Commission Agenda 11152010docsonline.palmettofl.org/palmetto/Agendas/city/... · RCIZ 9O SPECIAL...
Transcript of Commission Agenda 11152010docsonline.palmettofl.org/palmetto/Agendas/city/... · RCIZ 9O SPECIAL...
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SPECIAL FUNCTION PERMIT APPLICATION toEVENT NAME EVENTDATESGN 2 S opAPPLICANT EVENT TIME my cao
ADDRESSl c PHONE S33
CONTACT im B S PHONE
DETAILS OF FUNCTION LOCATION PARADE ROUTE ETC cst Uoct out oE
ANTICIPATED ATTENDANCE
CITY SERVICES REQUII2ED lPOLICE Streets Blocked Traffic Control Security OtherPUBLIC WORKS Barricades Cleanup Setup Other
If a temporary restroom is utilized for aperiod greater than five S days a Temporary Use Permit is requiredApplication is available at City Hall
TEMPORARY RESTROOM FACILITIES ofunits ofdaysProposed locations
INSURANCE REQUIl2EMENT Insurance naming the City ofPalmetto as an Additional Insured must beprovided to the City Clerk ten 10 days prior to any event thatispart ofthe Special Function Permit
Please review Exhibit A for insurance coverage requirements To purchase insurance policies of appropriatecoverage through the City please complete and submit the Special Events Application Quote Form Exhibit B
The Special Function Permit Application must be submitted to City Clerks office at least 30 days prior to theevent
Sale or consumption of alcoholic beverages on City property is strictly prohibited
Ifyour event will include the use of loudspeakers you may be required to apply for a Special Permit Exceptionto the Citys Noise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code ofOrdinances
THIS PORTION OF THE PAGE INTENTIONALLY LEFT BLANK
PLEASE CONTINUE TO PAGE 2
Special Function Permit ApplicationPage 2
EVENTfi
2 Event DateSuN 2LS2o
l HAVE READ AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATIONCONDITIONS
CITY APPROVAL
Public Works Director
Risk ManagementParks DepartmentPolice DepartmentNorth RiverFire
APPROVED BY C SSION
Internal use onlyDate Received
Date lDate
Date
Date
Date
Date
i
r ow NQFZ Conae f
CIZR
d9O
SPECIAL FUNCTION PERMIT APPLICATION
EVENT NAME stival ChildrsnsPomade
APPLICANT I de Soto Historical Society Tic
ADDRESS 910 Third A p tRrrlPntm Fi 3421Y
CONTACTgMunutivelitertnr
EVENT DATEApril 22 x011
EVENT TIMEi 1000 an 300n
PHONE X17471
PHONE cyF71E7l
DETAILS OF FUNCTION LOCATION PARADE ROUTE ETC Use of Suttcn andIParirs
for Iii1 clrnn G antintiti TIof oan arrlmglA7P371tGlibSatfiarhrx
ANTICIPATED ATTENDANCE
CITY SERVICES REQUIREDPOLICE Streets Blocked X Traffic Control Security OtherPUBLIC WORKS Barricades X Cleanup Setup Other
See attached parade route of strreets blockedIf a temporary restroom is utilized for a period greater than five S days a Temporary Use Permit is requiredApplication is available at City Hall
TEMPORARY RESTROOM FACILITIES ofunits
Proposed locations
INSURANCE REQUIREMENT Insurance naming the City ofPalmetto as an Additional Insured must be
provided to the City Clerk ten 10 days prior to any event that is part ofthe Special Function Permit
Please review Exhibit A for insurance coverage requirements To purchase insurance policies of appropriatecoverage through the City please complete and submit the Special Events Application Quote Form Exhibit B
The Special Function Permit Application must be submitted to Ciry Clerks office at least 30 days prior to theevent
Sale or consumption of alcoholic beverages on City property is strictly prohibited
Ifyour event will include the use of loudspeakers you may be required to apply for a Special Permit Exceptionto the Citys Noise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code of Ordinances
THIS PORTION OF THE PAGE INTENTIONALLY LEFT BLANK
ofdays
PLEASE CONTINUE TO PAGE 2
Special Function Permit ApplicationPage 2
EVENT De Sago HettspI9titralClliclene PAeade Event Date Apii2 x011
I HAVE READ AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATIONCONDITIONS
Permittee te Sotaoe PtesiciaC10y3lA
CITY APPROVAL
Public Works Director
Police DepartmentNorth River Fire
APPROVED BY MMI SIGN
Internal use onlyDate Received
Date UDate
Date
Date
To City CommissionThru Diane Ponders Assistant City ClerkFrom Geoff Seger Parks Director
Subject Desoto ChildrensParadeDate of event Apri122 2011
Desoto ChildrensParadeParade and event held at Sutton and Lamb Parks The Parks Department will be
responsible for the closing ofroads along the parade route detouring traffic aroundthe parade route and reopening after the event is over During the event the staff is
responsible for debris removal and clean up when the event is over
Labor 6 hrs
Bobby Jackson 7191Victor Pompey 7461
Equipment used3 Public Works trucks @ 750 per hour 6750150 Safety Cones 35 directional signs
Rental Fee for Sutton Park1000am 300pm 10500
Total cost 31902
r 1 9 t
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SPECIAL FUNCTION PERMIT APPLICATION
EVENT NAME
APPLICANTTTarrrclP Sri Hi4trni1 iriPty Tm
ADDRESS 910 Third AvenaeWest tcn FL 34205
CONTACT Stern MrLym eaitive Dlxector
EVENT DATE Apri 30 x011
EVENT TIME 615 pn 1100pn
PHONE17471998
PHONE9417471998
DETAILS OF FUNCTION LOCATION PARADE ROUTE ETC Status at Hawkins Staclitm Fxooaeds Est
onNbnatee Avep ids at fitDisuses cnInatee Avaaaebetwaeri 9th St an31stStSattaclierl mm of h p Parxl mitr
ANTICIPATED ATTENDANCE
CITY SERVICES REQUIREDPOLICE Streets Blocked Traffic Control X Security OtherPUBLIC WORKS Barricades Cleanup Setup Other
If a temporary restroom is utilized for a period greater than five 5 days a Temporary Use Permit is requiredApplication is available at City Hall
TEMPORARY RESTROOM FACILITIES of units
Proposed locations
INSURANCE REQUIREMENT Insurance naming the City of Palmetto as an Additional Insured must be
provided to the City Clerk ten 10 days prior to any event that is part ofthe Special Function Permit
Please review Exhibit A for insurance coverage requirements To purchase insurance policies of appropriatecoverage through the City please complete and submit the Special Events Application Quote Form Exhibit B
The Special Function Permit Application must be submitted to City Clerks office at least 30 days prior to theevent
Sale or consumption of alcoholic beverages on City property is strictly prohibited
If your event will include the use of loudspeakers you may be required to apply for a Special Permit Exceptionto the Citys Noise Ordinance See Chapter5Amusements ofthe City ofPalmetto Code of Ordinances
THIS PORTION OF THE PAGE INTENTIONALLY LEFT BLANK
of days
PLEASE CONTINUE TO PAGE 2
Special liunction Permit ApplicationPage 2
EVENT ISato IiestsQe sttval wand Parade Event Daterr1 f111
I HAVE READ AND UNDERSTAND THE ABOVE SPECIAL FUNCTION PERMIT APPLICATION
CONDITIONS
Permittee Gus Sokos President 101410
CITY APPROVAL
jPublic WorksDuector6eGEcCPolice DepartmentNorth River Fire
APPROVED BY C SION
Internal use onlyDate Received
Date
Date
Date 0Date
To City CommissionThru Diane Ponders Assistant City ClerkFrom Geoff Seger Parks DirectorRe De Soto Heritage ParadeDate of Event Apri130 2011
De Soto Heritage Festival Grand ParadeThe Parks Department will be responsible for the closing ofthe Green Bridge and for thesafe detouring ofnorth and south bound traffic for the duration of the parade Theassociated costs are as follows
In Kind
19 48 traffic signs see map for locations25 36 safety cones FDOT approved to close the Green Bridge PPD to monitor
LaborEquipment 3 HoursJim MichenerBobby Jackson
City Truck
908171912250
Total 18522
CI nt 2131 HERNADESle
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 02032010
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Haas Wilkerson Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
4300 Shawnee Mission Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Fairway KS 66205
913 4324400 INSURERS AFFORDING COVERAGE NAIC
INSURED INSURER A ACE American Insurance Co 22667
Hernando de Soto Historical Society INSURER B
Inc dba De Soto Heritage FestivalINSURER C
910 Third Ave WINSURER D
Bradenton FL 34205INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED ORANY REQUIREMENTMAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
DDVETEYDTIONICY EPIpPpL LIMITS
LTR NSR TYPE OF INSURANCE POLICY NUMBER MMA M DA
A X GENERAL LIABILITY 620661902 013010 013011 EACH OCCURRENCE 1 00 00DAMAGE TO RENTED 500 D00X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR MED EXP Any one person EXCLU DED
PERSONAL ADV INJURY 1 000 00
GENERAL AGGREGATE 5 000 00
GENLAGGREGATE LIMIT APPLIES PER PRODUCTS COMPOPAGG 5000 0
POLICY jECOT LOC
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTOEa accident
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOSPer person
HIRED AUTOS BODILY INJURY
NON0WNEDAUTOSPer accident
PROPERTY DAMAGE
Per accident
GARAGE LIABILITYAUTO ONLY EA ACCIDENT
ANY AUTO OTHER THANEA ACC
AUTO ONLY AGG
EXCESSIUMBREI LA LIABILITY EACH OCCURRENCE
OCCUR CLAIMS MADEAGGREGATE
DEDUCTIBLE
RETENTIONWC STATU OTH
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY EL EACH ACCIDENT
ANYPROPRIETORPARTNERIEXECUTIVEOFFICERIMEMBER EXCLUDED EL DISEASE EA EMPLOYEE
If yes describe under DISEASE POLICY LIMITE LSPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES EXCLUSIONSADDED BY ENDORSEMENT SPECIAL PROVISIONS
Governmental Entity Form CG2026LD22318The certificate holder is named as an additional insured on the generalSee Attached Descriptions
ceurlal I nTlnnl o oavs forNonravmentIGRIIfIVMIG1IVLVGR
THE EXPIRATIONSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Palmetto DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
516 8th AVe W NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL
Palmetto FL 34221 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVESAUTHORIZED REPRESENTATIVE
ACORD 25 200108 1 of 3 S39930M39921 THOMC tivlcuIVICrVR111Vn1 1
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED the policyies must be endorsed A statementon this certificate does not confer rights to the certificate holder in lieu of such endorsements
If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain policies mayrequire an endorsement A statement on this certificate does not confer rights to the certificateholder in lieu of such endorsements
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract betweenthe issuing insurers authorized representative or producer and the certificate holder nor does itaffirmatively or negatively amend extend or alter the coverage afforded by the policies listed thereon
ruRU caauuiuest 2 of 3 539930M39921
DESCRIPTIONS Continued from Page 1
liability policy but only with respect to liability arising out of the
named insureds operations or premises owned by or rented to the named
insured per form CG2026LD22318
AMS 2532001108 3 of 3 S39930M39921
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