1f. Approval of Temporary On-Sale Non-Intoxicating Liquor License, 4th of July celebration, Chanhassen Lions Club1
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CITY OF
CHANHASSEN
&t
._ 690 COULTER DRIVE • P.O. BOX 147 • CHANHASSEN, MINNESOTA 55317
(612) 937 -1900 • FAX (612) 937 -5739
MEMORANDUM
TO: Don Ashworth, City Manager
FROM: Karen Engelhardt, Office Manager
DATE: June 20, 1995
SUBJ: Request for On -Sale Non - Intoxicating Liquor License, July 3,
Chanhassen Lions Club
Attached please find an application for an on -sale' non- intoxicating liquor license from the
Chanhassen Lions Club. The Lions plan to sell beer on July 3 during the community picnic
and street dance portion of the annual Fourth of July Celebration at City Center Park.
Attached is a copy of their liquor liability insurance that is effective for this date.
Recommendation
Staff recommends approval of the on -sale non - intoxicating liquor license request from the
Chanhassen Lions Club to sell beer, on July 3 in City Center Park as a part of the annual
Fourth of July Celebration.
PS- 09079 -01 (8/85) MINNESOTA DEPARTMENT OF PUBLIC SAFETY
PHONE 612-296-6159 LIQUOR CONTROL DIVISION
333 SIBLEY • ST. PAUL, MN 55101
APPLICATION AND PERMIT
FOR A 1 to 3 DAY -
TEMPORARY ON SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
NAME A
ORGNIZATIO
� /k
DATE RG NI E
NO. OF RS
T X EXEMPT NUMBER
9i �
:•TREET A DRESS
r 17
CITY
S
STATE
�1�
ZIP CODE
NAME OF P rk A KIN APPLICA
off- 1/
B SINESS P ONE
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H E PH0 E ,cam
( � ��72_0
DATES LIQU LL SOL TO 3 D YS �
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DOES ORG NIZATION HAVE A CHARTER
es O No
GEN L PURPOSE OF ORGAN17 ION
RGANIZATION O I R'S NAMt
ADDRESS
OT IZATIO OFFIC R' NAME
e-A� Y1
`
AD
f�,� Q Cu ��A b (� -_
ORGA 0 ICER'S NAME
cJl'�►1� S fit)
�j DDRESS
Location where lii se e used. f a outdoor area, describe.
! ate ✓ "`JfI��
Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor licensee providing
the services.
Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage yz
(Note: Insurance i not mandatory)
APPROVAL
CITY OF
DATE APPROVED
LICENSE DATES
CITY FEE AMOUNT
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
•vill be returned as the license. Submit to the City Clerk at least 30 days before the event.
i Rwo
PRODUCER :.;:.;:;.;::.::.;:.;:,:.;:.:
CORPORATE 4 INS AGENCY INC
7220 METRO BOULEVARD
EDINA MINNESOTA 55439
. ..............
INSURED
Lions Club of Chanhassen
P.O. Box 484
Chanhassen, MN 55317
06/19/95
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
COMPANIES AFFORDING COVERAGE
COMPANY
LETTER A TRANSCONTINENTAL INS. CO.
COMPANY B
LETTER ?
COMPANY
LETTER C
v
COMPANY D
LETTER
COMPANY E
LETTER
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
TR DATE (MM /DONY) DATE (MM /DD/YY)
GENERAL LIABILITY GENERAL AGGREGATE S
... .... ............... . ......................... :.............................
COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OP AGGR. $
CLAIMS MADE OCCUR. PERSONAL & ADV. INJURY $
_ ...... .......... .............. ; ..........................
OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $
FIRE DAMAGE (Any one tire) $
_....__ ................ ....... . .......... :.............................
OTHER
A LIQUOR LLP2660268 06/30/95 06/30/96
LIABILITY
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES /SPECIAL ITEMS
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
Chanhassen City Hall
Attn: Todd Hoffman
690 Coulter Drive
Chanhassen, MN 55317
SEE BELOW
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, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED R E
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
S
...............................
UMBRELLA FORM
......................................................
AGGREGATE
; S
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT
$
AND _....._._._
..........................._.....;......_
DISEASE - POLICY LIMIT
..._.............
..... .... .....
S
EMPLOYERS' LIABILITY
DISEASE-EACH EMPLOYEE
$
OTHER
A LIQUOR LLP2660268 06/30/95 06/30/96
LIABILITY
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES /SPECIAL ITEMS
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
Chanhassen City Hall
Attn: Todd Hoffman
690 Coulter Drive
Chanhassen, MN 55317
SEE BELOW
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, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED R E
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