1m Approval of One Day Beer License, Lions Club
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CITY OF
CHANHASSEN
MEMORANDUM
J City Center Drive, PO Box 141 TO:
~hanhassen, Minnesota 55311
Phone 612.937.1900 FROM:
General Fax 612.937.5139
:ngineering Fax 612.937.9152 DATE:
ublic Safety Fax 612.934.2524
Web www.ci.chanhassen.mn.1IS SUBJ:
Don Ashworth, City Manager
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Karen Engelhardt, Office Manager ~f~
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April 7, 1998
Approval ofT~!pporary On-Sale Beer License, Chanhassen Lions
Club, May 16 & 17
Attached please find an application for an on-sale beer license from the
Chanhassen Lions Club. The Lions would like to sell beer at their third annual
softball tournament on May 16 & 17, 1998 at Lake Ann Park. Also attached is the
liquor liability insurance certificate that is in effect for this event. No incidents
occurred at last year's tournament.
RECOMMENDATION
Approval of the on-sale beer license for the Chanhassen Lions Club on May 16 &
17, 1998 at Lake Ann Park is recommended.
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"he City of Chanhassen. A growing community with clean lakes, quality schools, a channing downtown, thriving businesses, and beautifUl parks. A great place to live, work, and play
PS-09079-01 18/851
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PHONE 612-296-6159
MINNE::>UTA DEPARTMENT OF PUBLIC SAFETY
LIQUOR CONTROL DIVISION
333 SIBLEY · ST. PAUL, MN 55101
APPLICATION AND PERMIT
FOR A 1 to 3 DAY TEMPORARY ON-SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
NAME OF ORGANIZATION
LiuA/S C-LuB Or::- L/jANJiASSc-/vl
STRE9I) ADDR,F?S
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NAME 9F PERSON MAKING APPLICATION
L(!)v..1~LL. . ET-rEK
DATES L1aUOR Will BE SOLD? 11 703 DAYS)
MA I~ 1/7 Iq9~
ORGANIZATION FFICER'S NAME
C D G / tV!:. () A C it ~ r R E-~ ( ~ f: 0 T
ORGt)NIZATlON OFFICER'S NAME
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ORGANIZATION OFFICER'S NAME
L. i,,/ (( --- . CJ B (/V 5 u -<v
NO. OF MEMBERS TAX EXEMPT NUMBER
I '1'? 5 0 J.j /. b _ Z l -3 9 f
CITY STATE ZIP CODE
CJ-J It tVJ-j It s S. E- .v Mill 5'53 r
BUSINESS PHON", HOME PHONE
1~/ll y1-{f-~:JLIL, IC-.Jl.I <13;"1-9301
DOES ORGANIZATION HAVE A CHARTER GENERAL PURPOSE OF ORGANIZATlm
r,l'Yes 0 No Sf: K V I ~_ j:::
ADDRESS
ADDRESS I
1--/ Iff t I (, fJ L A "-' 0
ADDRESS
.2 (J 2..- l~j 7 7 +l." S4 ,_
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location where license will be used. If an outdoor area, describe.
L it I( E A N f'vJ
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Will the applicant contract for intoxicating liquor services? If so, give the name and address of the liquor licensee providing
the services.
L u LI(6~
G (~c S, b J S j{:!.. J G~' T (I MG.,. G({'EEtJ :t5LE./ l'vJa../.
Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage.
(Note: Insurance is not mandatory)
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APPROVAL
CITY OF
DATE APPROVED
CITY FEE AMOUNT
LICENSE DATES
:'>ATE FEE PAID
APPROVED LIQUOR CONT~OL DIRECTOR
SIGNATURE CITY CLERK
NOTE:
Do not separate these two parts, send both parts to the address above and the original signed by this division
will be returned ,s the license. Submit to the City Clerk at least 30 days before the event.
~~~i~:;:;=..
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
RPORATE 4 INS AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
IRPORATE 4 INS AGENCY INC ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
~20 METRO BLVD COMPANIES AFFORDING COVERAGE
lINA, MN 55439 COMPANY Transcontinental Insurance Company
:tn: Ext: A
Lions Club of Chanhassen
PO Box 484
Chanhassen, MN 55317
COMPANY
B
COMPANY
C
COMPANY
D
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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.
o
'R
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE (MM/DDIYY) DATE (MM/DDIYY)
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
COMBINED SINGLE LIMIT $
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accidant)
PROPERTY DAMAGE $
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
.iUN p '{ '\9':31 AGGREGATE $
'J 1;'-
$
i'~4! i, 1,..,), ,;.
$
EL DISEASE - POLICY LIMIT $
EL DISEASE - EA EMPLOYEE $
Each Occ. $1,000,000
06/30/1997 06/30/1998 Aggregate $1,000,000
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR
OWNER'S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR!
PARTNERSIEXECUTIVE
OFFICERS ARE:
OTHER
iquor Liability
INCL
EXCL
A
LP167035734
JESCRIPTlON OF OPERA TIONS/LOCA TlONSNEHICLESlSPECIAL ITEMS
C"""""I"'I"'''''''''''' """':::DER" ...
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...... ::::::::::::::;;:::::::::::::::::::~~Bffl.;mmr:::i::)!%ma:::!::U:::::::.::::::::::::::::::::::...:..:.:...........:::::.::::.;::::::::::'<:'"
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
......l.!L.- 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 UPO THE MPANY,ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REP E~,i I:-
/,
City of Chanhassen
690 Coulter Dr.
Chanhassen, MN 55317
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