HomeMy WebLinkAboutDocumentation_Regular_Tab 17_10/12/2017 VILLAGE OF TEQUESTA pERM1T N0:
viu.n�e oF re�uEs�40MMUPViTY DEVELOPMENT DEPARTMENT submittal�ate:
345 Tequesta Dr. Deposit Amount:
SEP 2 7 2017 Tequesta, Florida 33469
(561j 768-0450 Fax(561� 768-0698 �
BUILDING DEPARTMENT -
SPECIAL EVENT PERMIT�APPLICATION
Any Vllage resident,or any�Ilage husiness holding a current�Ilage 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. Ariy su�h 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 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 a'r'ea$upon which the vent is to occur,or which is likely
to preempt or restrict use of property typically accessible by the gene`ral'public. Examples of special events include,but are
not limited to block parties,parades,races or walks,grand opening eJeri�;charity fundraisers,and other similar events not
speciflcally 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�Ilage Community Development Department at least forty five(45)days prior to the
date for which the speeial event is proposed;which application shali contain the foliowing information:
DATE OF SALE/EVENT: I D I 3 I ��1 HOURS: FROM: jo•vQ P�'n T0: q �O U 17�'Y�
TYPE OF EVENT: �a�I �25�1��L I
LOCATION OF EVENT: Chkr�� 1—uS �a!�'1=ir� ( �
PROPERTY OWNER: �L�4U��S 1'Ir'S� $�\� t.-►,u�"�-�'` (Attach written consent of property owner of record.)
Print Na e
CONTACT INFORMATION:
SPONSOR or PERSON(SJ RESPONSIBLE FOR EVENT: ��k'E- R��r-�So r1 / ' '�`r�- �a!'�.�5
EMAIL: n�l�rk�fe9u�S�s������-�
MAILING ADDRESS: 4"a3 TF �'���'J� PHONE NO.:�S� 1� 7`�- �F�'�7
�
FAX N0.:�5�� 7�f(,--4�7(0
� PROJECTED NUMBER OF ATTENDEES: �� COUNCILAPPROVAL REQUIRED: (k)YES ( )NO
• Any proposed spec(a!event whose attendance is contemplated to exceed 200 people in total shail Cequire final approval by
the vllage 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 ,
o The sen(ice of alcoholic beverages at any special event shall require the issuance of the appropriate state alcoholic
beverage perrnit,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 personnei 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
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A���� CERTIFICATE OF LIABILITY INSURANCE ���o""�°°"'"Y'
THIS CERTIFICATE IS 133UED AS A IMATTER OF INFORMATION ONLY AND CONFERS NO RIOHTS UPON THE CERTIFiCATE HOLDER.THIS
CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING lNSURER(S), AUTHORIZED
REPRESENTATiVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder ts an ADDITIONAL INSURED,tha policy(les)must have ADDITIONAL INSURED provisions or be endorsed
H SUBRO(iATION 13 WAIVED,subject to the tertns artd conditions of the policy,certatn policies may requlre an endorsement A statement on
this certiffcate does not coMer ri hts to the certiflcate holder in Ileu of such endorsemen s.
pRpp�� CONTA T
Marsh&McLennan Agency LLC �+� .305-591-0090 F^x .212-948-5665
850 N.W.41 st Street
Suite 100 E'""^'� .certsmiami�mma-fl.com
Miami FL 33178 oasu AFFORDINOCOVERAGE r+a�c�
asur�R�:Philadel hia lndemni Insurance Co. 18058
��� FIRSTBAPTI4 n�surt�t e:
First Baptist Church of Tequesta Inc. �sur�ec:
P.O.8ox 3718 NSURER D:
Tequesta FL 33469
UISURER E:
lNSURFR F:
COVERAGES CERTIFICAT NUMBER: 1481848959 REVISIO NUMBER:
THIS IS TO CERTIFY THAT THE POIIClES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDI710N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CER7IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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A X COMMIERCIALGENERALW&LITY PHPK1586894 12H3/2018 12113/2017 EpCHpCCURRENCE t1,000.000
ClA1MS-AAADE �X OCCUR MI E E nce 5300,000
MEDEXP one ) 575.000
PERSONAI&ADV INJURY 51.000,000
GEIJL AGGREGATE LIMfT APPLIES PER: GENERAL AGGREGATE 52,000,000
X POLICY❑�a �LOC PRODUCTS-COMP/OPAGG 52,000,000
OTHER: s
A AUTOMOB�EUABp.ITY PHPK1586894 1?J13l2016 12/13/2017 �� =1,000,000
ANY AUTO BODILY INJURY(Per penon) i
AUT�OS ONLY ��LED �DILY INJURY(PeracddenQ i
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X AUTOS ONLY x AUTOS ONLY Per acGd�t =
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A X UMBR�LALIAB X �� PHUB566171 12H3/2018 1?J13/2017 E,qCHpCC�RRENCE 53,000,000
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DED X RETENTION i 10.000 S
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AND EMPLOYERS'L.IABM.ITY Y/N
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OPFICER/MEMBER EXCLUDED9
(Nandatory in NHj E.L DISEASE-EA EMPLOYE S
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DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT S
DEECRIP710N OF OPERATIONS/LOCATION8!VENICLES�ACORD 101,Addltlanl ibmarks ScMdub,m�y W atfaeMO If mon ap�e�Is nquhotl)
RE: Fall Festival September 21,2017 and Fall Festival October 31st,2017
Certificate holder,es Designated Organization,is an Additional Insured as respects General Liability when required by written contract subject
to the terms,cond�fons and exGusions of the policy.
CERTIFICATE HOIDER CANCELLATION
8HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Villeg@ Of TeqUPSta THE EXPIRATION DATE THEREOF, NOTiCE WILL BE DELIVERED IN
345 T8ques te DfIV@, ACCORDANCE WITN THE POLICY PROVISIONB.
Tequesfa FL 33469
AUTFpWZED R�RESENTATNE
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