1k. Lions Club Liquor License-Lake Ann Park.MEMORANDUM
CITY OF !�
CHANHASSEN
690 COULTER DRIVE • P.O. BOX 147 • CHANHASSEN, MINNESOTA 55317
(612) 937 -1900 • FAX (612) 937 -5739
TO: Don Ashworth, City Manager
FROM: Karen Engelhardt, Office Manager�� `
V
DATE: April 2, 1996
Action by City Administrator
Endorsed aua
Modified
Rejected
Dat 5� �O
Date Submitted to Commission
Date Submitted to Council
SUBJ: Approval of Temporary On -Sale 3.2 Beer License, Chanhassen Lions Club
Attached please find an application for a 3.2 beer. license from the Chanhassen Lions Club. The
Lions would like to sell beer at a softball tournament at Lake Ann Park on May 18 and 19, 1996.
Also attached is the liquor liability insurance certificate; that is in effect for this event.
RECOMMENDATION
Approval of the 3.2 beer license for the
Ann Park is recommended.
lub on May 18 and 19, 1996 at Lake
PS- 09079 - 0118 /85) MINNESOTA DEPARTMENT OF PUBLIC SAFETY
PHONE 612-296-6159 LIQUOR CONTROL DIVISION
333 SIBLEY • ST. PAUL, MN 55101
APPLICATION AND PERMIT
FORA 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
NAME OF ORGANIZATION
DATE ORGANIZED
NO. OF MEMBERS
TAX EXEMPT NUMBER
ST EET AD RESS
.0. bo -/ z48
CITY
Y
elN ��c l�)
�a
STAT
ZIP CODE
.SS3,
NAME OF PERSON MAKING APPLICATION
BUSINESS PHONE
HOME PHONE
DATES LIQUOR WILL BE SOLD? (1 TO 3 DAYS)
/'j,
DOES RGANIZATION HAVE A CHARTER
PYes ❑ No
GENERAL PURPOSE OF ORGANIZATION
I (c,
OR NIZATION OFF CER'S A E
- s vG�v
ADDRESS
- 7 ,97 G4� &A)cRt bi j,7Zrzi�-
O ANIZATION OFFICER'S NAME
o 6(f
ADDRESS
41 IGN�ia�t/� �k' CfIANI� sc=/iI
0 GANIZATION FFICER'S NAME
M o 6 1&t611) 7"R�,q S ti t; ry !2
ADDRESS
U2� �. 7 7 ' St. (3 9 �AsEe/ J
Location where license will be used. If an outdoor area, describe.
LAIee AIM 1
Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor licensee providing
the services.
/
Lit_�CP 61''6S. b1_`;r,R - 1AJ6, C�C-E� �SLC IVA
Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage.
(Note: Insurance is not mandatory)
�CS - 1 9-A9 SC.oNTI Al 0 nl A)S . Co
APPROVAL
CITY OF
DATE APPROVED
CITY FEE AMOUNT
LICENSE DATES
DATE FEE PAID
APPROVED LIQUOR CONTROL DIRECTOR
SIGNATURE CITY CLERK
NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this division
will be returned -s the license. Submit to the City Clerk at least 30 days before the event.
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.....S ISSUED AS A MATTER Of
...........-" .......... ............................... ONLY AND
THIS CERTIFICATE I NFORMATION 0
rTODUCER
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
CORPORATE 4 INS AGENCY INC POLICIES BELOW.
7220 METRO BOULEVARD COMPANIES AFFORDING COVERAGE
EDINA MINNESOTA 55439
COMPANY
A TRANSCONTINENTAL INS. CO.
LETTER
.
................
COMPANY
......... B
NSURED _.._....... _._.._ ............. _ .
LETTER
COMPANY
C
Lions Club Of Chanhassen LETTER
P.Q. BOX 484 COMPANY
D
LETTER ...
01F t
Chanhassen, MN 55317 COMPANY
E
LETTER
COVERAGES ,.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM /DDNY) DATE (MM /DO/YY)
TR
GENERAL LIABILITY GENERAL AGGREGATE S
.. ...............................
COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OP AGGR. w S
CLAIMS MADE OCCUR. PERSONAL 6 ADV. INJURY $
............. _ _............. ....... .............. .......
OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE S
FIRE DAMAGE (Anyone fire) $
...................._..........
_ ._ ....... ......__.........._..._:.......
-- - MED. EXPENSE (Anyone person) : $
AUTOMOBILE LIABILITY COMBINED SINGLE $
LIMIT
ANY AUTO
ALL OWNED AUTOS BODILY INJURY $
(Per person)
SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY $
(Per accident)
NON -OWNED AUTOS
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURENCE $
............................................ .......... .....................
UMBRELLAFORM AGGREGATE S
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT $
..............................;........ ...............................
AND DISEASE- POLICY LIMIT S
EMPLOYERS' LIABILITY DISEASE -EACH EMPLOYEE S
OTHER
A LIQUOR LLP2660268 06/30/95 06/30/96 SEE BELOW
LIABILITY
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIALITEMS
LIQUOR LIABILITY: BODILY INJURY:$1,000,000 ea.person /$1,000,000 ea.occurrence;
PROPERTY DAMAGE: $1,000,000 ea.occ; LOSS OF MEANS OF SUPPORT: $1,000,000 ea
person /$1,000,000 ea. occ; ANNUAL AGGREGATE: $1,000,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Chanhassen City Hall LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Attn: Todd Hoffman LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
012 a
690 Coulter Drive AUTHORIZED R E •
Chanhassen, MN 55317