Event Permit. ~~,1./::J-~t'-/ ! Lee County. Le~,FiorJ'!1: Permit Type. 0 Film Permit. Taste of Pine Island. Permit Number SECP ALC

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Event Permit Event Name: Taste of Pine sland Applicant: Kiwanis Club of Greater Pine sland Contact: Pat Burman 239.558.

1 Event Permit Event Name: Taste of Pine sland Applicant: Kiwanis Club of Greater Pine sland Contact: Pat Burman Location: Phillips Park, 5675 Sesame Drive, Bokeelia Valid only for the Following date(s): January 24-25, 2015 Valid only for the Following time(s): 1/24-11:00 am to 6:00pm; 1/25-11:00 am to 5:00pm! Lee County ~ 1 Southwest ~forid'a Permit Number SECP ALC Permit Type j2g Special Event j2g Use of County Property j2g Sell & consume Alcohol 0 Consume Alcohol only 0 Film Permit Permit Conditions: Applicant must meet all event application requirements, including requirements of the sign-off agencies. The premises is to be left in the same condition as it was prior to the event. This permit is to be readily available for inspection during the entire event County-issued alcohol permits: Alcoholic beverages must not be sold/consumed llh hours prior to the conclusion of the event & vacating the facility. Board of County Commissioners Le~,FiorJ'!1: ~~,1./::J-~t'-/ Lee County Public Resources (239) ' r County Manager Date

2 Event Application Special Event Use of County Property AlcOhol within lee County,.. Facilities FHm>Video & \

3 '"'"""w -~ ~-~- Check the appropriate box(es) below: [X SPECAL EVENT PERMT lee County Event Permit Application Event Application fxi USE OF COUNTY PROPERTY PERMT '' [X' PERMT TO SELL AND CONSUME ALCHOLC BEVERAGES WTHN LEE COUNTY FACLTES FLM PERMT Section -GENERAL NFORMATON (All Permit Types) 'Title of Event Name of Production Date(s) of Event Production: Taste of Pine sland (Kiwanis Club of Greater Pjne sland) January 24th and 2015 """""' ~ "' "''"~ ~- «"~"""'''"-" """ ,,..,.,..,_~-~~---~ Sesame Drive location(s) of Event: ""''''""-,,,,,,,,,,..,_,,,,,, l Name of Applicant: Kiwanis Club of Greater Pine sland Applican~ Address'!! Applicant Ph ! Contact Person: (f different from applicant) Contact Phone Number: (f different from applicant) P.O. Box 72, Pineland, Florida Pat Burman ' ' ;. Address:. neislandkiwanis.com Estimated Attendance: 1500 Event Description: nclude each activity, when activities take place, etc. Taste of Pine sland, food vendors, arts & craft \fendors, live music Scholarship Pr"Ogram fo(the Kiwanis Club of Greater Pine sland ' Hours of Operation: January 24th from 11-6 and January 25th from 11-5, 2015 STRAP# of Parcel: F i Owner of Premises*: Lee County *Notarized. statement from the property owner specifically consenting to the proposed use required.

4 Lee County Event Permit Application Fill out the following questions for allpermit types: What is the Zoning Classification of the premises? County Park Are any temporary structures to be installed for the event? X Yes r No Type: tents being rented by Caloosa TO' Do you have the appropriate permits for the temporary structures? eves No * For a 'Special Event' and 'Use of County Property' permit, submit a site plan with all proposed facilities and activities indentified, including all parking areas. nsurance Company nsuring the Event: Hylant Group nc. -lndianapolic Note: Certificate of nsurance must be submitted at time of application Surety Company Bonding this Event (Name and Address): eves Event? X No!Xi Yes C. No Will Alcoholic Beverages be served/consumed at this Event? X! Yes No f yes, automobile coverage must be included on the certificate of insurance. f yes, products liability coverage must be included on the certificate of insurance. f yes, liquor liability coverage must be included on the certificate of insurance. Name & Address of Organization Providing Food: Food Vendors (Vendors will provide insurance coverage with application) Type of Food being Served: Hamburgers, fries, crab cakes, hot dogs, smoked chicken, smoked mullet Section - USE OF COUNTY PROPERTY PERMT Organization Sponsoring the Event: Kiwanis Club of Greater Pine sland Fi/1 out this portion for applications for Solicitation in the County Rights-of-Way: Name of Charity: Kiwanis Club of Greater Pine sland Address of Charity: P.O. Box 111, St. James City, Florida Phone Number: Non-profit certificate/registration number: (Proof of registration with the Dept. of Agriculture & Consumer Services or proof the organization is exempt from this requirement ) Section ll- SALE/CONSUMPTON OF ALCHOLC BEVERAGES PERMT s alcohol being sold/consumed on County Property? f Yes, then a "Lee County Alcohol Permit" is required. Only non-profit organizations can sell alcohol on County Property. C No Non-profit certificate/registration number: (Required if alcohol is to be SOLD at the event) Please note: A permit from the State of Florida Division of Alcoholic Beverages and Tobacco may also be required; please call (239) for further details

5 SECTON V- AGREEMENT The Applicant agrees that Lee County can, at its sole discretion, terminate and cancel its permit to use Lee County property at any time without prejudice. Applicant further agrees to waive, release, save and hold harmless Lee County from any and all claims, demands or cause of actions based upon Lee County's cancellation or termination of said permit. The Applicant agrees that the Lee County permit does not provide Applicant with any property rights in the County property in question or in the permit itself. The apj:! nt does acknowledge and hereby affirms that any and all information is accurate to the best of his/h k owledge. Witness Print Name of Applicant and Title Print Name of Witness

6 LEE COUNTY SHERFF'S OFFCE SX MLE CYPRESS PARKWAY FT. MYERS, FL Use of County Property_X_Special Event_X Alcohol_X Film Parking: n authorized parking areas only. Deputies: Two (2) Deputies: January 24, 2015/ hours. Two (2) Deputies: January 25,2015/ hours. Special nstructions: Consumption of alcohol is not allowed outside the permitted area. Capt. Scott Lucia "Detail Commander Title 3 November 2014 Date

7 FRE DEPARTMENT The Fire Deportment serving the area where the event is to be held signs this form. Please see User's Guide for contact infomwtion and Fire District Map. Check the appropriate box(es) below: fx' SPECAL EVENT PERMT JX USE OF COUNTY PROPERTY PERM!T r FLM PERMT AFTER REVEWNG THE APPLCATON, PLEASE NDCATE BELOW WHAT ARRANGEMENTS YOUR ORGANZATON WLL REQURE THE APPLCANT TO COMPLY WTH FOR THER EVENT. Fire Guards (How Many?) Fee for Services: Flammable Vegetation: First Aid E~uipment: Fire Extinguishing: Special Arrangements: Clt \ to()cl v -trlc'lo ( ) C\J -+ e~ r0~ ' r1 e tc'l A p pr-of)c 1 Q:f [!.f\ ~ r c, a:+ 1 w~ Lc.:t~J~.e-.<c.s Print Name: Signature: Title: Date:

8 Check the appropriate box(es) below:!xj SPECAL EVENT PERMT EMERGENCY MEDCAl SERVCES f PUBLC SAFETY t4752sx MLE CYPRESS PARKWAY FORT MYERS, FL (239} , X] USE OF COUNTY PROPERTY PERMT CJ FLM PERMT AFTER REVEWNG THE APPLCATON, PLEASE NDCATE BELOW WHAT ARRANGEMENTS YOUR ORGANZATON Will REQURE THE APPLCANT TO COMPLY WTH FOR THER EVENT. Treatment Facilities: Medical Personnel: Medical Supplies Equipment: Safety Requirements: Fee for Services Special Arrangements: Print Name: Signature: Title: Date: Page 18

9 DEPARTMENT OF TRANSPORTATON 1500 MONROE STREET FORT MYERS,Fl33901 (239) Check the appropriate box(es) below: X SPECAL EVENT PERMT X USE OF COUNTY PROPERTY PERMT X PERMT TO SELL AND CONSUME ALC0HQLC BEVERAGES WTHN LEE COUNTY FACLTES FLM PERMT AFTER REVEWNG THE APPLCATON, PLEASE NDCATE BELOW WHAT ARRANGEMENTS YOUR ORGANZATON WLL REQURE THE APPLCANT TO COMPLY WTH FOR THER EVENT. Parking: No Parking on paved Lee County roads. Sufficient width shall be maintained at all times for emergency vehicle access. ngress and Egress: Use all established means of ingress and egress. Special Arrangements: Use Lee County Sheriff's Office fortraffic control, as needed. Print Name: Signature: Title: Bryan D. Miller Bryan D. Miller Senior Project Manager Date: 11/6/14

10 LEE COUNTY PARKS AND RECREATON 3410 PALM BEACH BOULEVARD FORT MYERS,FLORDA33,16 (23,) Check the appropriate box(es) below: X SPECAL EVENT PERMT ){ USE Of COUNTY PROPERTY PERMT X PERMT TO SELL AND CONSUME AlCOH OUC BEVERAGES WTHN LEE COUNTY FACLTES r FLM PERMT AFTER REVEWNG THE APPLCATON, PLEASE NDCATE BELOW WHAT ARRANGEMENTS YOUR ORGANZATON WLL REQURE THE APPLCANT TO COMPLY WTH FOR THER EVENT. llumination: User group will pay to have lights on the fteld during set up. Event takes place during the day. Parking Areas: Parking will take place in ~urrounding businesses. This event s il self parking even~. Special Arrangements: User group will be responsible for trash removal and park clean up. They will also have portable toilets for patrons to use. Beer will be contained in the park and two deputies will be hired for event. Any damage to the fields will be billed after event. Kiwanis will be responsible for the installation and removal of electrical panels. Print Name: OanSZ' SJgnatur-<0 k Title: Deputy Director ::= Date: Page jlo

11 Lee County Event Permit Application LEE COUNTY RSK MANAGEMENT COUNTY ADMNSTRATON BULDNG- 4TH FLOOR 2115 SECOND STREET FORT MYERS,FLORDA33901 (239) Check the appropriate box(es) below: fx SPECAL EVENT PERMT fx USE OF COUNTY PROPERTY PERMT!X PERMT TO SELL AND CONSUME ALCOHOLC BEVERAGES WiTHN LEE COUNTY FACLTES FLM PERMT AFTER REVEWNG THE APPLCATON, PlEASE NDCATE BELOW WHAT ARRANGEMENTS YOUR ORGANZATON WLL REQURE THE APPLCANT TO COMPLY WTH FOR THER EVENT. nsurance Requirements: Commercial liability insurance with minimum limits of One Million Dollars ($1,000,000) pre occurrence to protect ag.afnst bodily njury artd/or property damage relative to the applicants use of aforementioned event on Lee County property, n addltion, Host Liquor Liability insurance will be required with minimum limits of One Millior1 Dollars ($1,000,000) per occurrence. Should Host Liquor Liability coverage be afforded under the Commercia! General Liability policy, minimum acceptable limits wh be Two Ml!Hon Dollars ($2,000,000) aggregate. Special Arrangements: certificate of nsurance shall be submitted as evidence of the required coverage listing Lee County of County Commissioners, P.O. Box 39.8, Fort Myers, Fl as the certificate holder and as an :.tm t,,,,.,,.l insure.d. Print Name: Mike Figueroa Signature: Title: Date:

12 l '. \. \ \~ "' \ ) \ / ) /. \_ CONNCES5:0N REST ROO\J,S PRESS SOX. ----e,.::~ Pi~~~ isu'nd ROAD

13 Lee Property Appraiser Web Tax Map Page 1 of 1.. _. 'ta>c-"milp.keg.e~d.;""' :Ro~4~~~e~ -!..=: ' i;taioejts. Aerial j2008 1st Qrtr Hi-Res (112 foot) Map 11120/ :07:29 AM mage i Currency Set Date Selected i F legal [PNE SLAND CENTER UNT 4 BLK F PB 10 PG 18 LOT 1 + POR LOTS 2/4/5 Parcel! Description i '. Parcel i LEE COUNTY Property a 5675 Sesame Dr 0 Owner!PO BOX 398 Address! Bokeelia, FL 33922! FORT MYERS FL ir-0 CCL tu) ~ -v0t /aerialleepa. org/dotnet/taxmap/tax.\1apprint. aspx 1120/2009

14 Welcome to Gate to Kids Area second Field f P 1 d & Train Ride. 'aste 0 fie S an -- Laser Tag Seafood Chowder Cook -Off Contest._., SEE OTHER FELD FOR KD'S GAMES More... Rock climbing Bounce Honse Fish Drop Field #2 4:30PM ~ La~~~;, Olow~«.oook-off & 1 0-/. z_l) b rr00ms. Perfect Cup JUug.w.g.. :.. Restaurants. ~fjv~ -:~ \ \ ' \\ \ -\ \ \ \... 1 ~t oh ALL v~~j()rs l D X D l't:h)+5 \SrtJ\Jj ow0

... ------------------------~ ----- -.. ' CERTFCATE OF LABLTY NSURANCE DATE (MM/DDNYYY) 10/30/2014 ' THS CERTFCATE S SSUED AS A MATTER OF NFORMATON ONLY AND CONFERS NO RGHTS UPON THE CERTFCATE HOLDER.

15 ~ ' CERTFCATE OF LABLTY NSURANCE DATE (MM/DDNYYY) 10/30/2014 ' THS CERTFCATE S SSUED AS A MATTER OF NFORMATON ONLY AND CONFERS NO RGHTS UPON THE CERTFCATE HOLDER. THS CERTFCATE DOES NOT AFFRMATVELY OR NEGATVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLCES BELOW. THS CERTFCATE OF NSURANCE DOES NOT CONSTTUTE A CONTRACT BETWEEN THE SSUNG NSURER(S), AUTHORZED REPRESENTATVE OR PRODUCER, AND THE CERTFCATE HOLDER. A"-C~D MPORTANT: f the certificate holder is an ADDTONAL NSURED, the policy(ies} must be endorsed. f SUBROGATON S WAVED, subject to. the tenns 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 ~~~!lt"' AdamBeiff. Hylant Group nc-ndianapolis ~~gnrjo F'rt\: _u;ee Nol:317 -an Pennsylvania Parkway, #201 ndianapolis N ~ifd~~ss:adam.reiffocvhvlantcom NSURER(S) AFFORDNG COVERAGE NAC# insurer A :Lexinaton lnsurajlce_gom.d_aov H9437 NSURED KWAN03 NSURERB: i Kiwanis nternational, All Clubs and Their Members!NSUPER C: 3636 Woodview Trace NSURERD: i ndianapolis N NSURER E: j NSURER F: i COVERAGES CERTFCATE NUMBER REVSON NUMBER THS S TO CERTFY THAT THE POLCES OF NSURANCE LSTED BELOW HAVE BEEN SSUED TO THE NSURED NAMED ABOVE FOR THE POLCY PEROD NDCATED. NOTWTHSTANDNG ANY REQUREMENT, TERM OR CONDTON OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHCH THS CERTFCATE MAY BE SSUED OR MAY PERTAN, THE NSURANCE AFFORDED BY THE POLCES DESCRBED HEREN S SUBJECT TO ALL THE TERMS, EXCLUSONS AND CONDTONS OF SUCH POLCES. LMTS SHOWN MAY HAVE BEEN REDUCED BY PAD ClAMS. JADDL:SUBRi l~fw TYPE OF NSURANCE NSR WVD! POLCY NUMBER LMTS y,,,,,, A GENERAL LABLTY 11/ ~ 1/1/2015 EACH OCCURRENCE $2,000, ~MMERCAL GENERAL ~lablty $500,000 ~1----J- CLAMS-MADE [3] OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV NJURY $2,000,000. t Liquor Liability GENERAL AGGREGATE $2,000,000 ~'L AGGR~E LMT APF,S PER: PRODUCTS COMP/OP AGG $2,000,000! POLCY j~g:! LOC Liquor Liability S1,000,000 A AUTOMOBLE LABLTY i11/1/2014 1/ ANY AUTO r- BODLY NJURY (Per person) : $ ALLOWNED SCHEDULED 1-- AUTOS 1-- AUTOS BODLY NJURY(Peraccident)l $ ~ HRED AUTOS ~ ~8~~WNED Aggregate S3,0oo,ooo UMBRELLA LAB H OCCUR EACH OCCURRENCE $ H EXCESS UAB CLAMS-MADE ' AGGREGATE $ A OED : RETENTON $ WORKERS COMPENSATON AND EMPLOYERS' LABLTY ANY PROPRETORPARTNERJEXECUTVE OFFCERMEMSER EXCLUDED? (Mandatory in NH) f yes, describe under DESCRPTON OF OPERATONS below Self-nsured Retention!o13136oos E.L. EACH ACCDENT $ E.L DSEASE- EA EMPLOYEE $ E.L. DSEASE- POLCY LMT ' $ All Claims $75,000 DESCRPTON OF OPERATONS LOCATONS VEHCLES (Attach ACORD 101, Additional Remarks Schedule, if n10n!l space is required) ificate Holder is named as Additional nsured as respects to General Liability only regarding the following Kiwanis event (setup, take & rain date(s) during policy term are included):!kwans CLUB OF PNE SLAND- 1/23-26/2014 OR ANY OTHER FUTURE DATE.(S) DURNG THS POLCY TERM- TAST OF PNE SLAND 2014 SCHOLARSHP FUNDRASER(FOOD, ARTS & CRAFT VENDORS, LVE MUSC) AT PHLLPS PARK/PNE SLAND CENTER (5675 SESAME DRVE, BOKEELA, FL 33922) CERTFCATE HOLDER LEE COUNTY BOARD OF COUNTY COMMSSONERS ND STREET :.- FORT MYERS FL CANCELLATON SHOULD ANY OF THE ABOVE DESCRBED POLCES BE CANCELLED BEFORE THE El,PRATlON DATE THEREOF, NOTCE WLL BE DELVERED N ACCORDANCE WTH THE POLCY PROVSONS. ACORD 25 (2010/05) ACORD CORPORATON. All rights reserved. The ACORD name and logo are registered marks of ACORD

16 POLCY NUMBER: COMMERCAL GENERAL LABLTY THS ENDORSEMENT CHANGES THE POLCY. PLEASE READ T CAREFULLY. ADDTONAL NSURED- DESGNATED PERSON OR ORGANZATON This endorsement modifies insurance provided under the following: COMMERCAL GENERAL LABLTY COVERAGE PART. Name of Person or Organization: LEE COUNTY BOARD OF COUNTY COMMSSONERS ND STREET FORT MYERS FL SCHEDULE (f no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO S AN NSURED (Section ) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CG Copyright, nsurance Services Office, nc., 1984 Page 1 of 1

DATE (MMDDYYYY) CERTFCATE OF LABLTY NSURANCE 10/1/2013 THS CERTFCATE S SSUED AS A MATER OF NFORMATON ONLY AND CONFERS NO RGHTS UPON THE CERTFCATE HOLDER. THS 1._C0RD _.

17 DATE (MMDDYYYY) CERTFCATE OF LABLTY NSURANCE 10/1/2013 THS CERTFCATE S SSUED AS A MATER OF NFORMATON ONLY AND CONFERS NO RGHTS UPON THE CERTFCATE HOLDER. THS 1._C0RD _./' CERTFCATE DOES NOT AFFRMATVELY OR NEGATVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLCES BELOW. THS CERTFCATE OF NSURANCE DOES NOT CONSTTUTE A CONTRACT BETWEEN THE SSUNG NSURER(S), AUTHORZED REPRESENTATVE OR PRODUCER, AND THE CERTFCATE HOLDER. MPORTANT: f the certificate holder is an ADDTONAL NSURED, the policy(ies) must be endorsed. f SUBROGATON S WAVED, 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 ~~~~ct Adam Reiff Hylant Group nc-ndianapolis ~g~j'o Ext\: r,e~ Nol: Pennsylvania Parkway, #201 ~~o"~~s:adam.reiff(q)hvlantcom ndianapolis N NSURER(S) AFFORDNG COVERAGE NAC# NSURER A :lexinaton nsurance Comoanv ~9437 NSURED KWAN03 NSURERS: Kiwanis nternational, All Clubs and Their Members NSURER C :o<, l nsured Local Club: GREATER PNE SLAND 'V lnsurerd: %PAT BURMAN PO BOX 111 NSURER E :a." 1 ', ST. JAMES CTY FL NSURER F : ~~~- COVERAGES CERTFCATE NUMBi,R: REVSON NUMBER: THS S TO CERTFY THAT THE POLCES OF NSURANCE LSTED BELOW HAVE BEEN SSUED TO THE NSURED NAMED ABOVE FOR THE POLCY perod NDCATED. NOTWTHSTANDNG ANY REQUREMENT, TERM OR CONDTON OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHCH THS CERTFCATE MAY BE SSUED OR MAY PERTAN, THE NSURANCE AFFORDED BY THE POLCES DESCRBED HEREN S SUBJECT TO ALL THE TERMS, EXCLUSONS AND CONDTONS OF SUCH POLCES, LMTS SHOWN MAY HAY<; BEEN REDUCED BY PAD CLAMS, NSR LiR :ADD71: i TYPE OF NSURANCE NSR VWD POLCY NUMBER ~&.~J6E'fl!//n ~~~)5%~ 1 LMTS A i GENERAL UA61LTY Y /1/2013 h 1/1/2014 EACH OCCURRENCE $2,000,000 ixl w COMMERCAL GENERAL LABLTY j ~~~~~~J?E~~~~ncel $500,000 CLAMS MADE EJ OCCUR MED EXP (Any one person) $5,000 X [ Agg Per District PERSONAL & AOV NJURY S2,000,000 ~ Liquor Liability GENERAL AGGREGATE $2,000,000 A A ~'L AGGREnE LMT APnS PER: PRODUCTS COM PlOP AGG $2,000,000 1 POLCY : P,~R.,: LOC Liquor Liability $1,000,000 H AUTOMOBLE LASLTY /1/2013 1/1/2014 te~~;;;,~~~~r'ngle w'" $ BODLY NJURY (Per person) $ ANY AUTO ALL0\>1/NED 'SCHEDULED BODLY NJURY (Per accident) $ AUTOS AUTOS X NON.OWNED fp~~~&ljjci,t?amage $ f-' HRED AUTOS ~ AUTOS i i Aggregate $3,000,000 UMBRELLA LAB ~ H OCCUR EXCESS LAB, i i CLAMS-MADE '! i OED RETENTON $ : WORKERS COMPENSATON AND EMPLOYERS' LABLTY y J N u EACH OCCURRENCE.S AGGREGATE $ ' $ T'r,~$~Jlts OJ~- ANY PROPRETOR/PARTNER/EXECUTVE ll ' N A E.L. EACH ACCDENT $ OFFCER/MEMBER EXCLUDED? (Mandatory in NH) E.L DSEASE EA EMPLOYEE $ f yes, describe under j DESCRPTON OF OPERATONS i below. ' E.L. DSEASE- POLCY LMT $ Self-nsured Retention p / ~ 1/1/2014 All Claims $75,000 i j DESCRPTON OF OPERATONS LOCATONS VEHCLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is named as Additional nsured as rtispects to General Liability only regarding the following Kiwanis event (setup, take down & rain date(s) are included): 1/23/2014-1/26/2014 OR ANY FUTURE DATE(S) DURNG THE POLCY TERM TASTE OF PNE SLAND 2014 SCHOLARSHP FUND RASER (FOOD, ARTS & CRAFT VENDORS, LVE MUSC) AT PHLLPS PARK/PNE SLAND CENTER (5675 SESAME DRVE, BOKEELA, FL 33922) CERTFCATE HOLDER CANCELLATON ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRBED POLCES BE CANCELLED BEFORE THE EXPRATON DATE THEREOF, NOTCE WLL BE DELVERED N PHLLPS PARK ACCORDANCE WTH THE POLCY PROVSONS. ATTN: PNE SLAND CENTER,, 5675 SESAME DRVE BOKEELA FL AUTHORZED REPRESENTATVE ~~ The ACORD name and logo are registered marks of ACORD ACORD CORPORATON. All nghts reserved.

18 Division of Public Resources LEE COUNTY S O UTHWEST FLORDA!. ~ YW?n_r....:.i...:.l_. "_!..., _ -:_/ _..:.... ;_ i =--...:. {_--'.: Date---~---- Year ---'---'--,.!.:.:...,...i-~ ;..t:_(-= Suppl. $ D Video $ # [~]' Permits $, i /.' D Copies$ D Other '. l :,:, '...- Amount Paid $ -----~.:'_.._...:. _ _. _' _ Cashier's Signature ---~ :':...:...:. :.: :::.:,_ ;...:: '! // D Cash 0 Check# ; /...:'..:..: '-:...: ; -~_:._ -' KWANS CLUB OF GREATER PNE SLAND FLORDA NC 5281 PNE SLAND AD BOKEELA, FL H.~tte _...:...ll~~...~... l :::_ ~,/ r_.:_ ~tr~ L~-L tbv)j,1cs?o~ot:cov~--t'fjco"'p>"';-;'oxaei/j 1 +-f.., /670 1 $ ;:J.tJ;.,Sa#wh ~~ r t;:~ ~ :-. FOR ;: :~;:E, ~;;-~-!i~---1-)o-m~ ~. ' -,

19 MEMORANDUM FROM THE DVSON OF PUBLC RESOURCES DATE: December 2, 2014 TO: County Management FROM: Samantha Westen, Administrative Assistant RE: Event Permit for Signature Attached is a Special Event application submitted by the Kiwanis Club of Greater Pine sland for the "Taste of Pine lsland 11 event which will take place at Phillips Park, 5675 Sesame Drive, Bokeelia on January 24, 2015 from 11:00 am to 6:00pm and January 25, 2015 from 11:00 am to 5:00pm. All needed sign-off sheets are included as well as the insurance certificate and site plan. Please sign the permit and return to Public Resources after review. f you have any questions or concerns, please call me at Thank you, w~ Samantha Westen Attachment

f i:ee County Event Pertnit --~ r~ -J-7-ty Permit Type Pine Island Garden Club 14th Annual Garden Gala Permit Number CP John A.

f i:ee County Event Pertnit --~ r~ -J-7-ty Permit Type Pine Island Garden Club 14th Annual Garden Gala Permit Number CP John A. Event Pertnit Event Name: Pine sland Garden Club 14th Annual Garden Gala Applicant: John A. Kendall Contact: John A. Kendall, 239.283.8175 Location: Phillips Community Garden Park, 5675 Sesame Dr. Bokeelia