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Res No 199-12-13756RESOLUTION NO. 199-12-1375 A Resolution authorizing the City Manager to permit Lululemon a business located on Sunset Drive, to hold their 1St Annual Yoga Celebration on November 11, 2012, in downtown South Miami on Sunset Drive from SW 58TH Avenue to Red Road. WHEREAS, Lululemon has submitted a Special Event Application; and, WHEREAS, this would be the 1st Annual Yoga Celebration held in the City of South Miami; and, WHEREAS, the applicant has requested permission to hold its event on November 11, 2012; and, WHEREAS, the applicant has paid for the deposit of $60.00, and will pay the following: Police ($850.00), Public Works ($274.25), includes personnel, barricades and garbage bags, Street Closure ($150.00), (Meters ($775.00) 31 meters @$25.00 each, and Deposit ($600.00), totaling $2,649.25, which will be paid prior to the event; and, WHEREAS, the applicant would like to close down Sunset Drive from SW 58TH Avenue to Red Road; and, WHEREAS, through this new venue of yoga, this event would be the first of many more to come, providing revenue to local businesses and showcasing downtown area. NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA: Section 1. The Mayor and City Commission authorize the City Manager to approve the lst Annual Yoga Celebration to be held on November 11, 2012, downtown South Miami closing Sunset Drive between SW 58th Avenue to Red Road. Section 2. If any section clause, sentence, or phrase of this resolution is for any reason held invalid or unconstitutional by a court of competent jurisdiction, the holding shall not affect the validity of the remaining portions of this resolution. Section 4. This resolution shall become effective immediately upon adoption by vote of the City Commission, PASSED AND ADOPTED this 2nd day of October , 2012. Pagel of 2 Res. No. 199 -12 -13756 n CITY CLERK READ AN PPROVED AS FOR COMMISSION VOTE: 4 -0 LAN , LEGALIT D Mayor Stoddard: Yea E� N THERE Vice Mayor Liebman: Yea } Commissioner Newman: absent Commissioner Harris: Yea TY TTORNEY I V1 Commissioner Welsh: Yea Page 2 of 2 t. APPLICATION CHECKLIST This list is to ensure that all necessary documents are included and that all required procedures were followed. The Special Event Committee will check your application against this simpler checklist use this checklist to ensure all information was submitted as required. O APPLICATION: Completed Special Events Permit Application, with required attachments, at least 21 days prior to the proposed event OFEE: A $60 Application Payment must accompany your application upon submission in cash, check or money order. 0 SIGNATURE: Application submission. must be signed and notarized upon QCITY Briefly. discuss your Organization /Business, the MANAGER'S purpose of your event, the benefits, if. any, that the LETTER: event will have on the City and any additional information deemed pertinent to this application. O OTHER PERMIT: Complete any applicable permit application deemed necessary for your event, such as: (Check all that applies) Public Right -of -Way F] Off -Duty Police Officer o Pole Banner Banner(s) Overstreet Parking Meter Rental [] ciean -Up Deposit OINSURANCE:, Prior to the event, the event producer is required to submit a Certificate of Insurance naming the event and also shall name City of South Miami as an additional insured, in the amount of $1,0.00;000. O SITE A site plan must be submitted with your application PLAN /SKETCH: which shows intersecting street(s), location of all on~ site buildings, parking areas, routes, barricades, etc. COPY: It is strongly recommended that you make a copy of your application for your own record. VII M APPLICANT/SPONSOR INPG. A4ATION The applicant for the Special Event Permit must be the authorized representative of the organization /business conducting the special event. This person must be available to work with the City's Special Event Permit Committee throughout the permitting process. A professional event organizer, or other representative, may apply for the Special Event permit on behalf of the organization /business. NAME OF ORGANIZATION: ADDRESS OF ORGANIZATION: OFFICE TELEPHONE: �?, )5) QG 5 047 b FAX: ADDRESS: i for t iii Y) p a� i 2,1 A SISAam 1VULY O -tY 0 EMAIL: IM M " (0 Y1I If the orga Applicant/organization owns the event location give permission for the Applicant/Organization to use my property. Comments: Property Owner's Name: Property; Owner's Address: Property Owner's Signatu Notary Signature: Phon owner complete the following- 2 -1(- Date: ``PYO %rrr L ELLINGSWORTH Gemmisslon # OD 908578 "* *= my commission Expires 09 -06 -2013 Bonded Through Of x�,, Atlantic Bonding Co. Inc. DEPARTMENT POLICE YES .. i EVENT FEE QUESTIONNATIRF ❑ Will your event obstruct the normal flow of traffic? ❑ Do you expect the total attendance for your event to be over 150 people t any one given time? Will you be requesting the use of Extra -Duty Police Officers? If yes, hr)%nl manu 1Plaaca nnfas if unit anSwararl Ivn to fhiS naaefinn nff_rinfu J k 8VN I @V%V2 .. 7VN N.. wz Va VM ! \V, %V H.. M VV i.V.• V.• MN4' officers can still be assigned to your event at a cost to you if deemed necessary) If NO, please describe why the event will not have a significant impact on the surrounding public streets and /or property area. Off -Duty Officer Applicant pg. 11 /See Special Event Fee Schedule for cost detail PUBLIC WORKS YES NO 41 : ( ❑ Will your event interfere with any;public right; of -way, such as roads, sidewalks, alley, etc.? 54 ❑ Will your event require any full and /or partial road closures? If yes, please complete the Right -of- -Way Application. (Please note: any right -of -way closures will require at least one off -duty officer and public works employee.) 6. [ Will your event require the use of barricades? If yes: how many what type lease note: all pubic right -of -way closures must have approved barricades) 7. Would you like the City to provide you with barricades for you event, at a cost? If yes: how many 8. ❑ ill you be applying for a Pole Banner? Please Aescribe. your plans for the cleanup and removal of recyclable goods, waste and garbage during and after your event. . F I , r J Public Right -Of- -Way Applicant pg. 12/Pole Banner Applicant pg. 15 See Special Event Fee Schedule f r.cost detail 3 -16 I South Miami CITY OF SOUTH MIAMI PUBLIC WORKS DEPARTMENT F I ° ' I d 4795 SW 75`h Avenue, Miami, FI 33155 (305) 668 -7205 Fax (305) 668 -7208 M"""`On"Cl Application to Conduct A Special Event Function on �'1I1' ° l Public Right -of -Way =aot NOTE: ALL FIELDS SHALL BE FILLED. No action can be taken on this application until all questions have been answered. As set forth in Ordinance No. 21 -09 -2013; temporary full roadway and sidewalk closure (NO SINGLE LANE ROADWAY CLOSURE PERMITTED) for special events, eight (8) hours max. Schedule of fees is attached. Use blank paper if you need additional writing space. PLEASE PRINT clearly, except for signature. Contact Information: Business /Organization Name Authorized Representative Name 5734 &Y'tl6 dylYLle JCiMA'l FL Business /O ganization Address City State Phone Number Fax Number Event Information: Event Name Project Location Event Date(s) Event Start Time Event Setup Time Zip Code E -Mail Event Day(s) o(am pm Event End Time (am / & Breakdown Time Type of Event VOA O( Ct? Wbra - Q1n (am /f) Anticipated Attendance 70 0 (am /m Total Duration (include setup) h it I HEREBY REQUEST A PERMIT FOR THE FOLLOWING: Anticipated effects on vehicular and pedestrian traffic during Project Maintenance of traffic provisions are specific (include sketch if necessary): The fo wing documents have been submitted with this permit application: Site plan / sketch of event. Clearly define boundaries and linear foot of road closures. 19/Maintenance of Traffic (MOT) for vehicular and pedestrian traffic during event. 'In signing this application, I understand that separate City andlor County permits may be required for this project. Furthermore, I am aware that I am responsible for ensuring that the project is completed in accordance with the plans and specifications as stipulated in the permit approval conditions. As well as acknowledge that any right -of -way closures will require at Wst one pff -duty officer, pKblic works employee and barricades.' FOR OFFICE USES O Permit No: 12 -1.6 Approved/ BY Date Permit Fee Comments Disapproved o U 12 -1.6 "•'.: 7e CITY OF 'UTH MIAMI PUBLIC WORKS DEPARTME 4795 SW 75 "' Avcitioe, Miami, FI 33155 (305) 668 -7205 Fax (305j V68 -7208 Public Right -of -Way Schedule of Fees Ordinance Item Measurement me Sou lls Mlaml, F �1 or i A a F !! AIFAnt zoo& 13 -16 PERMIT FEES Minimum permit fee $150 Permit extension fee, for 60 day period $150 PERMANENT TRAFFIC BARRICADE, GUARDRAIL AND _ GUIDEPOSTS Each 100 LF or fraction $85 TEMPORARY FULL ROAD AND SIDEWALK No single lane roadway CLOSURE closure permitted. *For special event 8 hr. period 'max., Incl. set up Per linear ft. of road, time. Excludes city events rounded to the next and events funded by the higher whole number in city. ft., per day $0.25 TEMPORARY SIDEWALK CLOSURE Each 25 SF or fraction $75 Permit requires French barricades along curb or EOP.* Maximum permit fee $101000 TEMPORARY STAGING Flat Fee per day for first AREA, CRANE, TRAILER, 5 days $200 TRUCK ON THE RIGHT- Every five days or OF -WAY fraction thereof after $300 MAINTENANCE OF Intrusion into and /or TRAFFIC (MOT) using one - way lane $100 Roadways with two -way traffic $200 Detour, per direction $100 Sidewalk intrusion, each $100 WORK WITHOUT After the fact pe'rm,ifi fee: PROPER PERMITS For any work performed AND /OR INSPECTIONS without proper permits Permit `fees :, And /or inspection's` quadrupled Minimum, per day $11000 PUBLIC WORKS HOURLY RATE Non - supervisor $40 Supervisor $45 13 -16 STIR PLAN /SKITCH A map of the event site Is required and should indicate event layout with proposed attractions, recommended street closures, parade or run/walk routes, etc. Please draw you map on .the space provided below, or attach your map to the applical4on upon submittal. The following must be identified and labeled: 1. Event Site (label streets, building, etc.) 3. Canopies, tents, stages 5. Fencing/Barricades x- 7. First aid facilities + 2. Routes (races, parades, etc.) 4. Restroom facilities R 6. Off duty poli ficers..R- 8. Parking Area PA 5 -16 PLANNING AND ZONING YES O 91 ❑ Are you confident that your event is in the City of South Miami limits? (Please note: that it is the sole responsibility of the applicant to ascertain the location is within the city's limit, You may call the Planning & Zoning department (305) 663 -6326 if you have any question(s).) 10. ❑ Zwill you be hanging any banners over public streets? If yes, please complete the Hanging Banner Application. (Please note: that all requests for banner over public streets must be reviewed and approved by the City Commission, which meets only twice a month.) 11. M/ ❑ Have you notified the event location neighbors about your event? Hanging Banner over Street Applicant pg. 94 /See Special Event Fee Schedule for cost detail PARKING DIVISION YES NO 12. ❑� ❑ Will you be renting any City parking meters? If yes, how many. _.....,. (Please note: that if you are closing or interfering with any right -of -way that includes parking meters you are required to pay the meter fee as well.) 13. ( ❑ Do you have enough on parking to accommodate your event? 14. [ Will your event involve the use of a shuttle and /or alternate parking sites? Parking Meter Rental Applicant pg. 93 /See Special Event Fee Schedule for cost detail CODE ENFORCEMENT YES NO 15. ❑ Will you be having any music and /or loud sounds during your event? 16. Will your event be starting before 8 a.m.? 171 ❑ Will your event end after 11 p.m. on a weekday and /or 12 a.m. weekend? PARKS AND RECREATION YES NO 18. ❑ TWill this event take place in any of the South Miami City parks? (Please note: A rental fee will be applicable if a City Park is being utilized. Reservations are made through the Parks & Recreation Department (305) 668- Zwill 32). 19. ❑ this event require the use of any Parks equipment or staff? 4 -16 Event Name: 0TIFICATI ®N I PETI . ION Event Date: 1 1 1 , 12 We, the undersigned businesses and /or residents, have been notified of street closures associated with the event noted about on said date, and hereby agree or disagree to the closure(s). We are also aware that this response may not effect this application being approved or disapproved. Z4"v a ! _ - . �� '/x & l err 7 31e� SV2- "� " Jar Hehoc� 1 . -41'<�h S prD "+- ,; P k'kk.1'5 rbea& OM(f F, - "'TL S4QrbV,&,5 F N ex, 1\1I 5 131S'cin, ct 1 3o5 w8 -1 38 G'l B%K fXV 5746 E>O0 rI3©S -66s� 733s 78b-A6 -8�0- (4P �U'N� -(- I 3b5. tC{B2. S'i ly 6 -16 Disapproved Approved Disapproved ❑ Disapproved d Disapproved ❑ Disapproved El Id Disapproved ■ 1 Disapproved El roved t!'l Disapproved F j roved Disapproved ❑ Approved dDisapproved ❑I GEMIcRAL REGUMMEN S Section I ✓ When marking any public street, curb and /or right -of -way no permanent marking substance may be used. All marking agents must be removed immediately after the completion of the event. ✓ Barricades shall require an additional rental fee established by the Public Works Department if a City Sponsored Event. If not sponsored by the City, then you must rent barricades through a barricade company. ✓ No pegs, stakes, or anchoring devices shall be driven into the concrete, asphalt, or City hardened right -of- way. ✓ Map of route or site plan of the scheduled event including all stations and descriptions of activities. ✓ Any temporary cover for stations such as a canopy shall be flame retardant and applicant shall provide proof of such certificate. ✓ Review of applicant's paperwork to note location, any food sales, volume of noise /music and duration. ✓ 72 hour notice given to all merchants whose street would be closed. - �-�� _ Please initial 4=71': , Section II ✓ In the event of a parade, a permit from the South Miami Police Department must be obtained. ✓ If Police service for traffic and /or crowd control is required, arrangements will be made through the City of South Miami Police Department for off -duty Police officers. The Police Department will determine the number of officers required. (Please be aware that costs might change on a yearly basis). ✓ Code Enforcement Department will check on each event to make sure that all codes and reaulations are being adhered to. ✓ All parking issues will be reviewed through the Planning Department, Parking Department and /or Code .Enforcement Department. JA ➢ Public liability insurance coverage ceri�ficate namirig th'e City'of'South Miami as an additional insured for the time. date, glace and name of the event, in the amount of $1.000.000 is reauired-brior ✓ Barricades: The average hourly rate for 125 Barricades for one (1) day usage is approximately $80.00, Please initial Section 111 ➢ Specific Requirements: All organizations sponsoring special events using public property or public streets within the City of South Miami must receive prior approval by resolution from the South Miami City Commission. The resolution must include the estimated reimbursement amount to be paid to the City for all City revenue loses and City expenditures associated with the approved special event. The adopted resolution may also specify an additional monetary contribution to be made by the organization to the City: the resolution shall specify how the additional monetary contribution is to be used by the City. ✓ A majority vote of approval (one -month in advance) by the City Commission will be required for large events. ✓ Deposit of Six Hundred Dollars 000.00) to defray cost of litter clean -up, must accompany application, plus a permit fee of $60.00. If clean -up is not required, deposit may be refunded. The litter deposit.may differ depending upon the event. ($100.00 will be retained by the City as an Administrative processing fee'. deducted from the $600.00 deposit). ➢ (Please be aware that rates shall increase on a yearly basis, due to cost of living increases). ➢ For Grant Recipients: Payment of these charges could be deducted from the designated grant amount approved by the City. ✓ Public Works - The average hourly rates are approximate $40.00 per non - supervising emplo ee, per hour, and $45.00 for supervising employee, per hour. Please initial 7 -16 Sept 27`h 2012 I, Lindsay Borden — the Regional Manager of Florida for lululemon athletica, give Cristina Suarez permission to sign the indemnification Page that is part of the special event application. Please let me know if you have any questions. 239 216 6262 Best, Lindsay Borden Regional Manager of Florida Lululemon athletica IND r.v1NIFICATI ®N AGR ,MINT TFUS AGREEMENT ( "Agreement ") is entered into by and between _fulU ltmuyr GSA` g 1 t+1 0 C11 ( "Applicant "), and the City of South Miami ( "City ") on the date on which the last of the Parties executes this Agreement. RECITALS WHEREAS, the Applicant has submitted a Special Event Permit Application to the City for (event title) .cs.0 YIDS a wn SU n ulr at V 1 �►� ) (location) on (date(s)) `�� �.�(Yl �j{',Y t� . ( "Special Event "); and WHEREAS, pursuant to of the City's Code and the City's Special Event Regulations, the Applicant must execute an indemnification and hold harmless agreement protecting the City from any and all claims which may arise out of the Special Event. NOW, THEREFORE, in consideration of the matters recited above, the mutual covenants set forth herein, and other good consideration the receipt and sufficiency of which is hereby acknowledged, the Parties hereby agree as follows: 1. The above recitals are true and correct. 2. Applicant agrees to indemnify, defend and hold the City, its officers, affiliates, employees, successors and assigns, harmless from and against any and all such claims, suits, actions, damages, or causes of action arising as a result of the Special Event, or of the condition of the site on which the Special Event is held including any personal injury or loss of life, or damage to or loss of property, and from and against any costs, attorney's fees, expenses or liabilities incurred in and about the defense or settlement of any claims, and the investigation thereof. 3. Permits for Special Events must be on event site at all times. 4. No Street shall be closed without authorization from the City of South Miami Public Works Department and Police Department. 5. Traffic shall be maintained in accordance with Florida Department of Transportation (FDOT), Miami -Dade County standards and any additional requirements by the City of South Miami Public Works Department and Police Department. 6. Event areas shall be restored to equal or better condition than they were before the event started. 7. If all restoration work is not performed within 30 days of work completion, the City of South Miami Public Works Department may restore the event area and charge the applicant for the cost of restoration plus a minimum of 15% for administrative fee and any additional incidental fees. 8. Applicant must pay all fees prior to the start of their event(s). 9. Applicants that receive approval for their event more than thirty (30) days in advance shall notify the City'of South Miami Special Event/Marketing Coordinator at least forty-eight (48) hours prior to start of their event. 10. Any damage to private property shall be restored to its original condition or better and as accepted by the Owner. IN WITNESS WHEREOF, each of the parties hereto has caused this Agreement to be executed. and sealed by its duly authorized signatory(ies) on the date set forth below and notarized. Subscribed and sworn before me, this L01� day of cibla, a Notary Pu lic in and for "► a ' County, �of Hc>tLOLa Sig t ruan (NOTARY PUBLIC) 8 -1.6 APPOCANT'S TITLE .. W4 DATE: -- L ELLJNGsWQRTH Commission # DD 908578 My commission Expires 09.06.2013 Bonded Shro 9 inc. 00ntic Bonding _ WWW.sunbiz.org - Department of State Home Contact Us E- Filing Services Document Searches Previous on List Next on List Return To List Events Name History Detall Dy cnilry Name Foreign Profit Corporation LULULEMON USA INC. Filina Information Document Number F06000007086 FEI /EIN Number 753060494 Date Filed 11/13/2006 State NV Status ACTIVE Last Event NAME CHANGE AMENDMENT Event Date Filed 08/16/2007 Event Effective Date NONE Principal Address 1818 CORNWALL AVENUE 400 VANCOUVER, BC, CANADA BC V6J1C -7 CA Changed 01104/2011 Mailing Address 1818 CORNWALL AVENUE 400 VANCOUVER, BC, CANADA BC V6J1C -7 CA Changed_ 01 /04/2011 Registered Agent Name & Address C T CORPORATION SYSTEM 1200 SOUTH PINE ISLAND ROAD PLANTATION FL 33324 US Officer /Director Detail Name & Address Title CEOD DAY, CHRISTINE MS. 1818 CORNWALL AVENUE, UNIT 400 VANCOUVER, BC, CANADA BC VW`IC -7 CA Title CFOD CURRIE, JOHN MR. 1818 CORNWALL AVENUE; UNIT 400 VANCOUVER, BC, CANADA BC V6J1C -7 CA Title TO Forms Page 1 of 2 Help Entity Name Search ........ ..... .............. ............ ..... ._... ...... ........... .: Submit httn*//www c„nhi7..ora / .ocrints /cordet_exe ?action= DETFIL &ina doe number= F060000070... 9/24/2012 www.sunbiz.org - Department of State NEGUS, DAVID MR. 1818 CORNWALL AVENUE, UNIT 400 VANCOUVER, BC, CANADA BC V6J1C -7 CA Title SO NICHOLAS, ERIN MS. 1818 CORNWALL ACVENUE, UNIT 400 VANCOUVER, BC, CANADA BC V6J1C -7 CA Annual Reports Report Year Filed Date 2010 01104/2010 2011 01/04/2011 2012 01/25/2012 Document Images 01/25/2012 --ANNUAL .._..._.. REPORT __.... . ... View image in PDF Searches I E- Filing Services I Forms I Help 01/04/2011 -- ANNUAL REPORT: Viewimage.in PDF format; 01104!2010 — ANNUAL REPORT View image in P,D.F format_ , 05/19 /2009 -- ANNUAL REPORT' View,lmage;in PDF format 04/25/2008 --ANNUAL REPORT View. image in PDF,format, .. ; ... 08/16/2007 -- Name Change Vlew ►mage in.PDF format . 04/13/2007 — ANNUAL REPORT.Vlew,lmage m PDF_ format .. 11/13/2006 -- Foreign Profit View;lmage.in PDF format ,.,,., Note: This is not official record. See documents if question or conflict. Previous on List Events Next on List Name History Return To List ...__.. .._...._...._...- ............__ .._..._.. ....., .... _.__..... __.... . Home I Contact us I Document Searches I E- Filing Services I Forms I Help Copvright© and Privacy Policies State of Florida, Department of State Page 2 of 2 ............................. . ............ Entity Name Search htt-o: / /www.sunbiz.orv, /scripts /cordet.exe ?action= DETFIL &inq doc number= F060000070,.. 9/24/2012 OL100I03 CITY OF SOUTH MIAMI - OL Business Master Inquiry - Licenses Business: 7806 LULULEMON USA INC. Business address b/34 SW /2 STREET SOUTH MIAMI FL 33143 Type options, 1= Select Opt Lic Nbr _ 13 00009864 12 00009864 11 00009864 press Enter. Classification RETAIL & WHOLESALE TRADE RETAIL & WHOLESALE TRADE RETAIL & WHOLESALE TRADE Mailing address 40U-1818 CORNW VANCOUVER, BC Status AC RN RN 9/24/12 17:05:20 CN V6J1C7 .Amount Due .00 .00 .00 Bottom Total Amount Due .00 F3 =Exit FS= Officers F7= Miscellaneous information F12= Cancel OL110I01 CITY OF SOUTH MIAMI - OL 9/24/12 License Master Inquiry 17:05 :35 Business control nbr 7806 License number 13 00009864 Last activity. Pin number 8946 Business name & address Mailing address LULULEMON USA INC. 400 -1818 CORNWALL AVE 5734 SW 72 STREET VANCOUVER, BC SOUTH MIAMI FL 33143 Classification RWT RETAIL & WHOLESALE TRADE Exemption applied . License status, date ACTIVE Appl, issue date 5/04/11 9/21/12 Expiration, valid thru 9/30/13 9/30/13 Gross receipts amount .00 Date renewal printed Date printed, reprinted 9/21/12 Prior license . . . . 12 00009864 Municipal code reference Press Enter to continue. CN V6J1C7 9/20/12 F3 =Exit FS= Additional charges F6= Charges F7= Miscellaneous F9= Additional requirements F10= Receipts More,.. information F24 =More keys South Miami F t o r[ d a CITY OF SOUTH MIAMI PARKING DIVISION Alt - 6130 Sunset Drive, South Miami, FI 33143 (305) 668 -2512 Fax (305) 663 -6346 Parking Stalls /Meters Rentals Application zoos Pursuant to Section 15 C -1 (a) (2) (b) of the Code of Ordinance, "Rental Fees for Public On/Street curbside spaces (Parking space) are $25.00 per space per day, seven days per week based on twenty -four (24) hour use ". 1 Business /Organization Name Applicant Name FLA Business /Organization Address City State Zip Code (60")GG 1,17cb CLWY U. @ )U it k"yl b ow hone Number Fax Number E -Mail . Name of Event: Purpose for utilizing parking meters: om RW Number of On /Street Number of Day's Start a.m. End a.m. curbside spaces requested: curbside spaces desired: _ Timer 4 Time: .m I IE `Z6 14 I, Le f? I hereby certify the above information is true, correct and complete .as of the date of this submittal. It is understood that I this applicant will be reviewed and may be adjusted periodically by City Staff; if any information should change that I shall amend or supplement this application within five business days of the change. 115 Ir pplicant's'! na ' 'No FJ Date" 'd W141- .4 ApDlicant's Signatur FOR -- • DENIED APPROVED AS PRESENTED APPROVED WITH CONDITION • Meter rr • Daily Av=nls + Comment: KING DIVISION SIGNATURE 14 -16 DATE Estimated Total Cost South Mtatnt CITY OF 6OUTH MIAMI PLANNING & ZONING DEPAI.; MENT F ` " a 6130 Sunset Drive, South Miami, FI 33143 (305) 663 -6326 Fax (305) 668 -7356 Att -AW Hanging Banner Over Public Street 11 I I F Request Form for Special Event Zoos Application for the purpose of requesting approval to display banners over public streets promoting events as set forth in Ordinance No. 10- 071911; LDC Section 20- 4.3(N). Complete this permit application form and submit the application to the Planning & Zoning Department located in the Sylva Martin Building in front of City Hall. This application must be submitted at least 30 days prior to the event date. An application fee of $300 must be paid at time of submittal. If approved by the City Commission, this fee covers installation and removal of banner. If approved, take the permit and the banner to the City's Public Works Department located at 4795 SW 75th Avenue Miami, FL 33155, at least one week prior to the installation date. The Public Works Department will install and remove the banner on the dates specified by the approved permit. Name of Non -for- Profit Organization Organization Address Authorized Re- presentative Name Phone No. Rep. Title Event Name: o Event Date: Event Type: Approximate Installation Date Requested: thru Banner Location Requested: F�J'5800 Sunset Drive 0 5880 Sunset Drive Briefly describe event for which you wish to. display z banner in South Miami: ➢ -Applicant understands, that the Banner installation is 10 -14 days before the advertised event day. ➢ Installation and removal dates are based on workload. The City is not responsible for the condition of.the banner during this period., ➢ Applicant agrees to pickup banner within seven (7) days after the event. The city may discard the banner(s) after the specified period. ➢ Banner Specifications- 30ft X 3 -4ft wide, 60ft of 1/2 (half) nylon rope with hooks and the banner must vents. A•• licant's Signature Date _.. _ _.. - ... .... .... ZONING PLANNING & OFFICE USE • NLY* SUBMITTED ' BY- INITIAL ➢_ Illustration. of_banner- showing. height „width of the banner, and Lettering Copy of liability and /or property damage insurance required "Application fee $300 (per application) . City Commission.Appcoval Resolution No. Comment: 15 -16 Comm. Date: CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) wow. 109/28/2012 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 Marsh USA Inc., Multinational Incoming Unit a service of Seabury and Smith, Inc. 9830 Colonnade Boulevard, Suite 400 PO Box 659520 San Antonio TX 78265 -9520 INSURED Lululemon Athletica Inc. a/o Lululemon USA Inc. 400 - 1818 Cornwall Avenue Vancouver, BC V6J 1C7 1111604tZ_[c1*1 CERTIFICATE NUMBER: INSURER B: INSURER C : INSURER D : INSURER E: 10 -691 -4100 REVISION NUMBER- 210-737-3584 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. ILTR THE EXPIRATION DATE HEREOF,"N'OTTCI —[HILL" BE DELIVERED IN ADD S R 6130 Sunset Drive POLICY EFP POLICY EXP South Miami, FL 33143 TYPE OF INSURANCE INSR WVD POLICYNUMBER MMIDD/YYY MMIDD/YYY LIMITS A GENERAL LIABILITY CGL2003478 11/01/2011 1.1/01/2012 EACH OCCURRENCE $1,00_0,000 COMMERCIAL GENERAL LIABILITY X REMI ETORENTED PREMISES (Ea occurrence ) _ $100, 000 CLAIMS -MADE OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1f0001000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGO $1,000 000 $ POLICY PRO - CT El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ N ED HIRED AUTOS AUUTOS TOS Peraccident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE 4 _ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ Id T Y I S I ER ANY PROPRIETOR /PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Store #1.0725: organizing a yoga event coiled "Sunset on Sunset" to be held on Sunset Drive between 57th and 58th Avenue in South Miami, FL from 4 PM - 7:30 PM on November 1.1, 2012 The City of South Miami. is included as an additional insured on the General Liability policy as requlxed- hy_.wra.tben_..conLLact., ... CYf.4vyf JS.. @P4 t.,.i hx �y 1 4 ti IJ� gR .J�uk 1j((f(.�pvd�4.'$ii SnY.S S �i iiS.Fi f 1�,/f Yaf? I.ERTIFICATE HOLDER CANCELLATION f ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD DS 432281567 SHOULD ANY OF THEABOV JESf�+iB�D' d�i6"lE3,6E.6- WNGELLED'd�I =FORE City of South Miami THE EXPIRATION DATE HEREOF,"N'OTTCI —[HILL" BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 6130 Sunset Drive AUTHORIZED REPRESENTATIVE South Miami, FL 33143 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD DS 432281567