Co Sponsored Events Subcommittee Co-Spon. Events

City of St. Petersburg

City Council

Co-Sponsorship Subcommittee

Thursday, September 17, 2015, 11:00 AM

City Hall Room 100

Subcommittee Members Charlie Gerdes Jim Kennedy Steve Kornell

Bill Dudley (Alternate)

Agenda

I. Call to Order II. Approval of seventeen (17) FY 16 Group B & C events; waiver of non-profit

requirement of five (5) events III. Approval of two (2) FY 16 Group C events for exemption from the beer and wine

only restriction; IV. Approval of one (1) FY 16 Group C event for the sale and consumption of beer,

wine, and alcoholic beverages

V. Public comment

VI. Adjournment

Event #

Event Name1st Year

Non Profit Profit Organization Event Dates Times Event Location

57 Ma' Ceo YESMUSEUM OF FINE ARTS OF ST PETERSBURG, FLORIDA, INC.

CAVALLO EQUESTRIAN ARTS, LLC

01/28/16 ‐ 01/31/16

6pm ‐ 9pm Daily Albert Whitted Park

60 Walk to Defeat ALS NOALS ASSOCIATION‐ SOUTHERN FLORIDA CHAPTER, INC.

03/05/16 7am ‐ 2pm Elva Rouse Park

61Historic Kenwood Pinot in the Park

NOHISTORIC KENWOOD NEIGHBORHOOD ASSOCIATION, INC.

04/03/16 6pm ‐ 10pm Seminole Park

62 Painting in the Park 2016 YESMUSEUM OF FINE ARTS OF ST PETERSBURG, FLORIDA, INC.

4/24/16 11am ‐ 4pmMuseum of Fine Arts North Lawn

63 Stuart Society Wine Weekend NOMUSEUM OF FINE ARTS OF ST PETERSBURG, FLORIDA, INC.

02/04/16 ‐ 02/07/16

2pm ‐ 11pmMuseum of Fine Arts North Lawn

64 Corvette Car Show NO SUNCOAST CORVETTE ASSOCIATION, INC. 05/28/16 8am‐5pm North Straub Park

65 American Stage in the Park NO THE AMERICAN STAGE COMPANY, INC.04/13/16 ‐ 05/08/16

6pm ‐ 10:30pm Demen's Landing

66 The Great Brainwash NO BRAIN TUMOR ALLIANCE, INC. 08/06/16 5:30a ‐ 4:00pmNorth Straub, South Straub, Albert Whitted and Vinoy Park

67 Cupid Undie Run NO CUPID CHARITIES CORPORATION 2/14/16 1pm ‐ 5pm 1st Ave N & 2nd Street N

68 Umphreys McGee YES REFUGE MINISTRIES OF TAMPA BAY, INC.NO CLUBS ENTERTAINMENT INC

08/06/16 4pm ‐ 10pm Vinoy Park

69 Tampa Bay Caribbean Carnival NOTRINIDAD & TOBAGO AMERICAN ASSOCIATION OF CENTRAL FLORIDA, INC

06/11/16 & 06/12/16

12pm ‐ 10pmAlbert Whitted Park OR Vinoy Park

70 Spring Beer Fling YES MY HOPE CHEST CORPORATION BIG CITY EVENTS, LLC 03/19/16 12pm ‐ 10pm Vinoy Park

71 Relay For Life of St. Petersburg NO AMERICAN CANCER SOCIETY, INC. 4/8/16 4pm‐10pm South Straub Park

72 Extreme Mudwars NO PIER AQUARIUM, INC. ACTIVE ENDEAVORS, INC.07/16/16 & 07/17/16

9am‐5pm Spa Beach Park

73 Sunshine Grand Prix YES FLORIDA CYCLING FOUNDATION, INC. 03/25/16 8am ‐ 8pm Al Lang Area

74 Reggae Rise Up Music Festival YES TBA LIVE NITE EVENTS , LLC 03/05/16 3pm ‐ 10pm Vinoy Park

75 Jelly Bean Fling NOTHE JUNIOR LEAGUE OF ST. PETERSBURG FLA., INCORPORATE

03/26/16 10am ‐ 1pmVinoy Park / North Shore Park


2015 ‐ 2016

Co‐Sponsored EventsProfit / Non Profit Report ‐ Group "B" & "C"

CITY OF ST. PETERSBURG PARKS & RECREATION DEPARTMENT CO-SPONSORED EVENT APPLICATION

www.slpaID .Drg

~ .JeI 0 P

C> (/) ~ .

Date ReceIved: heck or Cash:

Applica tion #:

Packet: Permit #:

Event Title: IMa' Ceo Phone No.: 1813-995-4749 Fax No.: 1

Entity Name: r-Ic-a-va- I-IO- E-q-U-e-st-rr-'a-n-A-rt-s-L-LC-------------- Federall.D. Number: 1.-4-5--3-6-4-42-6-7------

Event Date(s): 14 days in February Location: j50lltb Straub Park ,4wr .-------

Day 1 of Event: IThursday Time Gates Open: 16:oopm

Day 2 of Event: 1 Time Gates Open:

Day 3 of Event: jsunday Time Gates open: j r-----

Application Prepared by: 10 lissio Zoppe

Title: lowner, Director

Address: 17820 Irvin Road

Email Address: [email protected]

Ending Time:

Ending Time:

Ending Time: 18:00pm

Phone: 1813-995-4749

Cell Phone: 1813-995-4749

City: IMyakka City State: IFL Zip: 134251

Additional Contact Person: r-IT-o-m- C- r-a-n-gl-e------------------- Day Phone: 1702-334-0772

What month/year were you incorporated as nonprofit? I'n-/a--------------------------

List all 501 (c)3 entities that will benefit from this event. In/a

Name of the for-profit entity? r-Ic-a-va- I-Io- E-q-U-e-st-ri-a-n-A-rt-s,-L-L-C--------------------

Describe how this event will contribute to the quality of life in and enhance the image of St. Petersburg.

Please see attached document

Describe what economic benefit and impact this event will bring to St. Petersburg.

Please see attached document

Each co-sponsored entity must possess liability insurance naming the City of St. Petersburg as an additional insured and secure said insurance in the amount determined by the City.

Does your group presently have liability insurance? IX YES

Are there plans to sell or distribute beer/wine at your event?

Will there be an admission / registration fee? IX YES r Please provide the website address for your event. maceocirco.com

NO

r NO

IX YES

How much? Istarting at $1,000,000

r NO

Advanced Fee: Day of:

Please provide a phone number that can be advertised to the public. ITBD by ticketing

What is the estimated attendance for this event? Spectators 14,500 Participants Ir-n-/a-- Last Year's Total Attendance jn/a

Page 1 of 8

Please check the equipment and/or faci lities you are requesting.

Recreation Eg!!.lRment

Showmobile (Yes/No) INO

# Bleacher(s) needed. Each bleacher approx. 180 peoPle)1

Tables (6 ft) # needed I Chairs # needed 1100

Public Address System

# of portable risers needed (4 in. x 8 in. x 16 in. sections)1

~p'eciill Events Facilities

r Mahaffey Theater

r Col iseum

r Sunken Gardens

r Boyd Hill

I Non-City Locations

Which Location?

ISouth Straub Park

The following departments may provide and charge for additional services. You will be provided cost estimates in your Cosponsored Agreement.

POLICE: TRAFFIC: FIRE' PARKS SERVICES: toration RECREATION SERVICES:

Note: The City does not provide tents, Port-O-lets, or large quantities of tables and chairs.

I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name: !OIiSSiO Zoppe

Co-Sign: I Title: lowner / Director

Title: I Date: 106/03/2015

Date: 1

NOTE: a.

b.

c.

If person/entity preparing this application is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c)3 designation must accompany this application. If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.

PLEASE ATIACH THE FOLLOWING

1. Route map for parade, run, walk, and/or bike event. 2. Site map of event and detail schedule of each day's events including open and close times. 3. Complete Appendix B and Appendix C. 4. Check for $30.00 for co-sponsored application processing (non-refundable). 5. Check for park permit fee. See Appendix A for fee structure. 6. A copy of 501 (c)3 designation (if applicable)

FOR FURTHER INFORMATION, PLEASE CALL LYNN GORDON, PARKS & RECREATION MANAGER, 727-893-7766 or EMAIL: [email protected]

Page 2 of8

PARKS & RECREATION DEPARTMENT CO-SPONSORED EVENTS

SUMMARY SHEET

Review and check all conditions which apply to this event: Note the corresponding obligation for each condition.

Condition

IX Public Invited

IX Located in Park

IX Vending Product I Merchandise Sales

IX Vending Food I Beverage

I Vendors I Exhibitors

IX Vending Beer I Wine

IX Erecting Tents - Larger than 10ft x 12ft

I Fence Installation

I Other Structures

I Open Flame Food Preparation

I Pyrotechnics

I Require Street Closure

IX VIP Area

I Staging

I Amplified Sound

I Security

IX Sanitary Facilities - Port-O-Lets

I Off-site Parking I Shuttle

I Semitruck I Tractor Trailer

Marketing: Please check all that apply.

IX Invitations

IX Posters I Flyers

IX Newspaper I Internet

How many?

Obligation

General Liability Insurance

Park Permit

Occupational License

Health Inspection

Alcohol Permit Additional insurance Required

How many? 13 horse stables

What type? I-IB-i9- T- o- p- T- h-e-a-tr-e-, s-m- a-II- t-ic-k-et-in- g--

Temporary Structure Permit


Temporary Structure Permit What structure? I Fire Inspection Permit

Fireworks Permit

Parade or Street Closure Permit(s)

I Professional I Showmobile I Other

I Performers I Announcement Only

I Daytime - Private I Overnight - Private I Event Time Frame - SPPD

Regular Units ~ Disabled Units ~ Hand Washing ~

IX Radio

IX Television

IX Remote Broadcast

Page 3 of8

City logo should be used in any promotional materials, posters, flyers, ads, website, public service announcements, and press releases.

Electrical Requ irements:

Does your event require any power needs using more than the standard 11 0/ 20amp located in the parks? rx YES r NO

If YES, check all that apply. r RV'S r Coffee Vendors r Ice Bins r Freezers r Ice Cream Vendors r Catering Trucks

rx Other:

Please explain the details of the above items checked. Tell us how much and what type of power they would require.

We will require 8 legs of 110 amp for electricity for the show,lights, music, etc.

Will you supply your own generators? r YES rx NO

Will your event have a licensed electrician on-site during the event? r YES rx NO If YES, who?

Will your event be requesting any variances from City policies or procedures? If YES, please explain.

If City permits, licenses, or services are required for event, who will pay for them?

Name: ITBD

Address (including zip):

Type of music, # of stages, and # of bands.

Phone:

Show music only to be played in Big Top. Ambiant music to be played outside in front of tent.

List Vending Products. Name & Provider.

General Show Merchandise ie: T-shirts, programs, magnets, mugs, etc. Food Concessions: popcorn, soft drinks, Italian Sausage, Italian Ice, Lemonade, etc. Provider to be determined.

For Use of Beer/Wine - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.

Big Cat Catering 4716 Cronin Drive, Sarasota, FL 34232

Explain subject/purpose of all speeches/demonstrations which will occur.

Discuss your load in/load out parking needs, include times and dates.

Load in: 2 days prior, one day rehearsal/media day Load out: 1.5 days after closing at event. Minimal on-street parking - 1 day load-in, 1 day load out.

Page 4 of8

Other Comments: Please describe your fee structure.

On site pricing: Ringside Seating: $55.00 Adult - Mezzanine Seating: $35.00 Child - Mezzanine Seating: $24.00 Adult - General Seating: $25.00 child - General Seating: $12.00

VIP Experience: $85.00 includes backstage stables tour, pre-show experience, VIP area lounge, priority seating, Souvenir lanyard, complimentary beverage and program

Other comments:

Advance tickets offer a $3.00 to $5.00 rebate off of each ticket value

I represent and warrant that the purpose of the proposed activity/event and conduct of the sponsor(s) and the participants shall conform to all requirements of law and all ordinances of the State of Florida, Pinellas County, and the City of St. Petersburg including, but not limited to, City noise ordinances and Parks and Recreation Department Policies and Procedures. I acknowledge that failure to observe such laws, ordinances, or policies and procedures will result in an immediate cancellation of the event and all permits.

WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE PARKS AND RECREATION DEPARTMENT POLICIES AND PROCEDURES PERTAINING TO THE USE OF PARKS AND THE PARK RULES SET FORTH IN ARTICLE II, CHAPTER 21, OF THE ST. PETERSBURG CITY CODE, INCLUDING BUT NOT LIMITED TO THE INDEMNIFICATION AND INSPECTION OBLIGATIONS ASSUMED BY ME AND THE PERSON OR ENTITY ON WHOSE BEHALF THIS APPLICATION IS BEING MADE.

I certify that the facts contained in this application are accurate.

Name: IOliSSiO Zoppe Title: lowner 1 Director Date: 106/03/2015

Page 5 of8

Describe how this event will contribute to the quality of life in and enhance the I mage of St.Petersburg.

--Ma'Ceo is the perfect opportunity for St. Petersburg to broaden its already diverse arts scene. This acrobatic and theatrical horse show will enhance, enrich, educate and expose innovative artistic elements to the St. Petersburg, and visiting patrons. Situated in our brand new black & white romantic big top theatre, Ma'Ceo offers high-end entertainment in an intimate atmosphere. This one-of-a-kind show boasts an international cast performing original acrobatics, aerial arts, choreography, live singing, heartpounding stunts on horses and theatrical elements; in which Ma'Ceo is proud to highlight the rare and beautiful bond between man and horse. This is a chance for the community to be enlightened and exposed to the intricacies and fragility of this age-old connection. The history of this bond has been in the Zoppe family for over 170 years, and is practiced and carried on with great care. Within this bond of communication and trust, Ma'Ceo will dazzle spectators with daredevil stunts and enchanting choreography, leaving them both breathless, and coming back for more. St. Petersburg will be setting the bar for high-end, innovative and esteemed arts on the international stage.


--This is a unique and beautiful event that will appeal to all, but will also draw a new demographic to the downtown St. Pete area, and expand to the cultural community at large. Aside from the performing arts and fine arts appeal, 440,000 Floridians are involved in the equine industry as horse owners, service providers, employees, and volunteers. Even more participate as spectators. The equestrian community is very passionate about attending equestrian events that are both of an entertainment and enlightening value to them. With this type of tight nit community, we know that the draw will be far and wide. Overall, the horse industry has a $5.1 billion impact on the Florida economy. This show has yet to be featured in St. Petersburg. It will appeal to a vast public, stretching from the general public, to the equine community, the arts community, families, couples, the animal lover in general, and patrons of all ages and walks of life. This show especially appeals to the upper echelon community for its display of class, beauty and uniqueness. There is a wide array of beautiful and exotic equine breeds, and a wonderfully talented and beautiful international cast that spikes the interest of any enthusiast, as they perform never before seen stunts, and hold the attention of any expert and novice alike.

We know that the production of Ma'Ceo will be great for local business, as it will bring in a new wave of visitors; allowing them to explore and discover the multitude of cafes, fine dining, shopping, night life, parking facilities, accommodations and beautiful scenery of the Historic and, once-again booming Downtown St. Petersburg area.


Event Title:

Entity Name:

--~."/~ ~~ --... st.pelersburg

WWW.81polo .orA

-Ending Time:

Ending Time:

Ending Time:

Date Received: ) p z b ..;Check or Cash: cAlf: dP.x;-.,r.d.

. ' 0 Application #: Packet:

Phone: I <6/'3 --~o~-~ S b~ Cell Phone: I ctJ3~~-~S-~

.---_____________ C_it_y:_I_~--+--~--St-at-e: I te-- Zip: 1"3.3~ If

EmaiiAddress: I \)~(l.\~rQaJ..Sg.~l_o Additional Contact ~erson: ~SA""1Lbl ,flJa= Olica... ~1~t~Day Phone: 1<61 3-b31 '"--1'Q::.d ~h What monthlyear were you Incorporated as nonprofit? I Au '1°,"1- I 'i"?;:Z _ ~ List all 501 (c)3 entities that will benefit from this event. I ~ I\-(..S Prs$Oc::...I~ U'I'-- H-A-clto-.p~

I Name of the for-profit entity?



Each co-sponsored entity must possess liability insurance naming the City of St. Petersburg as an additional insured and secure said insurance in the amount determined by the City. /

Does your group presently have liability insurance? rV YES r NO Howm~ 1I1kt// ~(}C4~ Are there plans to sell or distribute beer/wine at your event? r YES rv1fo I t; ()~ I ~o (/ A4~ Will there be an admission / registration fee? r YES ~O Advanced Fee: I Day of:

Please provide the website address for your event. 1 UJtJ/w. wtllJ:.i1 /. oj stL· ort: Please provide a phone number that can be advertised to the public. / r -&l::-7-3---6~~-1--~9<-=-~-W--~---A:-:&&'=------

What is the estimated attendance for this event? Spectators 1/(70 Participants I ~t1t1 Last Year's Total Attendance I

Page 1 of8

Please check the equipment and/or facilities you are requesting.

Show mobile (Yes No) ()

# Bleacher(s) needed. Each bleacher approx. 180 people)1

Tables (6 ft) # needed I Chairs # needed I Public Address System


~ecia l Events Faci lities

I Mahaffey Theater

I Coliseum

I Sunken Gardens

I Boyd Hill


Which Location?


POLICE: TRAFFIC: FIRE: Paramedics. Inspectors PARKS SERVICES: Cleanup Personnel. Dumpster(s). Trash Receptacles. Event Site Preparation and Restoration RECREATION SERVICES: On-site Presence. Logistics Help. Liaison w ith Other Ddepartments

Note: The City does not provide tents, Port-O-Lets, or large quantities of tables and chairs.

I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. 'agree to obtain the required liability insurance and to secure

:~::er~~p~:,::ai:;cz==::on j'~7E£' Co-Sign: Title: Date:

NOTE: a.

b.

c.


PLEASE ATTACH THE FOLLOWING

1. Route map for parade, run, walk, and/or bike event. 2. Site map of event and detail schedule of each day's events including open and close times. 3. Complete Appendix B and Appendix C. ~. Check for $30.00 for co-sponsored application processing (non-refundable). 5. Check for park permit fee. See Appendix A for fee structure. 6. A copy of 501 (c)3 designation (if applicable)


Page 2 of8

-. _/~

N., _ ---.. st.petersburg WWW.ltpote.org


SUMMARY SHEET


Condition

~c lnvited W Located in Park

I" Vending Product / Merchandise Sales

I" Vending Food / Beverage

I" Vendors /txl ilbltotS Sf On 5(J~ I" Vending Beer / Wine

I" ~cting Tents - Larger than 10ft x 12ft

I" Fence Installation

Ij/""Other Structures

I" Open Flame Food Preparation

I" Pyrotechnics

I" Require Street Closure

I" v~rea

r0t~ging 0mplified Sound

~rity ~ ~ary Facilities - Port-O-Lets

I" Off-site Parking / Shuttle

I" Semitruck / Tractor Trailer


I" Invitations

I" Posters / Flyers

I" Newspa~

How many? I 1.0 fr, 10

How many? I~ What type? r-

Obligation


Park Permit


Health Inspection

What structure? 1:5~





Fire Inspection Permit

Fireworks Permit


~fessional I" Showmobile I" Other

I" v Performers r ~uncement Only

I yDaytime - Private ~ernight - Private r Event Time Frame - SPPD

Regular Units I ~ Disabled Units I &- Hand Washing I

r Radio

r Television

I" Remote Broadcast

Page 3 of8


Electrical Requirements:

Does your event require any power needs using more than the standard 11 0/20amp located in the parks? , YES JV1Jo If YES, check all that apply. RV'S Coffee Vendors , Ice Bins Freezers Ice Cream Vendors , Catering Trucks

rz;.--6ther:


~ I

Will you supply your own generators? , YES ~ YES ~ If YES, who? Will your event have a licensed electrician on-site during the event?

Will your event be requesting any variances from City policies or procedures? If YES, please explain. J./ ()


Name: I --tlt- I}L-'S Its S4C-11r--r1 dAJ Phone: I <{I '3 - ~ '37

'~~~33bI1 Address (including zip): '3;t-i?- ~ An' d..t-~ Type of music, # of stages, and # of bands.





Page4of8


Other comments:


WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, I ACKNOWLEDGE THAT I HAVE READ AND FULL Y UNDERSTAND THE PARKS AND RECREATION DEPARTMENT POLICIES AND PROCEDURES PERTAINING TO THE USE OF PARKS AND THE PARK RULES SET FORTH IN ARTICLE II, CHAPTER 21, OF THE ST. PETERSBURG CITY CODE, INCLUDING BUT NOT LIMITED TO THE INDEMNIFICATION AND INSPECTION OBLIGATIONS ASSUMED BY ME AND THE PERSON OR ENTITY ON WHOSE BEHALF THIS APPLICATION IS BEING MADE.

I certify that the factsoontained in this application are accurate.

Name: I (d>~' YiL W~ Title:

PageSofB

~\WII ..r-..

sl.pelersburg WWW.8Ip810 .org

Appendix B President or CEO

Responsible Party Information

Please complete the information below for each responsible party.

Name ofthe Nonprofit Corporation: I ~k .. eJ+L S Assoc..i;rT(6t.J FLD~ VA- c..H-~Gtl-

Name of Responsible Party (President or CEO ONLY): \( \ 'M.. berl-e y \-k.-V\ V\. ~

Title of Responsible Party: ~,<-S ,C:L ~...l-

Physical Address of Responsible party,1 3d. 4 J.. Porl6&~~ Ct'rt:.lk-t~ 'k- 3>(. 15' Phone Number of Responsible Party: I <613- 0'37 - qOO() ~.f. /65 Email AddressofResponsibleparty. l l<.ha.. ... f\o...20..I.so. -\! \ • O~ Nonprofit (Employee Identification Number): I Cl t:\- '3 \ "d- Lt l,;L

Name of the For-profit Corporation:

Name of Responsible Party (President or CEO ONLY):

Title of Responsible Party:

Physical Address of Responsible Party: I Phone Number of Responsible Party:

Email Address of Responsible Party:

For-profit (Employee Identification Number) I

Please include a copy of the the current IRS Nonprofit Affidavit I For Profit

Page 7 of8

Internal Revenue Service

Date: March 21, 2007

AMYOTROPHIC LATERAL SCLEROSIS ASSOCIATION FLORIDA CHAPTER % DARA ALEXANDER BOARD PRES 3242 PARKSIDE CENTRAL TAMPA FL33619

Dear Sir or Madam:

Department of the Treasury p, O. Box 2508 Cincinnati, OH 46201

Person to Contact: DALPHENE NAEGELE 31-04012 CUSTOMER SERVICE SPECIALIST

Toll Free Telephone Number: 877 -829-5500

Federal Identification Number: 94-3124732

Group Exemption Number: 4119

This is in response to your request of March 21 , 2007, regarding your organization's tax-exempt status.

Your organization is exempt under section 501 (c)(3) of the Code because it is included in a group ruling issued to Amyotrophic lateral Sclerosos Association, located in CA

Our records indicate that contributions to your organization are deductible under section 170 of the Code, and that you are qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Internal Revenue Code.

If you have any questions, please call us at the telephone number shown in the heading of this letter.

Sincerely,

~'r(~ Michele M. Sullivan, Oper. Mgr. Accounts Management Operations 1

APPENDIX C Name of Event:

SfAT8v1ENTOFREVENUEAND EXPENSES FORM Date(s) of Event: I __ .~ PRIOR YEARS EVENT

sl.pelersburg (Must be completed) /

www.stpolo.org C 'f. ~SOo H1.fL 0( 0' ~ I. REVENUEOOUFCES(attach sheet if more space isneeded) Amount

:: 1 ~(VWA-~~L Pf1t?n-tJpmID

1r---___ _

4 1~ ------------------------------------------ I~ ----------------5· 1 I 6· 1 ...-, --------

7· 1 I s· 1 1 ..--------

TOTAL GFOSS REVENU~ % ~ 3 I 1)0 c) , II. EXPEN~attach sheet if more space is needed) , :: :~~e~~/ifWIO? :- : ~~~~~ 5. I U£-1ft!ac= 6. 5e:Ce.vUZ; 7. I ?oQ:rA:~ TO IL i?13 8. I ~

II '65,13 I 360.00 I 3 90.cxJ I ~//.:n I q to. 00 I 0 .<./7

...-------------------------------------- 1 TOTALOPERATINGEXPENset ,. I.£; 7 CI I, 1?

TOTAL NET INOOMl -Ii ~ I to I ()JCf,. Q ~ III. ALLOCATION OF NET INOOME( attach sheet if more space is needed)

4. ~----~~~~~~~~~~~~~~~~~~~~-----------------

5. :------1l..IUW.YL.",,~~\d-t:K./J:~t=krU~~~:::=tIi~~==--~ ..----______________ _ 6.

Prepared by: I ~t.tw-.I2~

I Aint Application I Page 80f8

Date: I 77~/I~ 9.Jbmit Application by

anail

Client" 42045 AMVOLATE

ACORD, .. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDOIYVVV)

5/19/2015

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 pollcy(les) 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 ~~:ll~cr Mary O'Connor (C) WhartonlLyon & Lyon J~g,N~o, Ext): 973 992-5775 if All 9 .J AIC, No): 73-992-6660 101 S. Livingston Avenue ~D"b~~ss: [email protected] Livingston, NJ 07039

INSURER(S) AFFORDING COVERAGE NAIC' 973 992-5775 INSURER A : Hanover Insurance 22292 INSURED INSURER a :

Amyotrophic Lateral Sclerosis Assoc. -INSURERC :

1275 K Street NW, 2nd Floor, Suite 250 INSURER 0 :

Washington, DC 20005 INSURERE: -INSURERF:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED~BOVE FOR E OLiCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM~ENT WITH RESP T 0 ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S S 0 A THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR -- ADDl SUBR POLlCV EFF POllCV EXP -lTR __ TYPE OF INSURANCE INSR WVD POllCV NUMBER .(MMlDDIYVVYt (MMIDDlYVVVl LIMITS

A ~NERALLIABllITV ZHV949968803 ~4101/2015 04/01/201E EACH 'OcCURRENCE $1,000,000

X COMMERCIAL GENERAL LIABILITY ~~r~~~J?E~~~J~?onco) $500.000

- ~ CLAIMS· MADE I-.! OCCUR MED EXP (Any ono person) $10,000

~ -------------------- PERSONAL & ADV INJURY 51 000,000

I- ---------------------GENERAL AGGREGATE $ 2,000,000

~'L AGGRE~E LIMIT APPLIES PER:

I I POLICY I 1j'~.LIKl,....:L=O,=,C __ 'I __ i--.I------------I-----I----+ """";m;;;;n-;=....., ....... ;o-r-- I-$------- -AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I _

PRODUCTS· COMP/OP AGG $ 2,000,000

I- j Ea accidonl) I "

ANY AUTO - ALL OWNED I- AUTOS

~ HIRED AUTOS

SCHEDULED _ AUTOS

NON·OWNED I-- AUTOS

A ~ UMBRELLA LlAB llcJ OCCUR

EXCESS LlAB n CLAIMS.MADE

OED I xl RETENTION $0

BODILY INJURY (Per person) $

BODILY INJURY (Per accidenl) $

$

UHV A01456404 ~4101/2015 04101/201 Er-=E:..::AC:::.:H:...=OC.=.C::.:U:.:..:R:..::RE::.:N:=:CE=--_--t-:'$..:..:15=00~0"...0~0~0"______l AGGREGATE $15000 000

$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVED OFFICER/MEMBER EXCLUDED?

1 ~5R~1~~s l I ~~' ________ I N/A E.L EACH ACCIDENT $

(Mandatory In NH) E.L DISEASE· EA EMPLOYEE $ II yes, describe under DESCRIPTION OF OPERATIONS bolow E.L DISEASE· POLICY LIMIT $

DESCRIPTION OF OPERATIONS !LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Ride to Defeat ALS on 11n/15 at Pinellas Trail to Central Ave., then wlb on Central Ave. to Treasure

Island Causeway and also from the Pinellas Trail sib on 37th Street S. to 54th Ave. S. for the ALS

Association Florida Chapter

The City of St. Petersburg, Florida is named as Additional Insured under General Liability per form CG 2026

07/04.

CERTIFICATE HOLDER CANCELLATION

,

City of St. Petersburg, Florida SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEUED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

175 5th St N ACCORDANCE WITH THE POLICY PROVISIONS.

Saint Petersburg, FL 33701 AUTHORIZED REPRESENTATIVE

I £..6.J~ ~. L/t.t,AJI-A./ © 1988·2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S312759~308458 MMM

Uetail by Entity Name

Detail by Entity Name

Florida Not For Profit Corporation

ALS ASSOCIATION- SOUTHERN FLORIDA CHAPTER, INC.

Filing Information

Document Number FEIIEIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date

Principal Address

4631 N.W. 31ST AVENUE #166

733812 591647857

09/12/1975 FL INACTIVE ADMIN DISSOLUTION FOR ANNUAL REPORT

10/04/2002

NONE

FORT LAUDERDALE, FL 33309

Changed: 01/10/2001

Mailing Address

4631 N.W. 31 ST AVENUE #166 FORT LAUDERDALE, FL 33309

Changed: 01/10/2001

Registered Agent Name & Address

BELL, LISA 3374 N.W. 47 AVENUE COCONUT CREEK, FL 33063

Name Changed: 01/10/2001

Address Changed: 01/10/2001

Officer/Director Detail

Name & Address

Title PO

BELL, LISA

Page 1 of2

http://search.sunbiz.orglInquiry ICorporationSearch/SearchResultDetail ?inquirytype= Entity... 7/27/2015

Uetall by Entity Name

3374 N.W. 47 AVENUE COCONUT CREEK, FL 33063-1808

Title VD

GUNTER,CAROL 18930 N.W. 44TH AVENUE OPA LOCKA, FL 33055-2620

Title STD

SCARPITTA, GAIL 5520 LAKEWOOD CIRCLE NORTH, APT. #614 MARGATE, FL 33063

Annual Reports

Report Year 1999 2001

Document Images

Filed Date 03/02/1999 01/10/2001

01/10/2001 -- REINSTATEMENT View image in POF format 03/02/1999 -- ANNUAL REPORT:==V=ie=w=i=m=ag=e=in=p=O=F=fo=rm=at==:

02/16/1998 -- ANNUAL REPORT :==V=ie=:w=im=:a=g:::e=:in=:p=O=F=fo:::r=:m=at==: 06/20/1997 -- ANNUAL REPORT View image in POF format OS/20/1996 -- ANNUAL REPORT:==V=ie=w=im=a=g=e=in=p=O=F=fo=r=m=at==:

04/24/1995 -- ANNUAL REPORT View image in POF format ~------~----------~

~ © and privacy policies

State or Florida, Department or State

Page 2 of2

http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/27/2015

~~ It. p8tarabuPI ~ para I .8CP8aUln

Contract #: 14636 Date: 27 Jul 20~ 5

ALS ASSOCIATION PATIIE PALMER 3242 PARKSIDE CENTER CIRCLE TAMPA FL 33619 USA

Contract/Perm it

User: Status:

SCTegard Firm

Home #: () Business #: (810) 360-5930

Cell #: ()

Purpose of Use: Walk to Defeat ALS Expected: 900 Co-Sponsored Event Contract Balance

$230.00

Conditions of Use: Insurance Required

Other Information:

Use of beer and wine

Use of fencing Use of liquor

No

No No

Datels) and Tlme(s) of Use: Starting: Frl 04 Mar 16 07:00 am Ending: Sat 05 Mar 16 05:00 pm

Facility/Equipment

Elva Rouse Park

Park

Elva Rouse Park

Park

Additional Fees:

Extra Fee - Bookings Co-Sponsored Application Fee

Co-Sponsored Park Permit Fee

Charges:

Fees $ 0.00

Extra Fees

$230.00 Tax

$0.00

Balance of rental due and payable Immediately.

Payments:

Additional Notes:

Day

Fri

Sat

Date

04 Mar 2016

05 Mar 2016

Hours

11 :00

11:00

Total

$230.00

I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement I also understand this Agreement Is not flnal until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Sign Name)

(print Name) PATTIE PALMER

ALS ASSOCIATION Name of User Or anization, If Applicable

Printed: 27 Ju12015, 04:47 PM .

User: sctegard

Time

07:00AM

06:00 PM

06:00AM

05:00 PM

Quantity 1

2

Fee Extra Fee

$0.00 $230.00

$0.00 $0.00

Charge $30.00

$200.00

$230.00

Tax $0.00 $0.00

$0.00

Deposit Total Applied Contract Balance

$230.00 $0.00 $0.00

CITY OF ST. PETERSBURG, FLORIDA

By:(Sign Name):

Tax Total

$0.00 $230.00

$0.00 $0.00

Total $30.00

$200.00

$230.00

Account Balance

$230.00

Parks and Recreation Superintendent

(Print Name) Parks and Recreation Department

Page: 1

Contract #: 14636 User: SCTegard

Date: 27 Jul 201'5 Status: Firm

supervisor 117 Foreman

o Approved or o Rejected Date:


Manager

o Approved or o Rejected Date: Manager

The Americans with Disabilities Act (A.D.A.) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, assistive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TTD devices, please contact us using the Florida Relay Service at 800-955-8771.

Printed: 27 Jul 2015, 04:47 PM

User: sctegard

Page: 2

ALS ASSOCIATION PATIIE PALMER 3242 PARKSIDE CENTER CIRCLE TAMPA, FL 33619 USA

Description

Previous Balance

Applied To: 14636 - Walk to Defeat ALS

Elva Rouse Park - Park

....... st.petersburg


March 4,2016 7:00 am to March 5, 2016 5:00 pm

Payment: Check

Balance

APPROVED REFUNDS ARE BY CHECK ONLY

Receipt #: 2392903 User: SCTegard Issued: Tue 28 Jul 15 03: 1 0 pm

Amount

$230.00

$200.00

($200.00)

$30.00


Date Received: Check or Cash: Application #: Packet: Permit #:

Event Title: Historic Kenwood's "Pi not in the Park" Phone No.: 1727-452-5816 Fax No.: 1

Entity Name: rH-is-to-r-ic-K-e-n-w-o-o-d-N-e-ig-h-b-o-rh-o-o-d-A-s-s-oc-i-at-io-n-------- Federall.D. Number: 157-0953652

Event Date(s): Isaturday, April 2nd, 2016 Location: Iseminoie Park, St. Petersburg

Day 1 of Event: IAPrii 2nd Time Gates Open: 16PM Approx Ending Time: 110PM Approx

Day 2 of Event: 1 Time Gates Open: 1 Ending Time: I

Day 3 of Event: 1 Time Gates Open: 1 Ending Time: rl-----

Application Prepared by: Ipaul Dickens Phone: 1727-452-5816

TItle: HKNA - Board Member and Volunteer/Event Coordinator Cell Phone: 1727-452-5816 cell

Address: 12270 7th Ave. N. City: 1st. Petersburg State: IFL Zip: 133713


Additional Contact Person: IDebby Armstrong Day Phone: 1727-408-1114

What month/year were you incorporated as nonprofit? IMay 18,2011, effective Sept 10,2010

r---------------------------------------List all 501 (c)3 entities that will benefit from this event. Historic Kenwood Neighborhood Association

Name of the for-profit entity?

Describe how this event will contribute to the quality of life in and enhance the Image of St. Petersburg.

See website: Pinotinthepark.org It contributes to the quality of life by enjoying great food, wine, friends, neighbors, tourists. It builds a good bond between the City and the residents by putting on a positive event that benefits both groups.


The tickets sales from our last event was approximately $1 0.6K, plus the donated food and wine.




Will there be an admission / registration fee? IX YES r NO

r NO

IX YES

How much? 11,000,000

r NO

Advanced Fee: $85 TBD Day of: 1$85 TBD

Please provide the website address for your event. www.pinotinthepark.org

Please provide a phone number that can be advertised to the public. r-17-2-7--3-2-7--8-7-86-------------------------

What is the estimated attendance for this event? Spectators 1108

Page 1 of8

Participants 142 Last Year's Total Attendance 1150


Recreation Equipment

Showmobile (Yes/No)

# Bleacher(s) needed. Each bleacher approx. 180 people)1

Tables (6 ft) # neededl Chairs # needed I Public Address System I # of portable risers needed (4 in. x 8 in. x 16 in. sections)1

Special Events Facilities

, Mahaffey Theater

, Coliseum

, Sunken Gardens

, Boyd Hill

, Non-City Locations

Which Location?


POLICE: Public Safety Personnel. Marine Servjces TRAFFIC: Personnel. Equipment (cones. barricades. no parking signs) FIRE: Paramedics. Inspectors PARKS SERVICES: Cleanup Personnel. Dumpster(s). Trash Receptacles. Event Site Preparation and Restoration RECREATION SERVICES: On-site Presence. Logistics Help. liaison with Other Ddepartments


I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary citylcounty/state pe its/lie es. I further certify that the facts contained in this application are accurate.

Name: Paul Dickens Title: Chairman of PIP Date: 8/4/15 f-------

Co-Sign: Carolyn Gambuti Title: HKNA - President 2015 Date: 8/4/15

NOTE: a.

b.

c.

If person/entity preparing this application is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (e)3 designation must accompany this application. If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.



FOR FURTHER INFORMATION, PLEASE CALLL YNN GORDON, PARKS & RECREATION MANAGER, 727-893-7766 or EMAIL: [email protected]

Page 20f8


SUMMARY SHEET ~ ""'1"""'" '


Condition

IX Public Invited

IX Located in Park

IX Vending Product / Merchandise Sales

IX Vending Food / Beverage

r Vendors / Exhibitors

IX Vending Beer / Wine

How many?

Obligation


Park Permit


Health Inspection

IX Erecting Tents - Larger than 10ft x 12ft How many? ITBD - 1 large



IX Fence Installation

IX Other Structures

IX Open Flame Food Preparation

r Pyrotechnics

r Require Street Closure

r VIP Area

r Staging

IX Amplified Sound

r Security


r Off-site Parking / Shuttle

r Semitruck / Tractor Trailer

Marketing: Please check all that aPt'fy.

r Invitations

IX Posters / Flyers

IX Newspaper / Internet

What type? HKNA - to provide (pvdrope)

What structure? Bike racks around fire pit

r Professional r Showmobile J Other

IX Performers r Announcement Only




Fireworks Permit


r Daytime - Private r Overnight - Private IX Event Time Frame - SPPD

Regular Units ~ Disabled Units r Hand Washingr

r r r

Radio

Television

Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 11 0/20amp located in the parks? IX YES , NO

If YES, check all that apply. , RV'S ,Coffee Vendors ,Ice Bins ,Freezers ,Ice Cream Vendors , Catering Trucks

, Other:


TBD - approximately the same as last year, a couple of whisper generators, extension cords and the "turtle" (power stand).

Will you supply your own generators? ,YES ,NO

Will your event have a licensed electrician on-site during the event? , YES , NO If YES, who? ICity Employee - same as last yea


INone to our knowledge


Name: IHKNA

Address (including zip): 12270 7th Ave. N., St. Petersburg, Florida 33713


TBD- Same as last year, probably a two man guitar act (low key).


Phone: 1727-452-5816

We will recruit local restaurants to prepare an accompanying side dish and recruit wine distributors for wine.

For Use of Beer/wine - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.

Historic Kenwood Neighborhood Association P.O. Box 15134, St. Petersburg, FL 33733 727-452-5816 cell


Nothing political, Just welcoming the guests to the neighborhood and thanking sponsors, explaining salmon bake etc.


Same as last year, we will load from street.

Page 4 of 8


The fee structure is to cover our costs and hope to make money. We are currently at $85 a ticket which covers our costs and helps us buy some needed fixed assets, which will eventually get us to profitability.

Other comments:

We like to thank the city for their continued support in our adventurelfund raising event.

I represent and warrant that the purpose of the proposed activity/event and conduct of the sponsor(s) and the participants shall conform to all requirements of law and all ordinances of the State of Florida, Pinellas County, and the City of St. Petersburg including, but not limited to, City noise ordinances and Parks and Recreation Department Policies and Procedures. I acknowledge that failure to observe such laws, ordinances, or pOlicies and procedures will result in an immediate cancellation of the event and all permits.



Name: Ipaul Dickens /o?P ~ mi.: 1 .--C-ha-ir-m-an---P-IP----- Date: 1'-8/-4/-1-5 ----

Page 5 of8

*

*

*

*

*

*

..

Appendix A

Co-Sponsored Event Park Fee Structure

Events in Vinoy Park will be assessed $300.00 per event day (e.g.,1 day event = $300.00, 2 days = $600.00, 3 days or more = $900.00.) This includes the $30.00 park permit tee.

Events in any other park will be assessed $200.00 per event day (e.g., 1 day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). This includes the $30.00 park permit fee .

The above fees will be due at the time you submit your application plus the $30.00 co-sponsored application fee.

All co-sponsored event applications must be submitted at least 6 month prior to the event.

Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non refundable $1,200.00 late fee.

The City requires payment in advance for all City services estimated and/or provided for first time events and one of a kind nonrecurring events.

Payment will be required at least ten (10) business days prior to the start of the event and shall be in the form of cash, certified check, or an irrevocable bank letter of credit.

All first time entities requesting events will be required to complete a credit application •

Page6of8

st. petersburg WWW.Slpele.org




Name of the Nonprofit Corporation: Historic Kenwood Neighborhood Association

Name of Responsible Party (President or CEO ONLY): Carolyn Gambuti - President, Paul Dickens - Chairman

Title of Responsible Party: IChairman - Pinot in the Park (PIP)

Physical Address of Responsible party:I2270 7th Ave. N.

Phone Number of Responsible Party: 1727-452-5816 cell

Email AddressofResponsibleparty:[email protected]

Nonprofit (Employee Identification Number): IFEIN: 57-0953652




Physical Address of Responsible Party: I

Phone Number of Responsible Party:




Page 70f8

WWW.8IplIllI.org

APPENDIXC STATEMENT OF REVENUE AND EXPENSES FORM

PRIOR YEAR'S EVENT (Must be completed)

I. REVENUE SOURCES (attach sheet if more space is needed)

1.ITicket sales (10B@@$B5)

2. Donations and tips

3.

4

Name of Event:

Date(s) of Event: I

r-----------------------------------------------------------5.

6.

7.

B.

Amount

$9,1 BO.OO

$1,400.00

TOTALGROSSREVENU~ $10,5BO.00

II. EXPENSES (attach sheet if more space is needed)

1. ITent and supplies rental

2. ICity fees and services

3. IEntertainment

4 IAdvertising and marketing

5. Iport-o-Iets

6. Supplies-decorations-fencing-grills

7.

B.

9.

10.

11. r----------------------------------------------------------

12.

$3,BOO.00

$600.00

$400.00

$950.00

$300.00

$3,950.00

TOTAL OPERATING EXPENSESI $10,000.00

TOTAL NET INCOM~r-----$-5-BO-.0-0----

III. ALLOCATION OF NET INCOME ( attach sheet if more space is needed)

1.IHKNA - Neighborhood $5BO.00

2·1 3·1~ ------------------------------------------4.1 ,---------------------5·1 6·~1 -----------------------------------------

Prepared by: Paul Dickens

Print Application Page B ofB

,--------------------------

Date:

Submit Application by Email

$5BO.00

IAU94,2015

Cllent#' 902521 . 04HISTOKEN

ACORDru CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) 0311312015

THIS CERTIFICATE IS ISSUED AS A ml\ I Il:n OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE "cn llrl~ATE un, ns::a 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. .mrv", I AN I • If the holder Is an AUUIIIUNA .. INKIIAJ:n, the _ ... ' -J muat be ,If II/UN IS .............. ~b~ect to the tenns and conditions of tha may require an endDrsement, A statement on this certificate doe. not confer rights to the certificate holder In lieu of .uch

PRODUCER iJim~T 88& T Insurance Services, Inc, I r~.N:o. Eat): 888 743·2217 I r~,No): OOOO"'~OOl 414 Gallimore Dairy Road I=~, Suite F

HAiCtI Greensboro. NC 27409

: 'NAUAI!R'" : Auto ~wnunj ••. Co 118988 INSURED 'I"AIIRJ!RR :

Historic Kenwood Neighborhood IIH8URERC:

Association Inc i IN8URERD:

PO 80x 15134 IINSURERE:

St Petersburg. FL 33733·5134 II"AIIRJ!R "

~~"-III"'''''' II J: tdIII.llRI:D, NIII.IIRI:D,

THIS IS TO CERTIFY THAT THE pnl I"'II:~ 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

Inlfr lYPEOFI POUCY HUMBeR I'ULICT~ . POI-ICT~ UMITS IINBR IWVD A ' GENERAL UABIUTY 9923122008409814 , ............... i=!!=~!:~1!i EACH· IstMn nnn

I-- " .. X GENERAL LIABILITY DAMAQEW~ Is50.000 :=0 CLAlMS-MADE [!J OCCUR . M~ ~ona 118l1I0II\ 1,-5...LQOO .

~,,~ , & ADV INJURY Is1nnn nnn f.--

I Go~NERA1 Is1nnn nnn I--

n'~~LlcY-ci~g; AnS: :

I DDnnlll'TCl • COMPIOP AGG Is1.nnn nnn

Is '"' rOMOBILE LIABIUTY lea .cdd8~~INUU: LIMlf Is -

: BODILY INJURY (Per ~ I ~ "- ANY AUTO

- SCHEDULED ALL OWNED I BODILY INJURY (Per acddenl) $ - AUTOS - AUTOS NQN.OWNED . (P';.-;>~=I~AMAGE S - HIRED AUTOS - AUTOS

S

UMBRELLA UAB HOCCUR

I EACH "' ...... , .. ,. •• ,., ... " $ - EXCES8UAB ,." .. " .n" S

DED I I IS Is WORKERS COMPENSATION 1:m:~t.~1 I~I+ AND EMPLOYERS' UABIUTY ),LN ANY I IIVI:D E.L.EACH Is N/A

irYlla, 1IesCnb!,;J:sr E.L, DISEASE· EA "' .... nvo::", I S

ibelow ~.L Qls~g· POUCY LIMIT I S

DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIIac:II ACORD 101, Additional Remarb 8checIuIe, If mono apace" requlf1Id)

Ref: Town Improvement Association. Inc. Is listed as additional Insured In regards to general liability. Location: 2302 1st Ave. N., St. Pete, 33713. 2460 Burlington Ave., N. & 217 25th St. N. City of St. Petersburg Is listed as an additional Insured In regards to general liability.

The policy Includes HOST Uquor Uablllty (see attached under section C)

CERTIFICATE HOLDER CANCELLATION

City of St. Petersburg SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NonCE wn.L BE DELIVERED IN

1400 19th Street North ACCORDANCE WITH THE POUCY PROVISIONS.

Saint Petersburg. FL 33713 AUTHORIZI!D REPRESENTATIVE

I ~~Al.~ @ 1988·2010 ACORD CORPORATION. All rights reserved.

ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S13849802nW13054639 E83

INTERNAL REVENUE SERVICE P. O. BOX 250B CINCINNATI.OH 45201

Date: MAY 18 2011

HISTORIC KENWOOD NEIGHBORHOOD ASSOC IATION INC

PO BOX 15134 ST PETERSBURG. FL 33733-5134

Dear Applicant:

DEPARTMENT OF THE TREASURY

Employer Identificatlon Number: 57·0953652

DLN: 1705325B32B010

Contact Person: JEFFREY GAUNCE 10# 31614

Contact Telephone Number: (877) 829-5500

Accounting Period EndIng: December 31

Public Charity Status: 509( a)( 2)

Form 990 Required: Yes

Effective Date of Exemption: September 10. 2010

Contrlbution Deductibility: Yes

Addendum Applles: Yes

We are pleased to inform you that upon review of your application for tax exempt status \ve have determl ned that you are exempt froo Federa I i nCOOle tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to recelve tax deductible bequests. devises. transfers or gifts under section 2055. 2106 or 2522 of the Code. Because this letter could help resolve any questions regardlng your exempt status. you should keep it in your permanent records.

Organizations exempt under sectlOn 501(c)(3) of the Code are further classlfled as either public charitles or prlvate foundations. We determined that you are a public charlty under the Code section(s) llsted in the heading of this letter.

Please see enclosed Publlcatlon 4221-PC. Coopliance Guiae for 501(c)(3) PubllC Charitles. for sooe helpful informatlon about your responsibilities as an exempt organizatlon.

Letter 947 (DO/rGl

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ma..{J . W"C-

c'-"+/c....trci<!.. +)~ $4~.roT 2 0/'1

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t.V \uz.." vV c. C-O mplC ~

(!)&lr p I A..(\ n I 'J ~.

7~1 I

\ , I I

I l ; I

SEMINOLE PARK

we - Port-O-Lel St:;J tiOIl S

F -- Fire Pil l20 flo frolll ""virion

- - - - Ba rricadc ~- ......

B - Mus ic Telll (2 Guitaris ts)

P -- Food PI ep Area

------ --- ----_.-_______ 11/

r; - -0{J1

~I ~,

~ ,

" I - I

I I

J

Te=Nf ~

'Ol>l-~ SGA-TttJq

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~ ..,. .... st.petersburg


HISTORIC KENWOOD NEIGHBORHOOD ASSOC CAROLYN GAMBUTI PO BOX 15134 ST PETERSBURG, FL 33733 USA

Description

Previous Balance

Applied To: 14705 - HISTORIC KENWOOD PINOT IN THE park

Seminole Park - Park April 2, 2016 6:00 am to April 3, 2016 12:00 pm

Payment: Check

Balance


Receipt #: 2399109 User: DWBurns Issued: Thu 06 Aug 1508:21 am

Amount

$230.00

$230.00

($230.00)

$0.00

~-" It. PI18l'lllu.. ~ parD I .1,reaUn

Contract #: 14706 Date: 06 Aug 2015

HISTORIC KENWOOD NEIGHBORHOOD ASSOC PAUL DICKENS PO BOX 15134 ST PETERSBURG FL 33733 USA

Purpose of Use: HISTORIC KENWOOD PINOT IN THE park Expected: 150


Other InfOrmation:



Date(s) and TIme(s) of Use:

Facility/Equipment

Seminole Park

Park

Seminole Park Shelter 1

Seminole Park

Shelter 2

Additional Fees: Extra Fee Co-Sponsored Application Fee

Extra Fee - Bookings Co-Sponsored Park Permit Fee

Charges:

Yes

No

No

Starting: Sat 02 Apr 1606:00 am

Day Date Time

Sat 02 Apr 2016 06:00AM

03 Apr 2016 12:00 PM

Sat 02 Apr 2016 06:00AM

03 Apr 2016 12:00 PM

Sat 02 Apr 2016 06:00AM

03 Apr 2016 12:00 PM

Quantity 1

Hours Quantity

30:00 1

Contract/Perm it

User: Status:

DWBums Firm

Home#: 0 Business #: (615) 943-5166

Cell#: 0

Co-Sponsored Event Contract Balance $0.00

Ending: Sun 03 Apr 1612:00 pm

Fee Extra Fee Tax Total

$0.00 $200.00 $0.00 $200.00

$0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00

Charge Tax Total $30.00 $0.00 $30.00

$30.00 Charge Tax Total

$200.00 $0.00 $200.00

$200.00 $0.00 $200.00

Fees

$ 0.00

Extra Fees

$230.00

Tax

$0.00

Total $230.00

Deposit Total Applied Contract Balance $0.00

Account Balance

$0.00


Payments:

Date 06 Aug 2015

Additional Notes:

Printed: 06 Aug 2015, 08:21 AM

User: dwburns

Amount $230.00

$0.00 $230.00

Payment Type Check

Reference Rental

Receipt Number 2399109

Page: 1


I have read this Agreement and agree to comply with the tenns and conditions set forth In this Agreement I also understand this Agreement Is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Slgn Name>

(Print Name) PAUL DICKENS

HISTORIC KENWOOD NEIGHBORHOOD ASSOC

Supervisor 1/ J Foreman

Manager

Manager

User: Status:

._,

DWBurns Firm


By:(Sign Name): Parks and Recreation Superintendent


D Approved or D Rejected Date:


D Approved or DRejected Date:

The Americans with Disabilities Act (A.D.A.) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, asslstive listening devices, etc. , should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771.


User: dwburos

Page: 2

8/6/2015 Delall by Enlily Name



HISTORIC KENWOOD NEIGHBORHOOD ASSOCIATION, INC.

Filing Information

Document Number FEI/EIN Number Date Flied State Status Last Event Event Date Filed Event Effective Date

Principal Address

2267 6th Ave. N. ST.PETERSBURG,FL33713

Changed: 01/19/2013

Mailing Address

POST OFFICE BOX 15134

N38463 57-0953652 06/01/1990 FL ACTIVE AMENDMENT 01/18/2011 NONE

ST. PETERSBURG, FL 33733-5134

Changed: 04/08/2005


Rohr, Jeremiah 2267 6th Ave. N. ST. PETERSBURG, FL 33713




Name & Address

Title PRES

Gambuti, Carolyn POST OFFICE BOX 15134 ST. PETERSBURG, FL 33733-5134

hltp:lIsearch.sunbiz.orgllnquiry/CorporallonSearchiSearchResullDelall?lnqulrytype=EnlllyName&dlrectionTvpe=lnlllal&searr.hN::om"nrti .. .,. j.J1 <:!Tr'\O 'I"

8/6/2015

Title VP

Heyen, Sue POST OFFICE BOX 15134 ST. PETERSBURG, FL 33733-5134

Title SEC

Gordon, Brenda POST OFFICE BOX 15134 ST. PETERSBURG, FL 33733-5134

Title TRES

ROHR, JEREMIAH POST OFFICE BOX 15134 ST. PETERSBURG, FL 33733-5134

Annual Reports

Report Year 2013 2014 2015

Document Images

Flied Date 01/19/2013 01/04/2014 01/10/2015


01110/2015 -- ANNUAL REPORT [ View Image In PDF format ~~==~==~====~ 01104/2014 -- ANNUAL REPORT View Image in PDF format ~==~~====~--~

01/19/2013 -- ANNUAL REPORT ;::;::=VI=e=w:;:;:'==m=ag;::;e::'n::p:::D:::F=fo::;:rm:::a:::t==~ 01/11/2012 -- ANNUAL REPORT ~~VI=e=w='=m=ag=e=in=p=D::::F:::-fo-=rm=8=t=~ 01/18/2011 -- Amendment View tmag~ In PDF format

01/17/2011 -- ANNUAL REPORT View Image In PDF format ~~======~=====. 01/04/2010 -- ANNUAL REPORT View 'mage In PDF format ~~~~~====~=.

02/05/2009 -- ANNUAL REPORT View Image in PDF format

01/18/2008 -- ANNUAL REPORT !===VI=e=w=,=m=ag=e=tn=p=D:::F=fo=rm=a=t===:

10/19/2007 -- Amendment View image in PDF format

04/15/2007 -- ANNUAL REPORT View Image In PDF format ~~~==~=======. 04/28/2006 -- ANNUAL REPORT ~~~~~==~~~

04/08/2005 -- ANNUAL REPORT 08/13/2004 -- ANNUAL REPORT :=:=VI=e=w=l=m=ag=e=in=p=D=F=~=orm==at==:=' 04/21/2003 -- ANNUAL REPORT View image in PDF format

~===============. 03/24/2002 -- ANNUAL REPORT View image in PDF format ~r ~~~~======-~

04/30/2001 -- Name Change ;::;==VI==ew= ,m==ag:::e=,=n =PD:;:;F=~::::orm==a=t ==. 03/27/2001 -- ANNUAL REPORT View image in PDF format

http://search.sunblz.org/lnqulry/CorporationSearchlSearchResuItDetall?lnqulrytype=EntityName&directionType=lnltial&searchNameOrder=HISTORIC... 213

CITY OF ST •. PETERSBURG PARKS & RECREATION DEPARTMENT CO-SPONSORED EVENT APPLICATION

--~~ _f~

~\WII --.... slpetersburg www.8Ipala.Dru

Date Received: 01/ ,1Je Check or Cash: _a.r_~_2<"",;,-,,6 3'1 Application II : C~ Packet: T3 Permit II : 1'-170/

Event Title: Ipainting in the Park 20'6 Phone No.: 17278962667 Fax No.: 1727-894-4638

Entity Name: Ir-M-u-s-eu-m-o-f-F,-·n-e-A-rt-s-s-t.-p-e-te-r-sb-u-r-g------------ Federall.D. Number: 1590949278

Event Date(s): IAPril24th 20'6 Location: INorth Straub Park/Museum Grounds

Day' of Event: ~pril 24th Time Gates Open: I .... ,-:O-O-p-m-- Ending Time: F:oopm

Day 2 of Event I r------ Time Gates Open: I Ending Time: ...-1-----

Day 3 of Event: I Time Gates Open: "'-1 ---- Ending Time: I

Application Prepared by: pP Fatseas Phone: 1727-896-2667

Title: IFacilities Manager

Address: 1255 Beach Dr.

Email Address: ~p@fine-arts .org

Cell Phone:

City: 1st. Petersburg

1727-667-3830

State: IFL Zip: 13370'

Additional Contact Person: 1 r-A-n-n-a-G-Ie-n-n-------------------- Day Phone: 1727-896-2667

What month/year were you incorporated as nonprofit? 1 rO-2/-2-O-/1-9-6-'-----------------------

List all SO, (c)3 entities that will benefit from this event. In/a

Name of the for-profit entity? I...-n-/a-..;.....---------------------------

Describe how this event will contribute to the quality of life in and enhance the image of St. Petersburg. his is a free out oor activity t at ce e rates the creativity wit in us a . Art activities are esigned or a ages and abi ities wit an

emphasis on painting. Last year we brought together over 900 people that participated in community built murals, hands-on activities, and experimenting with different modalities of painting. Through this process we raised awareness of local cottage industries and independent businesses. he event is a metaphor for the city of St. Petersburg arts, ingenuity, collaboration, philanthropy, and business. The Museum works with

St. Anthony's Triathlon to inform the athletes of the opportunity to participate with their families; The Local Buds Artisan Collective organized vendors to provide food and educational opportunities (anything from making kambucha to starting your own succulent garden); Keep St. Petersburg Local utilized their social media contacts to promote the event; Kane's Furniture provided financial support or the purchase of supplies; and HSN provided over '5 volunteers.





Will there be an admission / registration fee? rYES

Please provide the website address for your event. ww.fine-arts.org

NO

r NO

IX YES

How much? 1',000,000.00

r NO


Please provide a phone number that can be advertised to the public. 1727-896-2667

What is the estimated attendance for this event? Spectators 1

Page 1 of8

Participants 1'500 Last Year's Total Attendance 1940

Please check the equipment and/or facilities you are requesting .


Showmobile (Yes/No) /NO

# Bleacher(s) needed. Each bleacher approx. 180 people)~ Tables (6 ft) # needed/O Chairs # needed ~ Public Address System /NO

# of portable risers needed (4 in. x 8 in. x 16 in. sectionS)~


I Mahaffey Theater

I Coliseum

I Sunken Gardens

I Boyd Hill


Which Location?

INorth Straub Park/Museum of Fir


POLICE: TRAFFIC FIRE: PA S SERVICES: RECREATION SERVICES: On-site Presence, Logistics Help, Liaison with Other Ddepartments



Name: I Title:

co-sign: / i------------------- Title:

Date:

Date:

NOTE: a.

b.

c.





Page 2 of 8

~ .. ~ _/~

~"x. ~.-sliletarlllurg

WWW.IIJ010.0rg


SUMMARY SHEET


Condition

IX Public Invited

IX Located in Park



I Vendors / Exhibitors


I Erecting Tents - Larger than 10ft x 12ft

I Fence Installation

I Other Structures

IX Open Flame Food Preparation

I Pyrotechnics


I VIP Area

I Staging

IX Amplified Sound

I Security

I Sanitary Facilities - Port-a-Lets

I Off-site Parking / Shuttle

I Semitruck / Tractor Trailer


I Invitations

IX Posters / Flyers


How many?

Obligation


Park Permit


Health Inspection


How many? 1 What type? 11-------------



What structure? 1 Temporary Structure Permit


Fireworks Permit


I Professional I Showmobile lather

IX Performers I Announcement Only


Regular Units , Disabled Units, Hand Washing,

IX Radio

I Television

I Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 11 0/20amp located in the parks? IX YES r NO

If YES, check all that apply. r RV'S IX Coffee Vendors IX Ice Bins r Freezers IX Ice Cream Vendors IX Catering Trucks

r Other:


Will you supply your own generators? r YES IX NO

Will your event have a licensed electrician on-site during the event? r YES IX NO I(YES, who?



Name: IMuseum of Fine Arts Phone: 17278962667 Address pncludingzip): rI2~SS~B~ea~c~h~D~r~iv~e~N~E~;~3~3~70~1~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Museum 0 Fine Arts, 255 Beac Drive NEj St. Petersburg, FL 33701


Page4of8

Other Comments: Please describe your fee structure. Art activities are ree or everyone.

endors will have separate fee. They are Informed that we advertise this event as free and to price their product accordingly.

Other comments:




Name: Date:

Page 5 of 8

*

*

*

*

*

*

*

*

Appendix A

Co-Sponsored Event Park Fec Structul'c

Events in Vinoy Park will be assessed $300.00 per event day (e.g., I day event = $300.00, 2 days == $600.00, 3 days or more = $900.00.) This includes the $30.00 park permit fcc.

Events in any other park will be assessed $200.00 per event day (e.g., I day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). This includes the $30.00 park permit fee.


All co-sponsored event applications must be submitted at Icast 6 month prior to the cvent.

Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non refundable $1.200.00 late fee.

The City requires payment in advance for all City services estimated and/or provided for first time events and one of a kind nonrecurring evcnts.


All first time entities requesting events will be required to complete a credit application.

Page 6 ofB

__ J).... f-....:~iiiiiiiii ~\WII ~ ...

st.petersburg WWW.Slpalo.oro




Name of the Nonprofit Corporation: Museum of Fine Arts, St. Petersburg, FL, Inc.

Name of Responsible Party (President or CEO ONL V): IKent Lydecker

Title of Responsible Party: IDirector of Museum

Physical Address of Responsible Party: 255 Beach Drive NE; st. Petersburg, FL 33701

Phone Number of Responsible Party: 1727-896-2667

Email Address of Responsible Party: [email protected]

Nonprofit (Employee Identification Number): 159-0949278


Name of Responsible Party (President or CEO ONL V):


Physical Address of Responsible Party: 1



For-profit (Employee Identification Number) 1


Page 70f8

~~ ~JQ~iiiii APPENDIX C Name of Event: Ipainting in the Park 2016

STATEMENT OF REVENUE AND EXPENSES FORM I ~~ --.... PRIOR YEAR'S EVENT Date(s) of Event: IApril 24, 2016 April 24, 2016

sl.petersburg WWW.Blpele.org

(Must be completed)


1. lin kind advertising from keep St. Pete Local

2. ~endor Participation Fee

3· lsponsorshiPs

41

Amount

$300.00

$250.00

$5,000.00

s.rl ------------------------------------------6.1 i-------------

7·1 8 · 1~------------------------------------------

,-----------------------TOTALGROSSREVENU~


1. ICity Fees

2. IMuseum Security

3. Iperforming Vendors

4 IBar Tender

5. IRefreshments for Volunteers

6. ~-Shirts for volunteers

7. Iprinting of postcards

8. IPaid advertising

9. Iparking for volunteers and vendors

10. IArt Supplies

11. IFurniture rental

12. Ilabor

$230.00

$200.00

$750.00

$90.00

$200.00

$700.00

$800.00

$200.00

$75.00

$3,000.00

$250.00

$220.00

TOTAL OPERATING EXPENSESI $6,715.00

TOTAL NET INCOME""I -----~$1-,1-6-5.-00-----

III ALLOCATION OF NET INCOME (attach sheet if more space is needed)

l. r----------------------------------------------------------

2. r----------------------------------------------------------

3. r----------------------------------------------------------

4. r----------------------------------------------------------

5.

6.

TOTAL ALLOCATION OF NET INCOMEI

Prepared by: PP Fatseas Date: /Feb 3,2015

Print Application Page 8 of8 Submit Application by E

Members/ Face chalk Painter

Tent

Painting

with

Bubbles

CJ C1 02S

E ctI

~C] ... :::I

~ ~ GJ ...

ctI

'" C1J ~ '0

~

tJ~ 0 ~~

J 'i) (.

'fr

Beach Drive

C ~ ~e / / l Boxes I Art for

your head

Color Dots

Erupting

paintings

Legend

0 = Banyan Trees LJ D = Tents

Zoom

~ Through

=clean up Color

station

,- --,

~J =activity, no tent

= car painting

MUSEUM OF FINE ARTS JP FATSEAS 255 BEACH DRIVE NE ST PETERSBURG, FL 33701 USA

Description

Previous Balance

Applied To: 14707 - WINE WEEKEND

North Straub Park - Park

.. z ~ ......

sl.petersburg


February 4, 2016 6:00 am to February 8, 2016 7:00 am

Payment: Check

Balance


Receipt #: 2399137 User: DWBurns Issued: Thu 06 Aug 1508:45 am

Amount

$30.00

$30.00

($30.00)

$0.00


MUSEUM OF FINE ARTS JP FATSEAS 255 BEACH DRIVE NE ST PETERSBURG Fl 33701 USA

Purpose of Use: WINE WEEKEND


Other Information:


Use of fencing

Use of liquor

Yes

Yes

No

Expected: 550

Contract/Perm it

User: Status:

DWBurns Firm

Home #: () Business #: (727) 896-2667

Cell#: 0

Co-Sponsored Event Contract Balance

$0.00

Datels) and T1mels) of Use: Starting: Thu 04 Feb 16 06:00 am Ending: Mon 08 Feb 16 07:00 am

Facility/Equipment

North Straub Park

Park

Additional Fees:

Extra Fee Co-Sponsored Application Fee

Charges:

Fees

$ 0.00

Extra Fees

$30.00

Tax

$0.00


Payments:

Date 06 Aug 2015

Additional Notes:

Day Date Time Fee Extra Fee

Thu 04 Feb 2016 06:00 AM $0.00 $0.00

08 Feb 2016 07:00 AM

Quantity 1

Charge $30.00

Total

$30.00

Deposit Total Applied

Amount $30.00

$0.00 $30.00

Payment Type Check

Tax $0.00

Contract Balance

$0.00

Reference Rental


By:(Sign Name):

Tax

$0.00

Total

$0.00

Total $30.00

$30.00

Account Balance

$0.00


I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement I also understand this Agreement Is not final until approved and executed by the Parks and Recreation Superintendent or designee.

Parks and Recreation Superintendent By:(Slon Name)

(Print Name) JP FATSEAS

MUSEUM OF FINE ARTS

Supervisor ii/ Foreman

Manager


User: dwbums



D Approved or D Rejected Date: -------

Page: 1

~......-I II •• Ilarallu., ~ parka a Plc:raadoD

Contract#: 14707

Date: 08 Aug 2015

Manager o Approved or o Rejected

Contract/Perm it

User: Status:

DWBums FIrm

Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, asslstive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .


User: dwburns Page: 1

8/6/2015 Detail by Entity Name


Florida Not For profit Corporation

MUSEUM OF FINE ARTS OF ST PETERSBURG, FLORIDA, INC.

EiIID9 IDfo[m~tioD


Principal Address

255 BEACH DR NE

702039 59-0949278 02/20/1961 FL ACTIVE AMENDMENT 05/05/2015 NONE

SAINT PETERSBURG, FL 33701-0498

Changed: 05/23/2000

Mailing Address

255 BEACH DR NE SAINT PETERSBURG, FL 33701-0498

Changed: 05/23/2000


Lydecker, Kent, Dr. 255 BEACH DRIVE N.E. ST PETERSBURG, FL 33701




Name & Address

Title Chairman

Mahaffey, Mark, Mr. 255 BEACH DR. NE. ST.PETERSBURG,FL

http://search.sunblz.orgllnqulry/CorporationSearchlSearchResultDetall?inqulrytype=EntityName&dlrectionType=lnitlal&searchNameOrder=MUSEUMFI...1/3

8/6/2015

Title VC

Collins, Cathy, Mrs. 255 BEACH DRIVE N.E. ST. PETERSBURG, FL 33701

Annual Reports

Report Year 2013 2014 2015

Document Images

Flied Date 04/24/2013 04/30/2014 04/22/2015


05/05/2015 -- Amendment View Image In PDF, format

04/22/2015 -- ANNUAL REPORT View Image In PDF format

04/30/2014 -- ANNUAL REPORT :=:==VI=e=w:-l=m=ag=e=ln=p=D=F=fo=rm=a=t==~ 04/24/2013 -- ANNUAL REPORT View Image In PDF. format

~------------~--------------------~ 04/23/2012 -- ANNUAL REPORT View Image In PDF format

==~~==~======~ 05/20/2011 -- ANNUAL REPORT

05/07/2010 -- ANNUAL REPORT ::========--========~ 04/17/2009 - ANNUAL REPORT

06/05/2008 - ANNUAL REPORT ;::==-==========:-::::==~ 04/15/2008 -- ANNUAL REPORT 04/20/2007 -- ANNUAL REPORT ~======~::::::::::=;:====~ 03/16/2006 -- ANNUAL REPORT

~~-===~==~==~~ 04/04/2005 -- ANNUAL REPORT r 03/2212004 -- ANNUAL REPORT ~======::::::::===-===~ 02/14/2003 - ANNUAL REPORT

01/28/2002 -- ANNUAL REPORT ~--===:::::::==:::::;-===--=~ 05/14/2001 - ANNUAL REPORT

~------------~--------------------~ 05/23/2000 -- ANNUAL REPORT

~~==~~~~==~ 03/0411999 -- ANNUAL REPORT

~~~==~~~~~~ 04/13/1998 -- ANNUAL REPORT View Image In PDF format

02/19/1997 - ANNUAL REPORT ;::::==V1=I=ew=l=m=ag::"'~=ln=PD=F=~=orm=at==:::::: 06/17/1996 - ANNUAL REPORT >-l _____ Vl_e_w .... l ..... m.....:ag;.-.e_ln_p_D_F_fo_rm_a_t ____ -'

05/01/1995 - ANNUAL REPORT View Image In PDF format ~------------~~----------------~

---------~(c.,ill1d~

State of Florida, Department of State

hltp:IIsearch.sunblz.orgllnqulry/CorporationSearch/SearchResuIlOetall?inqulrytype=EntltyName&dlreclionType=lnitial&searchNameOrder=MUSEUMFI.. . 213

CITV OF ST. PETERSBURG PARKS & RECREATION DEPARTMENT CO-SPONSORED EVENT APPLICATION

~~-_/~

~~ -.p-..

slpetersburg WWW.llpBI8.0I'U

Date Received:

Check or Cash: Application #:

Packet: Permit #: ,4107

Event Title: !WIne Weekend 2016 Phone No.: 1727-896-2667 Fax No.: 1727-894-4638

Entity Name: ~he Museum of Fine Arts Federall.D. Number: 159-09449278

Event Date(s): IFebrUary 5th, 6th, and 7th 2016 Location: ~he Musuem of Fine Arts & North Straub Park

Day 1 of Event: ISetup Time Gates Open: I .... n-/a---- Ending Time: In/a

Day 2 of Event: IDlnner Time Gates Open: 12:00pm Ending Time: rI1-1-:0-0-p-m---

Day 3 of Event: IBreakdown Time Gates Open: In/a Ending Time: In/a

Application Prepared by: ~P Fatseas

Title: IGrounds and Facilities Manager

Address: 1255 Beach Dr.

Phone: 1727-896-2667

Cell Phone: 1727-667-3830

City: 1st. Petersburg State: IFL Zip: /33701

Email Address: [email protected] Additional Contact Person: rl----------------------- Day Phone: I

What month/year were you Incorporated as nonprofit? 1 .... 1-96-2--------------------------

List all 501 (c)3 entities that will benefit from this event. ~he Museum of Fine Arts

Name of the for-profit entity? I r ---'----------------------------

Describe how this event will contribute to the quality of life in and enhance the image of St. Petersburg. e Stuart Society is a main un raising arm 0 t e Museum 0 Fine Arts. Wine Wee en is one of ive major un raiser's presente y

he Stuart Society each year. All proceeds from the fundraising events go to support the programs, exhibitions and other expenses of he Museum of Fine Arts. As an integral part of the downtown community these events contribute to the sustainability of the museum.

Nearly $4 Million has been raised since the inception of the Stuart Society fifty-one years ago.

he Stuart Society funds have supported publications, operating expenses, major exhibitions, art acquisitions, art restorations, ducational programs and capital improvements.

Describe what economic benefit and impact this event will bring to St. Petersburg. e purpose 0 the event again, is to ensure t e sustainabi ity 0 the Museum of Fine Arts. eing a prominent cu tura institution t at

shares the waterfront park both with the city and the residents of St. Petersburg, it is important that the Museum continue to thrive, with he Museum Thriving we are able to Implement additional public programs and events that the residents of St. Petersburg are able to

attend, Like Painting in the park a free event put on by the Museum of Fine Arts. Additionally this event will draw people from around he country to participate and patronize other restaurants and shops as well as stay in local hotels.




Will there be an admission / registration fee? IX YES I NO

I NO

IX YES

Please provide the website address for your event. ww.wineweekendstpete.org

How much? I

I NO


Please provide a phone number that can be advertised to the public. rI7-2-7--8-9-6--2-6-6-7------------------

What is the estimated attendance for this event? Spectators /200 Participants /350 Last Year's Total Attendance /500

Page 1 of8


Recreation Equipment Special Events Facilities

Showmobile (Yes/No) INO r Mahaffey Theater

# Bleacher(s) needed. Each bleacher approx. 180 people)~ r Coliseum

Tables (6 tt) # neededlO Chairs # needed 10 r Sunken Gardens

Public Address System 10 r Boyd Hill

# of portable risers needed (4 in. x 8 in. x 16 in. sectionS)~

r Non-City Locations

Which Location?


POLICE: Public Safety Personnel. Marine Services TRAFFIC: Personnel. Equipment (cones. barricades. no parking signs) FIRE: Paramedics. Inspectors PARKS SERVICES: Cleanup Personnel. Dumpster's). Trash Receptacles. Event Site Preparation and Restoration RECREATION SERVICES: On-site Presence. Logistics Help. Liaison with Other Ddepartments


I certify that the event will be open to all citizens and that indiViduals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name: IKent Lydecker

Co-Sign: I

Title: IDirector Museum of Fine Arts

Title: I

Date:

Date:

NOTE: a.

b.

c.





Page 20f8

...... _/~

~'---.... slpelerlDUI'I WWW.I',OIO • .,.


SUMMARY SHEET


Condition

r Public Invited

IX Located in Park

r Vending Product I Merchandise Sales

r Vending Food I Beverage

r Vendors I Exhibitors



r Fence Installation

r Other Structures

r Open Flame Food Preparation

r Pyrotechnics


IX VIP Area

IX Staging

IX Amplified Sound

IX Security


IX Off-site Parking I Shuttle

r Semitruck I Tractor Trailer


IX Invitations

IX Posters I Flyers


How many?

Obligation


Park Permit


Health Inspection


How many? 11 Whattype? Ir-------------



What structure? I Temporary Structure Permit


Fireworks Permit


r Professional r Showmobile IX Other

r Performers r Announcement Only

r Daytime - Private r Overnight - Private r Event Time Frame - SPPD

Regular Units ! Disabled Units! Hand Washing!

IX Radio

IX Television

IX Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 11 0/20amp located in the parks? r YES IX NO


r Other:


Will you supply your own generators? IX YES r NO

Will your event have a licensed electrician on-site during the event? r YES IX NO If YES, who?


r If City permits, licenses, or services are required for event, who will pay for them?

Name: I Address (including zip):


BD


Phone: I

For Use of Beer/Wlne - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.

re Museum of Fine Arts

Page 4 of 8


Other comments:




Name: ,"",---~ _____ T_it_le_: IDirector Date: 1214/2015

Page 5 of8

*

*

*

*

*

*

*

Appendix A


Events in Vinoy Park will be assessed $300.00 per event day (e.g.,1 day event = $300.00, 2 days = $600.00, 3 days or more = $900.00.) This includes the $30.00 park pennit fee.

Events in any other park will be assessed $200.00 per event day (e.g., 1 day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). This includes the $30.00 park permit fee.







Page 6 of8




Name of the Nonprofit Corporation: fhe Museum OF Fine Arts

Name of Responsible Party (President or CEO ONLY): IKent lydecker

Title of Responsible Party: IDirector

Physical Address of Responsible Party: 255 Beach Drive NE; St. Petersburg, Fl33701











Page 7 of 8

~..~fji!iiiiiiii ~ --.....

slpetersburg WWW.8Ip818.0rg

APPENDIX C Name of Event:

STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: I PRIOR YEAR'S EVENT (Must be completed)


1.

2.

3.

4

5.

6.

7.

~-------------------------------------------------------

~-------------------------------------------------------

r------------------------------------------------------~-------------------------------------------------------

8.

II. EXPENSES (attach sheet If more space is needed)

1.

2.

3.

4

5.

6.

7.

8.

9.

10.

11.

12.

TOTAL GROSS REVENUEI

Amount

TOTAL OPERATING EXPENSESI

TOTAL NET INCOM~i------------

III. ALLOCATION OF NET INCOME (attach sheet if more space Is needed)

1.1 2./r -----------------------------------------3.1 i-----------------

4. 1 5·~1 ----------------------------------------6.1 r------------

TOTAL ALLOCATION OF NET INCOM~

Prepared by: Date:

Print Application Page 8 of8 Submit Application by E

amPIN

NE

VI

~ Finn Gallery

~ The Canopy

Fareham PI N

VI Getaway Homes Parkshore Grill

• J! Ghost Tour of 51. Pelersburg & Tampa Bay

3rdAve NE 3rd Ave NE

The Birchwood

The Moon Under Water

VI

Fareham PI N

Annata Wine Bar y

The Hooker Tea ! ~

..;..... -. Markelplace'Express\! ~

~{

TrySI Gaslro Lounge YI

The Eagle Cafe 19J

~ cS S ~

Qj

':i MFA Cafe !

• ,-, North Slraub Park

Museum of Fine Arts

tm

- .

~ I. Q ~ 0

~ -...: $'

C(j

Coogle




MUSEUM OF FINE ARTS OF ST PETERSBURG, FLORIDA, INC.

Elliog loformati2n


Principal Address

255 BEACH DR NE

702039 59-0949278 02/20/1961 FL ACTIVE AMENDMENT 05/05/2015 NONE

SAINT PETERSBURG, FL 33701-0498

Changed: 05/23/2000

Mailing Address

255 BEACH DR NE SAINT PETERSBURG, FL 33701-0498

Changed: 05/23/2000


Lydecker, Kent, Dr. 255 BEACH DRIVE N.E. ST PETERSBURG, FL 33701




Name & Address

Title Chairman

Mahaffey, Mark, Mr. 255 BEACH DR. NE. ST.PETERSBURG,FL

htlp:/Isearch.sunbiz.org/lnqulry/CorporalionSearchiSearchResuItDelall?lnqulrylype=EntllyName&directionType=lnitlal&searchNameOrder=MUSEUMFI... 1/3

8/6/2015

Title VC

Collins, Cathy, Mrs. 255 BEACH DRIVE N.E. ST. PETERSBURG, FL 33701

Annual Reports

Report Year 2013 2014 2015

Document Images

Flied Date 04/24/2013 04/30/2014 04/22/2015

05/05/2015 -- Amendment

Detail by Enlily Name

04/22/2015 -- ANNUAL REPORT i===~~==::::=--::==: 04/30/2014 -- ANNUAL REPORT View Image In PDF format

04/24/2013 -- ANNUAL REPORT ;::::==V=le=w=lm=a:-=g:'-e=ln=p=D=F:-fo-rm~a=t ==~ 04/23/2012 -- ANNUAL REPORT 05/20/2011 - ANNUAL REPORT :=:======~=-===:;:::======::::::;;::=. 05/0712010 -- ANNUAL REPORT

04/17/2009 -- ANNUAL REPORT ;-=:==-=======--=--==:--~ 06/05/2008 -- ANNUAL REPORT

04/15/2008 -- ANNUAL REPORT ;::::;:=====-==::-::====:-: 04/20/2007 -- ANNUAL REPORT View Image In PDF format

03/16/2006 -- AN NUAL REPORT ~==V=le=w=lm=a=g:::e=ln:::R:::D:::F=fo=rrn=a=t ===-:


03/22/2004 -- ANNUAL REPORT ~=V:::le=w=l=m=ag=e:::lh:::p;:D:;;:F:::fo=rm=a=t==: 02/14/2003 -- ANNUAL REPORT =-=::=VI=--ew_l::m::;ag=e:::in=p:::D=F-;:~==on:n:;:::::;at;::::::::;=. 0112812002 -- ANNUAL REPORT I View Image In PDF format

05/1412001 -- ANNUAL REPORT ~==V=le=w=l=m:::ag=e=lh=p=D=F=~=orm==at==~ 05/23/2000 -- ANNUAL REPORT ~t =-==V=le=w=lm= a::::g:::e=ln=p=D=F=fQJ=rm=a=t ==--: 03/04/1999 -- ANNUAL REPORT View Image Ih PDF format

04/13/1998 - ANNUAL REPORT ;::::=VI;;:e=w:-I:-:'m=ag=e=ln=p=D:-F-~::orm==at=~ 02/19/1997 -- ANNUAL REPORT View Image In PDF format

06/17/1996 -- ANNUAL REPORT ;:-===-:;:::====-==== =: 05/0111995 -- ANNUAL REPORT

~---------~---------------~

--------------------------------~((iilnd~

State of FlOrida, Department of Stdte

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MUSEUM OF FINE ARTS JP FATSEAS 255 BEACH DRIVE NE ST PETERSBURG, FL 33701 USA

Description

Previous Balance

~ ---.. st.petersburg


Applied To: 14706 - PAINTING IN THE PARK 2016

North Straub Park - Park April 24, 2016 11:00 am to April 24, 2016 6:00 pm

Payment: Check

Balance


Receipt #: 2399130 User: DWBurns Issued: Thu 06 Aug 15 08:42 am

Amount

$30.00

$30.00

($30.00)

$0.00

~-" II. patal'lburl ~ parks a rac.eadoa


MUSEUM OF FINE ARTS JP FATSEAS 255 BEACH DRIVE NE ST PETERSBURG FL 33701 USA

Purpose of Use: PAINTING IN THE PARK 2016


Other Information:

Use of beer and wine Use of fencing Use of liquor

Yes

Yes No

Expected: 1,500

Contract/Permit

l:Jser: Status:

DWBums Firm

Home #: () Business #: (727) 896-2667

Cell #: ()


$0.00

Date's) and Tlmels) of Use: Starting: Sun 24 Apr 1611:00 am Ending: Sun 24 Apr 1606:00 pm

Facility/Equipment

North Straub Park

Park


Charges:

Fees $ 0.00

Extra Fees $30.00

Tax $0.00


Payments:

Date 06 Aug 2015

Additional Notes:


Sun 24 Apr 2016 11 :00 AM

06:00PM

$0.00 $0.00

Total $30.00

Quantity 1

Charge $30.00


$0.00 $30.00

Amount $30.00

Payment Type Check

Tax $0.00

Contract Balance

$0.00

Reference Rental

CiTY OF ST. PETERSBURG, FLORIDA

Tax

$0.00

Total

$0.00

Total $30.00

$30.00

Account Balance

$0.00


I have read this Agreement and agree to comply with the terms and conditions set forth in this Agreemenl I also understand this Agreement is not final until approved and executed by the Parks and Recreation Superintendent or designee. By:(Sign Name):

Parks and Recreation Superintendent By:(Sign Name)

(print Name) JP FATSEAS

MUSEUM OF FINE ARTS Name of User 0 anization, If Applicable

Supervisor 117 Foreman

Manager


User: dwburns


o Approved or 0 Rejected Date:

o Approved or 0 Rejected Date: _____ _

Page: 1

~~ It. pBtBrablll'l ~ parkl a rBCP8adan

Contract#: 14706

Date: 06 Aug 2015


Contract/Permit

User: Status:

DWBurns Firm

Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, asslstive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using no devices, please contact us using the Florida Relay Service at 800-955-8771 .


User: dwburns

Page: 1

.. z ~ ---.. st.petersburg

Rental #: 14706

MUSEUM OF FINE ARTS 255 BEACH DRIVE NE ST PETERSBURG FL 33701 USA

PAINTING IN THE PARK 2016 Amendment Reason: Fee Due Now

pyrpose of Use: Function:Not Changed Description:


Dates and Time of Use: # of Bookings: 1

Additional Fees:

Payment Method:

JP FATSEAS

Supervisor III Foreman

Manager

Superindendent

Starting: N/C

Damage Deposit: N/C Adjustment: N/C Initial Due: N/C Prior Contract Total: $ 30.00

Statementing: Due immediately

Contract/Perm it Amendment Printed: 06 Aug 2015,08:42 AM

User: dwbums

Ending: N/C

Payable By: N/C Ad): N/C Initial Pay: N/C Contract Total: N/C

Amendment #: 1

Amended: 06 Aug 2015

Expected: N/C

Date

o Approved or 0 Rejected Date

o Approved or 0 Rejected Date

o Approved or 0 Rejected Date _____ _

Page: 1

APPENDIX C Name of Even~: IWlne Weekend 2016

slpetersburg Www.8tpete.oro

STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: IFeb 5th 2016 PRIOR YEAR'S EVENT (Must be completed)


l·IReserVations

2.llIve Auction

3·IMlscelianeous

4 ISponsors

5· 1 6·i-1 -------------------

7·1

IFeb 7th 2016

Amount

$49,795.00

$460,300.00

$17,651.00

$211,135.00

8·~1 ---------------------------------------

r------------------------TOTAL GROSS REVENUEI

II. EXPENSES (attach sheet if more space Is needed)

1. Ilinens

2. IFood and Beverage

3. Icrose out fees

4 Ilegal fees

5. Imiscellaneous

6. IMusic

7. IEntertainment

8. Iprlnting/postage

9. Irentals

10. Falet

11. I

$6,564.05

$32,663.54

$48,091.05

$2,239.02

$22,255.32

$500.00

$1,400.00

$2,262.16

$16,741.13

$1,650.00

12·1;--------------------------------------------

TOTAL OPERATING EXPENSESIi-----$-1-34-,3-6-6.-27---

TOTALNETINCOMEIi---------$6-0-4,-5-14-.7-3--------


1. 1100 % went to support the mission of the Museum of Fine Arts. $604,514.73

2· 1 3. Ii------------------------------------------4·1 ..------------------

5·1 6·1~-----------------------------------------

TOTAL ALLOCATION OF NET INCOM~.------------------

Prepared by: ~P Fatseas Date: 18.12.15

Print Application Page 8 of8

CITY OF ST. PETERSBURG PARKS & RECREATION DEPARTMENT CO·SPONSORED EVENT APPLICATION

--..... -~ ~\w. --.... slpetersburg

www.slpala.aro

Event Title: 23rd Annual Corvettes at the Pier Corvette Show

Date Received:

Check or Cash: Application #: Packet:

69 c

Permit #: 1(..1711

Phone No.: 1727-686-2~ Fax No.: 1 ~============~==========~~~--~ ~--~======--~

Entity Name: Isuncoast Corvette Association I Federall.D. Number: J Event Date(s): IMay 28, 2016 Location: INorth Straub Park j

~====~~---------.======-Day 1 of Event: IMay 28, 2016 Time Gates Open: 18:00 AM Ending Time: 14:00 PM

Day 2 of Event: 1 Time Gates Open: 1 Ending Time: 1

Day 3 of Event: I Time Gates Open: I Ending Time: 'FI ===== Application Prepared by: IRobert Bryce

Title: Vice President, Suncoast Corvette Association, Show Director

Phone: 1727-686-2131 I -----.==---.!==~--

Cell Phone: 1727-686-2131 ]

Address: 14201 69th Avenue North I City: Ipinellas Park I State: I_FI ____ ----' Zip: 13378~. __ 1

Email Address:[email protected] j Additional Contact Person: IGeOrgia Greene I Day Phone: 1727-399-2437 j

What month/year were you incorporated as nonprofit? 112119/1986 J

List all 501 (c)3 entities that will benefit from this event. ,..I---------------------'=~~--'==.;.J~

Name ofthe for-profit entity? INone J


Provide a destination for the residents of the City of St. Petersburg to view over 200 of America's only true sports car in full show fashion, the Chevrolet Corvette, from Corvette Clubs and Corvette owners all over the State of Florida. Attract business for the downtown district during the holiday weekend.

--- - -----------Describe what economic benefit and impact this event will bring to St. Petersburg.

Provide an influx of business to the shops, stores and restaurants along Beach Drive and the St. Petersburg waterfront from not only the several hundred participants of the show, but the hundreds of spectators coming to view the show.


Does your group presently have liability insurance? I8l YES n NO How much? 1$1,000,000.00 _

Are there plans to sell or distribute beer/wine at your event? r YES IX NO

Will there be an admission / registration fee? /Xj YES n NO Advanced Fee: $30.00 I Day of: $35.00

Please provide the website address for your event. www.suncoastcorvette.com

J

Please provide a phone number that can be advertised to the public. ,-17-2-7.-6-8-6.-2-1-31------------------.

What is the estimated attendance for this event? Spectators 11 OO~ Participants 1400 J Last Year's Total Attend~nce lapx 1000

Page 1 of8



Showmoblle (Yes/No)


o Mahaffey Theater

Coliseum

L Non-City Locations

Which Location?

# Bleacher(s) needed. Each bleacher approx. 180 people)D 0 Tables (6 ft) # needed! I Chairs # needed ! I 0 Sunken Gardens

Public Address System I I 0 Boyd Hili

# of portable risers needed (4 In. x 8 In. x 16 In. sections)! I


POLICE: Pybllc Safety Personnel. Marine Services TRAFFIC: personnel. Equipment (cones. barricades. no parking signs) FIRE: paramedics. Inspectors PARKS SERVICES: Cleanup Personnel. Dympster's). Trash Receptacles. Event Site Preparation and Restoration RECREATION SERVICES: On-site presence. Logistics Help. Liaison with Other Ddepartment5

~: The City does not provide tents, Port-O-Lets, or large quantities of tables and chairs.

I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report ofthe event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Nam., IRobert Bryce

Co-Sign: Georgia Greene

I T~le: Vice President Show Director

Title: President, SCA

Date: 6/30/2015

Date: 6/30/2015

NOTE: a. If person/entity preparing this application is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c)3 designation must accompany this application.

b.

c.

If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.




Page 2 of8


SUMMARY SHEET


Condition

~ Public Invited

~ located in Park

~ Vending Product / Merchandise Sales

~ Vending Food / Beverage

18] Vendors / Exhibitors

0 Vending Beer / Wine

0 Erecting Tents - larger than 10ft x 12ft

0 Fence Installation

0 Other Structures

0 Open Flame Food Preparation

0 Pyrotechnics

~ Require Street Closure

0 VIP Area

n Staging

~ Amplified Sound

0 Security

~ Sanitary Facilities - Port-O-lets

~ Off-site Parking / Shuttle

0 Semitruck / Tractor Trailer


~ Invitations

~ Posters / Flyers

~ Newspaper /Internet

How many? 120 - 30 typical

Obligation

General liability Insurance

Park Permit

Occupational license

Health Inspection



What type? I How many? I What structure? /--------------1



o Professional

o Performers

------------------------~

r Showmobile CI Other

o Announcement Only


Fireworks Permit


r ' Daytime - Private n Overnight - Private 0 Event Time Frame - SPPD

RegularUnits D Disabled unitsD HandWaShingl1 I

IX ~

0

Radio

Television

Remote Broadcast

Page30f8



Does your event require any power needs using more than the standard 11 0/20amp located In the parks? rYES IX/ NO

If YES, check all that apply. n RV'S 0 Coffee Vendors n Ice Bins r Freezers r Ice Cream Vendors 0 Catering Trucks

n Other:

Please explain the details of the above Items checked. Tell us how much and what type of power they would require.

Will you supply your own generators? rYES IXNO




Name: Isuncoast Corvette Association

Address (Including zip): IPO Box 836, Largo, FI 33779


I Phone: 1727-686-2131

Pre-recorded music broadcast via the Club's sound system and 1 band for live entertainment 9:00 AM - 3:00 PM. Request city stage platform for band and band equipment, four 4' x 8' stage sections.


Auto finishing and car care products, specialty auto parts, custom auto body and interior products, small food vendors, automobile related memorabilia, Jewelry, leather goods, statues and wood carvings.

For Use of BeerIWlne - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.


No speeches or demonstrations will be scheduled or occur.

Discuss your load Inlload out parking needs, Include times and dates.

Load-In: 6:00 AM - 8:00 AM day of show Load-out: 4:00 PM - 5:00 PM day of show

Page 4 of8

------

~ )


Fees are collected from show participants only. There Is no admission charges to any spectators for the show.

Fee structure Is to cover the cost of the Park, permits, park maintenance and cleaning expenses, ADA portable toilets, ADA sink basin, show expenses Including door prizes, trophies, advertising, dash plaques, event shirts, event coffee mugs, registration, classification, judging materials and charity donations.

Other comments:

The Suncoast Corvette Association, a Florida non-profit Corporation (N06738, State of Florida), has held this event for the past 19 years ON the Pier and for It's 4th year In South Straub Park, since the Pier has been closed for demolition. We strongly desire to continue this annual event with the st. Petersburg waterfront and the Tampa Bay skyline as It's beautiful venue. Although we are a small car club without any formal sponsorship, we have successfully held this show every year for the past 22 years, attracting Corvettes from cities all across the State of Florida, and as many as 4 states Including Georgia, South Carolina, Kentucky and New Jersey, as well as participation by the National Corvette Museum, Bowling Green, KY, and Sebring Raceway, Sebring, FI.




Name: I~obert Bryce I Title: _____ 1 Vice President, SCA, Show Dir,. Date: 106/3012015

Page 5 of8

...

...

...

...

*

...

*

*

Appendix A


Events in Vinoy Park will be assessed $300.00 per event day (e.g., I day event = $300.00, 2 days = $600.00, 3 days or more = $900.00.) This includes the $30.00 park permit fee.




Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non refundable $1,200.00 late fee .




Page 6 of8

WWW.8Ipala.org




Name of the Nonprofit Corporation: I

Name of Responsible Party (President or CEO ONLy): , __________________ J Title of Responsible Party:

Physical Address of Responsible party:l ------------__ --_1 Phone Number of Responsible Party:

-' Email Address of Responsible Party:

Nonprofit (Employee Identification Number): I ------------------------------------------------------~

NameoftheFo~profitCorporntlo~ I~N_o_ne ________________________________________________________ ~1

Name of Responsible Party (President or CEO ONLY): I Title of Responsible Party: __________________________________ J Physical Address of Responsible Party: 1_

-----------Phone Number of Responsible Party:

---------



Please Include a copy of the the current IRS Nonprofit Affidavit I For Profit

Page 7 of8

NDIX C Name of Event: nd Annual Corvettes at the Pier STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: IMay 23, 2015 .------


I. REVENUE SOURCES (attach sheet If more space Is needed)

1.IShow Entry Fees

2.IYendor Fees

3.lsponsor Donations

1

] J

41 ~----==~--==~--~~~==~--~--====~======~

5·1 F===~-----===~-=~~~------------------~-----

6·1 ~--==~~======~=================-~====~~---.

Amount

$5,130.00

$800.00

$1,000.00

7·1 J

8./i---~=----';;";';:;;"";=----'=""';"---";;;'_ - _""'" _'------"---===--~---'l ~====:::::::::::: TOTALGROSSREVENU~ $6,930.00

II. EXPENSES (attach sheet If more space Is needed)

1. IPark Use 1 City Co-Sponsored Event Application Fee

2. IVendor Permit Fee ~ J:=== ----= '----

$230.00

$25.00

3. IPark Cleaning Fees I $450.00

4 I Police Officer 1 Street Closing Fees $200.00

5. IStage Platform Rental $80.00

6. IShowOperatlng Expenses (Show expendables, printing services, etc) $500.00

7. IEvent Shirts (free to each pre-registered partlcipant)- $863.00

8. IEvent Coffee mugs (free to each pre-registered participant)- $240.00

9. ITrophles $750.00

10. Iport - Let Rental $420.00 I 11 . ICharity Donation to Selected St. Petersburg Non-Profit Charity

12. 1- choice of one shirt or one mug per entry

$800.00 =:J $0.00

-1

~ I ~========~====~

$4,558.00 J $2,372.00 I

TOTAL OPERATING EXPENSES/ TOTALNaINCOM~~--~==~-------=~~

III. ALLOCATION OF NET INCOME (attach sheet If more space is needed)

l·lclub annual operating expenses. :==J ;..1-====-_ $_80_0...;;.0",,0===-_-:

2·lcharity Donations to additional charities during the year.* J I i'" __ =~==$ __ 1.;;;;,0=0=0=.0,-,0==---,= -,1

3· llnsurance Policy ~ :=1 ====$=30=5=.0=0======:1

4·IEmergent Expenses during the year II $200.00 J s'j=1 ==================1II:==-----====...;;;=~1 6. * Hospice, Boy Scouts, Girl Scouts, VA Hospital, several as needed charity events during the~. I 1

TOTAL ALLOCATION OF NET INCOM~~====$=2,=30=5=.0=0===~1

Prepared by: IRobert Bryce -------- ________ --'1 Date: 16/3012015

Print Application Page 8 of8

~.......,., It. petersburg ~ parka a "Icrl.dan


SUNCOAST CORVETTE ASSOCIATION INC

ROBERT BRYCE

4201 69TH AVE N ST PETERSBURG FL 33781 USA

Purpose of Use: Corvette Show


Other InformatIon:

Use of beer and wine Use of fencing

Use of liquor

No No No

Expected: 1,000

Date!s! and Tlme!s! of Use: StartIng: Frl 27 May 16 03:00 pm

Facility/Equipment

North Straub Park

Park

North Straub Park

Park

Additional Fees: Extra Fee • BookIngs Co-Sponsored Application Fee


Charges:

Day

Fri

Sat

Date TIme

27 May 2016 03:00 PM

09:00 PM

28 May 2016 06:00AM

06:00 PM

Hours Quantity

12:00 1

12:00

2

Contract/Permit

User: Status:

SCTegard Firm

Home#: ()

Business #: (727) 686-2131

Cell #: ()


Ending: Sat 28 May 16 06:00 pm

Fee Extra Fee

$0.00 $0.00

$0.00 $230.00

Charge $30.00

$200.00

$230.00

Tax $0.00

$0.00

$0.00

Tax Total

$0.00 $0.00

$0.00 $230.00

Total $30.00

$200.00

$230.00

Fees

$ 0.00

Extra Fees

$230.00 Tax

$0.00 Total

$230.00 Deposit Total Applied Contract Balance

$0.00 Account Balance

$0.00

Balance ofrental due and payable Immediately.

payments:

Date 10 Aug 2015

Additional Notes:

Amount $230.00

I have read this Agreement and agree to comply with the terms and condItions set forth In this Agreement I also understand thIs Agreement is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Sjgn Name)

(Print Name! ROBERT BRYCE

SUNCOAST CORVETTE ASSOCIATION INC Name of User Organization, If Applicable

Printed: 12 Aug 2015, 01 :34 PM

User: sctegard

$0.00 $230.00

Payment Type Check

Reference Rental




!PrintName! Parks and Recreation Department

Page: 1

Contract #: 14771 Date: U Aug 2015


Manager

Manager

User: Status:

o Approved or 0 Rejected

SCTegard Firm

Date:

o Approved or 0 Rejected Date: -------o Approved or 0 Rejected Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, assistlve listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .

Printed: 12 Aug 2015, 01 :34 PM

User: sctegard

Page: 2

Dctail by Entity Namc



SUNCOAST CORVETTE ASSOCIATION, INC.

Filing Information


Principal Address

Largo Community Center 400 Alt. Keene Road Largo, FL 33771

Changed: 02/15/2014

Mailing Address

P.O. BOX 836 LARGO, FL 33779

Changed: 03/06/2009

N06738 NIA 12/19/1984

FL ACTIVE AMENDMENT 11/17/1986

NONE


KARR, MICHAEL 11231 KAPOK GRAND CIR MADEIRA BEACH, FL 33708




Name & Address

Title PO

GREENE, GEORGIA

Page 1 of3

http://search.sunbiz.orglInquiry ICorporationSearch/SearchResultDetail ?inquirytype=Entity... 8/12/2015


10603 95TH ST. N. LARGO, FL 33777

Title TR

MALKIN, SANDRA J 12546 CAPRI CIRCLE NORTH TREASURE ISLAND, FL 33706

Title VP

BRYCE,ROBERT 4201 69TH AVE NORTH PINELLAS PARK, FL 33781

Annual Reports

Report Year 2013

2014

2015

Document Images

Filed Date 02/13/2013 02/15/2014 0210612015

02/06/2015 -- ANNUAL REPORT :====V=ie=w=im=a=g=e=ln=p=D=F=fo=rm=a=t===:

02/15/2014 -- ANNUAL REPORT View image in PDF format ~==============~

02/13/2013 -- ANNUAL REPORT View Image in PDF format ~==============~ 04/09/2012 - ANNUAL REPORT View image in PDF format

04/15/2011 -- ANNUAL REPORT :==V=ie=w=im=a=g=e=in=p=D=F=fo=rm=a=t==:

01/09/2010 - ANNUAL REPORT View Image in PDF format ~==============~


02/15/2008 -- ANNUAL REPORT :====V=ie=w=im=a=g=e=ln=p=D=F=fo=rm=a=t===:

07/14/2007 -- ANNUAL REPORT View Image In PDF format ~==============~ 03/29/2006 -- ANNUAL REPORT View Image In PDF format

01/21/2005 -- ANNUAL REPORT :====V=ie=w=im=a=g=e=in=p=D=F=fo=rm=a=t===:

03/08/2004 - ANNUAL REPORT View image In PDF format

03/17/2003 -- ANNUAL REPORT :====V=ie=w=i=m=ag=e=ln=p=D=F=fo=rm==at===:

05/12/2002 -- ANNUAL REPORT View image In PDF format ~==============~ 03/05/2001 -- ANNUAL REPORT View Image in PDF format

01/29/2000 -- ANNUAL REPORT :==V=le=w=l=m=ag=e=in=p=D=F=fo=rm=at==:


02/26/1998 -- ANNUAL REPORT :====Vi=,e=w=im=ag=e=ln=p=D=F=fo=rm=a=t===:

04/25/1997 -- ANNUAL REPORT View Image In PDF format ~==============~

02/23/1996 -- ANNUAL REPORT :====V=ie=w=lm=a=g=e=in=p=D=F=fo=rm=a=t===:

05/01/1995 -- ANNUAL REPORT View image in PDF format ~------~----------~

Page 2 01'3

http://search.sunbiz.org/Inquiry ICorporationSearch/SearchResultDetail ?inquirytype=Entity... 8/12/2015


~._/~

-~~ --.... slpetersburg WWW.llpele.oro

Date Received:

Check or Cash: Application II: Packet: Permit II :

Event Title: IThe Great BrainWash Phone No.: /727-781 -4673 Fax No.: 1

Entity Name: IBrain Tumor Alliance Federall.D. Number: '12-6--3-4-2-90- 7-4- -----

Event Date(s): IAU9Ust 6,2016 Location: North Straub Park, Vinoy Park and Beach area

Day 1 of Event: 1 Time Gates Open: r-17-:0-0a-m-- Ending Time: 13:00pm

Day 2 of Event: 1 Time Gates Open: 1 Ending Time: 1 ,-----

Day 3 of Event: 1 Time Gates Open: 1 Ending Time: 1

Application Prepared by: IDebbie TUrner

Title: IExecutive Director

Phone: /727-781 -4673

Cell Phone: 1727-674-3746

Address: 12561 Nursery Rd., Ste. D City: IClearwater State: IFL lip: 133764


Additional Contact Person: 1'------------=:...-------=---- Day Phone: 1

What month/year were you incorporated as nonprofit? ISeptember 2010

~---------------------------List all 501 (c)3 entitles that will benefit from this event. Brain Tumor Alliance and All Children's Hospital



We will be bringing families to the downtown area wherein they will be enjoying water slides, obstacles and a huge party in the park afterwards, thereby utilizing the beautiful downtown parks, the waterfront and bringing business to local hotels, shops, restaurants and a great tourist destination. Our event this year brought people from Canada, Georgia, Wisconsin, Pennsylvania, California, Maryland and Boston.


The participants will be staying in hotels, eating at restaurants and shopping in the stores. Moving the event from South Straub to North Straub will increase the use of the shops and restaurants by further visibility to participants and the business establishments.





r NO

IX YES

How much? 1

r NO


Please provide the website address for your event. brainwash.bralntumoralliance.org

Please provide a phone number that can be advertised to the PUblic. I .-7-2-7--7-8-1--4-6-73--------------------

What is the estimated attendance for th is event? Spectators 1100

Page 1 of8

Participants 1800 Last Year's Total Attendance 1857



Showmobile (YeslNo) Ino # Bleacher(s) needed. Each bleacher approx. , 80 peOPle)~

Tables (6 ft) # neededlnla Chairs # needed Inla

Public Address System Jn/a


Special Event$ Facilities

r Mahaffey Theater

r Coliseum

r Sunken Gardens

r Boyd Hill

r Non-(ity Locations

Which Locat ion?


POLlCE: Public Safety Personnel. Marine Services TRAFFIC: Personnel Equipment (cones barricades no parking signs) FIRE: Paramedics Inspectors PARKS SERVICES: Cleanup Personnel Dumpster(s} Trash Receptacles Event Site Preparation and Restoration RECREATION SERVICES: On-site presence logistics Help liaison with Other Qdepartments

Note: The Ctty does not provide tents, Port-O-Lets, or large quantities of tables and chairs.

I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary cltylcounty/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name I !"Je);A/\ ,-. lv, /ler;;zl.tJu klrft le IEyflOvdvc" UI?"# Date: I t/ f'{ It s:-Co-Sign: title' Date:

NOTE: a.

b.

c.

If person/entity preparing this application is not representing a nonprofit entity. the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c)3 designation must accompany this application. If your entity has outstanding financial obligations with any department within the City of St. Petersburg. your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.


1. Route map for parade, run, walk. and/or bike event. 2. Site map of event and detail schedule of each day's events including open and close times. 3. Complete Appendix B and Appendix C. 4. Check for $30.00 for co-sponsored application processing (non-refundable). 5. Check for park permit fee. See Appendix A for fee structure. 6. A copy of SOl (c)3 designation (if applicable)

FOR FURTHER INFORMATION, PLEASE CALL L YNN GORDON, PARKS & RECREATION MANAGER, 727-893-7766 or EMAIl: [email protected]

Page 2 of 8

slpetersbUl'1l WWIlU.Ilpolll.lra


SUMMARY SHEET


Condition

IX Public Invited

IX Located In Park

0 Vending Product / Merchandise Sales

I Vending Food / Beverage

IX Vendors / Exhibitors

/Xl Vending Beer / Wine


n Fence Installation

n Other Structures


I Pyrotechnics

IX Require Street Closure

I VIP Area

I Staging

IX Amplified Sound

I Security


I Off-site Parking / Shuttle

I Semitruck / Tractor Trailer


IX Invitations

IX Posters / Flyers


Obligation


Park Permit


Health Inspection

How many? 11 - 10 Vendors / Exhibitors


How many? 13 What type? 'rl------------



What structure? 1 Temporary Structure Permit


Fireworks Permit


r Professional r Showmobile r Other

IX Performers r Announcement Only


Regular Units ~ Disabled Units r Hand Washlngp

IXI IX r

Radio

Television

Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 11 0/20amp located In the parks? r YES IX NO

If YES, check all that apply. r RV'S I Coffee Vendors 0 Ice Bins r Freezers r Ice Cream Vendors r Catering Trucks

r Other:


Will you supply your own generators? r YES IX NO




Name: IBrain Tumor Alliance Phone: 1727-781-4673

AddressOncludingzip): ~12~5~6~1 ~N~u~rs~e~~~R~d~~~S~te~.~D~,~C~le~a~rw~a~te~r~,~FL~3~37~6~4~~~~~~~~~~~~~~~~~~~~~~


OJ, no stages and no bands


Tijuana Flats, Rolling Oats, Kind Bars, Einstein Bagels, Little Cesars


Brain Tumor Alliance. We will not be selling beer, it will be free to particicpants

Explain subject/purpose of all speeches/demonstrations which will occur. I Speeches from brain tumor survivors


We would need the parks on Friday, August 5 to set up slides and obstacles and the North Straub park as well, starting at 9:00am and ending by 4:00pm

Page4of8


It Is $25 between now and December, Increases to $35 from December to March, Increases to $45 from March to July and then $50 and $55 day of event

Other comments:




Name: IDebble Turner Title: IExecutive Director Date: IAU9Ust 14, 2015

Page 5 of8

*

*

*

*

*

*

Appendix A

Co-Sponsored Event J>nrk Fee Structure





Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non refundable $ 1.200.00 late fee.




Page 6 of8

~~ _c@!iiii ~~ ---.. st.petersburg

www.81pele.org




Name ofthe Nonprofit Corporation: IBrain Tumor Alliance

Name of Responsible Party (President or CEO ONLY): IDebble Turner

Title of Responsible Party: IExecutive Director

Physical Address of Responsible Party: 2561 Nursery Rd., Ste.D, Clearwater FL 33764



Nonprofit (Employee Identification Number): /26-3429074

Name of the For-profit Corporation: INA







Page7of8

".

APPENDIX C Name of Event: IThe Great BrainWash

st.petersburg WWW.8Ipolo.oro

STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: IAugust 6,2016 PRIOR YEAR'S EVENT (Must be completed)


1.j1,000 runners

2.jSponsors

3.jVendors

4 IFundraislng

5.j Donations

6·1

Amount

$35,000.00

$25,000.00

$1,000.00

$40,000.00

$500.00

7·1~------------------------------------------

B.j j------------------


1. jClty of St. Pete

2. jBoUnCYTimeS

3. jRentals

4 jShlrts and medals

5. Permits

6.

7.

B.

9.

10.

TOTALGROSSREVENU~

~---------------------------------------------------------11.

~---------------------------------------------------------12.

$101,500.00

$B,500.00

$B,OOO.OO

$2,230.00

$3,500.00

$75.00

TOTAL OPERATING EXPENSESI $22,305.00 TOTAL NET INCOM~i------$-7-9,-19-5-.0-0---~

III. ALLOCATION OF NET INCOME (attach sheet if more space is needed)

1.j60% to Ail Children's Hospital

2.j40% to BTA

$47,517.00

$31,67B.00

3.j 4.jr------------------------------------------~

5.j i--------------------,

6. j

Prepared by: IDebbie Turner

Print Application

TOTAL ALLOCATION OF NET INCOM~ $79,195.00

PageBofB

Date:

Submit Application Ely Email

IB/14/2015

August 21,2015

Charlie Gerdes

.!I\!. brain, tumor ~~ aliance

Parks & Recreation Department 1400 19th Street North St. Petersburg, FL 33713

Re: Request to serve Hard Liquor at The Great BrainWash

Dear Mr. Gerdes:

On August 6, 2016 we will again be putting on our fourth annual Brain Tumor 5k run. We are in the process of obtaining the necessary permits from the City of St. Petersburg to hold this event in North Straub Park and Vinoy Park. We will also obtain insurance showing that it will be an event including alcohol.

As we did this year, we would like to apply for approval to serve hard liquor at our August 6,2016 Great BrainWash event. We will not be selling the liquor, but will have a vendor doing liquor tastings such as Florida Cane Vodka.

Please let me know if there is anything further that you require.

Sincerely,

Executive Director

2561 Nursery Rd., Ste. D, Clearwater, FL 33764 Phone: 727-781-4673 Fax: 727-781-6425

~-" st. palarsburg ~ parks a racraadon

Contract #: 14926 Date: 01 Sap 2015

BRAIN TUMOR ALLIANCE INC DEBBIE TURNER 2561 NURSERY RD STE D CLEARWATER FL 33764 USA

Purpose of Use: THE GREAT BRAINWASH


Other Information:



Expected: 900

Yes Yes

No

Contract/Perm it

User: Status:

DWBurns Firm

Home#: 0 Business #: (727) 781 -4673

Cell#: O


$730.00

Date!s) and Tlme!s) of Use: Starting: Frl 05 Aug 1606:00 am Ending: Sun 07 Aug 16 12:00 pm

Facility/Equipment

North Straub Park

Park

South Straub Park

Park

Vlnoy Park

Park

North Shore Park Park

Elva Rouse Park

Park



Co-Sponsored Park Permit Fee (Vinoy)

Charges:

Fees $ 0.00

Extra Fees

$730.00 Tax

$0.00


Payments:

Additional Notes:

Printed: 01 Sep 2015, 09:03 AM

User: dwburns

Day

Fri

Fri

Fri

Fri

Fri

Date

05 Aug 2016

07 Aug 2016

05 Aug 2016

07 Aug 2016

05 Aug 2016

07 Aug 2016

05 Aug 2016

07 Aug 2016

05 Aug 2016

07 Aug 2016

Hours

108:00

54:00

Total $730.00

Time Fee Extra Fee

06:00AM $0.00 $200.00

12:00 PM

06:00 AM $0.00 $0.00

12:00 PM

06:00 AM $0.00 $300.00

12:00 PM

06:00 AM $0.00 $0.00

12:00 PM

06:00AM $0.00 $200.00

12:00 PM

Quantity Charge Tax 1 $30.00 $0.00

Quantity Charge Tax 2 $400.00 $0.00

1 $300.00 $0.00

3 $700.00 $0.00

Deposit Total Applied Contract Balance $730.00 $0.00 $0.00

Tax Total

$0.00 $200.00

$0.00 $0.00

$0.00 $300.00

$0.00 $0.00

$0.00 $200.00

Total $30.00

$30.00 Total

$400.00

$300.00

$700.00

Account Balance $730.00

Page: 1

Contract #: 14926 Date: 01 Sep 2015

I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement. I also understand this Agreomentls not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Slgn Name)

(Print Name) DEBBIE TURNER

BRAIN TUMOR ALLIANCE INC Name of User Or anization, If Applicable


Manager

Manager

User: Status:

DWBurns Firm


By:(Slgn Name): Parks and Recreation Superintendent

(Prjnt Name) Parks and Recreation Department


o Approved or o Rejected Date.


The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, assistive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771.



L~;;; ~ ---.. st.petersburg

Rental #: 14926

BRAIN TUMOR ALLIANCE INC 2561 NURSERY RD STE D CLEARWATER FL 33764 USA

THE GREAT BRAINWASH

Amendment Reason: Fee's Due Now

Purpose of Use: Function:Not Changed Description:

Conditions of Use:

Insurance Required


Additional Fees:

Payment Method:

DEBBIE TURNER


Manager

Superindendent

Starting: N/C

Damage Deposit: N/C Adjustment: N/C Initial Due: N/C Prior Contract Total: $ 730.00


Date

01 Sep 2015

Contract/Permit Amendment Printed: 01 Sep 2015, 09:03 AM

User: dwbums

Ending: N/C

Payable By: N/C Adj: N/C Initial Pay: N/C

Contract Total: N/C

Amount

$730.00

Amendment #: 1

Amended: 01 Sep 2015

Expected: N/C

Date

D Approved or D Rejected Date

D Approved or D Rejected Date _____ _


Page: 1

9/112015



BRAIN TUMOR ALLIANCE, INC.

Filing Information

Document Number FEIIEIN Number Date Flied State Status

N08000008932 26-3429074 09/24/2008 FL ACTIVE

Delall by Entity Name

Last Event Event Date Filed Event Effective Date

NAME CHANGE AMENDMENT 03/21/2014

Principal Address

2561 Nursery Road Suite D CLEARWATER, FL 33764

Changed: 01/09/2014

Mailing Address

2561 Nursery Road Suite D CLEARWATER, FL 33764

Changed: 01/09/2014

NONE


TURNER, DEBORAH L 2561 Nursery Road Suite D CLEARWATER, FL 33764




Name & Address

Title Executive Director

hltp:/lsearch.sunbiz.ora/lnauhv/CorooralionSearch/SearchResuItDp.t:lil?inm .irvlvnp.=FnlilvN:lm .. R.rfir .. ,.tlnnTvn .. =lnili"IR. .... "r,. ... ". ".., .. f"\r.l .. r~I:IC 11.I\IT. 'ftA ~ I')

9/1/2015

TURNER, DEBORAH L 2561 Nursery Road Suite D CLEARWATER, FL 33764

Title Director

Swingle, Mike 2561 Nursery Road Suite D Clearwater, FL 33764

Annual Reports

Report Year 2013 2014 2015

Document Images

Filed Date 02/20/2013 01/09/2014 02/04/2015

02/04/2015 -- ANNUAL REPORT

03/21/2014 -- Name Change




View image in PDF format

View image In PDF format

View Image In PDF format



01/19/2010 -- ADDRESS CHANGE View image in PDF format ------------~~----------~



09/24/2008 -- Domestic Non-Profit View Image In PDF format

~©and~


hllp:"search.sunbiz.orallnauirv/CorooralionSearch/Sp.arr:hRp.~Illtnp.t",iI?innlllrvtvn.,=~nlih/l\J"m .. R.nlr ..... t;n" T .. "o-I""'~19 ~~~.~"~I ___ ,.... .... _._nn A"''''' ".

CITY OF ST. PETERSBURG PARKS 8r RECREATION DEPARTMENT CO-SPONSORED EVENT APPLICATION

__ J).._/~

~~ --.... slpetersburg WWW.I.pI.I.Dra

Date Received: Check or Cash: ___ :-::=_

Application It: C 7 Packet: '"P 13 Permit It: i 'i?'2 er

Event Title: ICUPld'S Undie Run Phone No.: /602.741 .78471 Fax No.: I

Entity Name: ICUPid'S Charities 1 Federall.D. Number: 1.-4-S--3-6-7-2-77-6-----

Event Date(s): IFebruary 13,2016 I Location: 1260 1st Ave N.

Day 1 of Event: /2.13.16 I Time Gates Open: '-12-:3-0-"":""-- Ending Time: 1.-3-:3-0----:;"-)

Day 2 of Event: I Time Gates Open: I Ending Time: I

Day 3 of Event: 1 Time Gates Open: 1 Ending Time: 1.------

Application Prepared by: IKatherine Zehr Phone: /602 .741 .7847

Title: IRace Director Cell Phone: /602.741 .7847

Address: /1000 Eden Isle Dr. NE City: 1st. Petersburg State: IFL Zip: 133704

Email Address: [email protected] l Additional Contact Person: .... IT-a-ra-o-e-Lu-c-ia-'-E-ri-n-A-It-h-Off-------------J-' Day Phone: 1727.S99.8737'727.420.ij

What month/year were you incorporated as nonproflt71october 26, 2011

~------------------------~ List a1lS01(c)3 entities that will benefit from this event. Cupid's Charities, The Children's Tumor Foundation

Name of the for-profit entity7

Describe how this event will contribute to the quality of life In and enhance the image of St. Petersburg.

The Cupid's Undie Run has raised over $7 million in the course of five years for the research of Neurofibromatosis. It has been covered on CNN, The Today Show, NPR, The Huffington Post and more. Just this year, All Children'S Hospital here in St. Pete opened an NF clinic, which is only one of a handful in the United States. This gives St. Pete an advantage and leading edge in NF care. By having the Cupid's Undie Run, it shows additional support and gets the community involved. Last year, the wonderful city of St. Pete raised $6S,012 for NF research!!!

--------Describe what economic benefit and impact this event will bring to St. Petersburg.

We will be bringing SOO people to downtown St. Pete on a quiet Saturday morning. This will benefit local restuarants, shops, etc. We will also be using local breweries and small business owners as sponsors in order to "Keep it Local".

Each co-sponsored entity must possess liability insurance naming the City of St. Petersburg as an additional insured and secure said insurance In the amount determined by the City.

Does your group presently have liability insurance? IX' YES


Will there be an admission / registration fee? ~ YES 0 NO

r ' NO

r:; YES

How much? I$~ million each occuranc~$2d ~I NO ,..--------

Advanced Fee: $25 Day of: $SO ....----------------~------------------~-------~

Please provide the website address for your event. www.cupidsundierun.com

Pleasepro~deaphonenumberthatcanbeadvertLls-ed-to-t-h-e-P-U-b-lk-.~16-0-2-.7~~~1-.7-8-4-7-~-~---------~~--~

What Is the estimated attendance for this event? Spectators I I Participants 1500 I Last Year's Total Attendance 1406

Page 1 of8



Showmobile (Yes/No) INO Special Events Facilities

I Mahaffey Theater

I Coliseum

o Non-City Locations

Which Location?

# Bleacher(s) needed. Each bleacher approx. 180 peoPle)n

Tables (6 ft) # neededlo =oJ Chairs # needed 10

Public Address System 10 ]

# of portable risers needed (4 In. x 8 In. x 16 In. sectlons)D

I Sunken Gardens

n Boyd Hill

The following departments may provide and charge for additional services. You will be provided cost estimates In your Cosponsored Agreement.

POLICE: Public Safety Personnel. Marine Services TRAFFIC: personnel. Equipment (cones. barricades. no parking signs) FIRE: paramedics. Inspectors PARKS SERVICES: Cleanyp Personnel. Dumpster's), Trash Receptacles. Event Sjte preparation and Restoration RECREATION SERVICES: On-site presence. Logistics Help. liaison with Other Ddepartments


I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability Insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name: I Katherine A. Zehr I Title: IRace Director

Co-Sign: _________________ --!! Title: __ _

Date:

Date: 18

.2

.15


b.

c.

If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking Information or the required completed appendixes listed below will not be processed.




Page 2 of8


SUMMARY SHEET


Condition

~ Public Invited

0 Located in Park

0 Vending Product / Merchandise Sales

0 Vending Food / Beverage

0 Vendors / Exhibitors

0 Vending Beer / Wine

0 Erecting Tents - Larger than 10ft x 12ft


0 Other Structures


0 Pyrotechnics

~ Require Street Closure

0 VIP Area

r Staging

0 Amplified Sound

0 Security

0 Sanitary Facilities - Port-O-Lets

0 Off-site Parking / Shuttle



IX Invitations

~ Posters / Flyers

~ Newspaper / Internet

How many?

Obligation


Park Permit


Health Inspection

Alcohol Permit Additional Insurance Required

How many? I :~:: ::::ure? 1--------------1



Temporary Structure Permit I------------------------~


Fireworks Permit

Parade or Street Closure Permlt(s)

o Professional o Showmobile 0 Other

n Performers 0 Announcement Only

o Daytime - Private 0 Overnight - Private r Event Time Frame - SPPD

Regular Units I I Disabled Units n Hand Washing~

Ig]

Ig]

IX!

Radio

Television

Remote Broadcast

Page 3 ofa



Does your event require any power needs using more than the standard 11 0120amp located in the parks? 0 YES I&J NO

If YES, check all that apply. 0 RV'S 0 Coffee Vendors U Ice Bins 0 Freezers rJ Ice Cream Vendors 0 Catering Trucks

C Other:


Will you supply your own generators? e YES O NO

Will your event have a licensed electrician on-site during the event? rYES r NO If YES, who?



Name: IcuPid's Charities ~ Phone: 1770-366-7321

Address (including zip): 13457 Ringsby Ct. #205, Denver, CO 80216


None


For Use of Beer/Wlne - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.



We ask for the three metered spots outside of Yard of Ale (260 1 st Ave N.) to be tagged for our loading needs during the event.

---- --------

Page40f8


Registration begins at $25 and goes up in small increments so that on event day, the registration is $50

Other comments:

I represent and warrant that the purpose of the proposed activity/event and conduct of the sponsor(s) and the participants shall conform to all requirements of law and all ordinances of the State of Florida, Pinellas County, and the City of st. Petersburg including, but not limited to, City noise ordinances and Parks and Recreation Department Policies and Procedures. I acknowledge that failure to observe such laws, ordinances, or policies and procedures will result in an immediate cancellation of the event and all permits.


I certify that the facts contained In this application are accurate.

Name: IKatherine A. Zehr ____ --'1 Title: IRace Director Date: 18.2.15

Page 5 of8

*

•

•

*

*

*

*

*

Appendix A


Events in Vinoy Park will be assessed $300.00 per event day (e.g., I day event = $300.00, 2 days = $600.00,3 days or more = $900.00.) This includes the $30.00 park permit fee.








Page 6 of8

--~.."k@ii2iiii ~ ---.. sl.pelersburg

WWW.8Ipala.org




Name of the Nonprofit Corporation: ICUPid's Charities

Name of Responsible Party (President or CEO ONLY): IChad Leathers

Title of Responsible Party: IExecutive Director

Physical Address of Responsible party:13457 Rinsby Ct #250, Denver, CO 80216





Name of Responsible Party (President or CEO ONLy):

Title of Responsible Party: 1_-Physical Address of Responsible Party: 1

---

Phone Number of Responsible Party: 1 ---

Email Address of Responsible Party: 1_

For-profit (Employee Identification Number) 1 ___ _ --- .-----


Page 70f8

_l

__ J J

~._QJ@iiiiiii APPENDIX C Name of Event: ICupld's Undle Run

~ ---.. STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: 12.14.15 _ I PRIOR YEAR'S EVENT

st.petersburg www.8Ipala.org

(Must be completed)

I. REVENUE SOURCES (attach sheet If more space Is needed) Amount

1. 1 Event Registration $10,000

$65,012 2. Event Fundralslng I I~-----=~~~~

3. 4~------------------~--~~~~----------:1

r--------=-=======~--------~==--~~~==~--~~ ~~~~~--------==~ 5. ~ 6·r--------------=~----~~-------=~~=---~~J ~-=--------------~1

~====~------------~~~----~~ -~ J I

~==~--------------~ 8. J

~==~------~====== TOTAL GROSS REVENU~


1. :-1 ---====---========----==---==~] ;--= ___ ==-=1 2. 1 J J ~~~~~~--~~~=-~~~~=--=--~-=======~

3. I 4 :-1 ~~~~---==~==-~~~~~=~ I

r--====---===-----~ 5. I J 6. :-1 ~~--~--~--~====~--~~--~~J

7. ~I --~~------~~~====~==~====~~I~~==~~===-~

r-~========~--==~

8. I I r-~==~========--~

9. I ] F==================:' 10. 1 I

~=-----------======~======------======~----~-~.~ ~------==--------==~ 11·1 J

~-------------------------------------===~~~ F==================~ 12·1 ___ J :========'

TOTAL OPERATING EXPENSE~ TOTAL NET INCOM~r-----------=====----,


l·lchildren's Tumor Foundation II $65,012 I F=========~========'

2·1 II I F===========================================~ F=================='

3·1 I I:======~I 4·1 I F.-1 -=====~I 5·1 I ~I =====~J 6·1_ - - "'..=======1-1,

TOTAL ALLOCATION OF NET INCOM~ ________ ~

I I Date: ---------------------------------~

Prepared by:

Print Application Page 8 of8 J~bmlt Application by Em1

8/6/2015


Foreign Not For profit Corporation

CUPID CHARITIES CORPORATION

Filing Information

Document Number FEIIEIN Number Date Filed State Status

Principal Address

3457 RINGSBY COURT 205 DENVER, CO 80216

Changed: 05/01/2015

Mailing Address

3457 RINGSBY CT UNIT 205 DENVER, CO 80216

Changed: 05/01/2015

F12000005048 45-3672776 12/17/2012 DC ACTIVE


BROOKS, BILL 5218 ST REGIS PLACE BELLEISLE,FL32812


Name & Address

Title D

LEATHERS, CHANDLER J 185 SOUTH 4TH STREET W#4E BROOKLYN, NY 01211

Title Treasurer

LORBERBAUM,STEVE 7000 BRICKYARD ROAD


hltp:/lsearch.sunbiz.orgllnqulry/CorporalionSearchiSearchResuIIDelail?inqulrytype=EnlllyName&dlreclionType=lnlllal&searchNameOrder=CUPIDCHA.. 1/2

8/6/2015

POTOMAC, MD 20854

Title P

HANRAHAN, BRENDAN 1200 EAST WEST HWY #615 SILVER SPRING, MD 20910

Title V

GILL, ROBERT A 2711 WOODLEY RD NW WASHINGTON, DC 20008

Title S

FORYS, TAMARA 1200 EAST WEST HWY #615 SILVER SPRINGS, MD 20910

Annual Reports

Report Year 2013

2014

2015

Document Images

Filed Date 04/15/2013 01/12/2014 05/01/2015

Delall by Entity Name

05/01/2015 -- AN NUAL REPORT View image in PDF format --------~----------~

01/12/2014 -- ANNUAL REPORT 04/15/2013 - ANNUAL REPORT ;=-:--Vl==e-w-'m-:-;==g==e:::'n;:::p=-D-F"";;fo=rm-a-=t =---: 12/17/2012 -- Foreign Non-Profit View image in PDF format

~------~----------~

~l£:and~

State of Flonda, Department of State

hllp:/Isearch.sunblz.org/lnqulry/CorporallonSearchlSearchResuIIDelall?inqulrylype=EntityName&directlonType=lnltial&searchNameOrder=CUPIDCHA .. 212

INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201

Date: J UN Z 7 20·,2 CUPID CHARITIES C/O BRENDAN HANRAHAN 302 EMILY DR LILBURN, GA 30047-5223

Dear Applicant:

DEPARTMENT OF THE TREASURY

Employer Identification Number: 45-3672776

DLN: 17053326343021

Contact Person: EDWARD S SCHLAACK

Contact Telephone Number: (877) 829-5500

Accounting Period Ending: June 30

Public Charity Status: 170(b) (1) (A) (vi)

Form 990 Required: Yes

Effective Date of Exemption: October 26, 2011

Contribution Deductibility: Yes

Addendum Applies: No

10# 31536

We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c) (3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.

Organizations exempt under section 501(c) (3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Letter 947 (DO/CG)

CUPID CHARITIES

Enclosure: Publication 4221-PC

- 2-

Sincerely,

~r:~t.~ Director, Exempt Organizations Rulings and Agreements

Letter 947 (DO/CG)

Denis W. Burns

From: Sent: To: Subject: Attachments:

Hi Polly and Denis!

Katherine Zehr <kzehr727@gmail,com> Tuesday, August 04, 2015 11:57 AM Polly P. Brannon; Denis W. Burns Cupid's Undie Run Cupid_501c3 (1) (l).pdf; Co-sponsoredApplication for 2016.pdf

I've submitted the application for the Cupid's Undie Run and the $30 is in the mail, so should hopefully be there sometime this week. I've also attached a copy of the application, because I'm not sure if it went through when I hit submit (hopefully you won't get a dozen copies of it).

Included in the attachments is a copy of our 501(c)(3) designation as well. As soon as I speak with Sgt. Pratt I can get the event detail schedule and route map to you. It just depends on what our route will be as a timeline.

Thank you both so much for all of your help! Please let me know if I've forgotten anything or if you need anything extra.

-Katherine Zehr (h) 727.290.9142 (c) 602.741.7847

1

~-" It. petersburg ~ parkl a recPBadoD

Contract#: 14929 Date: 01 Sep 2015

CUPID CHARITIES CORPORATION KATHERINE ZEHR 1000 EDEN ISLE DR NE ST PETERSBURG FL 33704 USA

Purpose of Use: CUPID'S UNDIE RUN


Other Information:



Yes

No No

Expected: 600

Contract/Permit

User: Status:

DWBurns Firm

Home #: () Business #: (727) 290-9142

Cell #: ()


Date/s) and Tlme/s) of Use: Starting: Sat 13 Feb 1612:00 am Ending: Sat 13 Feb 16 11:59 pm

Facility/Equipment

Special Programs

Special Event


Charges:

Fees $ 0.00

Extra Fees $30.00

Tax $0.00


Payments:

Date 10 Aug 2015

Additional Notes:


Sat 13 Feb 2016 12:00 AM

11:59 PM

$0.00 $0.00

Total $30.00

Quantity 1

Charge $30.00

Deposit Total Applied $0.00 $30.00

Amount $30.00

Payment Type Check

Tax $0.00

Contract Balance $0.00

Reference Rental


By:{Sign Name):

Tax

$0.00

Total

$0.00

Total $30.00

$30.00



I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement. I also understand this Agreement Is not final until approved and executed by the Parks and Recreation Superintendent or designee.

Parks and Recreation Superintendent By:{Sjgn Name)

(Print Name) KATHERINE ZEHR

CUPID CHARITIES CORPORATION Name of User Or anization, If Applicable


Manager


User: dwburns



o Approved or 0 Rejected Date: ------

Page: 1

~/ at. petersburg ~ parka a recrBsUon

Contract#: 14929

Date: 01 Sop 2015


Contract/Perm it

User: Status:

DWBurns Firm

Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, asslstive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .



9/1/2015


Foreign Not For profit Corporation

CUPID CHARITIES CORPORATION

Filing Information

Document Number FEJlEIN Number Date Filed State Status

Principal Address

3457 RINGSBY COURT 205 DENVER, CO 80216

Changed: 05/01/2015

Mailing Address

3457 RINGSBY CT UNIT 205 DENVER, CO 80216

Changed: 05/01/2015

F12000005048 45-3672776

12/17/2012 DC

ACTIVE


BROOKS, BILL 5218 ST REGIS PLACE BELLEISLE,FL32812


Name & Address

Title D

LEATHERS, CHANDLER J 185 SOUTH 4TH STREET W#4E BROOKLYN, NY 01211

Title Treasurer

LORBERBAUM,STEVE 7000 BRICKYARD ROAD

Delall by Enlily Nome

http://search.sunbiz.org/lnqulry/CorporationSearch/SearchResultDetail?inquirytype=EntltyName&directionType=lnitlal&searchNameOrder=CUPIDCHA. 1/2

911/2015

POTOMAC, MD 20854

Title P

HANRAHAN,BRENDAN 1200 EAST WEST HWY #615 SILVER SPRING, MD 20910

Title V

GILL, ROBERT A 2711 WOODLEY RD NW WASHINGTON, DC 20008

Title S

FORYS, TAMARA 1200 EAST WEST HWY #615 SILVER SPRINGS, MD 20910

Annual Reports

Report Year 2013

2014

2015

Document Images

Filed Date 04/15/2013 01/12/2014 05/01/2015

Oelall by Enlily Name

05/01/2015 -- ANNUAL REPORT View Image In PDF format --------~------------~

01/12/2014 -- ANNUAL REPORT View Image In I?DF format --------~~----------~

04/15/2013 - ANNUAL REPORT View Image In PDF format --------~~----------~

12/17/2012 -- Foreign Non-Profit View Image In PDF format --------~~----------~

~©and~

State of FlOrida, Department of State

hltp:lIsearch.sunbiz.org/lnquiry/CorporationSearch/SearchResultDetail?lnquirytype=EntityName&directionType=lnitlal&searchNameOrder=CUPIDCHA.. 212


Event Title: IUmphrey's McGee

Entity Name: No Clubs-We Are Concerts/Music Farm Presents

Event Date(s): IAug 5-7

Date Received:

Check or Cash: Application #: Packet: Permit #:

Phone No.: 1941 5040283 Fax No.: INone

Federall.D. Number: 147-3317510

Location: IVinoy Park

Day 1 of Event: ITBD Time Gates Open: ,'4-:0-0P-M-- Ending Time: 1'1-0:-00- P-M---

Day 2 of Event: rl----- Time Gates Open: I Ending TIme: I Day 3 of Event: I Time Gates Open: I Ending TIme: 1..--- ---Application Prepared by: IGaetano Rifugiato Phone: 1941 504 0283

Title: IPresident Cell Phone: 1941 504 0283

D

Address: ..-16-6-6-C-en- t-ra-I-A-v-e - - ------------ City: 1St Petersburg State: IFI Zip: 133701

Email Address: rln-o-c-IU-b-sp- r-e-se- n- [email protected] -------------

Additional Contact Person: 1..----------- ---------- --- Day Phone: I

What month/year were you incorporated as nonprofit? We are not a non profit but will use a non profit tbd

List all 501 (c)3 entities that will benefit from this event. ITBD

Name of the for-profit entity? ..-IT-B-D- - -------------- -------------


Because it is another event being added to the landscape in St Petersburg, it will bring the profile of the area even more to National attention. This hopefully will have a long term effect on growth for the area.


By attracting 7-10,000 people we hope local businesses will see an increase in business. We aim to have all local businesses to vend food and beverage at venue. We will also like to give the opportunity to have local business have the first choice when it comes to sponsoring the event. We will also have an area where local charities can have a booth to advertise and raise awareness to their cause.

Each co-sponsored entity must possess liability insurance naming the City of st. Petersburg as an additional insured and secure said insurance in the amount determined by the City.



r NO

IX YES

How much? 11 million plus

r NO

Will there be an admission / registration fee? IX YES r NO Advanced Fee: Day of:

Please provide the website address for your event. Not available yet

Please provide a phone number that can be advertised to the public. 17278225665

What is the estimated attendance for this event? Spectators 14-7000 Participants

Page 1 of8

Last Year's Total Attendance 16000



Showmobile (Yes/No)

# Bleacher(s) needed. Each bleacher approx. 180 people) I Tables (6 ft) # needed 1 Chairs # needed 1




I Mahaffey Theater

I Coliseum

I Sunken Gardens

I BoydHiII


Which Location?


POLICE: TRAFFIC: F PARKS SERVICES: Pre aration and Re toration RECREATION SERVICES: On-site Presence. Logistics Help. liaison with Other Ddepartments



Name: 1 TItle: Co-Sign: 1;------------------- TItle:

Date:

NOTE: a.

b.

c.

Date:





Page 2 of8

--.... st.pelersburg IYVlW.8IpOIC.OI'U


SUMMARY SHEET


Condition

IX Public Invited

IX Located in Park



IX Vendors I Exhibitors



IX Fence Installation

IX Other Structures


I Pyrotechnics


IX VIP Area

IX Staging

IX Amplified Sound

IX Security


r Off-site Parking I Shuttle

IX Semitruck I Tractor Trailer


r Invitations

IX Posters I Flyers


Obligation


Park Permit


Health Inspection

How many? 111 - 20 Vendors I Exhibitors


How many? 18 What type? ~Iw-i-re-----------------------



What structure? IRVSlTrailers Temporary Structure Permit


Fireworks Permit

I Professional IX IX Performers r IX Daytime - Private

Regular Units 11/100

IX Radio

r Television

r Remote Broadcast

Page 3 of8

Showmobile I Other

Announcement Only


r Overnight - Private r Event Time Frame - SPPD

Disabled unitslTBD Hand Washing~

City logo should be used in any pronlotional materials, posters, flyers, ads, website, public service announcements, and press releases,


Does your event require any power needs using more than the standard 11 0/20amp located in the parks? IX YES r NO

If YES, check all that apply. IX RV'S r Coffee Vendors IX Ice Bins r Freezers r Ice Cream Vendors IX Catering Trucks

r Other:


For Stage equipment we will need 3 phase,


Will your event have a licensed electrician on-site during the event? IX YES r NO If YES, who? ITBO



Name: INo Clubs-We Are Concerts/Music Farm Phone: 1941 5040283

Address (including zip): r-16-6-6-C-e-n-tr-a-1 A- v-e-, -st- p-e-t-er-s-b-u-rg-,-FI- 3-3-7-0-1----------...;.-.--------------


Max 2 stages, mainly reggae style music,


rOd, beve,age, band me"h, clothing

For Use of BeeriWine - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.



May need day before to set up stage, day of event early load in, The event will be one day only.

Page4of8


Once we have the day locked down we can give more info regarding artists and fee structure.

Other comments:




Name: IGaetano Rifugiato Title: IpreSident Date: 120 Sept 2014

Page 5 of8

*

*

*

*

*

*

*

*

Appendix A


Events in Vinoy Park will be assessed $300.00 per event day (e.g., I day event = $300.00, 2 days = $600.00, 3 days or more = $900.00.) This includes the $30.00 park permit fcc.

Events in any other park will be assessed $200.00 per event day (e.g., I day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). This includes the $30.00 park pennit fcc .

The above fees will be due at the time you submit your application plus the $30.00 co-sponsored application fcc.


Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non refundable $) ,2()(),OO late fcc .




Page 6 of8

AppendixB President or CEO



Name of the Nonprofit Corporation: IRefuge Ministries of TampBay Inc

Name of Responsible Party (President or CEO ONLY): IBruce Wright

Title of Responsible Party: Ipastor Director

Physical Address of Responsible Party: 3680 49th Ave N Apt 1, St Petersburg 33713

Phone Number of Responsible Party: 1727278 1547


Nonprofit (Employee Identification Number): IN/A Doc no N12000010413

Name of the For-profit Corporation: INO Clubs-We Are Concerts/Music Farm

Name of Responsible Party (President or CEO ONLY): IGaetano Rifugiato

Title of Responsible Party: Ipresident

Physical Address of Responsible Party: 666 Central Ave, St petersburg, FL 33701

Phone Number of Responsible Party: 1941 5040283


For-profit (Employee Identification Number) 147-3317510


Page 7 of8

APPENDIXC Name of Event: 1 .s;U&\l{'LI" ~\L:X)<V \ 0 STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: I2::rLAL""" (. I ?O t <"1.-----

PRIOR YEAR'S EVENT . f \..::> ~ I (Must be completed)

I. REVENUE SOURCES (attach sheet if more space is needed) Amount

1. \\. C-\'LQ:::\ S iPrL-~~ ,--~~----~--~~~~----------------------------

\ 80 ,lYD1) (JV

2. r-------------------------------------------------

3. U~ ,-~~~~---------------------------------------

4 ~?O"-lc;otSL) ,--~~=-~~~------------------------------------

5. ,--------------------------------------------------

6. ,--------------------------------------------------

7. ~------------------------------------------------

B.

TOTALGROSSREVENUEI I ~8 d.\.Sl' . dV


1.

2.

3.

4

5.

6.

7.

B.

9.

10.

11.

12.

~T,' Si1\-&1 rVfr-, SalA.(?.x1~/) cr\'I, D\\lfUl/1Vbvl ~l$TS

r------------------------------------------------,------------------------------------------------

(,DoTI OD

TOTAL OPERATING EXPENSESI J g 0, ~ 3 \ . ~ LI TOTAL NET INCOMEI


1·/ 2· 1r------------------------------------------3· 1 ht. Vt,NDo 0\ \SAt OJ ~,8=-O-,--=(3,....--~-1-. '3,-G/----

4· 1 5' 1 r---,g~~:---:-8-Nl----:C4L::--:-----r162--=~:---~~) tJ-r-:--o--=~=-oo.-tJ-~-T-'/-((-.-=~;:---r- r.-_::::r_b_' ~_. _'0_6 __ ___

6.

TOTAL ALLOCATION OF NET INCOMEI \'8 r:g 45=0' Ol) )

Prepared by: Date:

Print Application Page B ofB Submit Application by

Email

NO CLUBS ENTERTAINMENT INC GAETANO RIFUGIATO 666 CENTRAL AVE STPETERSBURG,FL33701 USA

Description

Previous Balance

Applied To: 14928 - UMPHREYS MCGEE

Spa Beach Park - Park

.. I-C ~

--.~ st.petersburg


August 5, 2016 6:00 am to August 7,2016 9:00 pm

Payment: Check

Balance


Receipt #: 2416939 User: DWBurns Issued: Tue 01 Sep 1509:35 am

Amount

$30.00

$30.00

($330.00)

($300.00)

~~ st. petersburg ~ park. a racr8adan


NO CLUBS ENTERTAINMENT INC

GAETANO RIFUGIATO

666 CENTRAL AVE ST PETERSBURG FL 33701 USA

Purpose of Use: UMPHREYS MCGEE


Other Information:


Date!s) and Tlme!s) of Use:

Facility/Equipment

Spa Beach Park

Park

Albert Whitted Park

Park

Albert Whitted Park

Shelter 1

Albert Whitted Park

Shelter 2

Albert Whitted Park

Shelter 3


Extra Fee - Bookings Co-Sponsored Park Permit Fee (Vinoy)

Charges:

Yes Yes

No

Expected: 6,000

Starting: Frl 05 Aug 16 06:00 am

Day Date Time

Fri 05 Aug 2016 06:00AM

07 Aug 2016 09:00 PM

Fri 05 Aug 2016 06:00AM

07 Aug 2016 09:00 PM

Fri 05 Aug 2016 06:00 AM

07 Aug 2016 09:00PM

Fri 05 Aug 2016 06:00 AM

07 Aug 2016 09:00 PM

Fri 05 Aug 2016 06:00AM

07 Aug 2016 09:00 PM

Quantity 1

Hours Quantity

63:00 1

Contract/Perm it

User: Status:

DWBurns Firm

Home#: 0 Business #: (941) 504-0283

Cell#: 0


Ending: Sun 07 Aug 16 09:00 pm


$0.00 $300.00 $0.00 $300.00

$0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00 $0.00

Charge Tax Total $30.00 $0.00 $30.00


$300.00 $0.00 $300.00

$300.00 $0.00 $300.00

Fees $ 0.00

Extra Fees $330.00

Tax $0.00

Total

$330.00


Account Balance ($300.00)


Payments:

Date 15 Oct 2014 01 Sep 2015

Additional Notes:


User: dwburns

Amount $300.00

$30.00

$0.00 $330.00

Payment Type Check Check

Reference Rental Rental

Receipt Number 2223900 2416939

Page: 1


I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement. I also understand this Agreement Is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Slgn Name)

(Prjnt Name) GAETANO RIFUGIATO

NO CLUBS ENTERTAINMENT INC Name of User Or anlzation, If Applicable

Supervisor \I ) Foreman

Manager

Manager

User: Status:

DWBurns Firm



(Print Namel Parks and Recreation Department




The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, asslstive listening devices, etc. , should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771.



~ ---.. st.petersburg

Rental #: 14928

NO CLUBS ENTERTAINMENT INC 666 CENTRAL AVE ST PETERSBURG FL 33701 USA

UMPHREYS MCGEE

Amendment Reason: Due Now

purpose of Use: Function:Not Changed Description:

Conditions of Use:

Insurance Required


Additional Fees:

Payment Method:

GAETANO RIFUGIATO

Supervisor Ii I Foreman

Manager

Superindendent

Starting: N/C

Damage Deposit: N/C Adjustment: N/C initial Due: N/C Prior Contract Total: $ 330.00



User: dwbums

Ending: N/C

Payable By: N/C Adj: N/C initial Pay: N/C Contract Total: N/C

Amendment #: 1

Amended : 01 Sep 2015

Expected: N/C

Date




Page: 1

9/1/2015



REFUGE MINISTRIES OF TAMPA BAY, INC.

Filing Information

Document Number FEI/EIN Number Date Filed Effective Date State Status

Principal Address

3680 49th Ave. north Apt. 1 St. Petersburg, FL 33714

Changed: 06/04/2013

Mailing Address

7050 48th St. north Pinellas Park, FL 33781

Changed: 04/22/2015

N12000010413 47-2524520 11/02/2012 11/02/2012 FL ACTIVE


WRIGHT, BRUCE J 3680 49th Ave. north Apt. 1 St. Peterburg, FL 33714



Name & Address

Title P

WRIGHT, BRUCE JREV 3680 49th Ave. north Apt. 1 St. Petersburg, FL 33714


hltp:/Isearch.sunblz.org/lnqulry/CorporationSearchlSearchResuItDetail?inaulrvtvoe=EntitvName&directionTvoe=lnltialR.!:Aarr.hN:lmp.nrrlpr=RI=~1 1r.I=MI il?

9/1/2015

Title DIR

SHEPERD,DAVE 2431 10TH AVE. NORTH ST.PETERSBURG,FL33713

Title DIR

MCCUTCHEN, JOE REV 1543 HWY 138 SE,SUITE 336 CONYERS, GA 30013

Title DIR

DON, THOMPSON REV. DR 2215 SUNSET DRIVE BRADENTON, FL 34207

Title DIR

SEGALL, DENNIS REV 4507 N. NEBRASKA AVE TAMPA, FL 33603

Title Director/Pastor

Wright, Barbara 7050 48th St. North Pinellas Park, FL 33781

Annual Reports

Report Year 2013 2014 2015

Document Images

Filed Date 06/04/2013 04/30/2014 04/22/2015

Detail by Enlily Name

04/22/2015 - ANNUAL REPORT View Image In PDF format



11/02/2012 -- Domestic Non-Profit View image in PDF format --------~----------~

~(9and~


http://search.sunblz.org/lnquiry/CorporationSearchlSearchResultDetall?inQuirytype=EntltyName&dlrectionTYDe=lnilial&searchNameOrder=REFUGEMI. .. 2/2

9/1/2015


Florida Profit Corporation

NO CLUBS ENTERTAINMENT INC

Filing Information

Document Number FEIIEIN Number Date Filed Effective Date State Status

Principal Address

666 CENTRAL AVE ST PETERSBURG, FL 33701

Mailing Address

666 CENTRAL AVE ST PETERSBURG, FL 33701

P12000057465 45-5630756 06/27/2012 06/28/2012 FL ACTIVE


RIFUGIATO, GAETANO MR 3535 7TH AVE NORTH ST.PETERSBURG,FL33713


Name & Address

Title P

RIFUGIATO, GAETANO MR 3535 7TH AVE N ST PETERSBURG, FL 33713

Title VP

CAMPILLO, LUCIEN 4935 58TH AVE S ST PETERSBURG, FL 33715

Title SEC

HUNDLEY, DAVID A


http://search.sunbiz.org/lnquiry/CorporationSearch/SearchResultDetall?inquirytype=EntityName&directionType=lnitial&searchNameOrder=NOCLUBS...1/2

91112015

2856 10TH AVE N ST PETERSBURG, FL 33713

Annual Reports

Report Year 2013 2014 2015

Document Images

Flied Date 03/10/2013 03/09/2014 01/11/2015


01/11/2015 -- ANNUAL REPORT View Image In PDF format ----------~~----------~

03/09/2014 -- ANNUAL REPORT View Image In PDF format --------~~----------~

03/10/2013 -- ANNUAL REPORT View Image In PDF format --------~~----------~

06/27/2012 -- Domestic Profit View Image In PDF format

.. ~©alld~

State of FlOrida, Department of State

hltp:/Isearch,sunbiz,org/lnquiry/CorporationSearch/SearchResuItDelail?inquirylype=EntilyName&directionType=lnillal&searchNameOrder=NOCLUBS, ., 212


.... .._/~ Date Received: ~ doJC ~~ --.... Check or Cash: ____ _

st.petersburg WWW.ltp8t8.0rg

Application #: Packet: c Permit #:

Event Title: ~AMPA BAY CARIBBEAN CARNIVAL Phone No.: 1727-666-4664 Fax No.: 1

Entity Name: ~RINIDAD & TOBAGO AMERICAN ASSOCIATION OF CENTRAL FLORIDI Federall.D. Number: r-15-9--33- 6-3-87- 9-----

Event Date(s): ~UNE 11 & 12, 2016 Location: ~INOY PARK

Day 1 of Event: ~UNE 11, 2016 Time Gates Open: r-IN-O-O-N-- Ending Time: r-11-0:-00- PM---

Day 2 of Event: ~UNE 12, 2016 Time Gates Open: INOON Ending Time: 110:00 PM

Day 3 of Event: I Time Gates Open: Ii-----..: Ending Time: I

Phone: 1727-666-4664 Application Prepared by: IGEORGE CARRINGTON

Title: IPRESIDENT OF TBCC Cell Phone: 1727-666-4664

Address: Ip.o. BOX 17062 I City: 1ST. PETERBURG I State: IFLORIDA Zip: 133733


Additional Contact Person: IrD-A-V-E-M-O-H-A-M-M-A-D---------------- Day Phone: 1727-224-7825

What month/year were you incorporated as nonprofit? 11990

List all SO 1 (c)3 entities that will benefit from this event. r~-RI-N-ID-A-D-&-T-O-BA-G-O-A-M-E-R-IC-A-N-A-S-S-O-C-IA-T-IO-N-O-F-C-E-NT-R-A-L-F-L-O-R-ID-A-, -IN-C-. --

Name of the for-profit entity? IN! A


ampa Bay Caribbean Carnival highlights the unique variety of culture found In the caribbean. During the weekend of this event, June 11 & 12th, 2016., The City of St. Petersburg will become the epicenter of diversified culture. Participants from Tampa, St. Pete's and urrounding cities and countries, including a few from our neighboring state - Georgia and as far as New York will descend upon st.

Petersburg to enjoy the Tampa Bay Caribbean Carnival unifies different demographics to join as one as they enjoy the rich and historical Caribbean event showcasing the ethnic foods, music and colorful parades in costumes that is associated with the Caribbean Culture. he local residents and visitors of st. Petersburg will experience the rich culture of the Tampa Bay Caribbean Community.


Our guest for this event will be in need of lodging and dinning opportunties, not to exclude shopping and transportation. The local St. Pete's businesses will benefit from the economical impact of the event.

Each co-sponsored entity must possess liability insurance naming the City of st. Petersburg as an additional insured and secure said insurance in the amount determined by the City.

Does your group presently have liability insurance? !Xi YES



Please provide the website address for your event. ampacaribbean.com

r NO

IX YES

How much? 11,000,000.00

r NO

Advanced Fee: 15.00 Day of: 120.00

Please provide a phone number that can be advertised to the public. flr-27---66- 6--4- 6-6-4- - ---------------

What is the estimated attendance for this event? Spectators 110,000 I Participants 1600 Last Year's Total Attendance ~OOO

Page 1 of8

dwburns

Typewritten Text

69


Recreation Eqylpment

Showmobile (Yes/No) IYES

# Bleacher(s) needed. Each bleacher approx. 180 peOPle)~ Tables (6 ft) # neededl30 I Chairs # needed 160

Public Address System INO

# of portable risers needed (4 in. x 8 In. x 16 In. sectlonS)~

Special Eyents Facilities

I Mahaffey Theater

I Coliseum

I Sunken Gardens

I Boyd Hili


Which Location?

~INOYPARK

The following departments may provide and charge for additional services. You will be provided cost estimates In your Cosponsored Agreement.

POLICE: Public Safety Personnel. Marine Services TRAFFIC: Personnel. Equipment (cones. barricades. no parking signs) FIRE: Paramedics. Inspectors PARKS SERVICES: Cleanup Personnel. Dumpster(sl. Trash Receptacles. Eyent Site preparation and Restoration RECREATION SERVICES: On-site presence. Logistics Help. liaison with Other Ddepartments

~: The City does not provide tents, Port-O-Lets, or large quantities of tables and chairs.

I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report ofthe event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name: GEORGE CARRINGTON

Co-Sign: DAVE MOHAMMAD

Title, ,RESIDENT

Title: CEO

Date: 08/2412015

Date: 08/24/2015

NOTE: a.

b.

c.



1. Route map for parade, run, walk, and/or bike event. 2. Site map of event and detail schedule of each day's events including open and close times. 3. Complete Appendix B and Appendix C. 4. Check for $30.00 for co-sponsored application proceSSing (non-refundable). 5. Check for park permit fee. See Appendix A for fee structure. 6. A copy of 501 (c)3 designation (if applicable)


Page 2 of8

-. ._f~

~~ .. --... stpelllribUra WWW.llPG11.0ra


SUMMARY SHEET


Condition

IX Public Invited

IX Located in Park





IX Erecting Tents - Largerthan 10ft x 12ft

~ Fence Installation

r- Other Structures

r- Open Flame Food Preparation

r Pyrotechnics


IX VIP Area

IX Staging

IX Amplified Sound

IX Security


IX Off-site Parking / Shuttle

r Semitruck / Tractor Trailer


IX Invitations

IX Posters / Flyers


Obligation


Park Permit


Health Inspection

How many? lover 30 Vendors / Exhibitors IE) Alcohol Permit Additional insurance Required

How many? F What type? ·F/r--IR- E----------

What structure? ISOUND STAGE




IX Professional

IX Performers

IX Showmobile r Other

r- Announcement Only


Fireworks Permit


IX Daytime - Private IX Overnight - Private IX Event Time Frame - SPPD

Regular Units ~ Disabled Units ~ Hand Washing~

IX IX r-

Radio

Television

Remote Broadcast

Page 30f8



Does your event require any power needs using more than the standard 11 0/20amp located In the parks? !Xl YES n NO

If YES, check all that apply. IX RV'S r Coffee Vendors r Ice Bins r Freezers n Ice Cream Vendors r Catering Trucks

IX Other:


HREE (3) RV'S 220 AMP

STAGE AUDIO - 220 AMP


Will your event have a licensed electrician on-site during the event? IXI YES r NO If YES, who? IMELVIN JOHNSON



Name: ~AMPA BAY CARIBBEAN CARNIVAL Phone: 1727-666-4664 Address (including zip): rlp~.O~. ~B~OX~17~0~6~2~S~t~p~et~e~rs~b~u~rg~F~lo~r~id~a~3~3~7~33~~~~~~~~~~~~~~~~~~~~~~


CARIBBEAN MUSIC ONE STAGE FIVE BANDS


PRODUCTS: AUTHENTIC CARIBBEAN & AMERICAN FOOD & FRUIT DRINKS

NAME & PROVIDER: VARIOUS VENDORS


REAT BAY DISTRIBUTORS - 2310 STARKY ROAD, LARGO FL 33771 - 727-584-8626



LOAD-IN WEDNESDAY JUNE 8TH, 2016, 8:00 - 4:00 PM LOAD-OUT MONDAY JUNE 13TH, 2016, 8:00- NOON

Page 4 of8


PRE-SALE OF TICKETS TO EVENT IS $15.00 PER PERSON DAY OF EVENTTICKET SALE IS $20.00 PER PERSON, KIDS 12 YEARS AND UNDER FREE

Other comments:




Name: IGEORGE CARRINGTON Title: IPRESIDENT Date: P8/24/2015

Page 5 of8

...

...

...

...

...

...

*

*

Appendix A

Co-Sponsored Event P~lrk Fcc StructUl"c



The above fees will be due at the time you submit your application plus the $30.00 co-sponsored application fee .



Thc City I'cquircs payment in advance for all City services estimated andlor provided for first time events and one of a kind nonrecurring events.



Page 6 of8

~~ IIIIIIJJQ~~\WII --.....

sl.pelersburg WWW.8IpOlo.org




Name of the Nonprofit Corporation: ~RINIDAD & TOBAGO AMERICAN ASSOCIATION OF CENTRAL FLORIDA, INC.

Name of Responsible Party (President or CEO ONLY): /GEORGE CARRINGTON

Title of Responsible Party: IPRESIDENT

Physical Address of Responsible party:lp.o. Box 17062 St. Petersburg, FI 33733




Name of the For-profit Corporation: IN/ A



Physical Address of Responsible Party: I





Page 7 of8

~a~ "f£~_ ~~ ...... APPENDIX C Name of Event: ~AMPA BAY CARIBBEAN CARNIVAL

STATEMENT OF REVENUE AND EXPENSES FORM Date(s) of Event: r.UNE 2016 'r.U-N-E-2-0-16--PRIOR YEAR'S EVENT I" I"

sl.pelersburg (Must be completed) Www.8Ipala.org


1. ISPONSPORSHiP - ABC - ADVENTISING, RADIO & MEDIA

2. ~ENDORS 3.IGATE RECiEPTS

4 ~ITY OF ST.PETERSBURG

5·1 6· ;'-1 ---------------------

Amount

$60,000.00

$50,000.00

$100,000.00

$6,000.00

7.1 ...-----------

8·1 TOTAL GROSS REVENU~ $217,000.00


1. ~ENUE - VINOY PARK, POLICE & CLEAN-UP $50,000.00

2. ~TAGE, SOUND & EQUIPMENT, FENCE $25,000.00

3. IPERMITS, WATER & LICENSE $1,000.00

4 IMARKETING - MEDIA, FLYERS & WEB $12,000.00

5. IENTERTAINMENT $100,000.00

6. IARTIST ACCOMMODATION & TRANSPORTATION $5,000.00

7. IMISC - VOLUNTEERS, PHONE & GOLF CART $2,500.00

8. ~ECURITY $5,000.00

9. I 10·;'-1 -----------------------

11. 1 i-----------

12. 1

TOTAL OPERATING EXPENSESI$200,500.00

TOTAL NET INCOM~i-':-$-'-16~,~50~0-.0--0-------


1. ~rinidad & Tobago American Association of Central Florida, Inc $2,500.00

2·1 3·1i---~~~~-~---~--~---------

4.1 i-----------

5·1 6·;'-1 ----------------------

TOTAL ALLOCATION OF NET INCOM~'-$-21-5-00-.-00--------

Prepared by: IGEORGE CARRINGTON Date: 108124/2015

Page 80f8

~.......,.; It, pat81'1burg ~ parkl a I'BCl'aadon


TRINIDAD & TOBAGO AMERICAN ASSOCIATION 0 GEORGE CARRINGTON 3150 PINELLAS POINTE DR ST PETERSBURG FL 33712 USA

Purpose of Use: TAMPA BAY CARIBBEAN CARNIVAL Expected: 10,000


Other Information:


Datels) and Tlmels) of Use:

Facility/Equipment

Albert Whitted Park

Park

Albert Whitted Park

Shelter 1

Albert Whitted Park

Shelter 2

Albert Whitted Park

Shelter 3

Vlnoy Park

Vinoy Park

Additional Fees:


Charges:

Yes Yes No

Starting: Tue 07 Jun 1606:00 am

Day Date Time

Tue 07 Jun 2016 06:00AM

13Jun2016 09:00 PM

Tue 07 Jun 2016 06:00AM

13 Jun 2016 09:00 PM

Tue 07 Jun 2016 06:00AM

13 Jun 2016 09:00 PM

Tue 07 Jun 2016 06:00AM

13 Jun 2016 09:00 PM

Tue 07 Jun 2016 06:00AM

13 Jun 2016 09:00 PM

Hours Quantity

159:00 3

3

Contract/Perm it

User: Status:

DWBurns Firm

Home#: 0 Business #: (727) 434-4282

Cell#:O


Ending: Mon 13 Jun 1609:00 pm

Fee

$0.00

$0.00

$0.00

$0.00

$0.00

Charge $600.00

$600.00

Extra Fee

$600.00

$0.00

$0.00

$0.00

$0.00

Tax $0.00

$0.00

Tax

$0.00

$0.00

$0.00

$0.00

$0.00

Total

$600.00

$0.00

$0.00

$0.00

$0.00

Total $600.00

$600.00

Fees $ 0.00

Extra Fees $600.00

Tax $0.00

Total $600.00




Payments:

Additional Notes:


User: dwburns

$0.00 $0.00

Page: 1

Contract#: 14930 Date: 01 Sep 2015

t have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement. I also understand this Agreement Is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Sign Name)

(Prjnt Name) GEORGE CARRINGTON

TRINIDAD & TOBAGO AMERICAN ASSOCIATION 0


Manager

Manager

User: DWBurns Status: Firm

CITY OF ST. PETERSBURG, FLORtDA

By:(Sign Name); Parks and Recreation Superintendent





The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, assistive listening devices, etc. , should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771.

Printed: 01 Sep 2015,10:14 AM


9/112015 Detail by Entity Name



TRINIDAD & TOBAGO AMERICAN ASSOCIATION OF CENTRAL FLORIDA, INC.

Filing Information

Document Number FEIIEIN Number Date Filed State

N96000000677 59-3363879

02/05/1996 FL

Status Last Event Event Date Filed

ACTIVE REINSTATEMENT 05/23/2014

Principal Address

3150 PINELLAS POINT DR S APT 3 ST PETERSBURG, FL 33712

Changed: 05/23/2014

Mailing Address


Changed: 05/23/2014


CARRINGTON, GEORGE 3150 PINELLAS POINT DR S APT 3 ST PETERSBURG, FL 33712




Name & Address

Title T

TROTMAN, JENNIFER

hltp:/Isearch.sunblz.org/lnquiry/CorporationSearch/SearchResuIIDelail?inquirytype=EnlltyName&directionType=lnilial&searchNameOrder=TRINIDADT... 1/2

9/1/2015


Title PD

CARRINGTON, GEORGE 3150 PINELLAS PT DR 8T PETERSBURG, FL 33712

Title CEO

Mohammed, Dave 1263 flushing avo clearwater, FL 33764

Annual Reports

Report Year 2014 2014 2015

Document Images

Filed Date 12/10/2014 12/12/2014 01/02/2015



12/12/2014 -- AMENDED ANNUAL REPORT View image in PDF format ----------~----------~

12/10/2014 -- AMENDED ANNUAL REPORT L...1 __ V_I_ew_·_tm_ag=-e_ln_PD_F_~_or_m_a_t __ --'


01/07/2011 -- REINSTATEMENT View Image In PDF format

10/28/2009 - REINSTATEMENT View image in PDF format

03/03/2008 -- REINSTATEMENT View image in PDF format



06/06/2002 -- REINSTATEM ENT View image In PDF format

02/06/1998 -- ANNUAL REPORT View image In PDF format


02105/1996 - DOCUMENTS PRIOR TO 1997 View Image In PDF format -------~---------~

~(f1and~


hllp:/Isearch.sunblz.org/lnquiry/CorporationSearch/SearchResuItDetail?inquirytype=EntityName&directlonType=lnitial&searchNameOrder=TRINIDADT... 212

lTV OF ST. PETERSBURG --.... _/~ Date Received:

ARKS & RECREATION DEPARTMENT O-SPONSORED EVENT APPLICATION

~ ......... st.patarsburg

Check or Cash: __ --::_

Application 1/: 70 www.llpoll.ora Packet: c.

Permit II: eL 1'1773

ventlltle: IC D (") ",' Phone No.: 1 9' .!.. - ~ IO ,1.') ,,) FaxNo·: I~l~ 'dC/ - -)' '-1/3 ~.JT ·( \fl9t Dee ( r' o~ ~ .... to '> .. v , ntity Name: I \:?); j C \ ~ t \J e (\ ~S i Federall.D. Number: jt-l ~ -()(., ~ .3.:1 S .. )

vent Date(s): 1 (Y) CI ( ( II I C(' h ~ \ (., location: , \j I (\ 6 ':\ ? G\ (' ¥:. ay 1 of Event: 13 /1 clll~ I llmeGatesOpen: ~ Endlngllme: 1 \ ~' l(jrf:)",...... ~ E'-.. .{ ~ d ay 2 of Event: I llme Gates Open: I Ending llme: 1'> ('vr. 0"1 ''-' ' ....

ay 3 of Event: , llme Gates Open: I Ending llme: 1

ppllcatlon Prepared by: I {'<\ c () \ (. v-. \I .e\.( I'V(. r Phone: I c I '~ .. 1 C Cc h '( (-tie: I Evet1 ·~ Prodv u. r Cell Phone: 16\ ~ - lGIu . J ~ G <)

ddress: 1\l~)3 W ·c.\..1\?(e.."'> .> S r- City: 1 \o.ms:>C\ , State: 1 F L. Zip: '-Is-'~-'G-' O-~-mall Address: Im O\'-II \: CA ~ e\unev-tn\-s tvd,C , Cc.in dditlonal Contact Person: , r-eyc\, c.. f\ _ J C.\,l.\' ____ ~ ______ I_D_a_y p_h_o_ne_:_'_l_)'_l_,_tt_'i_J._-G,.;......;9~G~, hat month/year were you Incorporated as nonprofit? I {y\ O::j :;)0 , 0

1st all 501 (c)3 entities that will benefit from this event. i-I ----'---=-------------------

arne of the for-profit entity? , \:S , ~ C, ~ ~ \J e () '" S escribe how this event will contribute to the quality o'lilfe In and enhance the Image of St. Petersburg.

S ?,(", ll<j "t..a (' '\=\',r, CJ UJ', \ \ 0.. ,\y C\ (\- '-\ 0 \... n 'J ~ .. ){ b C\.() p,. c ~t::>s ,e r ) c, \ .)

0.(")0 V I S\-orS tv ·t'ne. CCUJi\TCWC") 'St. ?e\-e. o.("€O\ (.Uh~("e th ~'-\ \oU I \\ be '''Y\OI e( j"('ct \ t'\ t\--t \y\c\() '1 \ oc c-\ \ ~ lie sand

() e 0.'( '0 '1 Crt \-y Q l "c 'l,S. .

escrlbe what economic benefit and impact this event will bring to St. Petersburg.

Th '\ ~ W ~ \\ b t. \-0 ~ S n:\ ':\ t Q'( C r rN. ,C"\ TCXfY"\P~/rl. nC\.v(. Sc\c\ cv\- he\-(.\

\0(0. \ I (AY""e C\ bU:>i :'\e.i5e~ h~" (.. Seen (.\ 'n o..v \ () 9 0 v ( h:..~ n" C\ \ \ C'\ \-4 cvt:Q..

. · h~Q\. \\-t prev , Q·..J :\ ',-/("ur~

rDu~ blc.c't:.S. Clod rn cV4'1 h"C\(\(lC\\ iM?c..t.~ 10'-1

ch co-sponsored entity must possess liability insurance naming the City of St. Petersburg as an additional insured and secure said surance In the amount determined by the City.

oes your group presently have liability Insurance? rI YES r /NO How much?! \ IY\. i \ \ ~ '"' I ~ 1\'\ . I' . G '\

re there plans to sell or distribute beer/wine at yo'! event? r-r YES r NO

ill there be an admission / registration fee? R YES r NO Advanced Fee: I":llt"t"'"",-<;-- Day of: 1:a ':2 )" lease provide the website address foryourevent.! fuCil. beck; . c. em I SPY-IDS) beer Pho 9 lease provide a phone number that can be advertised to the public. I ~ I 5 -916 ,- ~:> S" S-hat is the estimated attendance for this event? Spectators IS"; (DO PartIcipants r~ coc;; Last Year's Total Attendance Is-, GeO

Page 1 of8

Please check the equipment and/or facilitfes you are requesting.


r Mahaffey Theater howmoblle 6}1N0) I J)\ c. ~d t ) ~l(tyt Bleacher(s) needed. Each bleacher approx. lBO people)I, r

abies (6 ft) " needed I ! Chairs 1/ needed I. I n Coliseum

Sunken Gardens

ubllc Address System 1 n BoydHIII

of portable risers needed (4 In. x 81n. x 161n. sectlons)1


Which Locatlon7

he following departments may provide and charge for additional services. You will be provided cost estimates In your Consored Agreement.

The City does not provide tents, Port-O-Lets, or large quantities of tables and chairs.

ertlfy that the event will be open to all citizens and that Individuals will not be barred from participation due to race, creed, lor, national origin, sex, age, or physical Impairment. I understand that a financial report of the event Is due In the Parks d Recreation office within 30 days of the completion of the event. I also understand that the City Is to be shown as a coonsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure I necessary cI /county/state permltsllicenses. I further certify that the facts contained In this application are accurate.

arne: "J'=L~I-+f---'-';'-~---- Title: I rt/OJ/vct7(L o-Sign: Title:

Date:

Date:

OTE: a.

b.

c.

If person/entity preparing this application is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c)3 designation must accompany this application. If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt If paid. Applications lacking information or the required completed appendixes listed below will not be processed.

LEASE ATTACH THE FOLLOWING

• Route map for parade, run, walk, and/or bike event. · Site map of event and detaii schedule of each day's events Including open and close times.

Complete Appendix B and Appendix C. · Check for $30.00 for co-sponsored application processing (non-refundable). · Check for park permit fee. See Appendix A for fee structure. • A copy of 501 (c)3 deSignation (If applicable)

FOR FURTHER iNFORMATION, PLEASE CALL LYNN GORDON, PARKS & RECREATION MANAGER, 727-893-7766 or EMAIL: [email protected]

Page 2 ot8


SUMMARY SHEET


Condition

Public Invited

-I Located In Park

'" Vending Product I Merchandise Sales

Vending Food I Beverage

Vendors I Exhibitors

Vending Beer I Wine

How many? I T\3, \")

Obligation


Park Permit


Health Inspection

Erecting Tents - Larger than 10ft x 12ft How many? I\EO Alcohol Permit Additional Insurance Required




'./ Fence Installation

. "other Structures


Pyrotechnics

Require Street Closure

Security

-;/ Sanitary Facilities - Port-O-Lets

Off-site Parking I Shuttle

Semltruck I Tractor Trailer

arketing: Please check all that apply.

Invitations

if Posters I Flyers

Newspaper Iintemet

What type?

What structure? I Fire Inspection Permit

Fireworks Permit


r Professional r;J(' Showmobile r Other

rV' Performers r Announcement Only

IV" Daytime - Private rv" Overnight - Private ~ Event TIme Frame - SPPD

Regular Units ins D Disabled Units h~ \) Hand Washing I T~ \)

if Radio

rI Television

r Remote Broadcast

Page 3 of8

City logo should be used In any promotional materials, posters, flyers, ads, website, public service announcements, and press releases.

Ilectrical Requirements:

I oes your event require any power needs using more than the standard 11 0/20amp located in the parks? r7YES r NO

I YES, check all that apply. r RV'S r Coffee Vendors II Ice Bins n Freezers r Ice Cream Vendors r Catering Trucks

[V"Other:


Viii you supply your own generators? rv/vES r NO

~ YES r NO If YES, who? I g :)~'::1 s \-0 <"jt~ ~iII your event have a licensed electrician on-site during the event?

~iII your event be requesting any variances from City policies or procedures? If YES, please explain.

City permits, licenses, or services are required for event, who will pay for them?

arne: I.Bjq (, ~ Even ts _ ddress(inclucrrngzip): 1

1n::J3 W C'-\ \=,res.s ..s type of music, # of stages, and # of bands.

1st Vending Products. Name & Provider.

Phone: 1001 'S" t' 70 - ~:lS-~TafYlPC;\ ./ F(. '33 G..C.c..

or Use of Beer/wine - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.

m.,,\ \'\cpe C\--..~-\-J 11'11 r~ \ s·\- N S h~ S Seml.,,\c·,e F<.. 3:n7(P,

1 J.l - ~ '1 J . - lo\ ')._~ 3 ~plain subject/purpose of all speeches/demonstrations which will occur.

Discuss your load in/load out parking needs, Include times and dates.

~ "Iil i<; 9a.m - qPM 'ood ,'n I s-et (j t> Q. t \=>CI. ... k.

3/'J.ci \~ O>~ ~ 0 F ~ o..r t..

Page40fB

ther Comments: Please describe your fee structure.

ther comments:

represent and warrant that the purpose of the proposed activity/event and conduct of the sponsor(s) and the participants all conform to all requirements of law and all ordinances of the State of Florida, Pinellas County, and the City of SI. Petersburg

. eluding, but not limited to, City noise ordinances and Parks and Recreation Department Policies and Procedures. I acknowledge at failure to observe such laws, ordinances, or policies and procedures will result in an immediate cancellation of the event and

II permits.

ITHOUT LIMITING THE GENERALITY OF THE FOREGOING, I ACKNOWLEDGE THAT I HAVE READ AND FULLY NDERSTAND THE PARKS AND RECREATION DEPARTMENT POLICIES AND PROCEDURES PERTAINING TO THE SE OF PARKS AND THE PARK RULES SET FORTH IN ARTICLE II, CHAPTER 21, OF THE ST. PETERSBURG CITY ODE, INCLUDING BUT NOT LIMITED TO THE INDEMNIFICATION AND INSPECTION OBLIGATIONS ASSUMED BY ME NO THE PERSON OR ENTITY ON WHOSE BEHALF THIS APPLICATION IS BEING MADE.

ertify that the facts contained In this application are accurate.

Title: I flO We tilL. Date:

PageSof8

•

•

•

• •

•

*

*

Appendix A

Co-Sponsored Event Park Fec Structure

Events in Vinoy Park will be assessed $300.00 per event day (e.g., I day event = $300.00, 2 days = $600.00, 3 days or more "" $900.00.) This includes the $30.00 park permit fcc.

Events in any other park will be assessed $200.00 per event day (e.g., I day event = $200.00, 2 days '"' $400.00, 3 or more days = $600.00). This includes the $30.00 park permit fee.

The above fees wil\ be due at the time you submit your application plus the $30.00 co-sponsored application fcc.


Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non refundable li.~.ill,U.lli late fee.




Page6of8

---~._/~

~\WII

--.~ s"petersburg WWW ••• " •• II.OI..



lease complete the information below for each responsible party.

ame ofthe Nonprofit Corporation: I f(l~ \-\0 t'e... Cne,s \ ,--------------------------------

ame of Responsible Party (President or CEO ONLY): I Pi \ \ S <J.. S (.\\.1 (; (~ '\-"

;:x

Itle of Responsible Party: C "ec u \1 .. -e. \) \ ( <? (. \-c .""

hysical Address of Responsible party:1 13 '2 c.) i) a Sf N S em, (\ 0 \ e.. I F l 33 '11 <0

hone Number of Responsible Party; 7), 7 :: ~ q ).. - :1.). '.:--l.3

mail Address of Responsible Party: I_u \ ' r~ c" Q. W\ \.oj n () y e CY'e ~ \- ' 0 .' :)

onproflt (Employee Identification Number); I 'd, 0 .- C '')S q El G ('

ame of the For-profit Corporation: t J3)', <j C r-; t_\j..1.._E_\}_~_,,_t_S _______________ _ ame of Responsible Party (President or CEO ONL V): I m 0 f"\ " C. Q .\1 0. (' f) ~ \"

tie of Responsible Party: I B \ 5 C ;, 9 £ \1 ~0 I'S_ .. _

hysical Address of Responsible Party: I 11 <I3 L \J ' .C~'P ce s s S 1- Ta OJ P01 f EL S .i'G-C C:

hone Number of Responsible Party: I 'c i ~ ~ C ')0 ~.:;l 5 __ )' ~-------------------------------------------

mail Address of Responsible Party: Il'v\O(\~cQ\. ~~1o.() e'J~()T s rvd IO- CQr()_

or-profit (Employee Identification Number) I 4 Ct, ~ . oco y 3.;;:> s:-;;L


Page 7 of8

... .,.._/~

~\WII .... -- APPENDIX C Name of Event: <~ p 1 1(') C. ~ I! ~ .. 'r' . tiTle" STATEMENT OF REVENUE AND EXPENSES FORM - .,

PRIOR YEAR'S EVENT Date(s) of Event: I C~~ / I ci /1 (, I " I (; ) / I 9 1(., .petersburg wW.llpDID.Drl

(Must be completed,

REVENUE SOURCES (attach sheet If more space I. needed, Amount

.1 r-------------

1

·1 ·I~------~----------~~---------------

.1 r---------

·1 TOTAL GROSS REVENUEI

EXPENSES (IIttach sheet If more splice Is needed)

gOVjJD

o. ~------------------------------~----------~--1.

·2. 1i=-'=--------=~-"'-~-------------

~~----------------TOTAL OPERATING EXPENSE~ TOTAL NET INCOM~i-~~--------------

ALLOCATION OF NET INCOME ( attllch sheet If more splice Is needed)

~~~=-------~--------~I

~I------------

r---------------~------------------L~----=-~---=~-1


repared by: Date:

Page8of8

-

9/8/2015


Florida Limited Liability Company

BIG CITY EVENTS, LLC

Filing Information

Document Number FEI/EIN Number Date Filed State Status

Principal Address

1723 W Cypress St TAMPA, FL 33606

Changed: 04/06/2015

Mailing Address

1723 W Cypress St TAMPA, FL 33606

Changed: 04/06/2015

L12000067798 46-0643252 05/21/2012 FL ACTIVE


JAP, FERDIAN 1723 W Cypress St TAMPA, FL 33606


Authorized Person(s) Detail

Name & Address

Title MGRM

VARNER, MONICA 1723 W Cypress St TAMPA, FL 33606

Title MGRM

JAP, FERDIAN 1723 W Cypress St

Delail by Entity Name

http://search.sunbiz.orgllnquiry/CorporationSearch/SearchResuIIDelail?inquiry1ype=EntilyName&direclionType=lnilial&searchNameOrder=BIGCITYEV... 1/2

9/8/2015

TAMPA, FL 33606

Annual Reports

Report Year 2013 2014 2015

Document Images

Filed Date 04/30/2013 04/30/2014 04/06/2015

Ootoll by Entity Nomo

04/06/2015 -- ANNUAL REPORT View image in PDF format



05/21/2012 -- Florida Limited Liability View image in PDF format ----------=-------------~

'., ~©and~


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~I It. palarsburg ~ parks a reC'88doa


BIG CITY EVENTS, LLC MONICA VARNER 1723 W CYPRESS ST TAMPA FL 33606 USA

Purpose of Use: SPRING BEER FLING


Other Information:


Yes

Yes Yes

Expected: 6,500

Contract/Perm it

User: Status:

DWBurns Firm

Home#: 0 Business #: (813) 786-7480

Cell#: 0


Date(s) and Tlme(s) of Use: Starting: Wed 16 Mar 16 06:00 am Ending: Tue 22 Mar 16 09:00 pm

Facility/Equipment Day Date Time Fee Extra Fee Tax Total

Vlnoy Park

Vinoy Park

Wed 16 Mar 2016 06:00 AM $0.00 $300.00 $0.00 $300.00

22 Mar 2016 09:00 PM



Charges:

Fees $ 0.00

Extra Fees $330.00

Tax $0.00


Payments:

Additional Notes:

Hours

159:00

Total $330.00

I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreement I also understand this Agreement is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:(Sign Name)

(Print Name) MONICA VARNER

BIG CITY EVENTS, LLC Name of User Or anization, If Applicable


User: dwburns

Quantity 1

Quantity 1

Charge $30.00

Charge $300.00

$300.00


Tax $0.00

Tax $0.00

$0.00



By:(Sign Name):

Total $30.00

$30.00 Total

$300.00

$300.00

Account Balance

$330.00



Page: 1



Manager

Manager

Usor: Status:

D Approved or D Rejected

DWBurns Firm

Date:

D Approved or D Rejected Date: ______ _


The Americans with Disabilities Act (A.D.A.) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, assislive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .


User: dwburns

Page: 2

"'J)~~;; "/Q ~\WIII

--.~ st.petersburg

Rental #: 14773

BIG CITY EVENTS, LLC 1723 W CYPRESS ST TAMPA FL 33606 USA

SPRING BEER FLING

Amendment Reason: UPDATED

Purpose of Use:

Function: Not Changed

Description:


Dates and Time of Use: # of Bookings: 1 Starting: N/C

Mode

Revised

To

Revised

To

Additional Fees:

Payment Method:

MONICA VARNER

Facility I Equipment Day Vinoy Park - Vinoy Park Fri

Vinoy Park - Vinoy Park Fri



Damage Deposit: N/C Adjustment: N/C Initial Due: N/C

Start Date 18 Mar 2016

18 Mar 2016

18 Mar 2016

18 Mar 2016

Prior Contract Total: $ 30.00


Date

12 Aug 2015

Supervisor" I Foreman

Manager

Superindendent


User: dwbums

Ending: 21 Mar 2016

Start Time End Date 06:00AM 28 Mar 2016

06:00AM 28 Mar 2016

06:00AM 28 Mar 2016

06:00AM 21 Mar 2016

Payable By: N/C Adj: N/C Initial Pay: N/C

End Time 09:00 PM

09:00 PM

09:00 PM

09:00 PM

Contract Total: $ 330.00

Amount

$330.00

Amendment #: 1

Amended: 12 Aug 2015

Expected: N/C

Function Charge Co-Sponsored $ 0.00

Co-Sponsored $ 300.00



Date




Page: 1

__ J)/J'-;= "I-E ~\w. ......

st.petersburg

Rental #: 14773

BIG CITY EVENTS, LLC 1723 W CYPRESS ST TAMPA FL 33606 USA

SPRING BEER FLING Amendment Reason: Date changes

purposo of Use: Funclion:Nol Changed Description:


Contract/Permit Amendment Printed: 08 Sep 2015,08:56 AM

User: dwbums

Amendment #: 2

Amended: 08 Sep 2015

Dates and Time of Use: # of Bookings: 1 Starting: 16 Mar 2016 Ending: 22 Mar 2016 Expected: N/C

Mode Facility I Equipment Day Revised Vinoy Park - Vinoy Park Fri

To Vinoy Park - Vinoy Park Wed

Additional Fees:

Payment Method: Damage Deposit: N/C Adjustment: N/C Initial Due: N/C

Start Date Start Time End Date 18 Mar 2016 06:00 AM 21 Mar 2016

16 Mar 2016 06:00 AM 22 Mar 2016

Payable By: N/C Adj: N/C

End Time Function 09:00 PM Co-Sponsored

09:00 PM Co-Sponsored

Prior Contract Total: $ 330.00

Statementing: N/C

Initial Pay: N/C Contract Total: N/C

Date Amount

08 Sep 2015 $330.00

Date

MONICA VARNER




Manager


Superindendent

Charge $ 300.00

$ 300.00

Page: 1

9/8/201 5


Foreign Not For Profit Corporation

MY HOPE CHEST CORPORATION

Filing Information


Principal Address

7777 131ST ST N STE 5 SEMINOLE, FL 33776

Changed: 04/30/2015

Mailing Address

P.O. BOX 3081 SEMINOLE, FL 33775-3081

F10000002667 20-0299888 06/09/2010 NV ACTIVE


SAVOREDI, ALiSA 7380 128 ST N SEMINOLE, FL 33776




Name & Address

Title CP

SAVOREDI, ALI SA 7380 128TH ST. NO SEMINOLE, FL 33776

Title Treasurer

Spinello, Dana 12749 Sunland Ct

0 01011 by Entity Nomo

hltp:/Isearch.sunblz.orgllnquiry/CorporalionSearch/SearchResuIIOetail?inqulrytype=EntityName&direction Type=lnitial&searchNameOrder=MYHOPEC... 1/2

9/8/2015

Tampa, FL 33625

Title Director

Blanton, Haley Crum 1500 Kisk Blvd Trinity, FL 34655

Title Director

Jammo, Caitlin 911 Chestnut St Clearwater, FL 33759

Title Secretary

Tsagaris, Barbie 8707 Bardmoor Place #1 03C Largo, FL 33777

Annual Reports

Report Year 2013 2014 2015

Document Images

Filed Date 04/30/2013 04/28/2014 04/30/2015

Dotall by Entity Nomo



06/19/2013 - AMENDED ANNUAL REPORT View image in PDF format --------~~----------~


12/31/2012 -- Reg! Agent Change View image In PDF format



06/09/2010 -- Foreign Non-Profit View image In PDF format

~©and~


http://search.sunblz.orgllnquiry/CorporationSearch/SearchResultDetail?inquiry1ype=EntityName&directionType=lnitial&searchNameOrder=MYHOPEC... 212

CtTY OF ST. PETERSBURG PARKS & RECREATION DEPARTMENT CO-SPONSORED EVENT APPLICATION

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~~ ---.... sl.petersburg

Date Received:

Check or Cash: Application #:

c: WWW.Slpolo.oro Packet: Permit II: 1'19.76 '

Event Title: IRelay For Life of St. Petersburg Phone No.: 1727.812.2021 Fax No.: '727.545.3753

Entity Name: "',A-m-e-r-Ic-an-ca-n-c-e-r -SO-c-Ie-t-y-------------.- _ Federilll.D. Number: I ~ 3- 17884~1

Event Date(s): IFriday, Aprll8lh 2016 location: IStraub Park ,- 5av ~ Day 1 of Event: IAPril 8,2016 TIme Gates Open: .... 11-2:-00-P-M-- Ending Time: 11O:00PM

Day 2 of Event: 1 Time Gales Open: I ' Ending Time: I. Day 3 of Event: I TIme Gates Open: I Ending Time: .... 1.-.---'---Application Prepared by: IJamie Barbetto Phone: /727.812.7021

Title: Icommunity Milnager Cell Phone: 1727.260.3949

Address: /4-801 ~6~h -~ve;'ue N City: I~;~ellas Park State: f~L' .... - . Zip:' "33782

Email Address: ..... /a-m-I-e.-b-ar-b-e-lt-o-@-ca-n-c-_e-r.o-r-g----------....;....--------

Additional Contact Person: ISteven Rose Day Phone: /727.812.7012

What month/year were you Incorporated as nonprofit? 1.1986 .. . . . _ .. _ ... __ .... _ .... _ .... . _ .. __ .. .. _

List all 501 (c)3 entitles that will benefit from this event. ;..;.I-...;;;;....----.:.....;..;;;...;;.:.:...:::.;...;..;;..:..::;~..;.:;.;.;=:..=--.;.;-;:.;;;.;;;..,;;..;....;;....~=...;..;;,..-~

Name of lhe for-pront entity? km.~ri:an ~.~ ~:e~ .S:,~i:~ . _ .. _ . .. .... . Describe how this event will contribute to the quality of life in and enhance the image of st. Petersburg.

This is a yearly event that we hold in St. Petersburg, and it will help build awareness to the many resources and research the American Cancer Society does on a daily basis to keep the survival rate of cancer rising.

Describe what economic benent and Impacllhls event will bring to St. Petersburg.

Each co-sponsored entity must possess liability Insurance naming the City of st. Petersburg as an additional insured and secure said insurance in the amount determined by the City.

Does your group presently have liability Insurance? IX YES


Will there be an admission / registration fee? " YES

r , NO

rYES

NO

Please provide the website address for your event. www.relayforllfe.org/stpetefl

How much7IS300,O~~ IX' NO


Please provide a phone number that can be advertised to the public. 1 ... 7-2-7.-8-12-.7-0-2....;;,-------""--"'"--...... -----. ............... ---.....

What is the estimated attendance for this event? Spectators 1200 . particiPant~ 120~ ' Last ~e~r's Total Attendance I~ 5~ Page 1 of8


Recreation Equipment SDecial Events Fjlclllties

Showrnoblle (Yes/No) Ino r Mahaffey Theater

/I Bleacher(s) needed. Each bleacher approx. 180 peOPle)~ r Tables (6 ft) # neededlno ; Chairs II needed Ino . r Sunken Gardens

Coliseum

Public Address System Ino . n , • r Boyd Hill

# of portable risers needed (4In. x 8 In. x 16 in. sectionS)1


Which Location 1


POLICE: Public Safety personnel. Marine Services TRAFFIC: personnel. Equipment (cones, barricades. no park;ng.slgrul FIRE: paramedics. Inspectors .!...P.L.!AR!..!lKCl.>S,-,S""E.uRV-,-,I~C...,ES:<.I.; __ --:.C=.!;le .... aWn(.>1UP Personnel. Dumpster(s). Trash Receptacles, Event Site PrepM2!ion and Restoration RECREATION SERVICES: On-site Presence. Logistics Help. Liaison with Other Ddepartments

Note: The City does not provide tents, Port-Q-Lets, or large quantities of tables and chairs.

I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability Insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

N'm" I),mle Barbetto

Co-Sign:

Title: Community Manager

Title:

Date: Aug 18, 2015

Date:

NOTE: a.

b.

c.

If person/entity preparing this application Is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c)3 designation must accompany this application. If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.

PLEASE An ACH THE FOLLOWING

1. Route map for parade, run, walk, and/or bike event. 2, Site map of event and detail schedule of each day's events Including open and close times. 3. Complete Appendix B and Appendix C. 4. Check for $30.00 for co-sponsored application processing (non-refundable). 5. Check for park permit fee. See Appendix A for fee structure, 6. A copy of 501 (c)3 designation (if applicable)


Page 2 of8

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N: -t/;III

~Lpllirsburu WWW.llpoto.org

PARKS & RECREATION DEPARTMENT CO·SPONSORED EVENTS

SUMMARY SHEET


Condition

IX Public Invited

P.< Located In Park



r Vendors I Exhibitors

r Vending Beer I Wine



r Other Structures


r Pyrotechnics


r VIP Area

r Staging

IX Amplified Sound

r Security

IX Sanitary Facilities - Port-O-lets

r Off-site Parking I Shuttle

r Semltruck I Tractor Trailer


~. Invitations

IX Posters I Flyers

r Newspaper I Internet

How many?

Obligation


Park Permit

Occupational license

Health Inspection

Alcohol Permit Additional Insurance Required

How many? I Whattype7 ."------------



Temporary Structure Permit What structure? I Fire Inspection Permit

Fireworks Permit


r Professional r Showmobile r Other

IX Performers IX Announcement Only

r Daytime - Private r Overnight - Private r Event Time Frame - SPPD

Regular Units ! Disabled Units! Hand Washing!

15< ~

r

Radio

TelevIsIon

Remote Broadcast

Page 3 of8

City logo should be used in any promotional materials, posters, flyers, ads, website, public servIce announcements, and press releases.

I,

f 1

i I 1 I I : • I I I I

! j ! I

I t

Eleclrlcal Requirements:

Does your event require any power needs using more than the standard 11 0l20,lInp located In the parks? r YES IX NO

If YES, check all that apply. I RV'S I I Coffee Vendors r Ice Bins I Freezers I I Ice Cream Vendors I Catering Trucks

I Other:


Will you supply your own generators? I YES IX NO

Will your event have a licensed electrician on-site during the event? I YES IX NO If YES, who?


I If City permits, licenses, or services are required for event, who will pay for them?

Name: I _ .. '" _ Address (including zip):



Phone: I



Discuss your load in/load out parking needs, Include times and dates.

Page4of8

Other Comments: Please describe your fce structure.

Other comments:

I represent and warrant that the purpose of the proposed activity/event and conduct of the sponsor(s) and the participants shall conform to all requirements of law and all ordinances of the State of Florida, Pinellas County, and the City of St. Petersburg including, but not limited to, City noise ordinances and Parks and Recreation Department Policies and Procedures. I acknowledge that failure to observe such laws, ordinances, or policies and procedures will result in an immediate cancellation of the event and all pennits.


, certify that the facts contained In this application are accurate.

Name: IJamie Barbetto Title: l.~.ommunity Manager

Page 50f8

j , i ; i , j

~ , ~ (

~

*

*

*

*

*

*

Appendix A

Co-Sponsored Event Pm'k Fee Structure

Events in Vinoy Park will be assessed $300.00 per event day (c.g.,1 day event ::; $300.00, 2 days ::; $600.00, 3 days or more = $900.00.) This includes the $30.00 park permit fcc.

Events in any other park will be assessed $200.00 per event day (e.g., 1 day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). TIus includes the $30.00 park permit fee.

The above fees will be due at the time YOll submit your application plus the $30.00 co-sponsored application fce.

All co-sponsored event applications must be submitted at least 6 monLh prior to Lhe event.

Any application for a co-sponsored event submitted inside the six (6) month time frame will be assessed a non reft.mdable $1.200.00 late fee.

The City requires payment in advance for all City services estimated andlor provided for first time events and one of a kind nonrecurring events.

Payment wiII be required at least tell (10) business days prior to the start of the event am) shall be in the form of cash, certified check, or an irrevocable bank letter of' credit.


Page 6of8

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WWW.Slputu.oru




Name of the Nonprofit Corporation: I.Am:ric~n C~ncer So: icty

Name of Responsible Party (President or CEO ONLY):!. r-~-~e-. ,v-en-_ R-.o-.s-e-.- .-... -. -------------------

TItle of Responsible Party: Isenior Manager

Physical Address of Responsible party:14801 86th Ave N

Phone Number of Responsible Party: 1727.81 .~:l012


Nonprofit (Employee Identification Number): 113-1788491 ,

Name ofthe For-profit Corporation:








Page 70f8

~.."!.$@iiiii ~ ... APPENDIXC

STATEMENT OF REVENUE AND EXPENSES FORM PRIOR YEAR'S EVENT

Name of Event: IRelay For Ufe St. Petersburg

IIIP-" DiltC(S) of Event: IApr8,2016 '1-----st.pelersburg (Must be completed) WWW.SIPulu.org

I. REVENUE SOURCES (attach sheet If more space Is needed) Amount

l·IT.ca~s Fundraising 1 $30,000.00 2. Sponsorship i-1-.-..:.--:--$-1-5-'",0-0-0.-00-----

3. I 4~---------------------------------------------~1 --~~~----------

5. : 1 6. ' I~ --~~~--------

~ 1 8. ~I --~~------------

TOTALGROSSREVENU~ $45,000.00

II. EXPENSES (attach sheet If more space is needed)

1. ITent rentals

2. Iport-o-Iets

o I . /;--------. ...:..:- . ;....;,.. - ~. ' ..;...." ---$',300.00

3. IDJ $400.00 4 i-IF-o-od-- /-s-up-p-n-e-sf-o-r-su-r~vi-vo-r-s-----'--~-~' ~-~' --" -' ---------------~~~~--~

5. ( . - .. . .. ... -" ...... _ '.' i-----------'-----'"---

6. ~I...:.. _________________ ~. ""-' =' _ ..:...;;' _"--__________ -'-__ =_::..~ ~_---------_ 7. 0-1..::..:.. =..:... ____ ---'''--______ '--'-• ..:...;;. "...:.:. .. ..,;..._ =_" :..;..' ' "-' ~ ______ ~~--:;.:~ ~_---"------_ 8. ;..-1..::..- ____ ""--'-_-'--~ ____ -.:..:" . ..,,;;;;.- ;..,;.;. -=-- ;;;:,... ~ • • '--______ -""'--:.:.;. ••• ..;;.. •• ~" •• i------------'----

9. I.. ... _

lD·1 l1·lr· ..:...;;· ~~~---~----...:.:.· ..:...;;· -...:.:.·=-· .. =- ·"-· ~- '-------~------~

12.1 .. .. ,."... ." ... _.".. .. .. :.:.-........... i-----=. ;;...;._ ...... _ .. = .. _ .. -... ~_ ----

2.

3.

4.

5.


TOTALNETINCOMEi-1 -------.~~~~~3:~~~~. ~~~O-0-· -------$1,700.00

i----~~----------~-------------. - ~'- ~ ... ~ .. ~.~. -------------------... ~ .. ---.~ .. --.-. ----'---~~~

i------~----------~------------~~--~----------------~

6.i-----. ~_ = . .. ~ ... ~. ~~------...:.:.-----~~ .. ~. ~~--~--------lr- .. "-· ~·--...:.:.-------------TOTAL ALLOCATION OF NET INCOMEI .....

Prepared by: /Jamle Barbetto Date: /AU9 18,2015

.. ; : . ~~in~~APpli~~tion .. ~:..~. '.- ,,! ., PageSofS

I i j'

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I

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I \

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~h Straub Park ~ c:::::::s Beach D ~.

n CD ::l r+ .., Q)

~ CD •

-< Q) n :::T r+

n -c: C'"

Service # 1 200 amp 1 phase 120/208 Service # 2 200 amp 1 phase 120/208 Service # 3 200 amp 3 phase 120/208 E SO amp ground boxes W Hose Bib (potable water) P Pole Lights WF Water Fountain Park Length 449 ft. Park Width 265 ft.

~ r. NE.

8aYShore D· . r. NE.

Revised: August 17.2007

~-"" st. petersborg ~ parks a peCP8Bdan

Contract #: 14936

Date: 01 Sep 2015

AMERICAN CANCER SOCIETY JAMIE BARBETIO 4801 86TH AVE N PINELLAS PARK FL 33782 USA

Purpose of Use: Relay for Life


Other Information:


No No No

Expected: 0

Contract/Perm it

User: Status:

SCTegard Firm

Home#: 0 Business #: (727) 260-3949

Cell#: 0


$230.00

Datels) and Tlmels) of Use: Starting: Frl 08 Apr 1606:00 am Ending: Frl 08 Apr 16 11 :00 pm


South Straub Park

Park

Fri 08 Apr 2016 06:00 AM 11 :00 PM

$0.00 $230.00 $0.00 $230.00

Additional Fees: Extra Fee - Bookings Co-Sponsored Application Fee


Charges:

Fees

$ 0.00 Extra Fees

$230.00 Tax

$0.00


Payments:

Additional Notes:

Hours

17:00 17:00

Total $230.00

I have read this Agreement and agree to comply with the terms and conditions set forth in this Agreement. I also understand this Agreement is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By-ISian Name)

Iprint Name) JAMIE BARBETTO

AMERICAN CANCER SOCIETY Name of User Or anization, If Applicable


Manager


User: sctegard

Quantity 1

1

2

Charge $30.00

$200.00

$230.00


$0.00 $0.00

Tax $0.00 $0.00

$0.00

Contract Balance

$230.00


By:ISign Name):

Total $30.00

$200.00

$230.00

Account Balance

$230.00




D Approved or D Rejected Date: ______ _

Page: 1

~--" at. PB18Plbu'l ~ parka a .K.Blden

Contract#: 14936

Date: 01 Sep 2015

Manager D Approved or DRejected

Contract/Permit

User: Status:

SCTegard

Firm

Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, asslstive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .

Printed: 01 Sep 2015, 11 :52 AM

User: sctegard Page: 1



Foreign Not For Profit Corporation

AMERICAN CANCER SOCIETY, INC.

Filing Information


Principal Address

250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Changed: 06/08/2007

Mailing Address

F01000002790 13-1788491 05/24/2001 NY ACTIVE CORPORATE MERGER 08/30/2012 09/01/2012

OFFICE OF CORP. COUNSEL 250 WILLIAMS STREET ATLANTA, GA 30303-1002

Changed: 04/08/2008


CT CORPORATION SYSTEM 1200 SOUTH PINE ISLAND ROAD PLANTATION, FL 33324



OfficerlDirector Detail

Name & Address

Title SecretarylTreasurer, Director

Kean, Jeffrey L

Page I of 5

http://search. sunbiz.org/lnquiry ICorporationSearch/SearchResultDetail ?inquirytype=Entity... 9/1/2015


250 WILLIAMS STREET ATLANTA, GA 30303-1002

Title CFO

MICKLE, CATHERINE E 250 WILLIAMS STREET ATLANTA, GA 30303-1002

Title AS

Phillips, Timothy B 250 WILLIAMS STREET ATLANTA, GA 30303-1002

Title CEO

SEFFRIN, JOHN RPHD 250 WILLIAMS STREET ATLANTA, GA 30303-1002

Title Director

Alfonso, John 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Baskies, Arnold M 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Crome, Patricia J. 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Cullen, Kevin J, MD 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Foxhall, Lewis E. 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Lopez, Jorge Luis

Page 2 of 5

http://search.sunbiz.orgllnquiry ICorporationSearch/SearchResultDetail?inquirytype= Entity... 9/1/2015



Title Director

Hamilton, John W, DDS 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Heflin, Eugene 0 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Henderson, Allen H 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Henry, Susan 0 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Hernandez, Enrique, MD 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Jackson, Carol 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Heist, Daniel P. 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Rhee, Carolyn 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Meyerhoffer, Pamela K

Page 3 of 5




Title Director

Mueller, Scarlott K 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

West, Gil 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Rose, Clement S, MD 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Warne, Donald K, MD 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Title Director

Youle, Robert E 250 WILLIAMS ST. NW ATLANTA, GA 30303-1002

Annual Reports

Report Year 2013

2014

2015

Document Images

Filed Date 03/22/2013 04/03/2014 03/30/2015


04/03/2014 -- ANNUAL REPORT :===V=ie=w=im=a=g=e=in=p=D::::F=fo=rm=a=t==~ 03/22/2013 -- ANNUAL REPORT View image in PDF format

~============~ 12/13/2012 -- Reg. Agent Change:==V=ie=w=im=a::::g=e=in=p=D=F=fo=rm=a=t =~ 08/30/2012 -- Merger View image in PDF format

03/14/2012 -- ANNUAL REPORT View image in PDF format ~==============~ 03/03/2011 -- ANNUAL REPORT View image in PDF format

02/23/2010 -- ANNUAL REPORT ~==V=ie=w=i=m=ag=e=in=p=D=F=fo=rm==at==:::::: 03/30/2009 -- ANNUAL REPORT View image in PDF format ~ ______ ~ __________ -J

Page 4 or 5


Detail by Entity Name Page 5 015

04/08/2008 -- ANNUAL REPORT View Image in POF format

04/06/2007 -- ANNUAL REPORT :====V=le=w= l=m=ag=e=t=n ~PO::::F===fo=rm=a=t ==~ 04/14/2006 -- ANNUAL REPORT View Image In PDF format

09/10/2005 -- ANNUAL REPORT :====V=le=w= l=m=a=ge=l=n =P=DF==fo=rm=a=t ==~ View Image In PDF format



09/03/2002 -- ANNUAL REPORT :====v=j=ew==lm=a=g=e =jn=p=O=F=fo=r=m=at====:


05/24/2001 -- Foreign Non-Profit View image in PDF format

~ ~ and PllYacy roliclcs

• laic of f lorida, Department of State

http://search.sunbiz.org/lnquiry ICorporationSearch/SearchResultDetail ?inquirytype=Entity ... 9/1/2015


---.. ~ _/~

~ ... ...... slpetersburg wWW •• lp.I •• org

Date Received: Check or Cash: __ -:::-__ Application #: 72-Packet: 0 Permit #: / '1 7J. r

Event Title: IExtreme Mud Wars Phone No.: 18778202582 I Fax No.: 1

Entity Name: Active Endeavors Inc dba Tampa Bay Club Sport Federal /.0. Number: 1r-2-6-.0-0-164-'--1-8------'-'

Event Date(~): - 17116/16 + 7/17/16 Location: Ispa Beach Park _ _ ___ _ __ _

Day 1 of Event: 17116/16 : Time Gates Open: r-11-0-am--- Ending Time: 14pm -'

Day20fEvent: 17117/16 Time Gates Open: 110am Ending Time: 14pm I Day 3 of Event: 1 Time Gates Open: 1 Ending Time: 1

Application Prepared by: IChris Giebner Phone: 1877-820-2582, ext 2

Title: lowner Cell Phone: 1727-420-6868

Address: I 1""1-0-90-1-R-o-o-s-ev-e-lt-B-lv-d-,-S-te-1-0-0--D--------- City: 1St Pete State: IFL lip: 133716 J Email Address:[email protected]

Additional Contact Person: ' ..... Ia-n-E-Is-t-o-n-------------------.....;;;;;- Day Phone: 1877-820-2582

What month/year were you incorporated as nonprofit? In/a r-------------------------------~~--------~--

List aIl501(c)3 entities that will benefit from this event. TASCO, Hand4Hope, Secrets ofthe Seas Aquarium

Name of the for-profit entity? ________ .-1


Provide unique recreational opportunities to residents.


Bring 1000+ young professionals downtown with spending money. 2015 economic impact is estimated at S15-20K on top of team fees.


Does your group presently have liability insurance? IXI YES


Will there be an admission / registration fee? IX] YES r NO

r NO

~ YES

Please provide the website address for your event. www.ExtremeMudWars.com

How much? IS2000000 ---------

r NO

Advanced Fee: 300 Day of: o

Please provide a phone number that can be advertised t~ ilie- ~ublic.1 r-8-7-7-... -8-2-0--2--5-82 ...... - ... ext-2---------------........ .-.----

What is the estimated attendance for this event? Spectators 1150 Participants r8~ Last Year's Total Attendance 1700+ J Page 1 of8



Showmobile (Yes/No) Iyes


o Mahaffey Theater

r; Non-City Locations

Which Location?

# Bleacher(s) needed. Each bleacher approx. 180 peoPle)E1 0 Tables (6 ft) # neededlper tasiil Chairs # needed Iper tasco I 0

Coliseum

Sunken Gardens

Public Address System I I 0 Boyd Hill

# of portable risers needed (4 in. x 8 in. x 16 in. sections)D


POLICE: public Safety Personnel. Marine Services TRAFFIC: Personnel. Equipment (cones. barricades. no parking signs) FIRE: Paramedics. Inspectors PARKS SERViCES: Cleanup Personnel. Dumpster(s). Trash Receptacles. Event Site Preparation and Restoration RECREATION SERVICES: On-site Presence. Logistics Help. Liaison with Other Ddepartments

N2R: The City does not provide tents, Port-O-Lets, or large quantities of tables and chairs.


Name' IChrls Gleb"er

Co-Sign: (Tasco) I Title: ~o_w_n_er _______ --11 Date:

Title: Date: ----------------~ 1

8114/15


b.

c.

If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.



FOR FURTHER INFORMATION, PLEASE CALLJOHN ARMBRUSTER, PARKS & RECREATION MANAGER, 727-893-7766 or EMAIL: [email protected]

Page 2 of8


SUMMARY SHEET


Condition

~ Public Invited

18"1 Located in Park

CI Vending Product / Merchandise Sales

~ Vending Food / Beverage

~ Vendors / Exhibitors

I8l Vending Beer / Wine

~ Erecting Tents - Larger than 10ft x 12ft


0 Other Structures


0 Pyrotechnics

0 Require Street Closure

0 VIP Area

I8l Staging

rxl Amplified Sound

Ci Security

I8"J Sanitary Facilities - Port-O-Lets

0 Off-site Parking / Shuttle


Marketing: Please check all that apply_

rgj Invitations

IX! Posters / Flyers

rxl Newspaper / Internet


Obligation


Park Permit


Health Inspection


How many? Itasco What type? Ir-------'-------~

What structure? 1 ___________ --'

n Professional

n Performers

/59 Showmobile ~ Other

rx Announcement Only





Fireworks Permit


n Daytime - Private 0 Overnight - Private 0 Event Time Frame - SPPD

Regular Units D Disabled units D Hand WaShingl1 I

rx Radio

rx Television

r Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 11 0/20amp located in the parks? rYES 0 NO

If YES, check all that apply. r l RV'S r Coffee Vendors r Ice Bins r Freezers 0 Ice Cream Vendors r Catering Trucks

r Other:


I I I

-----------------------------~ Will you supply your own generators? rYES /8lNO

Will your event have a licensed electrician on-site during the event? rYES r NO If YES, who? J Will your event be requesting any variances from City policies or procedures? If YES, please explain.

--~ If City permits, licenses, or services are required for event, who will pay for them?

Name: ITampa Bay Club Sport orTASCO

Address (including zip): 110901 Roosevelt Blvd #100-0, ST. Petersburg, FL 33716


Showmobile with MC


1 __ -

I Phone: 1877-820-2582, ext 2

J I

~ For Use of Beer/wine - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.

Secrets of the Seas Aquarium (most likely) (727) 803-9799, Ext. 202 -or- [email protected]

---- - --_._--------'


1 ___ -


IUP'OTASCO ___ _ ____ J Page 4 of8


Teams can sign up ahead of time at $250-350/team. Spectators are free.

Other comments:

Tampa Bay Club Sport plans to run an adult version ofTASCO's mudwars using their existing setups. TBCS will do the marketing and registration of adult teams for the event. T ASCO will provide the equipment and staff for the event. Plans are to partner with the Secrets of the Seas Aquarium again to provide beer/wine sales to the participants. The charity will have all the proper permits etc for alcohol sales.




Name: ITraCey Giebner J Title: I_pr_e_si_de_n_t _______ -', Date: 1,_8/_1_4/_1_5 ____ J

Page 5 of8

Appendix A

Co-sponsored event park fee structure.

I. Events in Vinoy Park will be assessed $300.00 per event day (e.g., 1 day event = $300.00, 2 days = $600.00, 3 days or more = $900.00.) This includes the $30.00 park permit fee.

2. Events in any other park will be assessed $200.00 per event day (e.g., 1 day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). This includes the $30.00 park permit fee.

*

*

The above fees will be due at the same time the $30.00 co-sponsored application fee is due. 'fyou decide to cancel your event. all but $60.00 is refundable.

Requests made after the co-sponsored process, must be submitted no fewer than six (6) months before planned event.

Any event applying for the co-sponsorship inside the six (6) month time frame will be assessed a $1,200.00 administrative late fee.




Page 6 efB

~ ... ..wIER_ ~ .......

slpelersburg WWW.81P818.0rg




Name of the Nonprofit Corporation: ITasco

Name of Responsible Party (President or CEO ONLy): IShawn Oruoin


Physical Address of Responsible party:1



Nonprofit (Employee Identification Number): 1

Name of the For-profit Corporation: Active Endeavors, INC d/b/a Tampa Bay Club Sport __ I Name of Responsible Party (President or CEO ONLY): 1,_Tr_a_ce_y_G_ie_b_n_e_r _____________________ 1

Title of Responsible Party: Ipresident -~ Physical Address of Responsible Party: 10901 Roosevelt Blvd 1000, St. Pete, FL 3_3_71_6________________ _ _ j

Phone Number of Responsible Party: 1877-820-2582 x2 J Email Address of Responsible Party: [email protected] J

For-profit (Employee Identification Number) 126-0016418 __ J


Page 7 of8

__ J)..IIIrfJiiiiCiiiii ~\111 ---.. APPENDIX C Name of Event: IExtreme Mud Wars _

STATEMENT OF REVENUE AND EXPENSES FORM I 1 PRIOR YEAR'S EVENT Date(s) of Event: Jul12,2014 _ - Jul13,2014 I

stpetersburg (Must be completed) WWW.8Ipala.org


1. Iteam fees J I $36,500.00 2.lsponsors IIF =-=---'''''-----"$5=,O"-0-0.0-0------;

3·1 I I 4 rl ==~~~~======================~J ~I ~==~~====~

5· 1~- ~ I 6·1 11:=======: 7·1 J I s·l_ _ __ ] :=1 ====--==:

TOTAL GROSS REVENU~ $41,500.00 --------~-----------


1. ICity fees (fire/parklrec/police) I F====$=2:;;;;;O,=S2=4=.00====~~

2. FI ==~==============~============~I F===========~I 3. I I ]

F================================================~ F========~-====~~ 4 ICiub Sport expense (staff/signage/shirts/trophies/cc fees/advertising) I 5. I . I F=========-=~J'

$5,52S.00

6. I I I 7. i-

I =====================~=l i-==="-==-=====~J

S. I J i-===========~

9. I I J 10.1i===-======="'-==========-:1 r==~=-==--=~I

11.1 I :=======~I 12·1 I I

------------------------------------------------~F============== TOTAL OPERATING EXPENSESI $26,352.00

~~==========-=~ TOTALNETINCOM~_ _ 2 1_5,_14_S.00 __


l · IClUb Sport II $7,574.00 I 2.ITASCO donation ~ I F ====$7=,5=74=.0=0===~1

3·1 II I F============================~ F===============~

4·1 II I F==========~ 5·1 I I J F================~

6·1 ~I I 'F=================~,

TOTAL ALLOCATION OF NET INCOM~ _____ $_1..:.5,_14_S._00 ___ ---,1

Prepared by: IChristoPher Giebner I Date: Isep 19,2014 J Print Application Page S ofS

September I, 2015

Mr. Charles Gerdes Co-Sponsor Committee City of St. Petersburg St. Petersburg, FL, 33701

Mr. Gerdes,

Tampa Bay Club Sport 10901 Roosevelt Blvd N # 1 00-0

St. Petersburg, FL 33716 Phone: 877-820-2582

Fax: 820-749-8749 www.tampabayclubsport.col11 [email protected]

We are proud to announce that Extreme Mud Wars will be returning to Spa Beach Park once again on July 16-17, 2016!

We would like to once again, request permission to offer sales of distilled spirits/hard liquor to our guests for next year's edition. The last 2 years were a success with no issues. We will be monitoring this very closely and will follow all rules and regulations given to us without reservations. These additional sales will benefit our charities who are planned to remain the same as in the past; The Secrets of the Sea Marine Exploration Center and Aquarium, Hands 4 Hope, and T ASCO. All three charitable organizations have a myriad of benefits to the community and are closely interwoven into the culture of St. Petersburg.

We would like to extend an invitation to all council members to attend the event as well as we move towards our 7'h year running the adult edition of the event.

Extreme Mud Wars attracts a wide variety of participants from all over Florida and in addition to fundraising for those 3 charities, it also brings business to the downtown area for the entire weekend.

I greatly look forward to hearing back from you regarding this request.

Warm Regards,

Dir tor of Marketing Tampa Bay Club sport i [email protected] Cell: 727-804-0648

~-'" 81. pelersburg .~ parkl a rBcrBadon

Contract #: 14933 Date: 01 Sap 2015

TAMPA BAY CLUB SPORT CHRIS GIEBNER 10901 ROOSEVELT BLVD #100-0 ST PETERSBURG FL 33716 USA

Contract/Perm it

User: Status:

SCTegard Firm

Home#: 0 Business #: (877) 820-2582

Cell #: (727) 420-6868

Purpose of Use: Extreeme Mud Wars Expected: 700 Co-Sponsored Event Contract Balance

$230.00


Other Information:


Yes Yes No

Datels) and Tlmels) of Use: Starting: Frl15 Jul16 06:00 am Ending: Sun 17 Jul16 09:00 pm

Facility/Equipment

Spa Beach Park

Park

Spa Beach Park

Park

Spa Beach Park

Park

Additional Fees: Extra Fee - Bookings Co-Sponsored Application Fee


Charges:

Fees

$ 0.00

Extra Fees

$230.00

Tax

$0.00


payments:

Additional Notes:

Day

Fri

Sat

Sun

Date

15 Jul2016

16 Jul2016

17 Jul 2016

Hours

15:00

15:00

Total

$230.00


By:(Sign Name)

(Print Name) CHRIS GIEBNER

TAMPA BAY CLUB SPORT Name of User Or anization, If Applicable

Printed: 01 Sep 2015,11 :22 AM

User: sctegard

Time

06:00AM

09:00 PM

06:00AM

09:00 PM

06:00AM

09:00 PM

Quantity 1

2

Fee Extra Fee

$0.00 $0.00

$0.00 $230.00

$0.00

Charge $30.00

$200.00

$230.00

$0.00

Tax $0.00

$0.00

$0.00

Deposit Total Applied Contract Balance $230.00 $0.00 $0.00


By:(Sjgn Name):

Tax Total

$0.00 $0.00

$0.00 $230.00

$0.00 $0.00

Total $30.00

$200.00

$230.00

Account Balance

$16,157.22



Page: 1

Contract #: 14933 User: SCTegard Date: 01 Sep 2015 Status: Firm




Manager

D Approved or DRejected Date: Manager

The Americans with Disabilities Act (A.D.A.) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters, taped or Braille materials, assistive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TTD devices, please contact us using the Florida Relay Service at 800-955-8771.


User: sctegard

Page: 2

Detail by Entity Name Page I of2

'" -, .. ,. '" " . ~""' '''~'''I~~

FLORIDA DI·: 'PAR :i'M EN'I' ·OF STATE ~ . .f~Jf-~~ •~~ -~" I ' ''.---

DIVISION OF COItI'OItATIONS ~ . ~.:.ri1. Detail by Entity Name

Florida Profit Corporation

ACTIVE ENDEAVORS, INC.

Filing Information


Principal Address

1 0901 ROOSEVELT BLVD N 100-0 ST. PETERSBURG, FL 33716

Changed: 02/14/2012

Mailing Address

10901 ROOSEVELT BLVD N 100-0 ST. PETERSBURG, FL 33716

Changed: 02/14/2012

P02000004011 26-0016418

01/11/2002 FL ACTIVE


GIEBNER, CHRISTOPHER S 791 Suwannee Ct Ne ST. PETERSBURG, FLORIDA, FL 33702



Name & Address

Title P

GIEBNER, TRACEY L 791 Suwannee Ct NE ST. PETERSBURG, FL 33702

Title TS

GIEBNER, CHRISTOPHER S

http://search.sunbiz.org/lnquiry /CorporationSearch/SearchResultDetail ?inquirytype=Entitv... 9/1 I? 0 1 '\


791 Suwannee Ct NE ST.PETERSBURG,FL33702

Annual Reports

Report Year 2013 2014 2015

Document Images

Flied Date 01/16/2013 01/21/2014 01/12/2015


01/21/2014 -- ANNUAL REPORT!====V=i=ew='='m=a=ge=i=n=P=DF==fo=rm=a=t==~ 01/16/2013 -- ANNUAL REPORT View image in PDF format

~==============~ 02/14/2012 -- ANNUAL REPORT View image In PDF format

~==============~ 01/31/2011 -- ANNUAL REPORT View image in PDF format 03/03/2010 -- ANNUAL REPORT :=:::==V=ie=w='='m=a=ge=i=n =P=DF==fo=rm=a=t ==~ 04/06/2009 -- ANNUAL REPORT View image in PDF format 04/28/2008 -- ANNUAL REPORT !====V=ie=w=i=m=a=ge=i=n =P=DF==fo=rm=a=t ===:

08/09/2007 -- ANNUAL REPORT View image in PDF format ~==============:

04/11/2006 -- ANNUAL REPORT :=' ==V=ie=w=i=m=a::ge=i=n =P=DF=fo=rm=a=t ==: 01/26/2005 -- ANNUAL REPORT 1 View image in PDF format

~==============: 04/12/2004 -- ANNUAL REPORT 1 View image in PDF format ~==============~

01/05/2003 -- ANNUAL REPORT ~I ===V=ie=w=i=m=a=ge=l=n =P=DF==fo=rm=a=t ==~ 01/11/2002 -- Domestic Profit 1-1 __ V_ie_w_i_m_ag:::,.e_i_n_PD_F_f_o_rm_a_t_--I

~ © and prlyacy pOlicies

State or Florida, Department or State

Page 2 of2

http://search.sunbiz.orglInquiry ICorporationSearch/SearchResultDetail?inquirytype= Entity... 911 120 15




PIER AQUARIUM, INC.

Filing Information

Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date

Principal Address

244 Second Ave N Suite 203 ST. PETERSBURG, FL 33701

Changed: 02/25/2015

Mailing Address

244 Second Ave N Suite 203 ST. PETERSBURG, FL 33701

Changed: 01/20/2014

N26771 59-2899571

06/03/1988 FL ACTIVE

NAME CHANGE AMENDMENT

06/21/1988 NONE


LANGHANS, JARROD 1885 SHORE DR. S #435 SOUTH PASADENA, FL 33707




Name & Address

Title 0

Page I 01'3

http://search.sunbiz.orglInquiry ICorporationSearchiSearchResultDetail ?inquirytype=Entity... 9/1/2015


JOHNSON, LARI 200 2ND AVE S STE 159 SAINT PETERSBURG, FL 33701

Title P

LUTHER, MARK PH.D 2180 BAYOU GRANDE NE SAINT PETERSBURG, FL 33701

Title 0

BETZER, PETER PH.D 1830 7TH ST N SAINT PETERSBURG, FL 33704

Title 0

HILTON, ROBERT 300 BEACH DR. NE #501 SAINT PETERSBURG, FL 33701

Title VP

WALLACE, SUSAN H 343 BRIGHTWATERS BLVD NE. ST.PETERSBURG,FL33704

Title Treasurer

LANGHANS, JARROD 1885 SHORE DR. S #435 ST.PETERSBURG,FL33707

Annual Reports

Report Year 2013 2014 2015

Document Images

Filed Date

01/16/2013 01/20/2014 02/25/2015


01/20/2014 -- ANNUAL REPORT :==V=ie=w=im=a=ge=in=p=D=F=fo=rm=a=t=~ 01/16/2013 -- ANNUAL REPORT View image In PDF format

~==============~ 01/10/2012 -- ANNUAL REPORT View image in PDF format ~================~

01/06/2011 -- ANNUAL REPORT View image in PDF format ~==============~ 01/12/2010 -- ANNUAL REPORT View image in PDF format ~---------------~--------------------~


Page 2 of 3

http://search.sunbiz.orglInquiry /CorporationSearch/SearchResultDetail ?inquirytype=Entity.. . 9/1 /20 15

Detail by Entity Name Page 301'3

View Image in PDF format

01/10/2008 -- ANNUAL REPORT ~==V=I=ew==lm=a=g=e=ln=p=D=F=fo=r=m=at==~ 01/16/2007 -- ANNUAL REPORT View Image In PDF format 04/13/2006 -- ANNUAL REPORT :====V=le=w=l=m=ag=e=i=n =PD=F==fo=rm=a=t ===: 02/02/2005 -- ANNUAL REPORT View image In PDF format 02/17/2004 -- ANNUAL REPORT :====V=i=ew==lm=a=g=e =in=p=D=F=fo=r=m=at====:

02/18/2003 -- ANNUAL REPORT View Image In PDF format 01/16/2002 -- ANNUAL REPORT :====V=i=ew==lm=a=g=e=in=p=D=F=fo=r=m=at====:

04/03/2001 -- ANNUAL REPORT View Image In PDF format ~==============~ 03/20/2000 -- ANNUAL REPORT View Image In PDF format

04/21/1999 -- ANNUAL REPORT:==V=le=w=l=m=a=ge=l=n=p=DF=fo=rm=a=t==:

04/28/1998 -- ANNUAL REPORT View image In PDF format 05/13/1997 -- ANNUAL REPORT :==V=i=ew=lm=a=g=e =In=p=D=F=fo=r=m=at===:

03/29/1996 -- ANNUAL REPORT View image In PDF format ~================: 05/01/1995 -- ANNUAL REPORT View image in PDF format ~------~------------~

~ and P,lvjlcy poliCies

State of Florida, Depnrtment of Stdte

http://search.sunbiz.orglInquiry ICorporationSearch/SearchResultDetail?inquirytype=Entity... 9/1 120 15


--....... -~ ~ ... ......

sLpetersburg www.llpele.IIPg

Date Received: Check or Cash: Application #:

Packet: Permit #:

Event Title: Isunshine Grand Prix Phone No.: 1727-741-7250 Fax No.: I Entity Name: IFlorida Cycling Foundation, Inc. I Federall.D. Number: IApplied

Event Date(s): IMarch 19 - March 26,2016 Location: r-IB-a-yf-ro--n:...t-C-ri-te-r-iu-m----..;.....---------

Day 1 of Event: IMarch 25, 2016 Time Gates Open: 1 ..... S-:O-Oa-m-- Ending Time: Is:oopm

Day 2 of Event: 1 Time Gates Open: 1 Ending Time: Ii------~ Day 3 of Event: 1 Time Gates Open: i-I---~ Ending Time: 1

Application Prepared by: Ipablo Santa Cruz Phone:

Title: Ipresident Cell Phone: 1727-741-7250

Address:/ r-2-2-16-W-in-d-s-o-ng-c-o-urt-----.:=..------- City: ISafety Harbor State: IFlorlda Zip: 134695

Email Address: Irp-a-bl-o-@-to-p-v-Ie-w-I-n-te-r-na-t-io-n-a-I.c-o-m-----------------

Additional Contact Person: r-IT-im-M-O-Iy-n-e-a-u-x----------------- Day Phone: 1407-256-7971

What month/year were you incorporated as nonprofit?IAU9ust 2015 r---------------------------

List all 501 (c)3 entities that will benefit from this event. Pediatric Cancer Foundation, Eckerd Youth alternatives, YMCA, and others are ~



The Sunshine Grand Prix is a 6 days national caliber event bringing awareness and promotion to our area as a fun & safe cycling and healthy living destination. The event starts In Tampa on March 19 and ends In Clearwater on March 26. We are fortunate to be deSignated as the 1 st and 2nd events of the professional cycling league's calendar, which gives us the highest level competition and brings national media coverage.


The economic impact is driven by the expenditures of the over 15,000 expected participants, teams, officials, and spectators. We expect 500-600 participants per day, mostly from out of town.

Each co-sponsored entity must possess liability insurance naming the City of St. Petersburg as an additional Insured and secure said Insurance in the amount determined by the City.



Will there be an admission / registration fee? IXI YES r NO

r NO

rYES

Please provide the website address for your event. www.sunshinegrandprix.com

How much? IS1M/S3M

IX NO

Advanced Fee: 45 Day of: 155

Please provide a phone number that can be advertised to the public. r-IT-B-D-----------------------

What is the estimated attendance for this event? Spectators 11 5,OO~ I Participants 11,000 Last Year's Total Attendance I Page 1 ofS



Showmobile (Yes/No) INO


r Mahaffey Theater

# Bleacher(s) needed. Each bleacher approx. 180 people)li r Coliseum

Tables (6 ft) # neededl Chairs # needed I I r Sunken Gardens

Public Address System I I r Boyd Hill

# of portable risers needed (4 in. x 8 In. x 16 In. sectionS)!;


Which Location?


POLICE: public Safety Personnel. Marine Services TRAFFIC: personnel. Equipment (cones. barricades. no parking signs) FIRE: paramedics. Inspectors PARKS SERVICES: Cleanup Personnel. Dumpster(s), Trash Receptacles. Event Site preparation and Restoration RECREATION SERViCES: On-site Presence. Logistics Help. Liaison with Other Ddepartments


I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary city!county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name: Pablo Santa Cruz Title: President / Florida Cycling Fo~ Date: Aug 31 2015

Co-Sign: Tim Molyneaux Title: President / Topview Sports Date: Aug 312015

NOTE: a.

b.

c.

If person/entity preparing this application is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c13 designation must accompany this application. If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. Applications lacking information or the required completed appendixes listed below will not be processed.




Page 2 of8


SUMMARY SHEET


Condition

1& Public Invited

I.J Located In Park

C Vending Product / Merchandise Sales

r Vending Food / Beverage


C Vending Beer / Wine

n Erecting Tents - Larger than 10ft x 12ft

n Fence Installation

0 Other Structures


I Pyrotechnics


~ VIP Area

IX Staging

IXI Amplified Sound

I Security


C Off-site Parking / Shuttle

'- Semltruck / Tractor Trailer


IXl Invitations

IX Posters / Flyers


Obligation


Park Permit


Health Inspection



Temporary Structure Permit How many? 1

~--------~---------~---What type? I What structure? 1----------------1




Fireworks Permit


IX Professional I Showmobile I Other

I I Performers I Announcement Only


Regular Units D Disabled Unitsp-- Hand Washing I

~I

IX n

Radio

Television

Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 11 0/20amp located In the parks? r YES /X NO


r Other:


Will you supply your own generators? /X YES rNO

Will your event have a licensed electrician on-site during the event? r YES /XI NO If YES, who?



Name: IFlorida Cycling Foundation, Inc. Phone: 1727-741-7250 AddressOncludlngzip): 1~2~2~16~W~ln~d~s~~n~g~c~0~u~rt~,~sa~t~e~~H~a~rb~0~~~F~lo~r~id~a~3~46~7~7~~~~~~~~~~~~~~~~~~~~


NA





March 25, 2016 - 8:00am - 8:00pm. Our professional event services companies do this type of event over 50 times per year. They will manage all on site setup and take down.

Page40f8


All participants pay a registration fee ranging from $10 to $45 depending on the category (Juniors, Women 3-4, Women 1-2-3-, Men 5, Men 4, Men 3, Men Pro-1, Masters 40, Masters 50)

Other comments:



, certify that the facts contained in this application are accurate.

Name: Ipablo Santa Cruz Title: Ipresident Date: IAU9 312015

Page50f8

*

*

*

*

*

*

*

*

Appendix A


Events in Vinoy Park will be assessed $300.00 per event day (e.g.,1 day event = $300.00, 2 days = $600.00,3 days or more = $900.00.) This includes the $30.00 park permit fee.








Page 6 of8

sLpetersburg Www.stpata.DI'U




Name of the Nonprofit Corporation: IFlorida Cycling Foundation, Inc.

Name of Responsible Party (President or CEO ONLY): Ipablo Santa Cruz

Title of Responsible Party: Ipresident

Physical Address of Responsible Party: 2216 Windsong Court, Safety Harbor, Florida 34695



Nonprofit (Employee Identification Number): Applied - William Stainton from McFarlane Ferguson will provide by the end of the week.









Page 7 of8

st.petersburg www.8IpoIB.oru



Name of Event: IFlrst Annual In 2016

Date(s) of Event: I


1.

2.

3.

4

5.

6.

7.

B.

TOTALGROSSREVENU~


1.

2.

3.

4

5.

6.

7.

B.

9.

10.

11.

12.

~-------------------------------------------------------

~----------------------------------------------------~


TOTAL NET INCOM~r------------


1.1 2·1i---------------------_~1 i---=-=---=---=---3·1 4·1~-------------------------------------------------------------5.1 i----------=-

~I ] ~---------------------


Prepared by: Ipablo Santa Cruz Date: IAu9 312015

Print Application Page B ofB ~bmit Application by Ema

Time Category Awards Participants Fee Revenue TSO Pro 1-2 $250 100 $45 $4,500 TSO Masters 40+ $250 50 $45 $2,250 TSO Masters 50+ $250 50 $45 $2,250 TSO Women 1-2-3 $250 50 $75 $3,750 TSO Juniors 17-18 $250 50 $45 $2,250 TSO Men 3-4 35 $45 $1,575 TSO Men 5 35 $45 $1,575 TSO Juniors < 9 0 $10 $0 TSO Juniors 15-16 0 $10 $0 TSO Juniors 9-14 0 $10 $0 TSO Women 4 0 $45 $0 TSO Seniors 15 $45 $675 TSO Handcycles 15 $45 $675

$1,250 400 $19,500

TSO Tim Molyneaux from Topview Sports needs to provide the final times for the sch

August 31, 2015

Denis Burns St. Petersburg Parks & Recreation 1400 19th Street North St. Petersburg, FL. 33713

Good morning Denis,

Attached is the Co-Sponsored Event Application for our St. Petersburg's Criterium event, part of the Sunshine Grand Prix.

We appreciate your and Sergeant Pratt's guidance and support in choosing this great course for our event on Friday, March 5, 2016.

The following pages contain a map of the course and additional information about our organization and event.

Please let me know if there is anything else needed at this time.

Thank you,

jgi#4/~ Pablo Santa Cruz 727-7141-7250 Sunshine Grand Prix Florida Cycling Foundation, Inc.

http://www.sunshinegrandprix.com - full website live early/mid September.

Page 2 of5

Overview

The Sunshine Grand Prix is an initiative of the Florida Cycling Foundation, Inc., a 501 (c)(3) non profit organization (applied certification pending), which was established to foster cycling and healthy communities through advocacy, education, and promotion. We will accomplish our goals by developing and supporting programs that engage and empower our stakeholders and communities.

The Sunshine Grand Prix is our first annual and weeklong event throughout the Tampa Bay, will be held during the weel< of March 19 to March 26, 2016. This national caliber event will feature Tampa Bay with the best of Professional & Amateur Cycling Races and Fun Community & Healthy Living activities.

Our initial goals for 2015-2016 are to:

1. expand the membership of our board of directors and committees to ensure our foundation's financial strength and longevity

2. engage and highlight the Tampa Bay cycling community by hosting the Sunshine Grand Prix

3. generate meaningful charitable contributions to support cycling as a mode of transportation in Tampa Bay, and to support worthy programs form local cycling teams/clubs

Our expanded goals for 2016 and beyond will:

1. improve the collaboration among all cycling stakeholders

2. improve the access and safety of cycling in our communities

3. improve the programming of cycling related activities in our schools

4. improve the promotion of our region as a cycling and healthy living destination

Board of Directors

Administration

Legal

Finance

Page 3 of5

Programs

Collaboration among all cycling stakeholders

"--./

Access and safety of cycling in our communities "--./

Programming of cycling related activities in our

schools "--./

Promotion of our region as a cycling and healthy

living destination "--./

Florida Cycling Foundation, Inc.

Committees Executive I Legal I Finance

Marketing & Communications Sponsorships

Venue 2

Grants Community Activities

Site Planning I Signage Ambassadors I Volunteers

Concessions I Vendors Hospitality I VIP

Venue 3 Venue 4 Venue 5 Venue 6

Director Director Director Director Director Director

Commltt_. Committees Committees Committees Committees Committees

50%

25%

25%

Topview Sports I Event Services Companies

Surplus Distribution

Sunshine Grand Prix

Venue Director Discretion

Designated Charities Teams/Clubs

Page 4 of5

Schedule

Date liype IEvent Oity Sat, Mar 19 Criterium Tampa Twilight Tampa

Sun, Mar 20 Circuit Velo Fest Pinellas Park

Mon, Mar 21 Rest/Fun Bush Gardens Park Bash Tampa

Tue, Mar 22 Criterium Swan Lake Classic Lakeland

Wed, Mar 23 Road Ice Cream Hill San Antonio

Thu, Mar 24 Rest/Fun Frenchy's Beach Bash Clearwater

Fri, Mar2S Circuit st. Pete Twilight St. Pete

Sat, Mar 26 Criterium Clearwater Classic Clearwater

Sun, Mar 27 Rest Easter

Page 50f5

Denis W. Burns

From: Sent: To: Cc: Subject: Attachments:

Denis,

Pablo Santa Cruz <[email protected]> Sunday, August 30, 2015 11:01 PM Denis W. Burns Tim Molyneaux Sunshine Grand Prix - St. Pete Venue Sunshine Grand Prix - St. Pete Aug 31 201s.pdf; Sushine Grand Prix - St Pete Co Ssponsored Application.pdf

Attached is our letter and event application. The application fee will be hand delivered to your office on Monday afternoon.

Please let me know if you need anything else from us at this time.

Thank you.

Pablo Santa Cruz 727-741-7250

From: "Denis W. Burns" <[email protected]> Date: Friday, August 21, 2015 at 3:02 PM To: Pablo Santa Cruz <[email protected]>, "Joseph C. Pratt" <[email protected]> Cc: Tim Molyneaux <[email protected]> Subject: RE: loday's Meeting RE: Sunshine Grand Prix - st. Pete Venue

Good Afternoon,

I have attached the application, Please look over and return as soon as possible so I can process for Council Approval. Please feel free to contact either of us if you have any questions

Denis

From: Pablo Santa Cruz [mailto:[email protected]] Sent: Friday, August 21, 2015 2:40 PM To: Joseph C. Pratt; Denis W. Burns Cc: lim Molyneaux Subject: loday's Meeting RE: Sunshine Grand Prix - st. Pete Venue

Good afternoon Joe & Denis,

Thank you for the time spent with us this morning. Your guidance and support are much appreciated!

We look forward to working with you and your staff.

Regards,

Pablo.

1

Pablo A. Santa Cruz Chairman Sunshine Grand Prix, March 19-26 2016 Florida Cycling Foundation, Inc. (501)(c)(3) pending http://www.sunshinegrandprix.com

Your Sunshine City

2

Monday, August 31,2015 at 2:26:26 PM Eastern Daylight Time

Subject: Sunshine Grand Prix - St. Pete Venue

Date: Sunday, August 30, 2015 at 11:01:18 PM Eastern Daylight Time

From: Pablo Santa Cruz

To: Denis W. Burns

CC: Tim Molyneaux

Denis,

Attached is our letter and event application . The application fee will be hand delivered to your office on Monday afternoon.

Please let me know if you need anything else from us at this time.

Thank you.

Pablo Santa Cruz 727-741-7250

From: "Denis W. Burns" <Denjs.Burns@"&pete.org> Date: Friday, August 21, 2015 at 3:02 PM To: Pablo Santa Cruz <[email protected]>, "Joseph C. Pratt" <[email protected]> Cc: Tim Molyneaux <!i.m@to~Rorts.CQm>

Subject: RE: Today's Meeting RE: Sunshine Grand Prix - St. Pete Venue

Good Afternoon,

I have attached the application, Please look over and return as soon as possible so I can process for Council Approval. Please feel free to contact either of us if you have any questions

Denis

From: Pablo Santa Cruz [mailto:~toRviewinternational.coml

Sent: Friday, August 21, 2015 2:40 PM To: Joseph C. Pratt; Denis W. Burns Cc: Tim Molyneaux Subject: Today's Meeting RE: Sunshine Grand Prix - st. Pete Venue

Good afternoon Joe & Denis,

Thank you for the time spent with us this morning. Your guidance and support are much appreciated!

We look forward to working with you and your staff.

Regards,

Pablo.

FLORIDA CYCLING FOUNDATION INC PABLO SANTA CRUZ 2216 WINDSONG CT PALM HARBOR, FL 34695 USA

Description

Previous Balance

Applied To: 14948 - SUNSHINE GRAND PRIX

Special Programs - Special Event

~\111 ---.... st.petersburg

City of 5t. Petersburg


Payment: Check

Balance


Receipt #: 2417757 User: DWBurns Issued: Wed 02 Sep 1508:21 am

Amount

$30.00

$30.00

($30.00)

$0.00

Contract #: 14948

Date: 02 Sap 2015

FLORIDA CYCLING FOUNDATION INC PABLO SANTA CRUZ 2216 WINDSONG CT PALM HARBOR FL 34695 USA

Purpose of Use: SUNSHINE GRAND PRIX


Other Information:



No

No No

Expected: 10,000

Contract/Perm it

User: Status:

DWBurns Firm

Home #: () Business #: (727) 741-7250

Cell#: ()


$0.00

Date!s) and Tlme!s) of Use: Starting: Frl 25 Mar 16 07:00 am Ending: Frl 25 Mar 16 09:00 pm

Facility/Equipment

Special Programs

Special Event


Charges:

Fees $ 0.00

Extra Fees $30.00

Tax $0.00


Payments:

Date 02 Sep 2015

Additional Notes:


Fri 25 Mar 2016 07:00 AM

09:00 PM

$0.00 $0.00

Total

$30.00

Quantity 1

Charge $30.00


Amount $30.00

Payment Type Check

Tax $0.00


Reference Rental


By:!Sign Name):

Tax

$0.00

Total

$0.00

Total $30.00

$30.00




Parks and Recreation Superintendent By:(Sign Name)

(Print Name) PABLO SANTA CRUZ

FLORIDA CYCLING FOUNDATION INC

Supervisor II / Foreman

Manager


User: dwburns



o Approved or 0 Rejected Date: ------

Page: 1

Contract#: 14948

Date: 02 Sep 2015

Manager D Approved or DRejected

Contract/Perm it

User: Status:

DWBurns Firm

Date:

The Americans with Disabilities Act (A.D.A.) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, asslstive listening devices, etc" should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .


User: dwburns

Page: 1

9/4/2015



FLORIDA CYCLING FOUNDATION, INC.

Filing Information

Document Number FEI/EIN Number Date Filed State Status

Principal Address

N15000008500 NONE 09/02/2015 FL ACTIVE

201 N. FRANKLIN STREET, SUITE 2000 TAMPA, FL 33602

Mailing Address

201 N. FRANKLIN STREET, SUITE 2000 TAMPA, FL 33602


STAINTON, WILLIAM M 201 N. FRANKLIN STREET, SUITE 2000 TAMPA, FL 33602


NONE

Annual Reports

No Annual Reports Filed

Document Images

No images are available for this filing.

Delall by Enlity Name

http://search.sunbiz.orgllnquiry/CorporationSearchlSearchResultDetail?inquirytype=EntityName&directionType=lnitial&searchNameOrder=FLORIDAC... 1/2


~©i1nd~

. State of Florida, Department of State .

http://search.sunbiz.org/lnquiry/CorporatlonSearch/SearchResultDetail?inquirytype=EnlilyName&direclionType=lnitial&searchNameOrder=FLORIDAC. .. 2/2


__ .r."_/~

~\III ...... slpetersburg WWW.Blpala.oro

Date Received: Check or Cash: Application #: Packet: Permit #:

Event Title: 1 Reggae Rise Up Music Festival Phone No.: 1801.652.7955 Fax No.: 1

Entity Name: ILive Nlte Events, LLC Federall.D. Number: 1r-4-5-.5-5-0-25-5-1------

Event Date(s): IMarch 5th and 6th Location: IVinoy Park

Day 1 of Event: Isat 3.5.15 I Time Gates Open: 1 r-3-:0-0-p-m-- Ending Time: r-11-1-:0-0-p-m---'

Day 2 of Event: Isun 3.6.15 Time Gates Open: 13:00 pm Ending Time: 111 :00 pm

Day 3 of Event: I Time Gates Open: 1 Ending Time: 1

Application Prepared by: Ivaughn Carrick Phone: 1801.652.7955

Title: lowner Cell Phone: 1801.652.7955

Address: Ir3-24-So-u-th-40-0-W-es-t-#-27-5---------- City: ISLC State: lutah Zip: 184101

Email Address:[email protected]

Additional Contact Person: IrN-e-d-c-o-lI-et-t------------------- Day Phone: 1917.362.1410

What month/year were you incorporated as nonprofit? r-IN-/-A-------------------------

List all 501 (c)3 entities that will benefit from this event. IN/A

Nameofthe~~profitentlty7 Ir-L-~-e-N~~-e-E-v-en-t-~-L-L-C----------------------~


The eighth episode of the continuing festival series will be a great addition to one of the largest reggae markets in the country. More than just a reggae festival, Reggae Rise Up is also a celebration of the diverse and dynamic culture of each community we visi. Featuring cuisines from local eateries, local brews, and showcasing local artists to round out the experience.


The event will be attended by thousands of people, many of whom will visit local businesses ranging from restaurants to gas stations. We also plan to work out a "festival rate" with local hotels to encourage people to spend the weekend in St. Petersburg. The event itself will employ 50+ people who live in the St. Petersburg area.

Each co-sponsored entity must possess liability insurance naming the City of St. Petersburg as an additional insured and secure said Insurance in the amount determined by the City.




r NO

IX YES

How much? 1$5,000,000 Policy

r NO

Advanced Fee: $40.00 Day of: $50.00

Please provide the website address for your event. www.reggaeriseup.com ~--------------------------

Please provide a phone number that can be advertised to the public. Not available at this time, we will provide prior to announcing.

What is the estimated attendance for this event? Spectators 110,00,:>. I Participants 1100 I Last Year's Total Attendance 15000

Page10f8


Recreation Equipment Special Events Facilities

Showmobile (Yes/No)

Tables (6 ft) # needed

# of portable risers needed (4 in. x 8 in. x 16 in. sections)

# Bleacher(s) needed. Each bleacher approx. 180 people)

Chairs # needed


Mahaffey Theater

Sunken Gardens

Coliseum

Boyd Hill

Non-City Locations

Which Location?


I certify that the event will be open to all citizens and that individuals will not be barred from participation due to race, creed, color, national origin, sex, age, or physical impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a co-sponsor on any promotional materials produced for the event. I agree to obtain the required liability insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained in this application are accurate.

Name: Title: Date:

Co-Sign: Title: Date:

NOTE: a. If person/entity preparing this application is not representing a nonprofit entity, the application must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501(c)3 designation must accompany this application. b. If your entity has outstanding financial obligations with any department within the City of St. Petersburg, your application will not be processed until debt if paid. c. Applications lacking information or the required completed appendixes listed below will not be processed.


1. Route map for parade, run, walk, and/or bike event. 2. Site map of event and detail schedule of each day's events including open and close times. 3. Complete Appendix B and Appendix C. 4. Check for $30.00 for co-sponsored application processing (non-refundable). 5. Check for park permit fee. See Appendix A for fee structure. 6. A copy of 501(c)3 designation (if applicable)


POLICE: Public Safety Personnel, Marine Services TRAFFIC: Personnel, Equipment (cones, barricades, no parking signs) FIRE: Paramedics, Inspectors PARKS SERVICES: Cleanup Personnel, Dumpster(s), Trash Receptacles, Event Site Preparation and Restoration RECREATION SERVICES: On-site Presence, Logistics Help, Liaison with Other Ddepartments

Page 2 of 8

The following departments may provide and charge for additional services. You will be provided cost estimates in your Co-sponsored Agreement.

Owner 9/9/15


SUMMARY SHEET


Condition

IX Public Invited

r Located in Park






Obligation


Park Permit


Health Inspection

IX Erecting Tents - Larger than 10ft x 12ft How many?

~ Fence Installation What type?

110-12

Covered chainlink fencing




~I Other Structures

~ Open Flame Food Preparation

n Pyrotechnics

o Require Street Closure

IX) VIP Area

I&J Staging

I?<! Amplified Sound

~J Security

~ Sanitary Facilities - Port-O-Lets

n Off-site Parking / Shuttle

/Xl Semitruck / Tractor Trailer


/X, Invitations

/X Posters / Flyers

/XI Newspaper / Internet

What structure? Mobile Mini production offices Temporary Structure Permit


Fireworks Permit


/X Professional r Showmobile r Other

/XI Performers n Announcement Only

/X Daytime - Private /X Overnight - Private /X Event Time Frame - SPPD

Regular Units ~ Disabled Units ~ Hand waShing~

/X Radio

r Television

r Remote Broadcast

Page 3 of8



Does your event require any power needs using more than the standard 110/20amp located In the parks? IX YES I NO

If YES, check all that apply. IX RV'S I Coffee Vendors I Ice Bins I Freezers I Ice Cream Vendors IX Catering Trucks

IX Other:


Stage and lights, Box Office, Back stage production offices and artist green room areas. How much and what type of power will be determined once we are given the power specs at Vinoy Park

Will you supply your own generators? IX YES I NO

Will your event have a licensed electrician on-site during the event? IX YES I NO If YES, who? IParamount Power


IAt thi' time not that we are aware of.


Name: ILive Nite Events, LLC Phone: 1801.652.7955

Address (including zip): r"13-24-So-u-t-h-4-00-W-e-st-n-2-75-SL-C-, -U-ta-h-S-4-10-1---------=----------------

Type of music, n of stages, and n of bands.

8-10 Reggae bands each day will perform on 1 stage.


We will be able to provide this 45 days before event.

For Use of Beer/wine - Please provide name, address and phone number of the sponsoring 501 (c)3 or catering company.

I~o



If possible we would like to begin load in and set up on March 3rd at 9:00 am. Load out will take place immidiately following the event on March 6th and will finish by end of day on March 7th. Parking needs are undetermined at this time. We need to get more info on what is available to us.

Page40fS


Our fee structure is as follows. Some items are subject to change based on final taient booked, ticket sales, promotions, etc.

General Admission Pre-Sale: $40 General Admission Day Of: $50 VIP Pre-Sale: $B5 VIP Day Of: $ 1 00

Beer: $5-$6 Alcohol: $5-$B

Other comments:

We look forward to working with the City of St. Petersburg and the Parks & Recreation Department to produce a safe event that positively affects the community and the attendees.




Name: I f'J ( --J Title: lowner of Live Nite Events Date: 19/1/15

Page 5 ofB

*

*

*

*

*

*

*

*

Appendix A










Page 6 of8

--"'....,. "Q!@iiiiiii ~'-'---.. st.pelersburg

www.8Ipolo.org




Name of the Nonprofit Corporation: 1

Name of Responsible Party (President or CEO ONL V):


Physical Address of Responsible party:/



Nonprofit (Employee Identification Number): 1

Name ofthe For-profit Corporation: ILive Nite Events, LLC

Name of Responsible Party (President or CEO ONL V): IvaUghn Carrick

Title of Responsible Party: lowner

Physical Address of Responsible Party: 1324 South 400 West #275 SLC, Utah 84101

Phone Number of Responsible Party: 1801 .652.7955


For-profit (Employee Identification Number) 145-5502551


Page 7 of8

~.."I<@iiiiiii ~\WII .......

st.pelersburg WWW.SlpBIB.Orll

APPENDIX C Name of Event: STATEMENT OF REVENUE AND EXPENSES FORM !

PRIOR YEAR'S EVENT Date(s) of Event:

(Must be completed)

I. REVENUE SOURCES (attach sheet If more space Is needed)

1.

2. r-----------------------------------------------------------

3. r-----------------------------------------------------------

4 r-----------------------------------------------------------

5. r-----------------------------------------------------------

6. r-----------------------------------------------------------

7. r-----------------------------------------------------------

B.

TOTALGROSSREVENU~


1.

2.

3.

4

5.

6.

7.

B.

9.

10.

11 .

12.

r------------------------------------------===== ,----------------------------------------------------------

Amount

TOTAL OPERATING EXPENSES!

TOTAL NET INCOM~i-----------


1.1 2·~1 ------------==---~-==~--==~~~-==~----~

3.1 ;-----------

4·1 5.!~--------~--------~--~--------~----~-

6.1 __ _ i--------:.--=---~--="--


Prepared by: Date:

Print Application Page B ofB ubmit Application by Ema

LIVE NITE EVENTS, LLC VAUGHN CARRICK 324 SOUTH 400 WEST #275 SALT LAKE CITY, FL 84101 USA

Description

Previous Balance

Applied To: 14987 - REGGAE RISE UP

Vinoy Park - Vinoy Park

"%3 ~ .... ~

st.petersburg



Payment: Check

Balance


Receipt #: 2420386 User: DWBurns

Issued: Tue 08 Sep 15 10:27 am

Amount

$630.00

$630.00

($630.00)

$0.00

~-" st. petersbul'l ~ parks a PlCPBalloR


LIVE NITE EVENTS, LLC VAUGHN CARRICK 324 SOUTH 400 WEST SALT LAKE CITY FL 84101 USA

Purpose of Use: REGGAE RISE UP


Other Information:



Date(s) and Tlme(s) of Use:

Facility/Equipment

Vlnoy Park

Vinoy Park



Charges:

Yes

Yes No

#275

Expected: 10,000

Starting: Tue 01 Mar 16 06:00 am

Day

Tue

Date Time

01 Mar 2016 06:00 AM

08 Mar 2016 05:00 PM

Hours

179:00

Quantity 1

Quantity 2

2

Contract/Perm it

User: Status:

DWBurns Firm

Home #: () Business #: (801) 652-7955

Cell #: ()


$0.00

Ending: Tue 08 Mar 16 05:00 pm


$0.00 $600.00 $0.00 $600.00

Charge Tax Total $30.00 $0.00 $30.00


$600.00 $0.00 $600.00

$600.00 $0.00 $600.00

Fees

$ 0.00 Extra Fees

$630.00 Tax

$0.00 Total

$630.00 Deposit Total Applied Contract Balance

$0.00

Account Balance

$0.00


Payments:

Date 08 Sep 2015

Additional Notes:

Amount $630.00


By:{Sign Name)

(print Namel VAUGHN CARRICK

LIVE NITE EVENTS, LLC Name of User Or anization, If Applicable


User: dwburns

$0.00 $630.00

Payment Type Check

Reference Rental



By:{Sign Name): Parks and Recreation Superintendent

{Print Name) Parks and Recreation Department

Page: 1

Contract #: 14987 User: DWBurns Date: 08 Sep 2015 Status: Firm

supervisor 117 Foreman o Approved or 0 Rejected Date.


Manager ------

Manager o Approved or 0 Rejected Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language interpreters. taped or Braille materials, assistive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .



9/8/2015

LIVE NITE EVENTS I LLC

Entity Number: 8357503-0160

Company Type: LLC - Domestic

Entity Details: LIVE NITE EVENTS, LLC - Utah Business Search - Utah.gov

Address: 1989 EAST DONELSON LANE SLC, UT 84117

State of Origin:

Registered Agent: Vaughn Carrick

Registered Agent Address:

1989 E Donelson Lane

Salt Lake City, UT 84117

Status: Delinquent

Status: Delinquent as of 0711512015

Status Description: Failure to File Renewal

Employment Verification: ~ Registered with Verify Utah

History

Registration Date: 06/25/2012

Last Renewed: 04/11/2014

Additional Information

NArcs Code: 7113 NArCS Title: 7113-Promoters of Performing Arts. Sport

« Back to Search Results

Search by: Business Name r N~mber ~ecutive Nam~arch Hints ___ _

Business Name:

https:/Isecure.utah.gov/bes/details.html?entity=8357503-0160 1/1

CITY OF ST. PETERSBURG PARKS & RECREATION DEPARTMENT CO-SPONSORED EVENT APPLICATION ':#S ..........

Dale Received: 9/ ",!t~ , I Check or Cash: _ _ .",...-_ Application II: ?.r Packet: 4$ Permit II: 10/11'9"

'1Z"1 113 Event Tltle: 1 JE LLY BEftN FLlN6 Phone No.: fBQ5-501B Fax No.:laqy - 8)05 EntilyName: ISVNIOe LEA-tn)6 Of 6f. ~The5Web FederaII.D. Number. I Event Date(s): r MAIeCH ZW) 2.01(p Location: 1 NoeTH SHOI2C IV/NO'! PAeK Day 1 of Event: 1.3/tR(P/11fJ TIme Gates Open: I /~:OOIl'" Ending TIme: I I:O()pm Day 2 of Event I _ TIme Gates Open: 1 _ Ending Time: I

Day 3 of Event I Time Gates Open: 1 _ Ending Time: 1..------Application Prepared by: 1 C.HELS6A N 6150N Phone: 1121< 42.t.j - '-I~~r:J(o TItle: I COMM IITE6 Co-CHAI r<.. Or Jt;LLY flEf\N fuN0 Cell Phone: I SAME: Address: 1500 MfwmN I INbJlZ. Gf. N. City: IGf. PbTc State: '-1 -F-L-- Zip: 18310$ Email Address: cne Is _ lid n n @ n1-Sn . CDf'rI

Additional Contact Person: 1 RflCHOCL YOUNo&e. Day Phone: 172=1 - =t1l11-=tqJ What month/year were you Incorporated as nonprofit? I M f\ eCH 4 J I Cf B I List aU SOl (e)3 entities that will benefit from this event·lr-d-,,-N-I-Oe-;"'LYt--W-b-O-F-6-r-, -R-~-;n-ee-5-&J--e£p-----Name of the for-profit entity? I n /&1. Describe how this event will contribute to the quality of life in and enhance the image of St. Petersburg.

7Hls WIl-(,. 8E "'6 pTIf flNNUAv iJ6U>/ I3tFtN FUN(f) f4T 0'" BY THe;JZtN/~ U:AbU€ DF.sT.PGTt~8{)fZ6 . rr HAs ~tJM6 II n2F1DlrtON FlJ~TH6 ()l)MMUI'JITY

J fiND PJ?OYIDE.$ f'UN FffMILy nM6 FOe3 CI//LDe.&N riND TH€)~

mMII..-I£S 7tJ flrJ,enC,PII-Tc IN AN 17F1ST6e c(f;G HVNTJ

CeltFT-S1 /lND OTHbe,

B'FtST6Ie-nMc. FcsTIVln6,s.


7H6 J'LSp ,,; A VOLUN{cCrz., OetPfiNI2flTION tf)MM/mD TO Pe{)M()/ltVCP VOU4NT~IZISM IINDIMPE(JVlNCrI 71-/t. c.DMMUNIft-1 THeOVGJH emcnV6 IICnOA/ IJt.,If) tCflJtJ26HIP ~F 7}2IT1N6J) Y{)LUNTC6eS. vlSP ENI!ICI16S TI-IG 5T. f6;~/,I£?(p CAMMUIlI1V 81 tJlZb/tN121NG liND FwlVlYNCfJ cOCltt..- P/f!I).)eC15 filM6£) Hr d!JOOSJ7N~ TH6 Wcl.Ft1e6 ~F FflMIL/65 IWD C/l1u:JJ2€N.

Each cOoSponsored entity must possess Uability insurance naming the City of St. Petersburg as an additional Insured and secure said insurance In the amount determined by the City.

Does your group presently have liability insurance? ~ YES r NO How much? I Are there plans to sell or distribute beer/wine at your event? r YES K NO

Will there be an admission Ileglstration fee? f<. YES r NO Advanced Fee: r-.,-e,-l)- Day of: I TBD Please provide the website address for your event. JL5 T p~ n. 0 R:. (1 Please provide a phone number that can be advertised to the public. rl (;:J::"'l~1~)~B~~~5:--" -::5=-0=--:-:18::;-----------

What is the esrlmated attendance for this event? Spectators 1;00 Participants 150 last Year's Total Attendance '750 Page 1 0(8

- ... or .. ••• :

Please check the equipment and/or facilities you are reque5ting.

Recreation EQylpment

Showmobile(Yes/No) I T6D Special Events Facilities

r Mahaffey Theater

" Bleacher(s) needed. Each bleacher approx. 180 people,(l5) r Coliseum

Tables (6 tt) " neededif6 D Chairs /I needed r TBD . r Sunken Gardens

Public Address System 1,-B D r Boyd Hill

/I of portable risers needed (4 in. )( 8 In. x 16 in. sectlons)1 TBD

r Non-City locations

Which location?

The following departments may provide ahd charge for addltlonalservlc8s_ You will be provided cost estimates In your Cosponsored Agreement.

POLICE: public Safety personne'. Marine Services TRAFFIC' Personnel. Equipment (cones. barricades. no parking signsl fiRE: ParamediCS. Inspectors PARKS SERVICES: Cleanyp personnel. Oumgstec!sI. Trash Receptacles Event SIte Preparation and Restoration RECREATION SERVICES: On-site presence. logjsllcs Help. liaison with Qther Ddepartmems

Nm.!: The City does not provide tents, Port·O-Lets, or large quantities of tables and chairs.

I certify that the event will be open to all CItizens and that Individuals will not be barred from participation due to race, creed. color, national origin, sex, age. or physical Impairment. I understand that a financial report of the event is due in the Parks and Recreation office within 30 days of the completion of the event. I also understand that the City is to be shown as a cosponsor on any promotional materials produced for the event. I agree to obtain the required liability Insurance and to secure all necessary city/county/state permits/licenses. I further certify that the facts contained In this application are accurate.

N.me, I~ l1d~ I \?rg2~ill.Ol Of" &p 0"., q/3i15 Co-Slgn:\ . TItle: 16venfPJanml1qeo.cm,f' Date: t 3 2(JIS

hr Jell,! JJti1n'-FUiv. ' NOTE: a. If person/entity preparing this application is not representing a nonprofit entity, the

appJlcation must be co-signed by someone from a sponsoring nonprofit entity. A copy of the sponsoring entity's 501 (c)3 designation must accompany this application.

b. If your entity has outstanding financial obligations with ilny department withIn the City of St. Petersburg, your applicatIon will not be processed until debt If paid.

c. Applications Jacking Information or the required completed appendlxe511sted below will not be processed.

PLEASE ATIACHTHE FOLLOWING

1. Route map for parade, run, walk. and/or bike event. . 2. Site map of event and detail schedule of each day's events Includln9 open and dose times. 3. Complete Appendix 8 and Appendix C. 4. Check for 530.00 for co-sponsored application processing (non-refundable). S. Check for park permit fee. See Appendix A for fee structure. 6. A copy of 501 (e)3 desIgnation (it applicable)

FOR FURTHER INFORMATION. PLEASE CALL lYNN GORDON, PARKS & RECREATION MANAGER. 727-893-7766 or EMAIl: [email protected]

Page 2 of8


SUMMARY SHEET

Review and check all conditions which apply to this event: Note the corresponding obligation (or each condition.

Condition

)( Public Invited

)( located in Park

Obligation

r Vending Product I Merchandise Sales ...

Generaillabillry Insurance

Park Permit

Occupational Ucense

Health Inspection ' R' Vending Food I Beverage

J>( Vendors/exhibitors Howmany? I TBD B r Vending Beer / Wine Akohol Permit Additional Insurance Required

~ Erecting Tents -largerthan 10ft l( 12ft How many? I TBD '~~~---------------------





r Other Structures


r Pyrotechnics


r VIP Area

r Staging

r Amplified Sound

r Security

J(. Sanitary Facilities - Port-O-lets

r Off-site Parking / Shuttle

r Semltruck !Tractor Trailer

Marketing; Please check all that apply.

~ Invitations

'it Posters I Flyers

It Newspaper I Internet

What type7 ~-,]jUlB~j).::::;.... ______ _ Whatstructure7 .

Fire Inspec1ion Permit

Fireworks Permit


r ProfeSsional r ShowmobUe r Other

r Performers r Announcement Only

r Daytime - Private r Overnight - Private r Event Time Frame - SPPO

Regular Units , Disabled Units, Hand Washing,

r r r

Radio : '" Television

Remote Broadcast

Page30f8

City logo should b. used In any promotional materials, posters, flyers, ads, websfte, public service announcements, and press releases.


Does your event require any power needs using more than the standard 11 O/20amp located In the parks7 rYES r NO

If YES. check all that apply. r RV'S r Coffee Vendors r Ice Bins r Freezers r Ice Cream Vendors r Catering Trucks

r Other.


Will you supply your own generators7 rYES rNO Will your event have a licensed electrician on-site during the event? rYES r NO If YES. who?

Will your event be requesting any variances from City policies or procedures7 If YES. please explain.

TeD.

If City permits, licenses. or services are required for event, who will pay for them?

Name: I Address (Including zip): I Type of music, H of stages. and # of bands.

7f3D.

list Vending Products. Name & Provider.

Tl3D.

Phone: I

for u,~~ "',iWlne - PI .. ,e p,ovIde n.me, add .. " and phone number ofthe spon,oring 5.Hel' 0' catering compan,.

explain subjectlpurpose of all speeches/demonstrations which will occur .

. . ".

Discuss your load In/load out parking needs, Include limes and dates.

I Page4of8

Olhar Comments: Please describe your fce S!rutlure.

. f •

Other comments;

I represenl and warrant thai the purpose of the proposed activity/event and conduct of the sponsor(s) and the participants ' shaU conform 10 all requirements of law and all ordinances of the State of FlOrida, Pinellas County, and the City of St. Petersburg Including, but not limited to. City noise ordinances and Parks and Recreation Department Policies and Procedures. I acknowledge that failure to observe such laws, ordinances. or pOlicies and procedures will result in an Immediate cancellation of the event and all permits.

WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE PARKS AND RECREATION DEPARTMENT POLICIES AND PROCEDURES PERTAINING TO THE USE OF PARKS AND THE PARK RULES SET FORTH IN ARTICLE II, CHAPTER 21, OF THE ST. PETERSBURG CITY CODE, INCLUDING BUT NOT LIMITED TO THE INDEMNIFICATION AND INSPECTION OBUGA nONS ASSUMED BY ME AND THE PERSON OR ENTITY ON WHOSE BEHALF THIS APPLICATION IS BEING MADE.

I certify that the fads contained In thIs application are accurate.

Name: I ~ 0JjJjjI(V\I5 Title: I ?r~\dmT Of m.BR>ate: I q 18115

PageS 018

..

•

• •

•

*'

•

Appendix A


Events In Vinoy Park will be assessed $300 00 per event day (e.g.,1 day event = $300.00, 2 days = $600 00,3 days or more"" $90000.) This includes the $30 00 park permit fee

Events in any other park will be assessed $200.00 per evenl day (e.g., I day event = $200.00, 2 days = $400.00, 3 or more days = $600.00). This includes the $30.00 park permit fee.


All co-sponsored c\'ent applications must be suhmuted ut it:asl 6 month prior to the event.

Any application for a co-sponsored event submitted inside the six (6) month tllne frame will be assessed a non refundable $1,200.00 late fee.

Tbe City requires payment in advance for all City services estimated nndlor provided for first time events and one of a kind nonrecurring events.

Payment will be required at 'east ten (10) business days prior to the stuli of the event and shall be in the form of casb, certified cbeck, or an irrevocable bRnk leUer of credit.

All first lime entities requesting events will be required to complete D credit application .

...... :

. . .

Page 6 ora

1 I

WWW ••• IIIII.Drg




Name of the Nonprofit Corporation: l0'u n \ 0 '( LQ,o..g v.JL Of st. ?a:l' us 'ou 'fq

Name of Responsible Patty (President or CEO ONL V): I ellL()~ F\d elms


Physical Address of Responslblepatty:1 '500 De. MarT'\') LUt"r'tY ~\n9 0~ ~t. N \ 6U-\\'(l 20\

Phone Number orResponsibie Patty: I 401- 4 \00- 443\.0

Email Address of Responsible Party: I p'fQ.5 \~ @ ~ \5T pitl'o.... 0 Rg

Nonprofit (Employee Identification Number): r"1-n--:-1 a------------------------

Name of the For-profit Corpora lion:

Name of Responsible Party (President or CEO ONLy):

nUe of Responsible Party:




Please Include a copy of the the current IRS Nonprofit Affidavit I For Profit

Page70fa

I,


PRIOR YEAR'S EVENT (Must be completed I

REVENUE SOURCES (attach sheet If more space Is needed)

Name of Event:

Date(s) of Event: I

1.( 2.i-1 --------------------

. I

Amount

3·1 ;.--------4\ s.i-I ------------------------

6.' i----------7·1 8·;-1---------------------

~..-..----------------TOTAL GROSS REVENU~

IL EXPENSES (attach sheet If more space Is needed)

1. I , ~"-o----------------------------...------------rl--------------------3.

i-I -------4 ~-------------------------------------------I

,i--------5. ~-------------------------I 6. i-,-------

7. ~----------------------------------I

8. I i----------9. I I 10.11 i-----------

11. I I 12.11 i---------

TOTAL.OPERATING ExpeNSE~ TOTAL NET INCOM~i---------"----

Ill. AllOCATION OF NET INCOME ( attach sheet If more space is needed)

----------------------------------------1. r:-_______ - _____________________________ i-------------2.~1----------------_--- i----------3.:-1 _------------:--~----- i---------4,!-1 -----------7""'::-------- i---------s.!-I ____________________ i---------6.\

TOTAL AUOCATION OF NET INCOM~

Prepared by: Date:

Print AppHcation J Page 8 o(a

15 lO:22A Law O~~icu O~ Frank Russo 727 679 4608

';'~;''''C'''l··'of 2

•• ••• •• . ~ .

I

U.S. TREASURY DEPARTMENT INTERNAL R EVENUE S!"VICE

WASHINGTON 25, D. C.

DE.C 23 \9Sa Junior lBatuC ot St. Peu,rsburg. Florida. l31) Central AvSilue st. Pflbrsbw'S. 11or1Aa

Gentllnll&n:

::. t is the. opinion ot thi", of'ri cG!) booed upon the evidenoe }>l'esCf;ted.J thllt you are exempt from FedarRl income tax a8 an o!"l:an1. zat1or. desc:rlbed in section :;Ol.(c) (J) or tne Internal Jlevrulu~ Code ot 19; 4, a.s it is shown ttU\t ;Y()\I Are oI'f:anit.~d (lnd operated exclusively rOT · c~ritable purPO~$.

Acoordingly I you are not required to tile lncane tax returns unles'!: you ch~e thl! oMrac'ter of your org8Jl!zo. .. ;ton, the VUl"pOQRB

tor widcb yCfoJ were Orew'tAd) en- YOI:'r method or OlX!ratiQn. ~ 6\lc.b cha.og<:s :should be reported JJmnediatel,y t.o th.~ DistrIct Director or Internal. ReVemle for your di:stnct in order that their effect upon y01.ll' !ex~1. statua IlIA:J 00 d~term1ned I

'~().l are required., however., to file an information r~tur", ~ ~OA., nnnu.aJ.4r. lI.1.th UIE! DJlrt.riet Director of ln~ernal .Revenue for y[)ur district ~o long as lhis oxcmpt1on remains in erre(.;t. nus form .r.l8\Y be obtained trQln t.he Di.Btr1et Directur BlI.Il is required to 'of? rilf!ld 01'1 01' hefore the fifteenth day ot the fifth month following 1.h~ C 10se of )'OIir &l\DUal. 8.occunt1Ill! period t which ends Mareb :3J.,.

lk)n1.rlbut10ns made to you are deductftJle by 't.he donors in C(HD

puting their taxable income in the lIlanner Blld to i.ne extent provided by s~t10n 1?0 oC the 1954 Code.

3equests, legacies, 4ov1ses or transr~r~ ~ or for your use are deCS\lctible in comput,1ng the value or the taxabl.e elState of u decedent Cor l~eral estate toa.x purposeo in the ml!JUle.r Md to the extant prov1t\Qd by SQctioI13 2O.5S IUld 2106 of the 19~ Code. Oifb of p:'oper-ty ~ or for your us. are d84~ct1ble 1n computing laxable ,ir~s tor FedeI'u £Itt tu. purposes 1n th~ mart."\9f' and to the extent provided by aecti ~n 2522 ot the 19S4 Code.

t5 lO:22A Law O~~;CQ Df Frank Rus~o 7~7 .. c::; 519 460B

', .. 2 of 2

J£ ~-St. p~!'torsburg, Flor~

No lica.o1li ~ is incurl'ed by you fo"t' the taxes iDposed undel" the ]l'ed.~rB.l IU\lraDce Co~tribQ'tlcma 4.c1. (so~1al sec:uri ty taxes) ~nl.c:ss y~ hal ~ tiled a wa1 vel' of .. x_tion certitioate in aoc:ordanne 111 th the app,U.oDble "rovilliaru; of SUCh AQt. In 'Ute ovent. }'OU deaire Bocinl security coverage for 10Ur emplo1eeD or hove any ~ue~ions rela\ing to th~ fil1Dg of a waiver of 9xearption oertiricnte yc.J mould bl.ke the matter \lp with }'OU't District Director or IntGl"nlLl RE!"tenue-

Yr.rul" attetl.tiOl\ in Qall~d t.o '\Jut provisions of 1iZ9ct,10Jl !SO) (e)(3) of the In"tQrnal. RevetnJ~ Code of 1954 under 'illhiC!h yow. ~)CUlptiol1 11111 be revr..lked if any aub."Jt.antinl )Ja:rt of your betiv! ties consi~'ts of carr:Ying un propa.gaJUla, or otht.tJ'wiee attempting, to 1tU'luence leiisla-tion, ClT if YQU parti~ipate in, or intel'Vene jn (includ1l1g the . puvl1.sh1ng or distributing of atatemen1.1J), any pOlitical -:e.mpaign on h4ahll)" Dr ."'" ,..nYlcHtl''1 1.e ('0"'1"11',1"n ~rri('t •.

)3'a:f.l.ure to 1'11e tha reQ.u1!'ed. 1nfon:lat!M retu.rn or to O'thel'" Yi~e I~o~ly 'lith th~ ~rovbionB or tJQctlQn 60" or the Co1e II.r\d regUlations a~plluu.ble thereto may result io the tennill8t.ion Of your ey.empt, tJtatuG~

Any r~reronce her~in to a provision of the 195~ Code shall be doemed a ~ferQnc:r: to tht: corrcaponcUng ]:Irov1s1ons of the 19}9 CC>\e.

'!he 1)istrict. Directo!" of Int;(!mal Revenue for your '11:atr1ct 1s being adVised of thiG ~t1on.

~hi5 at'finu our PM-o%" ruling or J'anu&:1 2.?, 194J.

Very truly yOUl'S,

lAP· D. C.

~-" II. patarsburg ~ parkl a raCPBadan


JUNIOR LEAGUE OF ST PETERSBURG INC CHELSEA NELSON 500 DR MARTIN L KING JR ST N #201 ST PETERSBURG FL 33705 USA

purpose of Use: JELLY BEAN FLING


Other Information:


No No No

Expected: 750

Contract/Permit

User: Status:

DWBurns Firm

Home #: () Business #: (727) 254-1381

Cell #: ()


$330.00

Datelsl and Tlmelsl of Use: Starting: Sat 26 Mar 16 06:00 am Ending: Sat 26 Mar 16 09:00 pm


Vlnoy Park

Vinoy Park

Sat 26 Mar 2016 06:00 AM

09:00 PM

$0.00 $300.00 $0.00 $300.00



Charges:

Fees

$ 0.00

Extra Fees

$330.00 Tax

$0.00


payments:

Additional Notes:

Hours

15:00

Total $330.00

I have read this Agreement and agree to comply with the terms and conditions set forth In this Agreemenl I also understand this Agreement Is not final until approved and executed by the Parks and Recreation Superintendent or designee.

By:ISjgn Name)

(Print Name) CHELSEA NELSON

JUNIOR LEAGUE OF ST PETERSBURG INC Name of User 0 anization, If Applicable


User: dwburns

Quantity 1

Quantity 1

Charge $30.00

Charge $300.00

$300.00


Tax $0.00

Tax $0.00

$0.00


CITY OF ST. PET~RSBURG, FLORIDA

By:ISign Name):

Total $30.00

$30.00 Total

$300.00

$300.00



IPrintNamel Parks and Recreation Department

Page: 1



Manager

Manager

User: Status:

D Approved or D Rejected

DWBurns Firm

Date:

D Approved or D Rejected Date: -------D Approved or D Rejected Date:

The Americans with Disabilities Act (A.DA) guarantees equal opportunity for people with disabilities. Special accommodation requests such as sign language Interpreters, taped or Braille materials, assistive listening devices, etc., should be made at least one week prior to the activity or program. Individuals using TID devices, please contact us using the Florida Relay Service at 800-955-8771 .


User: dwburns

Page: 2




THE JUNIOR LEAGUE OF ST. PETERSBURG FLA., INCORPORATED

Filing Information

Document Number 707142 FEI/EIN Number 59-0759485 Date Filed 04/14/1964 State FL Status ACTIVE Last Event AMENDMENT

Event Date Filed 07/01/1991 Event Effective Date NONE

Princigal Address

500 DR. MARTIN LUTHER KING JR, ST NORTH 201 ST PETERSBURG, FL 33705

Changed: 01/22/2008

Mailing Address

500 DR. MARTIN LUTHER KING JR, ST NORTH 201 ST PETERSBURG, FL 33705

Changed: 01/22/2008


Fleming, Gigi 500 Dr MLK Jr St N Suite 201 ST PETERSBURG, FL 33705




Name & Address

Title P

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9/8/2015 Detail by Entity Nama

Adams, Gentry 500 DR. MARTIN LUTHER KING JR, ST NORTH 201 ST PETERSBURG, FL 33705

Title VP

Reed, Mary 500 DR MLK JR ST N ST.PETERSBURG,FL33705

Title Treasurer

Humlicek, Melanie 500 DR. MARTIN LUTHER KING JR, ST NORTH 201 ST PETERSBURG, FL 33705

Annual Reports

Report Year 2014 2014 2015

Document Images

Filed Date 03/18/2014 06/11/2014 04/21/2015


06/11/2014 -- AMENDED ANNUAL REPORT View image in PDF format --------~----------~


04/22/2013 - ANNUAL REPORT View image in PDF format

04/27/2012 - ANNUAL REPORT


















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04124/1998 -- ANNUAL REPORT




Detail by Entity Namo




--~.- -.-- ----.- ------- ---- -~©al1d~

State of Florida , Depa rtment of State

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Documents

Co Sponsored Events Subcommittee Co-Spon. Events