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MINNESOTA JOINT UNDERWRITING ASSOCIATION <br />445 MINNESOTA ST SUITE 514 <br />ST. PAUL MN 55101 <br />1- 800 - 552 -0013 651-222-0484 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 rate, current license and required documentation of liquor receipts are not attached. Coverage <br />cannot be bound prior to 12:01a.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 />Mailing Address 515 E Little Canada Rd, MN 55117 <br />Individual Partnership x Corporation _ X Non -Profit Other <br />If Applicant is Individual: <br />Applicant Name N/A Spouse Name N/A <br />If Applicant is a Partnership or Corporation: <br />Name of each Partner or Owner <br />Susan Nelson, President <br />Joseph Gilles, Vice President <br />Joy Kokaisel, Secretary <br />Lynda Beaudoin, Treasurer <br />Percentage of Ownership <br />0 <br />0 <br />0 <br />0 <br />Operating Location(s) Uist all Iocations: spooner Park, 350 Eli Rd, Little Canada, MN 55117 <br />Classification: Primary Nature of Business: Community Festival <br />Check all applicable: <br />Restaurant Club Bar x Special Event _Bowling Alley <br />*B*a.:*is* **** * * *5 ;****** ** wV Mx***5* ******* 4 v,.*** 3*** a ****** ****** a*** a t, F***** *** *** * * +*4 <br />NO'T'E: OFF SALE FACILITIES MUST HAVE A SEPARATE ENTRANCE TO QUALIFY FOR <br />AN OFF SALE RATE. <br />Off Sale Only <br />x On /Off Sales <br />Total receipts of entire establishment :$ Festival Receipts $14,454.88 <br />Gross receipts from Liquor Sales included above: $ $12,990.00 <br />Gross receipts from OFF SALE: $ 0 ON SALE: $ $12, 990.00 <br />Seating Capacity: _`!5Q.,._ Total N/A Bar Only <br />License in effect? Yes X No <br />Licensing Authority: City of Little Canada <br />Address: 515 E Little Canada Rd <br />City: Little Canada State: MN Zip Code: 55117 <br />Fax 651 - 766 -4048 <br />3 <br />