5.a) Temporary Liquor License, Scandia Softball Association � ,
Meeting Date: 8/4/2009
Agenda Item: �„ � ���
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City Council Agenda Report
City of Scandia
14727 209`h St. North
Scandia, MN 55073 (651)433-2274
Action Requested: Approve the Temporary Liquor License for the Scandia Softball
Association for September 1 l, 2009.
Deadline/ Timeline:
Background: • The Softball Association has requested a license for their beer
sales during games at the Scandia lighted ball field during the
annual Taco Daze event.
• The license application appears to be in conformance with
Ordinance No. 93, adopted by the Council on January 2, 2007. A
certificate of insurance has been received.
Recommendation: I recommend that the Council approve the license.
Attachments/ • License application
Materials provided:
Contact(s): James Lindberg, 651 433-2265
Prepared by: Anne Hurlburt, Administrator
(softball liquor license)
Page 1 of 1
07/21/09
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Minnesota Department of Public Safety .,,,xST
ALCOHOL AND GAMBLING ENFORCEMEiVT DIVISION �'� ""' ''�'
444 Cedar St./Suite 133 ���`�`�`'�
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— St. Paul, MN 55101-5133 "��,::�;�
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(651) 201-7507 FAX(651) 297-5259 TDD(651) 282-6555
APPLICATION AND PERMIT
FOR A 1 DAY TEMPORARY CONSUMPTION & DISPLAY PERMIT
(City or county may not issue more than 10 permits in any one year)
TYPE OR PRINT INFORMATION
N ME�OFQRGA Z TIQN • DATE ORGANIZED TAX EXEMPT NUMBER
'G�f°�- � S O C,.
CTAFRT ATlT1AFCC �,_. _ TATE ZIP CODE
02�BOs Q/�-,ala T./ cl�e a►�G�t. :s�-73
NAME OF PERSON MAKING APPLICATION BUSINESS PHONE HOME PHONE
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Q.•us
�33 -.3���
DATE SET PS WILL BE SOL TYPE OF ORGANIZATION
����' Z� CLUB CHARITABLE RELIGIOUS OTHER NONPROFIT
O IZATION Q�FICE AM 6� ADDRESS
w�,,�.s QC
ORGANIZATION OFFICER'S NAME ADDRESS
ORGANIZATION OFFICER'S NAME ADDRESS
Location where permit will be used. If an outdoor area,describe
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APROVAL
APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL
CITY/COUNTY DATE APPROVED
CITY FEE AMOUNT PERMIT DATE
(Not to exceed$25)
DATE FEE PAID — '� - '���
SIGNATURE 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 application is approved the Alcohol and Gambling Entorcement Division will return this application to be used
as the permit for the event PS-09098(5/06)
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MINNESOTA LIQUOR LIABILITY ASSIGNED RISK PLAN �����.�'�.�E�
MINNESOTA JOINT UNDERWRITING ASSOCIATION
445 MINNESOTA ST SUITE 514
SAINT PAUL, MN 5 5 1 0 1-0760
(651)222-0484 OR 1-800-552-0013
CI1Y 0�= 5�ANQIA
CERTIFICATE OF INSURANCE FOR LIQUOR LIABILITY COVERAGE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATtON ONLY AND CONFERS NO RIGHTS
UPON THE CERTIFICATE HOLDER. THE CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE CONTRACT LISTED BELOW.
POLICY NUMBER: 09-0409
CONTRACT PERIOD: 12:01 A.M. 9/11/2009 TO 12:01 A.M. 9/12/2009(or the time/hour the event license
expires)
CONTRACT HOLDER&ADDRESS
SCANDIA SOFTBALL ASSOCIATION
13569 170TH ST.
MARINE,MN 55047
SCHEDULED PREMISES: SCANDIA LIGHTED SB PARK AT THE TACO DAZE CELEBRATION
GAMES, SCANDIA, MN 55047
THIS IS TO CERTffY THAT THE CONTRACT OF COVERAGE DESCRIBED HEREIN HAS BEEN ISSUED
TO THE CONTRACT HOLDER NAMED ABOVE AND IS IN FORCE AT THIS TIME.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN TO THE COVERAGE
AFFORDED BY THE CONTRACT DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH CONTRACT.
TYPE OF COVERAGE
LIMITS OF LIABILITY
BODILY INJURY $ 50,000 EACH PERSON
100,000 EACH OCCURRENCE
PROPERTY DAMAGE $ 10,000 EACH OCCURRENCE
LOSS OF MEANS OF SUPPORT $ 50,000 EACH PERSON
100,000 EACH OCCURRENCE
ANNUAL AGGREGATE $ 300,000 ANNUALLY
SHOULD THE ABOVE CONTRACT BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE
PLAN WILL MAIL 60 DAYS WRITTEN NOTICE TO THE BELOW NAMED CERTIFICATE HOLDER,
HOWEVER, IN THE EVENT THE CANCELLATION IS FOR NON PAYMENT OF PREMIUM,THE PLAN
WILL MAIL A 10 DAY WRITTEN NOTICE.
CERTIFICATE HOLDER NAME&ADDRESS DATE OF ISSUE: 7/27/09
CITY OF SCANDIA
14727 209TH ST.N.
SCANDIA, MN 55073
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AGENCY NAME&ADDR_ESS AUTHORIZED REPRESENTATIVE
SECURITY STATE AGENCY
PO Box 190
SCANDIA, MN 55073