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3c. Lions Temp. Liq. License CITY OF CHANHASSEN 7700 Markel Bou levard PO Box 147 Chanhassen, MN 55317 Administration Phone: 952.227.1100 Fax 952.227.1110 Building Inspections Phone: 952.227.1180 Fax 952.227.1190 Engineering Phone 952.227.1160 Fax 952.227.1170 Finance Phone 952.227.1140 Fax 952.227.1110 Park & Recreation Phone 952.227.1120 Fax 952.227.1110 Recreation Center 2310 Coulter Boulevard Phone 952.227.1400 Fax: 952.227.1404 Planning & Natural Resources Phone: 952.227.1130 Fax: 952.227.1110 Public Works 1591 Park Road Phone: 952.227.1300 Fax: 952.227.1310 Senior Center Phone: 952.227.1125 Fax: 952.227.1110 Web Site \'II'NI.ci .chan hassen. m n.us J~ ~-~~-'- --~---~ MEMORANDUM TO: Todd Gerhardt, City Manager FROM: Karen Engelhardt, Office Manager )v/ O~V' January 3,2005 DA TE: SUBJ: Approval of Temporary On-Sale Liquor License, Chanhassen Lions Club, February 5,2005 Attached please find an application for a temporary on-sale liquor 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 5,2005 (or February 6, 2005 in the event the contest is rescheduled due to weather). Also attached is the liquor liability insurance certificate covering this event. RECOMMENDA TION Staff recommends approval of the Chanhassen Lions Club request for a temporary on-sale liquor license to sell beer at the February Festival on Lake Ann on February 5 (or February 6),2005 for a fee of $1.00. g: \user\karen \liquor\lions. doc The City 01 Chanhassen · A growing community with clean lakes, quality schools, a chamning downtown, thriving businesses, winding trails, and beautiful parks. A great place to live, work, and play. 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 ~ APPLICA TION AND PERMIT FOR A 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE (OrgaIÚzation or location limited to 3 pennits in a 12 month period) TYPE OR PRINT INFORMATION NAME OF ORGAN1ZA TION DATE ORGANIZED L,o.,s' 6.( C'1¡CV-. hL<S:.[e, I or ýç STREET ADDRESS CITY Pc O. ßoX lff?L/ C~C!."~''.JÚ¿-, NAME OF PERS?N ~ING APPLICATION BUSINESS PHONE b rc<o K 1'\5 ,:J5< 'I ('1 (,~ d- ~ ] '- f¡ ò c¡ Î DA'p:;~ LIQUOR WIk,L B~ SOU) (1 t~ 4 days) TYPE OF ORGANIZATION . ,J ,)r Jari S".- b/ dOG s= þ:CLUB 0 CHARITABLE 0 RELIGIOUS 0 OTHER NONPROFIT ~GANIZA TION OFFICER'S NAME ADDRESS / L '" Jj ç bc~r)l /20'11 -i2 9~o S' Rio! Iju,€ /' Ct--,ûl'^J~ fll-¡W )5!;> 0 ORGANIZA nON OFFICER'S NAME ADDRESS rrG..'"'. çl" e{(el 'ìre¿)·vr(",- f6o{ LYrt41"\ fYI/d. c4C<.^ ~c..~ r€(Ì¡ fllV ~~..-.? /ì ORGANIZA nON on1CER'S NAME ADDRESS . 0(:( v-t 1-/.eÇÇ / S"-<?( 1'<2"le---r fl &>-:1 f:ÞA ".'\50 fY, C(4~ J.,-<f.{f'/l 1"1/.-; f') (/7 Location "'here license will be used. If an outdoor area, describe Le'1hJ.( I-!~Î'" C-O./ì/,->u^,'l¡ PClíh/ ~SJOO Lc.Áe/.{"" f0rk... Or,.. cl¡cwAc..SS·E<'Î)Ý'-d/ f'r'?J"/ . TAX EXEMPT NUMBER Lf{-(7)6' ~'79 STATE I ZIP CODE MíV )'rJ/ì I HOME PHONE (G/"J) d-R(- ?YJ ~ Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. IJo Will tbe applicant carry liquor liability insurance? If so, tbe carrier's name and amount of coverage. (NOTE: Insurance is not mandato!}') APPROVAL APPLICA nON MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL CITY/COUNTY DATE APPROVED CITY FEE ATvl0UNT LICENSE DATES DATE FEE PAID SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED LIQUOR CONTROL DIRECTOR NOTE: Do not separate these two parts, send both parts to the address abo\'C and the original signed by this diyision will be returned as the license. Submit to the Cit} or County at least 30 days before the cyent. PS-09079(8/95) 12/20/2004 11:36 FAX 763 553 0894 ~ORQ. FM GLOBAL G1.1 002 F'RO~UCER (932)893-92.18 CORPORATE 4 INS AGENCY, 7220 METRO BOULEVARD EDINA, MN 5S439-21j3 CERTIFICATE OF LIABILITY INSURANCE FAX (952)893-9402 INL DATE (MMIDDJY'iyy¡ 06/30/2004 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 CO_VERAGE ,AFFORDED ~Y TH.E POLICIES BELOW. INSURED Channassën Lions cl ub PO Box 484 Chanhassen, MN 55317-0484 INSURERS AFFORDING COVERAGE INSURliRA: Lexington Insu_rance Co. INSURER 9: INSURER c: INSURER D: INSURER E: NAIC#. COVEBl\GES . .. THE POLICIES OF INSURANCE LISTED BELOW HAVE Bi:.EN ISSUED TO THE INSUREO NAMEIJ ABOVE FOR THE POLICY PE~IOD INDICATED. NOTWITHSTANDINI ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACï OR OTHER DOCUMENTWITH RESÞËCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER~IN IS SUBJECT TO All.. THE TERMS, EXCLUSIONS AND CONOITIONS OF' SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AÐ[}'L' TYPE 01' INSURANC/õ POUCY NUMBER POLICY EFfECTIVE I TR NSRD _ DATE UIIMIDDIVY) GeNlõRAL UABIUTY COMMERCIAL GENERAL LlAalUTY w~ CLNMS MADE D OCCUR POLICY È(ÞlRA1l0N "¡-""" UMrr:;; .. EACH OCClJRRENCE DAMAGE TO RENi1¡O I"RFMI!':F,o;: (F""OOl,lr»no~' MEO EXP (Any Dna pe""cn) PERSONAL II. NJV INJURY $ $ .$ $ GEN'L AGGREGATE LlMfT APPLIES PER: I PO~ICY n ~~8i n LOC AUTOMOBILE UABILlTY ANY AlITO ALL OWNED AUTOS gCHEOULED AUTOS HIRED AUTOS NON-OWNED AUTOS .. GËNERALAGGREGATE $ PRODUCTS.. COMPIOF' AGG .$ COMBINED SINGLE LlMfT (Es 8ct¡id~!) $ GARAG/õ LIAElILrTY =1 ANY AU_ï~ EJlClõS$iUM6RELLA UABIUTY =:J OCCUR D CLAIMS MADE T!-!.!:S !!\!8U!1ANCE IS ISSUED PURSUANT TO T.-:¡~ Mlh!NE:SOTA SURPLUS LINeS INSURANCE ACT, TH~lNSURE;:¡ IS AN ELlGIE?LE SJRPLUS U~Ef INvURER BUT IS NOT :>THERWISE ~'(',!=~SED 8Y THe- STATE OF MINNESOTA. IN ~A..,:: OF INSOLVËNÇY, PAYMENT OFICL.AJMS IS 1\0 I I..:iUAHANTE'ED. [', SURPLUS LINES TAX _u_ ElODIL Y INJURY (Per person) $ BODILY INJURY (Per 8~id"'lit) IJ PROP5R.TY DAMAt:>E (Per accident) 5: AUTO ONLY - EA ACCIDEfIlT $ EA ACe :Ii OTHER 1l-IAN AUTO ONLY; AGG S EACH OCCURRENCE $ ^GGR~GATE $ 5: ~ DEDUCTIBLE I RETËNTION S WORIŒRS CQMPENSA1l0N AND EMF'I.,OV/õRS' LIA61LfTY ANY PROPR,IETORiPAR,TN"RIf'XECUTIVE OFFICERMEMBE;R EXCLUOED? If yes, de8<:riDe under SPECIAL PROVISIONS below $ $ ¡-we; STATU- I ~IMITS 6.l. EACH ACCIDENT IOTH- ER .$ OnlER "b "1 . Liquor lla 1 1ty A 234075101 06/30/2004 1. Ë.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ See Below .._- 06/~O/2005 . I . ÔÊSCRJP110N OF OPERATIONS J lOCAilONS J VEHICLes I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ~ _imits: $10,000 PD each occurrence/$300,000 61 each person and eac support each person and ~ach occurrence/$600,OOO aggrega~e limit pe I occurrence/$300,OOO loss of c1 ub . Chanhass~n Lions Club PO Box 484 Chanhassen, MN 55317-0484 CANCELLATION I SHOULD Am' OF TIIE~E!OVE DESCRIBED POLlC1ES BE ~CELLED BEFORE THE IõXPJAA'I10N DATE THbEOF. THE ISSUING INSURER WILL ENDEAVOR To MAIL 10 DAYS WRJ~ NOllCE VO THE CER'I1FtCATE IiOLÞ¡;;R NAMED TO TIiE LEFT, ~LURE TO MAI~ SUCH NOTICE SHALl. IMPOSE NO OBUGATIDN OR LlABILl'I"( OF Am' KIND UPON T~E IN$URlõR. ITS A¢lõNTS OR REPRESENTATI\IES.. AUTHORJZEDREPRESEN,*,TNE £) . ~;, J . Dan Lindsay /MAkYB . ~"'~<1?.J- ©ACORD CORPORATION 1988 CERTIF"ICAT~QLDER ACORD 25 (2001/08)