HomeMy WebLinkAboutDocumentation_Regular_Tab 16_10/12/2017 VILLAGE OF TEQUESTA
COMMUNITY DEVELOPMENT DEPARTMENT PERMITNO:�s�� � l60
Submittal Date:
� 345 Tequesta Drive DepositAmount:
Tequesta, Florida 33469 STA
Phone: (561)768-0450 Fax:(561)768-0698
SEP 1 2 2017
SPECIAL EVENT PERMIT APPLICATION
EUILD NG dEPARTMENT
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. A special event that includes multiple addresses,for exampie within a shopping center, shali
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 event 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 waiks,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:
DATE OF SALE/EVENT: V 'C �� I�1 (� HOURS: FROM: •CIJ T0: `"I=�c1Y3�I
TYPE OF EVENT: CYI V h�
LOCATION OF EVENT: O� UV�Y�I�({_�(,�t'�/'�, 'i'/I� Cj-�C,� •
V U
PROPERTY OWNER: (Attach written consent of property owner of record.)
Print Name
CONTACT INFORMATION:
SPONSOR or PERSON(S)RESPONSIBLE FOR EVENT: R— 1c`� � V _15 �L.�'
— EMAIL:I� ' 0'1 . m
MAILING ADDRESS:_l2 S. LJ(� [,�. � � �I�.• PHONE NO.:�5��7���jQ—`lI�Z�
S�IT �1�. ClTU U � y'I O� FAX NO.: �� '`i"!-1 — J�Z.�
PROJECTED NUMBER OF ATTENDEES: �OO COUNCIL APPROVAL REQUIRED:�)YES ( )NO
• Any proposed Special Event whose attendance is contemplated to exceed 200 people in total shail 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
VILLAGE OF TEQUESTA
INDEMNIFICATION:
• By submitting a complete application, the Special Event holder/applicant and property owner(if��f�e�t�eg�sly agree
that they 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 at�Ei@��rp��'t�tion in
any activity in conjunction with the Special Event,including the consumption of alcoholic beverages.
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 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.
'�'EQUES 1'A
SPECIAL EVENT FEES:
• under 20o attendees:$40.00. SEP 1 9 2�j�
�-• Over 200 attendees:$100.00.
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SIGNATURE OF HOLDER/APPUCANT: � � DATE:
Print Name nature
SIGNATURE OF PROPERTY OWNER: DATE:
Print Name Signature
#f#�k#*�k�K*1�*########i#3######i7�#�k##�###i##f#i############►#######�k1�*f##########**#t###�K#i�3##�kt##
RECOMMEND FOR APPROVAL: .
COMMUNITY DEV. DIRECTOR: I V DATE: I ✓ /
BUILDING DIRECTOR: . DATE:
POLICE CHIEF: C DATE: �— L����
FIRE CHIEF: DATE: —���.�
PARKS/REC N: DATE:
APPROVED BY:
VILLAGE MANAGER: DATE:
Approval/Review Notes:
Client#: 12863 RAGNARHOL
ACORD,M CERTIFICATE OF LIABILITY INSURANCE oATE`M��oo�,
8115(2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UP.ON 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 CQNTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
the tertns 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 VILLAGE OF TEQUESTA NAME: Cheryl Phifer
Moreton&Company-Utah PHONE g01 531-1234 ac,N,:801-531-6117
A/C No Ext:
P.O. Box 58139 E-MAIL c hifer moreton.com
Salt Lake City,UT 84158-0139 S E P 1 2 2 017 ADDRESS: P @
INSURER�S)AFPORDING COVERAGE NAIC N
801 531-1234 iNsuRERA:philadelphia lndemnity Insuranc 18058
INSURED u,suReR e:Workers Compensation Fund 10033
Ragnar Holdings,LLC iNsuReR c:Advantage Workers Compensation 40517
Ragnar Events, LLC ir,suReR o:Allmerica Financial Bene�t Ins 41840
12 South 400 West,2nd Floor
INSURER E:
Salt Lake City, UT 84101
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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,
EXCIUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�ra TYPE OF INSURANCE INSRL WVD POLICY NUMBER MMID�DY� MM%DID�
LIMITS
A �( COMMERCIALGENERAILIABILITY x PHPK1622130 3l19/2017 03/19/201 EACHOCCURRENCE 5'I OOO,OOO
CLAIMS-MADE ❑X occuR PREMISES EaEoNccTwEr�ence s 100 000
MED EXP(Any one perwn) S�
PERSONAL 8 ADV INJURY S'I�OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000�000
PRO- PRODUCTS-COMP/OPAGG ;3�000�000
X POLICY JECT LOC
OTHER: S
p AUTOMOBILE LIABILITY x AW4A83493701 2103/2017 02/03/201 Ea aBc1'�deD SINGIE LIMIT s.� 000 000
X ANY AUTO BODILY INJURY(Per person) i
AI 1 OWNED SCHEDULED BODILY INJURY(Par accidenl) f
AUTOS AUTOS
X HREDAUTOS X NON-OWNED pe�accid ntDAMAGE f
AUTOS
S
A �( UMBRELIA LIAB X p�CUR X PHU6575629 3119l2017 03/19/201 EACH OCCURRENCE SrJ 00�Q�0
EXCE55 LIAB CLAIMS-MADE AGGREGATE E�J OOO OOO
DED X RETENTION S�OOOO s
B WORKERSCOMPENSATION 2914549 6�22�2��7 Q6�22/2Q� X SEq T OTH-
AND EMPLOYERS'LIABILITY
C OFFICER/MEMB�REXCLUD D7ECUTNE� N�A 3259669 6/22/2017 06/22l201 E.L.EACHACCIDENT f� OOO�OOO
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 1�,OOO,OOO
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5��OOO,OOO
DESCRIP710N OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Ramarks Schedule,may be attached if more space�s required)
Ragnar South Beach 2017
CERTIFICATE HOLDER CANCELLATION
V1118g0 Of T@qUQSta THE u EXPIRATOIONH DATE VTHER O FE NOTICE'WIBL CBE CDEL VEREDO NE
345 Tequesta Drive ACCORDANCE WITH THE POLICY PROVISIONS.
Jupiter,FL 33469
AUTHORIZED REPRESENTATIVE
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�O 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S957168/M949386 CHEPH
V�LLAGE OF TEQUESTq
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BUILDING DEPARTMFNT
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;•;"r Exchange 15
,;;;�a Hobe Sound Martin County Beach Park
�,.. SE Bridge Rd
C+ �' Hobe Sound,FL 33455
�,��r� 27.066306,-80.116126
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— Head west on SE Bridge Rd toward N Beach
Rd
— Turn left onto SE Shell Ave
� — Turn right onto SE Gleason St
— Turn left onto Florida A1A S
— Turn left onto US-1 N
— Turn left onto S Beach Rd
��" — Turn right onto Captian Artnours Way
— Arrival to Exchange 16 on the left.
Exchange16
Lighthouse Park
Captian Armours Way
1 Jupiter,FL 33469
26.951834,-80.084655
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� E OF�QUES7A
SPECIAL EVENT INFORMATION SEP 12 2D17
RAGNAR RELAY SOUTH BEACH 2O17 BUI�DINGpEpARTM��
Saturday, IVovember 11th to Sunday, November 12cn T
This document will provide information regarding Ragnar Relay South Beach 2017.
Ragnar has over 18 relay races nationwide and works continuously with many cities,
DOTs, businesses, and schools to provide a positive experience for everyone.
It will be a great chance to introduce Ragnar Runners to the beautiful landscapes of
Florida.The 200mi1e course will stretch from Melbourne Beach, FL and to the finish in
South Beach, FL.
We believe in providing a quality event that is safe and fun for participants and all
involved. I look forward to working with you on this year's event.
Please contact me regarding any questions you may have.
Best Regards,
eria Todd Roce Directo�
Ragnar Relay, Ragnar Events LLC
TEL(559) 380.7120 � FAX (801)499.5023
briaC�ragnarrelay.com � www.runragnar.com
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A. Event Description Q��LDfNG DEPARTMENT
Ragnar is the overnight running relay race that makes testing your limits a team sport.
At Ragnar, we strive to make life more awesome. This may sound like a lofty goal, but it
starts very simple. We believe in better health, lasting relationships and an enormous
amount of fun.
Ragnar Relay South Beach is sponsored and managed by Ragnar Events LLC. Ragnar
Events presented its first event, the Ragnar Relay Wasatch Back, in Utah in 2004. To
date, Ragnar Events has presented over 20 events in 10 states(the courses for some
events running through more than one state). The Ragnar Relay Series, now consisting
of over 18 events, is the largest series of overnight relays in the world. For more
information, see www.runragnar.com.
RAGNAR SOUTH BEACH SPECIFIC:
The Ragnar Relay South Beach is a long distance running relay race that will start in
Melbourne Beach, FL on Saturday, November 11th, 2017 and finish in South Beach, FL on
Sunday, November 12th, 2017.
Each team is responsible for providing two support vehicles,with six runners in each
vehicle.The first vehicle will drop off the first runner at the start, and then proceed to
the first exchange point. At the first exchange, the vehicle will drop off the second
runner and pick up the first runner when that runner's leg is complete.Teams will
repeat this pattern for six legs until they hand off to their second vehicle.This
leapfrogging pattern will continue all the way to the finish line.
We anticipate 300 teams to participate in the event. Each team is comprised of 12
individuals and 2 vehicles (there are a few "ultra" teams that only have six(6) individuals
and one van).Therefore, we anticipate 3,510 participants and 585 vehicles to be
involved in the race. During the relay, each team member runs three legs. Relay legs
typically range between 3 -8 miles and vary in difficulty.
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VILLAGE OF TEQUEST,1
SEP 1 2 2017
B. Organization Inforination BUILDING DEPARTMENT
Event Organizer;
Bria Todd Race Director
Ragnar Relay, Ragnar Events LLC
TEL (559) 380.7120 � FAX (801)499.5023
briaC�ragnarrela, .v com � www.runragnar.com
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C. Safety, Emergencies and First Aid
Runner safety is of foremost concern. All teams are provided a Race Bible that includes
a detailed course description and event rules. All runners sign waivers where they
acknowledge that the course includes areas where there may be traffic congestion and
that they must obey race rules, which require observance of all applicable traffic rules
and regulations.
Each team must have at least six reflective vests and two flashlights. These must be
presented at the time that the team checks in. During the designated night time hours,
teams are required to wear their night time safety gear. For example, Runners starting
their legs after 7:00 pm and before 6:15 am must be wearing a reflective vest, tail/butt
light and holding a flashlight or headlamp.Additionally, any team-member spectator
must wear a reflective vest during these hours when outside their vehicle on public
roads. Runners are required to obey all traffic laws and we instruct them to use the
sidewalk when available.
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Runners are also told to call Ragnar for any concerns of problems out on the course.
SEP 1 2 2011
There is a phone number that connects participants to the Race Command of tf��2i�c�EPARrMFN7
For the whole race there will be a Ragnar Race director on the phone to talk to runners.
We have 12-15 Ragnar staff and trained volunteers on the course at all times monitoring
the course. We also have trained medical staff along the course to handle any major
medical emergencies.
D. Volunteers
It is mandatory that each relay team provide three volunteers or they may opt out by
paying$120 per volunteer.That money is then given to our race charities, which in turn
will provide a volunteer.These volunteers are trained on site by Ragnar staff and they
will direct traffic,track the teams, and clean up once the event is over.
E. Insurance
We are sanctioned under USA Track and Field. If you would like a Certificate of Liability
Insurance for$1 Million in coverage, we are happy to provide that upon request. Please
inform us what entity to have listed on that certificate.
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VILLAGE OF TEQUESTq
SEP 1 2 �01]
A���L�ING DEPARTMEN7
Dear Vendor,
IRS regulation requires that we issue 1099 forms to certain companies and
individuals. In order to accurately prepare these forms, IRS requires that we obtain
and maintain form W-9 for all of our vendors.
Therefore, in order fo ensure our reporting accuracy, and processing of future
payments, please complete the enclosed form W-9 and return to us by mail or emai!
t0 �t'(�'�U!i(��)d�c��)�C'�!'��flci�f�,��l_.�_,l�ll',
Thank you for your immediate attention to this matter.
Sincerely,
Darren Otley
Accounting Manager
801-916-8339
Darren@ragnarrelay.com
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