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1e. Temporary Liquor License, Campfire USA 101 1ailrisM� CITY OF MEMORANDUM CHANHASSEN 7700 Market Boulevard TO: Todd Gerhardt, City Manager PO Box 147 Chanhassen, MN 55317 FROM: Karen Engelhardt, Office Manager Administration DATE: April 23, 2012 brk` Phone: 952.227.1100 Fax: 952.227.1110 SUBJ: Approval of Temporary Liquor License, Camp Fire USA MN Council, May 7, 2012 Building Inspections Phone: 952.227.1180 Fax: 952.227.1190 PROPOSED MOTION: Engineering The City Council approves the request from Camp Fire USA Minnesota Phone: 952.2271160 Fax: 952.227.1170 Council for a temporary intoxicating liquor license for their annual meeting on May 7, 2012 at the Chanhassen Library. The fee shall be set at $1." Finance Phone: 952.227.1140 Approval of this request requires a simple majority vote of the City Council. Fax: 952.227.1110 Park & Recreation Phone: 952.227.1120 Camp Tanadoona is holding their annual meeting in the Wilder Room at the Fax: 952.227.1110 Chanhassen Library on Monday, May 7, 2012. They would like to serve wine Recreation Center following the meeting. Liquor liability insurance has been submitted for the 2310 Coulter Boulevard event. Phone: 952.227.1400 Fax: 952.227.1404 RECOMMENDATION Planning & Natural Resources Staff recommends approval of the request from Camp Fire USA Minnesota Phone: 952.227.1130 Council's for a temporary on -sale liquor license for their annual meeting on Fax: 952.227.1110 Monday, May 7, 2012 at the Chanhassen Library. The fee shall be set at $1 in accordance with city code. Public Works 7901 Park Place ATTACHMENT Phone: 952.227.1300 Fax: 952.227.1310 1. Application Form Senior Center Phone: 952.227.1125 Fax: 952.227.1110 Web Site www.ci.chanhassen.mn.us g: \user \karen\Iiquor \camp tanadoona \camp tanadoona cc report 4- 23- 12.doc Chanhassen is a Community for Life - Providing for Today and Planning for Tomorrow t '' <t Minnesota Department of Public Safety ,- a t L *s., ? ALCOHOL AND GAMBLING ENFORCEMENT DIVISION st R 4 w „ may ,,,. 444 Cedar Street Suite 133, St. Paul MN 55101 -51>? %. i I w? } oM a, (651) 201 -7507 Fax . 651 297-5259 TTY 651) _b. -6555 t. WWW.DPS.STAT.L.MN. LTS APPLICATION AND PERMIT FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE TYPE OR PRINT INFORMATION NAME OF ORGANIZATION DATE ORGANIZED TAX EXEMPT NUMBER C., .4`-n P; ve U.S A- Minrus ot Ct,wic ( 1112 1)-O7o !Re STREET ADDRESS CITY STATE ZIP CODE ) NAME OF PERSON MAKING APPLICATION BUSINESS PHO HOME PHONE 3 —S5t Lek- , ciat4 - elt ttoiil Z S 5 w (.92.t)S ((AD, 812_ - i i 3 tp DATES LIQUOR WILL BE SOLD CLUB CHARITABI F) RFI.ICIMO11S OTHER NONPROFIT r‘i ORGANIZATION OFFICER'S NAME ADDRESS f ' CSI#i�! R.4 y ? ,� t l 0 113. t.D.Rt. ,S ", S LCI - 1e- 4 0 I M' : !; 1 tS } - 5SY KO ORGANIZATION OFFICER'S NAME ADDRESS ORGANIZATION OFFICER'S NAME ADDRESS Location license will be used. If'an outdoor area, describe �A t_ \1 - ^# i,.tIiYC.. .- '1 #„t:fo Lf Gil` 3 — 1 t 1 t"'','t. ' �s r'" i tV . kc i 3 Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. N Will the applicant c' rr liquor li bili insurance? I f s o, please provide the carric {s name and amount of coverage. �'.. _ c~�� ` '6`1 TY�It \‘ ,.. k �1\k e o c i eoc . APROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING ENFORCEMENT CITY /COUNTY DATE APPROVED CITY FEE AMOUNT LICENSE DATES DATE FEE PAID Sl(;NATUR CM' C..EIU OR C()UN V OFP ICJAL APPROVED t)IREC I OR ALC()El()I, AND (;AMIII.jN( ENFORCEMENT NOTE: Submit this form to the city or county 30 day prior to event. Forward application signed by city and /or county to the address above. if the application is approved the Alcohol and Gambling Enforcement Division will return this :application to be uxrl w the License for the event PS -09079 (05.'06; i""" CAMPF-1 OP ID: CB AMAZE)" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 04/05/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 651 -779 -7000 NAAMMEACT Assured Protection, Inc. 651 - 779 -0921 PHONE FAX 5671 Geneva Avenue N. IA/C, No. Extl: (A/C, Not: Oakdale, MN 55128 E-MAIL Kyle A. Anderson ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A:West Bend Mutual Insurance Co INSURED Camp Fire USA INSURER B : State Fund Mutual 3100 West Lake St Ste 100 Minneapolis, MN 55416 INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WWI POUCY NUMBER (MM/DD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY NSNO918338 09/01/11 09/01/12 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 200,000 CLAIMS -MADE I X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE _ $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIESPER' PRODUCTS - COMP/OP AGG $ 3,000,000 n mi. — I POLICY - IFC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ( ) NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) • $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE NUN0950884 09/01111 09/01/12 AGGREGATE $ 5,000,000 DED 1 X RETENTION $ 0 $ WORKERS COMPENSATION II WC STATU- OTH- AND EMPLOYERS' LIABILITY 4 TORY IMITS I E.R B ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N 40945.202 08125/11 08/25/12 E. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? I L- N /A (Mandatory in NH) EL. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CAMPS -NOT FOR PROFIT CERTIFICATE HOLDER CANCELLATION MNDEPTI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MN Dept of Public Safety THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN p ty ACCORDANCE WITH THE POLICY PROVISIONS. Alcohol & Gambling Enforcement Division AUTHORIZED REPRESENTATNE t4CedSt0 133 S M St Paul, MN 5515101 1 1 e 1 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD