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1h Temp Beer Licenses - LionsCITY OF C HASSE '", k~ ~, 5~i ':'1!!i) P,~rk & Recreation Fix 952~Z7 !404 N~lural F~ 9522271110 159! P:~ Road ?r:l: 952 227 !300 Fs,~ '}52 227 3!0 952 227 !125 ,,. ,< ~,,S~ MEMORANDUM TO: Todd Gerhardt, City Manager FROM: Karen Engelhardt, Office Manager DATE: December 8, 2003 ~ SUB J: Approval of Temporary Beer License, Chanhassen Lions Club, February 7, 2004 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 7, 2003. Also attached is the liquor liability insurance certificate covering this event. RECOMMENDATION Staff recommends approval of the Chanhassen Lions Club request to sell beer at the February Festival on Lake Ann on February 7, 2004 for a fee of $1.00. g:\user\karen\liquor\lion s.doc Minnesota Department of Public Safety LIQUOR CONTROL DIVISION 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 lmfited to 3 permits in a 12 month period) TYPE OR PRINT INFORMATION NAM], 7. OF ORGAN. IZATION S'F~E'I' Al)DRESS NA~ OF PIt,ON ~K~N(; APPLICATION I)ATI.~? 1JQUOR WIIJ, BE SOI,D (1 to 4 days) OR(}ANIZATION Ot:t:ICt.~R'S NAME ORGANIZATION OF'E:ICf_']CS NAMF. o o zxrxo omcEws N ME DATE ORGANIZED CIT)r ~ TAX EXEMPT NUMBER (';>C:q7 STATE [ ZIP CODE BUSINESS PHONE J ttOME PttONE TYPE OF ORGANIZATION ,~ CLtlB 7~ CtlARITABLE 17 RELIGIOUS ~ OTItERNONPROFIT AI)I)RESS ADDRESS Al)DRESS l.ocation ~hcrc liccnkc will bc used. If an outd~r area, describe Will thc applicant contract lbr intoxicating liquor sen'ices'? If so. give thc name and address of Iht Liqnor license providing the sen, ice. Will thc applicant carry liquor liability fl~surancc? If so. the carrier' snamc 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 CITY FEE AMOUNT DATE FEE PAID DATE APPROVED LICENSE DATES SIGNATURE CITY CI.ERK OR COUNTY OFFICIAl. APl'ROVED LIQUOR CONTROl. DIRECTOR NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this dMsion ~a'ill be returned as the license. Submit to the City or County at least 30 days before the event. PS-09079(8/95) CERTIFICA E OF LIABILITY INSURI_ iCE DATE (MM/DDP(YYY) 06/05/2003 dRODUCER (952)893-9218 FAX CORPORATE 4 [NS AGENCY, [NC. 7220 METRO BOULEVARD EDTNA, MN 55439-2133 INSURED Chanhassen Lions Club PO Box 484 Chanhassen, MN 55317 (952)893-9402 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 POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Lexington [nsurance Co. INSURER B: INSURER C: INSURER D: ; INSURER E: NAIC # COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN~ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IiNTS~R ~DD~ POLICY EFFECTIVE POLICY EXPIRATION NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY -bAMAGE 10 RENTED $ PREMISES {Ea occurence) ] CLAIMS MADE r-~ oCCUR MED EXP (Any one person) $ / I I PERSONAL & ADV'INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/Op AGG $ I POLICY ~IPRO-JECT [~-ILOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS THIS'. INSURANCE IS ISS JED PURSUA IT TO (PerBODILYaccident)lNJURY NON-OWNED AUTOS THE MINNESOTA SURPLU 3 LINES INSUF ANCE ACT. THE INSURER IS AN ELIGIBLE SUi PLUS PROPERTY DAMAGE LINES'INSURER BUT IS NOT OTHEF i/VISE (Per accident) $ ........... ,, ,~. ,~, ~, ~ ~r mmll~l=~U A. IN AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY CASE OF INSOLVENCY, P, ~,YMENT OF C AIMS EA ACC I ANY AUTO IS NOT GUARANTEED. OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY SURPLUS LINES TAX . , EACH OCCURRENCE $ I DEDUCTIBLE $ RETENTION $ $ WL; :51AlU- WORKERS COMPENSATION AND TORY L M TS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E-L- EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE "5 If yes, describe under SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $ OTHER 2340751 06/30/2003 06/30/2004 See Below Liquor Liability A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Limits: $10,000 PD each occurrence/$300,O00 BT each person and each occurrence/$300,O00 loss of ,uppo.t each pe.so, and each occu..ence/S600,000 aggregate imit pe. club. RECEIVED JUN 0 6 2003 CERTIFICATE HOLDER CANCELLATION CITY OF CHANHARRF:IU City of Chanhassen A1TN:3erry Rugemer 690 City Center Drive Chanhassen, MN 55317 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBEGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Dan Li ndsa¥/HB ©ACORD CORPORATION 1988