HomeMy WebLinkAboutDocumentation_Regular_Tab 04_09/13/2018 �
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- VILLAGE OF TEQUESTA
- Building Department
MEMORANDUM
TO: Honorable Mayor Abby Brennan and Council Members
CC: Michael R. Couzzo, Jr., Village Manager
`� ��
FROM: Jose Rodriguez, Director, Building Department �J � �/ -
DATE: August 23, 2018 �
SUBJECT: Special Event Permit Application for First Baptis Church of Tequesta, October
31, 2018, Fall Festival Event (�600 Attendees)
This is a Special Event application for an annual Fall Festival event by the First Baptist
Church of Tequesta, Inc., a registered Florida Not-For-Profit Corporation, signed by its
registered agent, Michael Richardson (see attached Special Event Permit Application), to
take place on its premises located at 423 Tequesta Drive. The event is to be held on
Wednesday, October 31, 2018 from 6:00 p.m. - 9:00 p.m. No alcohol will be served. The
projected number of attendees for the event is 600. There will be 23 tents set up at the
event all of which will be flame resistant (see attached Certificate of Flame Resistance). The
event is to be held within the East parking lot of 423 Tequesta Drive, which is purported to
be open, providing adequate means of ingress and egress (see Special Event Form, and
Architect graphic, attached).
The purpose of the event is to provide a "fun safe night of games for all of the Village of
Tequesta residents. Everything is free including hot dogs, soda, popcorn, cotton candy +
snow cones" (see Special Event Form, attached). The applicant, the First Baptist Church of
Tequesta, Inc., has provided proof of General Liability and Umbrella Liability insurance (see
Certificate of Liability Insurance, attached). The fee for the Special Event Application in the
amount of $135.00 (consisting of a $100 fee for the event for over 200 people, and a $35
inspection fee for one or more tents) has been paid by the applicant (see payment receipt
No. 259916, attached).
VILLAGE OF TEQUESTA � �
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT NO: � � , � -1 . y"
? ILLAGE OF TEQUESTF; Submittal Date: i '=�� " � �
345Tequesta Drive DepositAmount:
,�
- Tequesta, Florida 33469
Phone: (561) 768-0450 Fax: (561) 768-0698
$UILDING DEPARTMEN7
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 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: I O� 3 � I I� HOURS: FROM: ��`�`� ��ti� T0: �� ��-'v � ���
TYPE OF EVENT: t'C<< � �"FS �'�<<�
LOCATION OF EVENT: ���lurC �1 ��S� �Ar�� �<� Lu��{�
PROPERTY OWNER: ��urS���s �"�fS't ��Z Q�lS1 C��k�� �� (Attach written consent of property owner of record.)
Print Name
CONTACT INFORMATION:
SPONSOR or PERSON(S) RESPONSIBLE FOR EVENT: r��(�v�k �a �ti�LS ( r}�ikt ���C��n r� So:�
EMAII:�V�tlr��(�' t�yuFS{c,SC'�tu��� .^'e�
MAILING ADDRESS: �� 3 � E� �� t��� �'�'�� PHONE NO.: (5�t I� 7�C '4�{4 7
T�q ��es�c, 4—�. � 3`+l�`I FAXNO.:I °5�,�� 7�tL - 4-�1�L
�.
PROJECTED NUMBER OF ATTENDEES: �'C�C;� COUNCIL APPROVAL REQUIRED: O( )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 (X)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 Viliage 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
INDEMNIFICATION:
• By submitting a complete application, the Special Event holder/applicant and property owner (if different) expressly 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 attendance at or participation 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 Viliage 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�35.0_0�F'� Inspection Fee, due at time of application, and a
certificate of flame resistance is required for each tent. Inspection�o be done on the first day of event.
SPECIAL EVENT FEES:
• Under 200 attendees:$40.00.
• Over 200 attendeesF$100.00.
�_— , �
,
SIGNATURE OF HOLDER/APPLICANT: ���r � J����I ES ���� C���`�;� DATE: ��� ��� �
Print Na e Si�iatu %
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�i�;�.._. , � �.�, '� .� _ � � ' gr ��� ( ��
SIGNATURE OF PROPERTY OWNER: �^�` DATE:
Print Name Signature
*rs.�r:+st***:�:r.as*a.*s:ss..:+.s**.a:....a:..*.:..:.*.�**:ss*«r«.s...*+*.■:..s::rrs:s.:...«r.
RECOMMEND FOR APPROVAL:
COMMUNITY DEV. DIRECTO : DATE: �'����
BUILDING DIRECTOR: DATE:
POLICE CHIEF: DATE: j"�/ I 'i Y
FIRE CHIEF: r DATE: � ' L Z � L�
PARKS/RECR DATE: �� �
APPROVED BY: V ��LAG E M�NA y��f�
VILLAGE MANAGER: DATE:
Approval/Review Notes:
Village of Tequesta
;,� .
PUBLIC SAFr+:TY
,:-r:
�ecial Event Form
Date of Request: _� � 3 � �
Fire Dept. Contact: Police Dept. Contact:
Contact Person(s): ���e �Z'c.�n�."�so,} )"lLAv'� �a v�1�S
TelePhone Number(s}: � 5l0) �`�� --u�"7
Location of Event: ���5�-��P�is•� C.�urclt d� T�eq�,��.�-n �ask �a�k�a� �f
Expected Number of Attendees: ���
I�lumber of Tents at event: a3 Will Tents Contain Sides (must include flame
resistance certifieation a�id $35 fee per tent}�yes � no
EMS Services Provided (does not have to be VOT EMS Services can he privately
contr�cted):
Yes: No: � EMS Service Provider;
Police Detail Request: �S _ (see attached}
Brief Summary of Event: (can be typed or written wiCh/out an attach ent)
�ln.P Sa.4--e N�' �"t 0 �t- cLv�..e S �cY 0.��1 '��1E �(i��QoQ o � T�2. L�.2�
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Sac�a �t-bY�Ccrr� Cc'}��,-� c�i,��y '� �r�o�,-� co��eS,
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Provide information (site plan, writtet� description etc.} regarding ingress and
egress: t� L � ( l 1 � �
s�'t� �a•, �� h �ar�e. r-2 S�S�a.�c2 CeY`ltkcc����`D� c;..'C-tcc��Q.d �
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ACOR�� CERTIFICATE OF LIABILITY INSURANCE
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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 have ADDITIONAL INSURED provisions or 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 hoider in lieu of such endorsement�s).
CONTACT
PRODUCER NAME:
Marsh & McLennan Agency LLC PHor,e Fnx --
9850 N.W. 41 st Street ��rc,No.extl; 305-591-0090 �ac rqo1 212-948-5665
Suite 100 nooR�ess: certsmiami@mma-Fl.com
M18flll FL 33�7H . ___ INSURER(Sf AFFORDINGCOVERAGE �_ NAICp
_..——._ ._ . .___..._-------
insuReR n:Phdadelphia lndemrnty Insurance Co. i 18058
__._ _ . .._.._.. ..—_._._ . FIRSTBAPTI4. __ - __. _. . _ _ _ .__
INSURED
INSURER 8:
First Baptist Church of Tequesta Inc. -
P. O. Box 3718 INSURER C:
—- _ --- ---
Tequesta FL 33469 INSURER D !
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1658011630 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE�OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NO1lMTHSTANDING 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 POLIGES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
---- _- ____ ___ _ . - ---- -
INSR - AD�L.SUBR -- POLICY EFF POLICY EXP �
�TR� TVPE OF INSURANCE POLICY NUMBER MMIDD/YYri I MMIDDIYYYY '�, LIMITS
A � X COMMERCIALGENERALLIABILITY �� '��. � PHPK1752014 12/13/2017 �I 12/1320tB EACHOCCURRENCE � 51.000.000
, -,___ ; . ..---.....
� � r DAMAGE T�E�ED
�. CIAIMS-MADE ;r. OCCUR : �� �� PREMISES Ea occurrence �. S 300,000
. _ X_, r 1—-- � � --
' '�� � MED EXP(Any ane perwn) 5 15.000
. I �.._.._---- ----------�
---_ ----- j
�, PERSONAL 8 ADV INJURY S 1.000.000
GEN'L AGGREGATE LIMIT APPLIES PER '�� GENERAL AGGREGATE S 2.000.000
�---- -. '. .._.. ----_ _-. . ... __
X .POLiCY �. jE� . LOC �', � � �'�, ; � PRODUCTS-COMPIOP AGG S 2,000,000
. . �_._� �, : �---. .._. __-_ . .-----.. . _
OTHER I
� 5
A �AUTOMOBILE LIABILITY ' � '. PHPK1752014 ' 12/13I2017 �� 12I13l2018 I COMBINED SINGLE LIMIT 5 1.000.000
. _. I� : �: .La accidentl- - - .
ANV AUTO �BODILY INJURY(Per person) 5
.._...__ _ ( .. ). __._._._..
� OWNED � SCHEDULED �. BODILY INJURV Per acc�tleni . 5
_.,AUTOS ONLY� _,AUTOS � .__�__ .
x HIRED X NON-0VVNED �, �PROPERTY DAMAGE I S �
. ..AU7050NLY , ,AUTOSONLY �. ��.(Per_acc�tlent ___ _
—1 - } - _
i5
A X ;UMBRELLA LIAB X OCCUR PHUB611046 12I13/2017 I 12I13I201B I EACH OCCURRENCE _ __ i 5 3.000.000
EXCESSLWB ��,IMS-MADE I AGGREGATE 53,000.000
� ---__�__ _ .. _.. ..—_. _ . . . _.. ._-----..___:—__... . ..
DED X RETENTION S 5
WORKERS COMPENSATION ' PER �OTH-
AND EMPLOYERS'LIABILITY y�N � _STATUTE _ ER
ANVPROPRIETOR/PARTNER/EXECUTIVE ❑ N I A � ' E L EFCH ACCIDENT S
OPFICERiMEMBEREXCLUDED� `�--- -��--�-----�--���—��---���---�--�- �
(Mandatory in NH) E L DISEASE-EA EMPLOYEE�5
I(yes,tlescnbe under � ` � -----"
'DESGRIPTION OF OPERATIONS below E L.DISEASE-POLICV LIMIT 5
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES �ACORD 107,Addltional Remarks Schedule,may be attached if more space fs required)
RE: Fall Festival-October 31,2018
Certificate holder,as Designated Organization,is an Additional Insured as respects General Liability when required by written contract subject to the terms,
conditions,and exclusions of the policy.
CERTIFICATE HOLOER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILI BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Village of Tequesta
345 Tequesta Drive AUTHORIZED REPRESENTATIVE
Tequesta FL 33469
,�.
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�O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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EXT. RECEIPT NUMBER
Village of Tequesta 259916
345 Tequesta Drive
�+._ � Tequesta, FL 33469
,,� ._ �;,
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Ph: (561)768-0700 Paid By
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FIRST SOUTHERN BAPTIST CHURCH
423 TEQUESTA DR
Tequesta, FL 33469
Transaction Type Record Category Description Amount
03593190 Permit PSEP18-0009 Standard Item Special Event-Over 200 people $100.00
03593190 Permit PSEP18-0009 Inspection Special Event Tent Inspection Fee $35.00
Project Address TOtal $ 135.00
423 TEQUESTA DR Cash
Check
Credit $ 135.00
Tra n sfe rred
Tendered $ 135.00
Change $ 0.00
To Overpayment $ 0.00