2j Lions Club LicenseCIT OF
CiO, Center Drive, PO Box 147
Minnesota 55317
Pho,e 612.93Z 1900
General Fax 612.93Z5739
~ Iax 612.93Z9152
~ ]:ax 612.934,2524
www. ci. chanhassen, mn. us
MEMORANDUM
TO:
Scott Botcher, City Manager
FROM: Karen Engelhardt, Office Manager
DATE: January 4, 2001
SUB J:
Approval of Temporary Beer License, Chanhassen Lions Club,
February 3, 2001
Attached please find an application for a one-day beer license from the
Chanhassen Lions Club. The Lions would like to sell beer at the city's annual
February Festival on Lake Ann on February 3,2001. Also attached is the liquor
liability insurance certificate covering this event.
RECOMMENDATION
Staff recormnends approval of the Chanhassen Lions Club request to sell beer at
the February Festival on Lake Ann on February 3, 2001 for a fee of $1.00.
February 4th has been established as an alternate date in the event of inclement
weather.
g:\userkkaren\liquor~lions.doc
!
Ci~ of Chanhassen. A growing communit~ with clean lakes, aualit~ schools, a charmin~ downtown, thrivin~ businesses, and beaUtiful oar/es. A ereat place to li~Je, work. and nl~.
Minnesota Department of Public Safety
LIQUOR CONTROL DMSION
444 Cedar St./Suite 100L
St. Paul, MN 55101-2156
(612)296-6439 TDD (612)282-6555
APPLICATION AND PERMIT
FOR A 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
(Organization or location limited to 3 permits in a 12 month period)
TYPE OR PRINT INFORMATION
NAME OF ORGANIZATION
L,¥,,c C /oh
STREET ADDRESS
NA~.~OF PERSON MAKING APPLICATION
DATES_LIQUOR WILL BE SOLD (1 to 4 days)
ORO ~.Q~~ t./c.TION OFFICER'S NAME
ORGANIZATION OFFICER'S NAME
S-/'-eve .ff, o,-,.,e.-,,,'//e,
ORGANIZATION OFFICER'S NAME
DATE ORGANIZED
CITY
BUSINESS PHO~
TAX EXEMPT NUMBER
STATE ZIP C~D_~
tm/ /?
HOME PHONE
TYPE OF ORGANIZATION
IX'CLUB [] CHARITABLE [] RELIGIOUS [] OTHER NONPROFIT
ADDRESS
Cd /I /cdc;o9 c321
ADDRESS
ADDRESS /
Location wherc license will'bc used. If an outdoor area, describe
Will the applicant contract for intoxicating liquor sen4ces? If so, give the name and address of the LiqUor license providing the service.
Will the applicant carry liquor liability insurance? If s3, the carrier', s name and amount of coverage.
(NOTE: Insurance is not mandatory)
APPROVAL
APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL
CITY/COUNTY 'C~c~/~,~£$~"~ /~o-o'e.,. DATE APPROVED
CITY FEE AMOUNT
LICENSE DATES
DATE FEE PAiD
SIGNATURE CITY CLERK OR COUNTY OFFICIAL
APPROVED LIQUOR CONTROL DIRECTOR
NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this di~'ision -
will be returned as the license. Submit to the City or County at least 30 days before the event. -
PS-09079(S/95)
[ODUCER (612) 893-9218 FAX (612) 893-9402 IHIS CI::~<IIPICA'I~- IS ISSUi-U AS A MAI (~-R O~ INPUt<MAilON
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
RPORATE 4 TNS AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND OR
20 NETRO BOULEVARD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
N A, M N 5 S 439- 2133 COMPANIES AFFORDING COVERAGE
~n: Ext: A
COMPANY
Chanhassen Lions C]ub B
.
PO Box 484
: COMPANY
Chanhassen, NN 55317 i C
: COMPANY
~ D
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTV~THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V~TH 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.
'R: TYPE OF INSURANCE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
OWNER S & CONTRACTOR'S PROT
::
AUTOMOBILI-' LIABILITY
....... "ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
! HIRED AUTOS
: NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
:: - OTHER 3HAN UMBRELLA FORM
: WORKERS COMPENSATION AND
.: EMPLOYERS' LIABILITY
THE PROPRIETOR/
! ....... !INCL
PARTNERS/EXECUTIVE ! ....... :
OFFICERS ARE: i ~ EXCL
OTHER
Liquor Liability
5471.888
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
RECEIVED
MAY 3 1~ 2000
~TY OF CHANHASSEN
06/30/2000
POLICY EXPIRATION
DATE (MM/DD/YY)
06/30/200~
LIMITS
GENERAL AGGREGATE $
'"F~i]'~¥~;':'~;;~F~;~'~'"'~ .....................................
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) $
MED EXP (Any one person) $
COMBINED SINGLE LIMIT $
BODILY INJURY
(Per person) :
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
AUTO ONLY- EAACCIDENT : $
OTHER THAN AUTO ONLY:
._ ............................................. ~~~~~~:~:~:~~~:~~~~~~~~~~~~~~~~~:~~~~~~~~~~~~~:~~~~~~~:~~~~~~~:~:~~~:~:~~~~~~~~~~~
EACH ACCIDENT~ $
AGGREGATE~ $
EACH OCCURRENCE :$
AGGREGATE $
; WI,,, ~ I/-~ ( U- : ; fJ [ ~- :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
.............................. : ....... . ......... :..:.:,.....,.-:.:.:.....-....,.:.:.:........: ..:.:,:.:.,.....-..:-:.:
EL EACH ACCIDENT
EL DISEASE - POLICY LIMIT i $
"~:'~;~g~':'~'~'~'~;~';"i .....................................
Per ocCurrence $1,000,000
Aggregate $1,000,000
!SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
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 LEFT,
City of Chanhassen
Attn: Todd Hoffman BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGAT1ON OR LIABILITY
Chanhassen City Hal 1 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
Chanhassen, MN $S317 AUTHORIZE, REPRESENTATIVE
! Michael Hadtrath/SK
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