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Home My WebLink AboutDocumentation_Regular_Tab 08_01/11/2018 - VILLAGE OF TEQUESTA COMMUNITY DEVELOPMENT DEPARTMENT PERMIT NO: Submittal Date:/l - % - � 345 Tequesta Drive DepositAmount: G'�` Tequesta, Florida 33469 Phone: (561) 768-0450 Fax: (561) 768-0698 SPECIAL EVENT PERMIT APPLICATION 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 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 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 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 Viliage 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: ' % HOURS: FROM:� TO: / / TYPE OF EVENT: C_� tJNiJI LOCATION OF EVENT: �/'� �' �l��C.� �I�it�(`�'S't= PROPERTY OWNER: �( �I / jy,� �-�'� ��C� �( �5 �� (Attach written consent of property owner of record.) Print Name CONTACT INFORMATION: SPONSOR or PERSON�S)RESPONSIBLE FOR EVENT: / �L�GC 1�6� � J?G�P�f'�' ��(,�f/ �,P�'� CC � / 7�� EMAIL: �1�� ; MAILING ADDRESS: Z� � ��- PHONE NO.:S�O � 20 �r r U, � �-�T 8 Fax No.: �� r- �L� � � �+ PROJECTED NUMBER OF ATTENDEES:��O � 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 2018 SPONSORSHIP REQUEST Freedom 4 Miler �Tequesta, FL � July 4th 2018 Believe With Me � A 501(c)3 Non Profit Organization nedicated to gringing �lope and �felp to Ameriea's �old Star �amilies To Our Community and Businesses; Believe With Me is a SO l(c)3 non profit charitable organization that is dedicated to supporting America's Gold Star families. These families, who have lost a loved one in service to our nation's military, are serviced throughout the year through Believe With Me in an extensive project list that includes (but is not limited to): An Amef�ican Gold Stur Clar�istnzus- in 2017 over 600 Gold Star Children who are orphans of the War on Terror were given Christmas gifts sponsored by thousands of grateful Americans. To date we have serviced over 1500 Gold Star family members. An American Sweethea�•t- Hundreds of widows of war are given a Valentine's Day gift. This is a surprise for each widow and many respond saying it is the �rst Valentine's Day gift since the death of their loved one. The House Tliut 1 ove Built- Believe With Me purchases, renovates, and fully furnishes a home for a family of a fallen soldier. Believe With 1VIe also generously supports Gold Star families needing financial assistance through their darkest times to meet as many needs as possible. We are reaching out to you for donations and support towards Believe With Me's f'reeclona F'our Miler which will take place July 4th, 2018 at 7:15AM in Tequesta, FL. All proceeds from the race will benefit Believe With Me's work in meeting the needs of our Gold Star families. The Freedont -1 Miler•will be a family friendly event that includes a 4 mile race distance for all ages through the scenic course ofTequesta's beautiful residential neighborhoods. The I,itcle Ycrtriot's Mile will be for children ages 8-12, and a Tiny Cadets Dash for the 7 and under age group. After the race, there will be food, music, local vendors and other activities in Constitution Park for everyone to enjoy. No donation is too small. Your sponsorship will be recognized at the event in several ways that have been mapped out in the sponsorship menu. We are grateful for your support and truly appreciate your consideration. Sincerely, Lyette Reback Founder, Believe With Me BelteveWithMC.Com�l�efte,�ihelie�e�rilhme c�m�SGI 2i6 2005 Believe With Me 11420 US HWY 1 PMB 122 NPB,FL 33408 EIN#47-3192165 � Believe With Me COURSEMAP FREEDOM 4 MILER �TEQUESTA, FL � JULY 4th 2018 . . ., =t� SPnY�rs. I.�ar6•�i . :l�n.tow • ?.uo.anta�: '. ��,�"; START/FI N ISH :,��:: ,,.,� E,,;;�,.,,., ,. . �,,�:�� . ��:;;, :,_�.�,: ,.� :�,.,�,��, � �.��,�. Fii�:t P:�•�;tiyli��,:n . . � . . a �hurch nf . . . -�•qur;n, � - .. � ' F i�I'.,i��-ii��t•.i�r� . I;i�. I .'. Start near Constitution Park gate on Dover Road Right on Tequesta Drive 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 onto EI Portal to Tequesta Country Club gate Straight onto Tequesta Drive and over bridge Left onto Dover Rd. And to the start/finish area. Distance: 4 miles Believe With Me, a 501(c)3 non profit LyetteC�BelieveWithMe.com Lyette Reback, Founder 561 236 2005 � � ark Tequesta, FL Constitution P ,, 1 1 , � � � _ J 2018 � am staYt July 4th Z.15 . BelieveWithMe.com "Bringing Hope and Help to America's Gold Star Families" Constitution Park 7: 15am start July 4th 2018 ��*�� FREEDOM 4 MILER-LITILE PATRIOT MILE-TINY CADET DASH Red, White and Blue shirts for men and women Beautiful4 mile course Accuchip timing 1'11N ��O�i� '1'H� FN'�'I��F 1�l�lI�II�Y Certified Course �+O011� MIISIC 1�NI) Sllli�l��i�ISFS! Finisher Medals Age group awards , . � � '�l��c'�I Benefihng Lpette Reback s chanty �� • • / . BelieveWithMe.com L "Bringing Hope and Help to America's Gold Star Families" ♦ Believe With Me A 501(c)3 non profit organization EIN#47-3192165 Dedicated to Bringing Hope and Help to America's Gold Star Families To the Fire Department of Tequesta; Believe With Me will be hosting a Freedom 4 Mile race through the scenic neighborhoods of Tequesta on Independence Day 2018. For the safety and security of our competitors and those attending the event, we humbly request the presence of a Fire Department Detail Crew on July 4th, 2018 fi•om 7am to 11�m. Our evcnt will raise fiinds for Believe With Me to continue providing Christmas gifts for children of fallen soldiers, Valentine's Day gifts for the widows of war, Mother's Day events for the mothers of soldiers who have given their lives in service to our nation, and homes for families that due to impossible grief have lost their housing. Our list of aid for our Gold Star families is extensive, and the need for this race to raise funds and awareness is key to moving forward in our agenda. I sincerely thank each of you in the Fire Department for your service to our community, and it would be an honor and a joy to serve our Gold Star families alongside some of our commtmities finest servants. Serving those �vho gave their all, Lyette Reback Founder, Believe With Me Believe�VithMe.com lyette@believewithme.com 561 236 2005 � 6elieve With Me A 501(c)3 non profit organization EIN#47-3192165 Dedicated to �ringing �(ope and Nelp to America's �o(d Star Families 7 o the E��ire 1)cpart�ne�it ofTec��c,sta; {3elie�°c��ith :_l'Ie �vil1 be hostin�; a I�rec�lc►n�� 41'Iilc race dirou�;�h �l�c scet�ic �ic�ig}�borlloc�ds ofTecjuesta on Indeper�c�ence Da�� 201�3. 1�'or the s��f'et.� ��cl sccurity of o�u• cor�:ipetitors ��►�d t:hose a�ttenclir�� Che c��cut�, ��vc }�tu�iil�lv rec��iesl LI�►e l�n•ese�ic� ui'aTi�uc�k �t.ncl l�tcicler witl:t a G�irriso�i sizec� Ha�; li�i.ii�;�iug iiear �li�� luiisl�i linc o>> I�>over I)ri��e. Utu• event �vill raise f'tulds (or T3f�lie��c 11'ii�h ��Ie to contin�ic pro�iding Cl�iristrnas �;it'ts 1'or cl��ilclreii �f tallcn soldiers,Valenti�le's Day �;ift�s for the ��ielo��-s of��var: l'[ot.{�ct•'s Da�� c��cnt.s fi�r tl�c �mo(]�icrs of sol�licrs �v°l�io I�ia��c �;i��cu tl�cir livcs in se«�ice to our nat:ioii, �uZcl l�ionics lor fan�ilies that due to iin��r�ssil�le �;rief'ha�-e lc�st their hotisin�;. Ulu• list of aid for uiu• (�old Star Ia�nilies is e��ensi��, a��cl ll�ie need I=or t:his race Co raise fuiu(s and a��renes5 is kf�� to riioi�in�; for«�arc! in o�.ir agcnda. [ 5i�►ce�relv 1lialik each of�-ou in the �Fire Dep�u•tment toi• your ser�-ice to our comil�i�ni1�, and it �vould be �r� 1i�i�or ��iid a joti� to 5eiti�e our Gold Star families alo�i�;sicie soule of c�ur co�ni�i�inities Guest ser�ar�t.s. 5er�-i�i�; those ��vho ga��e their all, l.�et[e Rf�b�tck T'uiinc(ei; Believ�� \ illi ;��I�. Belie��e«'itli,A�lc•.r�,t1�i l��et t eC«'lielie��e��°i tl�mc:.cc�n� :�61 2i6 2(x)�> Aco� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 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 CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE 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 terms 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 NAME: TOfll M8Y2S,Jr. Mayes Insurance Group PHO�'�E : (561)848-7110 Aic No: (561)840-9650 1233 45th Street, A 1 E•MAIL tma es ma esinsurance rou com ADDRE55: Y � Y 9 P• INSURER S AFFORDINO COVERAGE NAIC# West Palm Beach FL 33407 iNsuRerta: Covington Specialty Insurance Company INSURED INSURER B: Believe With Me,Inc INSURERC: 11420 US HWY 1 PMV122 INSURERD: INSURER E: West Palm Beach FL 33408 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMRS L7R POLICY NUMBER MMIDDIYYYY MMIDD/YYYY X COMMERCIAL GENERAL LIAB�LITY EACH OCCURRENCE $ 'I,OOO,OOO CLAIMS•MADE a OCCUR PREMISES Ea occurrence S �OO,OOO MED EXP(Any one person) S 5,��0 A Y VBA523923 00 03/03/2017 03/03/2018 PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑jE� � LOC �,� PRODUCTS-COMPIOP AGG $ 1,OOO,OOO OTHER: s COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY � a accident g ANY AUTO � � � �� BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE s HIRED AUTOS AUTOS e�accideM S UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y�N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUi1VE ❑ N�A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED7 (MandaWry in NH) E.L.DISEASE-EA EMPLOYE Y If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES�ACORD 101,Addidonal Remarks Schedule,may be attached if more space is required) FREEDOM 4 MILER-7/4/2018 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Tequesta ACCORDANCE WITH THE POLICY PROVI310NS. Attn:Special Events AUTHORIZED REPRESENTATIVE 345 Tequesta Drive ��4/''rN"'� / •,C��,,�.� Tequesta FL 33409 r� '�� O 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD EXT.RECEIPT NUMBER ' - Village of Tequesta 231994 345 Tequesta Drive Tequesta,FL 33469 Ph:(561)768-0700 W — � a,� ... �`" .. .. �z", TEQUESTA VILLAGE OF ' 345 TEQUESTA DR TEQUESTA,FL 33469-3062 _ "sY�:^. _.-.-_ . ..'� t�, �'!�� .SY=a. x. '��' . �.:'i..$4 � T•� ��'�' "+t.6Y4 03591827 I Permit PSEP17-1012 Standard item Special Event-Over 200 people $100.00 .�:---r- - � .� +�:.,s� �-• ,�g: ,�». � _�..�� . .�_ ..;x, < � , �.� �_�' x� �_ t , P$ ,�. :'vux�- 're.l4.�! ��I }�-e�".z'r �;'� �W -"a'� - _ .� �� - , � �A'Y'� � ..r �. � � �'ttS,.,.t�_ . ��.. _; . ^ �„ - ,:«& -' --' . ,.._.... �.....«..�.� 399 SEABROOK RD j� � � Cashl Check $ 100.00 Credit Transferred .r�'+� i"`'s4'A �'�t;:�,e,x �`'�' �, �' �'Ts":A� .Ai i . « . - a..s'-. .,_ Village of Tequesta 345 Tequesta Drive Tequesta, FL 33469 Ph: (561) 768-0700 Fax: Pay by Account In Ewll TEQUESTA VILLAGE OF ��I�I�I�I�II��I� II 395 TEQUESTA DR TOTAL AMOUNT DLJE TEQUESTA, FL 33469-3062 $ 100.00 Pay by Invoice Coda Type Record No. Invoice No. Address Amount Due IIII'I�II'llll�llll�.11�l��"! Permit PSEP17-1012 00000869 399 SEABROOK RD $ 100.00 Effective Date: 11/28/2017 Amount Cost: $100.00 Total Amount Due $ 100. 00 ,, 'k ,: ._...:.-r...�..:.... - _ . . . ......::.:� , �.� - - _ - __ .,:{. - - _. .:...,: . . ... �...k.._._.,�..,...::��._: - - _. _ - _ =-�n� °�$� - -'�'��r- =t,�r�.,;,� _ _ " �.''k: - - _ - ,1? �� _ _ _. 'I^� _ {, ,'�': 'S� _ �'�:'�n•u. �:�� 2:' ��'��: +'FS �k`-Mr... �+• - - - a• .��, b< `r�l �1 � �'r� R��A �.�_. - - - � . .�:'' �:�: ' - - - �_ ,.n.. �:G'�.0� - - - .t:.S. 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