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\9lNNESOTA .JOINT UNDERWRITING ASSOCIATION <br />415 MINNESOTA ST SUITE; 5144 <br />ST. PAUL. MN 55101 <br />1- 800 - 552 -0013 651- 222 -0454 FAX: 651- 222 -7824 <br />APPLICATION FOR LIQUOR LIABILITY COVERAGE <br />Coverage will not be bound if the correct premium payment, written rejection or if quote exceeds 20"%, <br />above plan rale, current license and required documentation of liquor receipts are not attached. Coverage <br />cannot be bound prior to 12:01 a.m. the day following receipt of the above by the administrator. <br />Legal Name of Applicant Little Canada Canadian Days, Inc. <br />'trade Name (DBA) Canadian Days <br />Address PO Box 13642, Little Canada, MN 55113 - 0642 <br />Phone 651-433 -4541 <br />........Individual Partnership _K,. Corporation Non- Protit Other <br />f Applicant is Individual: <br />Applicant Name._____— ._..... _.. .._..__.. _....._. _..._. Spouse Name__ <br />If rApplicant is a Partnership or Corporation <br />Name of each Partner or Owner <br />Joy Kokaisel, Vice Pres <br />Jane ne Connelly, .Prey <br />Sarah Amundson, Sec <br />Lynda Beaudoin, Treas <br />Operai ing Location(s) -- I.ist all locations: <br />Percentage of Ownership <br />0 <br />0 ...._ <br />Spooner Park, 350 Eli Rd, Little Canada <br />Classification: Primary Nature of Busi ucss: Coranani ty Fes t <br />all applicable: <br />Restaurant <br />Club _,Bar <br />Special Even _ t3owli ng Alley <br />,,<.<,:. <br />NOTE: OFF SALE FACILITIES >U,ST HAVE A SEPARATE EN'IR, <br />AN OFF SALE RATE. <br />Salc Only <br />X On /0111 Sales <br />0 QUALIFY FOR <br />Total receipts of entire establishment S 436, 043 <br />Gross receipts from Liquor Sales included above: $ 2.':,'744 <br />Cross Neel OS from OFF SAI,E: S 0 _ ON SALE: S_ 21, '144 <br />Seating Capacity: 450 'total N/A Bar Only <br />License in effect? Yes X No <br />Licensing Authority: pity of Little Canada <br />Add ress: 515 b i ttie Canada Rd E <br />City: Little Canada Stale MN Zip Code 155 1 7 <br />Faxtl: 651-766-4048 <br />,..._ <br />3 <br />