DEP Form 18-21.900(2) "Special Event Certification" - Florida

What Is DEP Form 18-21.900(2)?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 15, 1998;
  • The latest edition provided by the Florida Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEP Form 18-21.900(2) by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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Download DEP Form 18-21.900(2) "Special Event Certification" - Florida

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SPECIAL EVENT CERTIFICATION
I,
, ____________________(title), ____________________ (Name of Corp.)
hereby state that I am (or I am authorized to represent) the lessee for Sovereign Submerged Lands Lease
Number _________________ which grants authorization to conduct ________________________, a
special event, and I further state that:
EVENT SCHEDULE: The existing lease authorizes the special event to occur on
to
________. The next event _____will _____will not be held on these dates. If you checked “will not,”
attach an updated schedule of the beginning and ending dates of preemption of sovereign submerged
lands for each event.
PROPERTY OWNERS WITHIN 500 FEET OF LEASE BOUNDARY: Have there been any changes in
the names of the adjacent property owners within 500 feet of the lease boundary who were previously
notified of the event?
Yes
No.
If you checked “yes,” attach the names and addresses of any new adjacent property owners for purposes
of noticing in accordance with the procedures in rule 18-21.0082.
RIPARIAN OWNERS OF ADJACENT UPLANDS: Have there been any changes in the names of
riparian owners who are located adjacent to the special event: there is a change?
Yes
No
If you checked “yes,” attach the names and addresses of the new riparian owners for purposes of
providing notice pursuant rule 18-21.0082.
COMPLIANCE WITH LEASE: The lessee certifies full compliance with all terms and conditions of the
lease for the preceding special event.
Yes
No.
If not, state areas of non-compliance and
explain what is being done to correct the noncompliance and when you will be back in compliance.
WILL THERE BE ANY PROPOSED CHANGES IN THE DESIGN OF PHYSICAL STRUCTURES
THAT WILL EXTEND OUTSIDE THE PREVIOUSLY AUTHORIZED LEASE BOUNDARY OR
INTO AREAS OF SENSITIVE RESOURCES IDENTIFIED IN THE LEASE?
Same
Changes. If
there are any changes, attach a sketch showing the proposed changes for the next special event. This
information will be used to determine whether new authorization for the changes will be required from
the Board. [Reconfigurations of structures within the boundaries of the lease area shall be allowed,
provided the reconfiguration avoids areas identified as containing sensitive resources. See rule 18­
21.0082(2)(c)6.]
WILL THERE BE ANY CHANGES IN THE NUMBERS, SIZES, DRAFTS, OR TYPES OF VESSELS
ASSOCIATED WITH THE PREVIOUSLY AUTHORIZED EVENT THAT WILL EXCEED ANY
LIMITATIONS IN THE TERMS AND CONDITIONS OF THE LEASE?
Same
Changes. If
there are any changes, provide details. This information will be used to determine whether new
authorization for the changes will be required from the Board.
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ______ day of
_, 19
, by
___________________________, of __________________________, a ______________________
corporation/partnership, on behalf of the corporation/partnership. He/she is personally known to me or
has produced _______________ as identification.
Signature of person taking acknowledgment: ________________________________
___________________________
________________________________
Form 18-21.900(2)
(Commission/Serial No.)
(Name, typed, printed or stamped)
Effective [10-15-98]
SPECIAL EVENT CERTIFICATION
I,
, ____________________(title), ____________________ (Name of Corp.)
hereby state that I am (or I am authorized to represent) the lessee for Sovereign Submerged Lands Lease
Number _________________ which grants authorization to conduct ________________________, a
special event, and I further state that:
EVENT SCHEDULE: The existing lease authorizes the special event to occur on
to
________. The next event _____will _____will not be held on these dates. If you checked “will not,”
attach an updated schedule of the beginning and ending dates of preemption of sovereign submerged
lands for each event.
PROPERTY OWNERS WITHIN 500 FEET OF LEASE BOUNDARY: Have there been any changes in
the names of the adjacent property owners within 500 feet of the lease boundary who were previously
notified of the event?
Yes
No.
If you checked “yes,” attach the names and addresses of any new adjacent property owners for purposes
of noticing in accordance with the procedures in rule 18-21.0082.
RIPARIAN OWNERS OF ADJACENT UPLANDS: Have there been any changes in the names of
riparian owners who are located adjacent to the special event: there is a change?
Yes
No
If you checked “yes,” attach the names and addresses of the new riparian owners for purposes of
providing notice pursuant rule 18-21.0082.
COMPLIANCE WITH LEASE: The lessee certifies full compliance with all terms and conditions of the
lease for the preceding special event.
Yes
No.
If not, state areas of non-compliance and
explain what is being done to correct the noncompliance and when you will be back in compliance.
WILL THERE BE ANY PROPOSED CHANGES IN THE DESIGN OF PHYSICAL STRUCTURES
THAT WILL EXTEND OUTSIDE THE PREVIOUSLY AUTHORIZED LEASE BOUNDARY OR
INTO AREAS OF SENSITIVE RESOURCES IDENTIFIED IN THE LEASE?
Same
Changes. If
there are any changes, attach a sketch showing the proposed changes for the next special event. This
information will be used to determine whether new authorization for the changes will be required from
the Board. [Reconfigurations of structures within the boundaries of the lease area shall be allowed,
provided the reconfiguration avoids areas identified as containing sensitive resources. See rule 18­
21.0082(2)(c)6.]
WILL THERE BE ANY CHANGES IN THE NUMBERS, SIZES, DRAFTS, OR TYPES OF VESSELS
ASSOCIATED WITH THE PREVIOUSLY AUTHORIZED EVENT THAT WILL EXCEED ANY
LIMITATIONS IN THE TERMS AND CONDITIONS OF THE LEASE?
Same
Changes. If
there are any changes, provide details. This information will be used to determine whether new
authorization for the changes will be required from the Board.
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ______ day of
_, 19
, by
___________________________, of __________________________, a ______________________
corporation/partnership, on behalf of the corporation/partnership. He/she is personally known to me or
has produced _______________ as identification.
Signature of person taking acknowledgment: ________________________________
___________________________
________________________________
Form 18-21.900(2)
(Commission/Serial No.)
(Name, typed, printed or stamped)
Effective [10-15-98]