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CITY OF MIAMI
DEPARTMENT OF PUBLIC WORKS
444 SW 2nd Avenue, 81h Floor - Miami, FL 33130 Telephone: (305) 415-1200
http://www.miamigov.com/publieworks/
PARKLET PILOT PROGRAM
PERMIT APPLICATION
All Parklet applications wili be reviewed on a first come -first serve basis.
Date Submitted: New_ Revised_ Application
APPLICANT
Name:
Address:
City, State, Zip:
Telephone Number:
Alternate Number:
Federal Tax ID Number (FEIN):
City Business Tax Receipt Number: Expiration Date:
Page 1 of 5
PARKLET OPERATOR (IF OTHER THAN APPLICANT)
Name:
Address:
City, State, Zip:
Telephone Number:
Alternate Number:
BUSINESS ENTITY (PERSON) PARKLET OPERATION WILL SERVE IF OTHER THAN
APPLICANT
Name:
Address:
City, State, Zip:
Telephone Number:
Alternate Number:
ENGINEER/ARCHITECT
Name:
Address:
City, State, Zip:
Telephone Number:
Alternate Number;
Email Address:
PARKING INFORMATION
Number of Parking Spaces to be occupied: Parallel
Parking Zone Number:
Page 2 of 5
INSURANCE
Name of Insurance Company (attach Insurance Certificate):
Applicant must furnish the City with a certificate of insurance with respect to Commercial General
Liability with limits of a least $1,000,000 per occurrence and a $2,000,000 General Policy Aggregate. The
certificate must afford coverage for Premises/Operations, Products/Completed Operations, Contractual
and Contingent Liability (Independent Contractors), persona[ and advertising liability, along with liquor
liability, if applicable. The coverage must be issued on a primary and non-contributory basis, and should
list the City as an additional insured.
In addition, if applicable, the applicant must provide a certificate covering all owned autos, along with
hired, borrowed or non -owned auto exposure listing the City as an additional insured, along with
statutory workers' compensation coverage.
The above policies shall provide the City of Miami with written notice of cancellation or material change
from the insurer in accordance to policy provisions.
Companies authorized to do business in the State of Florida, with the following qualifications, shall issue
all insurance policies required above:
The company must be rated no less than "A-" as to management, and no less than "Class V" as to
Financial Strength, by the latest edition of Best's insurance Guide, published by A.M. Best Company,
Oldwick, New Jersey, or its equivalent. All policies and/or certificates of insurance are subject to review
and verification by Risk Management prior to insurance approval.
1. Transect Zone of the Parklet area
2. Location/address of the Parklet area
Distance from the closest fire hydrant or fire connection to building
(cannot be closer than 10' to nearest hydrant or fire connection to a building)
Page 3 of 5
ft.
Acknowledgement and Agreement to Terms and Conditions
By my signature, I, (Applicant Name) , acknowledge that I have received a copy
of the Parklet Pilot Program Manual and agree to abide by the terms and conditions set forth in the Manual,
along with any terms and conditions included during the permitting process and any other applicable federal,
state, county, and local laws as amended during the term of the approved Permit. Failure to abide by such
terms and conditions, or misuse of the Parklet Permit, may result in the code compliance and/or revocation
of -the Parklet Permit.
Signature of Applicant Printed Name Date
Page 4 of 5
CHECKLIST OF ITEMS TO INCLUDE WITH THE
PARKLET PERMIT APPLICATION
1. Completed and signed Parklet permit application.
2. A copy of a current Business Tax Receipt from the City of Miami.
I Current liability insurance Certificate and documentation of Parklet insurance requirements.
4. A Parklet operations plan, including a sketch or drawing of the Parklet operations area, bicycle
lanes, fire hydrant and fire connection locations, and
a. Location Map
b. Plan showing dimensions, features, traffic device placement and location of Parklet
c. Elevations
d. Construction details and structural design, signed and sealed by an engineer.
e. Photos of proposed Parklet area from 4 different viewpoints.
f. A bond to secure restoration of the right-of-way.
g. And any other requirements as determined by the Department Reviewers.
S. A non-refundable application fee of $175.00 plus $11.50/square foot of parking space area
required for the proposed Parklet. Department of off-street parking fees (MPA) are XXX
/space/day.
If the application has insufficient space for you to complete any item, you may attach additional sheets that
are labeled with the applicant's name and applicable section of the application.
NOTE:
The Parklet Permit application must include all required attachments before
acceptance.
Page 5 of 5