1e. Approve Temp on-Sale Beer License, Chan Lions Club 1
CITYOF c
CHANHASSEN
690 COULTER DRIVE • P.O. BOX 147 • CHANHASSEN, MINNESOTA 55317
(612) 937 -1900 • FAX (612) 937 -5739
/dim by My kirrintsiniint
Endorsed t/ DR/ k
MEMORANDUM iliodifiea_
Rejecter+
Date 4 - 6
1 TO: Don Ashworth, City Manager Date Submitted to Commission
FROM: Karen Engelhardt, Office Manager Date Submitted to Cotftdi
,
DATE: April 8, 1992
1 SUBJ: , Two Day Temporary On -Sale Non - Intoxicating Liquor License Request,
Lions Club of Chanhassen, May 2 and 3, 1992
1
Attached please find a request from the Lions Club of Chanhassen for a two day on -sale
non - intoxicating liquor license. Their oganization would like to sell beer at a softball
tournament at Lake Ann Park on May 2 and 3, 1992. The Lions have submitted a copy
of their liquor liability coverage which meets city requirements.
RECOMMENDATION
Approval of the two day on -sale non - intoxicating liquor license request from the Lions
Club of Chanhassen for May 2 and 3, 1992, is recommended.
111
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1
1
1
Is
PRINTED ON RECYCLED PAPER
APPLICATION FOR NON - INTOXICATING LIQUOR LICENSE
"ON" AND "OFF" SALE
CITY OF CHANHASSEN
II HENNEPIN AND CARVER COUNTIES
STATE OF MINNESOTA
This form was prepared for purposes of background investigation
1 for either or both "On" and "Off" Sale Non - intoxicating Liquor
License applications. It does not supercede any laws, rules or
regulations of the Division of Liquor Control regarding the issuance
of liquor licenses. Failure to provide or falsification of infor-
mation requested may result in denial of the application.
6 ti S,91101/7 • 377...-9
Trad‘ N e Date of Application
M4Y 02 f- `�� 3 /1 ' 2 ( _, ‘9//
Licensing P rind
1 01)
01/ 7j
1. Type of Application: Off -Sale Non - intoxicating
I Sale Non - Intoxicating
!/ New Renewal Transfer
1
2 . firz4ff 0 " /
II
N e of Ap licant •hone ��� _te& ' Ad/
3 5 ( /) Ply"4/ ("IT
1 Home Addr ss City State
II 4. 5-2W l /�� // 47,tl� , � Date f Bi Place of
5.
1 Address of Business Location
6.
i Legal Description
7. List owners of building or premise to be licensed:
1
1 8.
Corporate or Partnership Title
1 Corporate or Partnership Address
10. List all partners, officers or directors, if corporation:
1 N e Address Da of Birth
v /:4
1 y = •4 d
/ ice 1 , ..q,
1
11. If this is a transfer application, give name, address, or persons
partnership or corporation holding license for the past year.
r
12. Who owns the tavern fixtures?
13. What vending or mechanical amusement device company has or will
have machines on the licensed premise?
•
14. Are you a Minnesota resident? Yes No
from to
If not, where resident: Dates of Residency '
15. Have you ever been convicted of violating Federal, S e or
Local liquor laws and /or regulations? Yes No
If yes, explain fully on seperate sheet of paper.
16. Applicant, and his associates in this application, will strictly
comply with all the Laws of the State of Minnesota governing
the taxation and the sale of non - intoxicating malt liquor;
and rules, regulations and ordinances, promulgated by the City
of Chanhassen; and I hereby certify th- I read the foregoing
questions and that the answers to sai, • - stions are t ue of
my own knowledge.
S = nature o Applicant
Subscribed and sworn to before
me this day of
19
Notary Public
My commission expires '
Acorn,. CERTIFICATE OF INSURANCE 1 - -- 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
II Hadtrath & Associates, Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
199 Coon Rapids Blvd.; Suite 110 POLICIES BELOW.
I Coon Rapids, MN 55433 COMPANIES AFFORDING COVERAGE
1 Ea Y A United States Fidelity and Guaranty Company
COMPANY B
' INSURED . LETTER
Chanhassen Lions Club I COMPANY
LETTER C
P.O. Box 484
' Chanhassen, MN 55317 COMPANY
LETTER D
' COMPANY E
LETTER
1 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
LTR DATE (MM /DD /YY) DATE (MM /DD /YY)
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
I BODILY INJURY
NON -OWNED AUTOS c
acident) $
GARAGE LIABILITY (Per Per accident)
_
''° PROPERTY DAMAGE $
I EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
I WORKER'S COMPENSATION
AND STATUTORY LIMITS
EACH ACCIDENT $
DISEASE— POLICY LIMIT $
EMPLOYERS' LIABILITY
DISEASE —EACH EMPLOYEE $
1 OTHER
A LIQUOR LIABILITY LLC12786407700 9 -28 -91 9 -28 -92 $500,000. Aggregate
I $500,000. Each Common Cause
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS
I CERTIFICATE HOLDER 0 CANCELLATION
SHOULD ANY bF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Chanhassen EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
690 Coulter Drive MAIL Ji DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Chanhassen, MN 55317 .; LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
'a LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ".
ACORD 25 -S (7/90) - • CACORD CORPORATION 1990
•