5.d)5) Temp License for Scandia Fire & Rescue Meeting Date: 12/20/2011
Agenda Item: � � � ��
City Council Agenda Report
City of Scandia
14727 209`h St. North
Scandia, MN 55073 (651) 433-2274
Action Requested: Approve a Temporary On-Sale Liquor License for the Scandia Fire&
Rescue Relief Association's annual dance.
Deadline/ Timeline: Event is scheduled for Saturday, February 25, 2012.
Background: • The license is in conformance with Ordinance No. 93, adopted by
the Council on January 2, 2007.
• The dance will be held at the Community Center and is the major
fund-raising event for the Relief Association.
• The City waives the fee for this license, and purchases the required
liability insurance on behalf of the Relief Association.
Recommendation: I recommend that the Council approve the license.
Attachments/ • None
Materials provided:
Contact(s): Jim Finnegan, Fire Chief(651 433-4383)
Prepared by: Brenda Eklund, Deputy Clerk
(Fireball liquor license 2012)
Page 1 of 1
11/22/11
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Minnesota Department of Public Safety �� `�.�� �'�
ALCOHOL AND GAMBLING ENFORCEMENT DIVISION ��. '�"
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W W W.DPS.STATE.MN.US
APPLICATION AND PERMIT
FOR A 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
TYPE OR PRINT INFORMATION
NAME OF ORGAMZATION DATE ORGANIZED TAX EXEMPT NUMBER
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STREET ADDRESS CITY STATE ZIP CODE
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NAME OF PERSON MAKING APPL CATION BUSINESS PHONE HOME PHONE
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DATES LIQUOR WILL BE SOLD � , � � TYPE OF ORGANIZATION
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ORGANIZATION OFFICER'S NAME ADDRESS
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ORGANIZATION OFFICER'S NAME ADDRESS
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ORGANIZATION OFFICER'S NAME ADDRESS
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Location license will be used. If an outdoor area,describe
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Will the applicant contract for intoxicating liquor service? If so,give the name and address of the liquor licensee providing the service.
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Will the applicant carry liquor liability insurance? If so,please provide the carrier's name and amount of coverage.
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APROVAL
APPLICATION MUST BE APPROVED BY CTTY OR COUNTY BEFORE SUBMITTING TO ALCOHOL&GAMBLING
ENFORCEMENT
CITY/COUNTY DATE APPROVED
CITY FEE AMOUNT �/�/G�,(�/`�o LICENSE DATES fT��,�,��CD I �
DATE FEE PAID
SIGNATiJRE CITY CLERK OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT
NOTE:Submit this form to the city or county 30 days prior to event. Forward application signed by city and/or county to the address
above. If the appiica6ou is approved t6e Alcohol aod Gambling Euforcement Division will return this applicaHon to be used as the License for the event
PS-09079(05106)