1c. Temp Beer Lic Lion Club Oktoberfest CITYOF
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690 COULTER DRIVE • P.O. BOX 147 • CHANHASSEN, MINNESOTA 55317
1 (612) 937 -1900 • FAX (612) 937 -5739
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MEMORANDUM
TO: Don Ashworth, City Manager
1 FROM: Karen Engelhardt, Office Manager
DATE: September 9, 1992
SUBJ: Approval of One Day Temporary Beer License, Chanhassen Lions Club,
Oktoberfest Celebration, September 25, 1992
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Attached please fmd an application for a temporary beer license from the Chanhassen Lions Club.
The Lions Club would like to sell beer at the annual Oktoberfest Celebration held on September
25, 1992, in the lower level parking lot at City Hall. Also attached is a copy of their liquor
liability insurance certificate which is in effect during this event.
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Approval is recommended.
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1 t4 : PRINTED ON RECYCLED PAPER
PS- 09079.0118/851 MINNESOTA DEPARTMENT OF PUBLIC SAFETY
PHONE612- 296 -6159 LIQUOR CONTROL DIVISION
333 SIBLEY • ST. PAUL, MN 55101
I w: X13 . APPLICATION AND PERMIT
�„
L: FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
I
NAME OF ORGANIZATION ' DATE ORGANIZED NO. OF MEMBERS TAX EXEMPT NUMBER
I TREET ADQRESS e aTY J‘ STATE ZIP CODE
4iAME O,F PERSON MAKING APPLICATION BUSINESS PHONE roME PHONE
t yL 1� c� ( a ) a - )s a � t a 4)6
' L�$ VI TES LIQUO WILL Bk SOLb? 11 TO 3 DAYS) { � DOES ORGANIZATION HAVE A CHARTER GENERAL. PURPOSE OF ORGANIZATION
v- 1 2 ,.z, ' i CI ) 'X c) C ✓x'i •' T x'es ❑ No j E; U ' L c-i .
/ [n
° �RGANII ATION OFFICER'S NAME A• RRESS / / �
`�. - L.,) ( C3 , 7' � j , r i C. \A ,ADDRESS
L? J I yti C L 7. e LS.3 O i _ C ry YZ-.
f3GANIZATION OFFICER'S NAME ADDRESS
I O R GANIZATION OFFICER'S NAME ADDRESS
' Location where license will be used. If an outdoor area, describe.
l )
I Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor licensee providing E
the services.
` L_ L' . "\ F= i `... 7 i_ ez_' } '�- i , L , 1 l
I Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage.
(Note: Insurance is not mandatory) ',).:
1 APPROVAL
I CITY OF DATE APPROVED
CITY FEE AMOUNT LICENSE DATES
1 DATE FEE PAID
APPROVED LIQUOR CONTROL DIRECTOR
I SIGNATURE CITY CLERK
1 NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this division
will be returned as the license Submit to the City Clerk at least 30 days before the event.
Ammo. CERTIFICATE OF INSURANCE ISSUE DATE (MM /DD/YY)
9 -6 -91
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Hadtrath & Associates, Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
199 Coon Rapids Blvd., Suite 110 POLICIES BELOW.
Coon Rapids, MN 55433 COMPANIES AFFORDING COVERAGE
LETTER A United States Fidelity and Guaranty Company
COMPANY B
INSURED LETTER
Chanhassen Lions Club COMPANY
LETTER C
P.O. Box 484 • -
Chanhassen, MN 55317 LETTER
NY
COMPANY
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
LTR DATE (MM /DD /YY) DATE (MM /DD /YY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $
COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP /OP AGG. $
CLAIMS MADE OCCUR. PERSONAL & ADV INJURY $
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $
FIRE DAMAGE (Any one fire) $
MED. EXPENSE (Any one person) $
AUTOMOBILE LIABILITY COMBINED SINGLE
ANY AUTO LIMIT
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS (Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
EACH ACCIDENT $
AND _
DISEASE— POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE —EACH EMPLOYEE $
OTHER
A LIQUOR LIABILITY LLC12786407700 9 -28 -91 9 -28 -92 $500,000. Aggregate
$500,000. Each Common Cause
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS
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CERTIFICATE HOLDER CANCELLATION
City of Chanhassen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
690 Coulter Drive EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
Chanhassen, MN 55317 MAIL _Q_ 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 REPRESENTATIVE
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ACORD 25 -S (7/90) CACORD CORPORATION 1990