1; , :c; i7•
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FREED M ,,
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T EQUESTA, FL 1 JULY 4T "2017
* * *
AllP Ale AL.
FINISHER MEDALS CERTIFIED COURSE
RED. WHITE AND BLUE
SHIRTS FOR MEN & WOMEN
ACCUCHIP TIMING AGE GROUP AWARDS
FUN FOR THE ENTIRE FAMILY
FOOD MUSIC SURPRISES
FOR MORE INFORMATION AND TO SIGN UP
RUN4FREEDOM.PBRACE.COM