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HomeMy WebLinkAbout06-27-2001 AdditionsADDITIONS TO AGENDA CITY COUNCIL MEETING WEDNESDAY, JUNE 27, 2001 OLD BUSINESS: 1. PUD Permit — Frattalone Excavating — Letter from City Engineer Correspondence Pages 1 and 2. 2. Lake Owasso — Updated Internal Controls Form Correspondence Pages 3 and 6. 3. Redevelopment Bond Sale — Action Steps Correspondence Page 7. — EDA Resolution Accepting Proposal on Sale of 53,000,000 of Tax Increment Bonds Correspondence Pages 8 — 9. — Bond Projections (Minimum Size with Redevelopment Project) Correspondence Pages 1.0 — 11. 4. Biagini Development Agreement Amendment — Table Action and Call for Special Meeting 5. Infiltration Pond Agreement Correspondence Pages 12 — 20. NEW BUSINESS: 1. Temporary Liquor License & Waiver of Fee — August 4 and 5, 2001 — Little Canada Recreation Association Sheriff's Dept. background checks are satisfactory. Liquor Liability Insurance is pending. Correspondence Pages 21 through 24. June 26, 2001 File: 814980J -0240 R. Green Company The Honorable Mayor and City Council City of Little Canada 5 Little Canada Road Little Canada, Minnesota 55117 RE: FRATTALONE OFFICE BUILDING CITY OF LITTLE CANADA, MINNESOTA Dear Council Members: As requested, we have reviewed the grading plans submitted for the Frattalone office building site. The submittal consisted of a grading plan prepared by Sunde Engineering, Inc., dated June 19, 2001. Based on the review, we would offer the following comments: 1. No drainage calculations or storm sewer calculations were submitted with the grading plan. Calculations need to be submitted for review and approval. 2. The proposed contours in the northwest comer of the site do not match into the existing contours. Modifications will need to be made to the proposed grading to tie into these existing contours. During a heavy rain event, it appears there may be runoff from the site dlrectly into Blacktum Pond in the northwest corner of the property. We would suggest a berm be graded along the edge of the 50 -foot setback to contain the drainage within the site. 3. The slopes in the northeast comer of the site are shown as 2:1 and 1:1 slopes. These slopes are difficult to maintain. We suggest more gradual sloping of 3:1 or greater. In the area of the 1:1 slope, a retaining wall may need to be constructed, 4. A grade break is shown on each driveway where water is directed to the east or the west. There is no indication whether or not the stormwater runoff going to the east will go onto Spruce Street where it will need to be collected. 5. The flared end section and rip rap for the pond outlet appear to be constructed directly over one of the 90 -inch conduits within the St. Paul Water Works easement. It may be beneficial to move the outlet to the east or west. 6. The outlet pipe is shown as an 8-inch PVC. This small pipe may have a tendency to plug with debris. It may be beneficial to use a larger outlet pipe with a weir orifice to restrict flow. The stormwater pond should have an emergency overflow constructed with rip rap and geotextile fabric to prevent erosion if the pond overflows, 7. The slopes above the 10 -foot wide bench in the pond are shown at 2:1. These slopes are typically at a 4:1 grade. The pond and grading plan should be sent to Ramsey Washington Metro Watershed for approval and permitting. 8. The water service to the shop and office should be split outside the building so that potable water to these buildings can be shut off by City personnel while maintaining fire protection. An easement allowing access by City forces to the valves is necessary. 9. There appears to be a conflict between the 18 -inch RCP storm sewer and 8 -inch PVC sanitary sewer service to the proposed shop building. o:1P9a.M14960162401ur- 062661 Ao u n dl. doc 1326 Energy Park Drive • St. Paul PAGE 1 651/644 -9446 toll free 888/356 -4389 &NCH P0:31 T00Z- 9Z-Nnr 20'd '10101 The Honorable Mayor and Council Members Page 2 10. The grading plan indicates the construction of the 28 parking stalls adjacent to the pond, shown as future parking on the proposed site plan. An additional handicap parking stall should be shown in front of the proposed office building to meet ADA standards. A letter describing these comments will be sent to Mr. Frank Frattalone along with a grading plan with comments for revisions to be made. If you have any questions regarding these comments, please call. Sincerely, Howard R. Green Company Lee Elfering Project Engineer LE:mw Howe PAGE 2 S y oweo \81498ono2awr- os26O1Co 50,20 "d N. dQ 'a @idh70H VO:at TO02- 92-N0f Minnesota Lawful Gambling Internal Controls Form - LG201 1 Ii k__,I_,,L Page 1 of 4 11/97 Organization Information gLJwj on Name License Number < ��� ,el aiin � 4-a/474-60S Developing Internal Controls for your Gambling Operation Your organization is ultimately responsible for developing and using proper intemal controls, and is responsible for the actions of your employees. The use of this form will help your organization identify key areas of concern and responsibility when developing your comprehensive internal controls (operations). Your internal controls will only work if they are properly developed, implemented, and maintained. Gambling Manager Responsibilities The gambling manager is the person who is in charge of the day -to -day activities of an organization's gambling operation. The gambling manager supervises all of the gambling activity and the personnel who help run the operation (including an assistant gambling manager, if any). Board rule states that a gambling manager's duties include, but are not limited to, the following duties: 1. Supervising, hiring, firing, and disciplining all gambling employees. 2. Determining the product to be purchased and put into play. 3. Reviewing and monitoring the conduct of games. 4. Verifying all receipts and disbursements. 5. Verifying all inventory. 6. Supervising all licensing and reporting requirements. 7. Assuring that the organization is in compliance with all lawful gambling statutes and rules. 8. Assuring that illegal gambling is not conducted at any permitted premises. _ The gambling manager must also ensure that required reports are properly filed with the Gambling Control Board, the Department of Revenue, the IRS, and, if required, the local unit of govemment. Assistant Gambling Manager (optional) The assistant gambling manager, if any, can be responsible for either: • supervising, hiring, firing, and disciplining all gambling employees (duty number 1, above).; OR perforrning three or more of duties 2 through 8 listed above under "Gambling Manager Responsiblities." One or more assistant gambling managers may be employed if each assistant gambling manager: • is directly supervised by the gambling manager; is an active member or employee of the organization; and is not an assistant gambling manager for another organization, except in a licensed bingo hall, as defined and restricted in Gambling Control Board rules. Gambling Manager and CEO Joint Responsibilities Together, the CEO and gambling manager must establish, implement,. and have available for review a written system for the following: Accounting controls Procedures and accountability for inventory control, opening and closing games, and auditing closed games. Recording, counting, and depositing funds from gambling. Security of gambling funds and equipment. _ Expenditure of gambling proceeds for lawful purposes and aliowabie expenses as approved bythe organization's membership. Administrative controls Develop administrative controls as part of the organization's business plan, showing how the organization is structured and who is responsible for what. _ Write a specific job description for each employee or volunteer. PAGE 3 Internal Controls Form - LG201 Membership Responsibilities Page 2 of 4 11/97 An organization's membership is responsible for providing oversight of the gambling operations, approving all expenditures from the gambling account, and participating in the gambling operation. Prepares monthly gambling report to membership (optional form Monthly Gambling Report to Member- ship - LG1004). Na e / Title WOir "stv_. , e � s v / / 4 i6 Audits gambling bankdeposits (compare to closed game and verify deposit on bank statement). (May not be the person who prepared the bank deposits.) Name + Title �}e6frS- Be tom- lilai(1ia q -LA, J AIfR �I!'� �nmqu v tt %d/'- o td igltT a loan. (7, 0I1 ee Ensures that membership gives prior authorization gambling expenditures. Name for all Title �1. a- Audits closed games. (May not be the seller.) Name Title au il�Yf-aah6epv a.ma'va „ex( ..e' . !... , ,,,. _�. tivininairine Records in organization meeting minutes the monthly gambling report and authorization of expenditures. Name Title non 7e to�, h/s. Zetrefiary�/'ea@/r Investigates and resolves cash variances (shortages). lame /Q� / /�T�iitlye� oquin -t 6ar PPS et',r ( wP °77 /11144r 6 vp )() 0-a1716-- dikneY3.e-L-, /_c,c-iLizoli ; Authorized to sign checks from the gambling account. (At least two members' signatures. May not be the treasurer of organization funds.) Name Title 74P.lta�Trohlo Pe MaUJaa2t� Reconciles and resolves any profit carryovervariances. __Name Title „Do L.Ih+4- tQPe)Uehaor C{ T1 �n(a)aSt)bnourii vYIesfi Keeps perpetual inventory records. (Must be someone other than the person(s) who conduct(s) the physical inventory.) Name Title ffJ nT L k 1, - • J . m a , a Prepares and verifies accuracy of reports submitted to the Department of Revenue and the Gambling.Control Board. me 22 / Titles 'poc� u m v 4JCi/i PRks C' l� P,d• e to-I-+ Conducts the physical inventory, going to the site(s) to actually count the inventory. -Nra�me Title \nn A P r�a/!PwlGry the s. Determines and verifies the organization's compliance with expense calculations. ame / Titles 1 o5Unig &ret)Se4P ,ir (1 A' Prepares gambling bank deposits. Name Title ,el erue 'i �jn( o -rain) m,X/ujtam 2/0?k. Handles fund losses of missing inventory, tickets, and/or receipts for games in play. Name Title ZS Q- tcoAde,,» a. j'}'!l!K/g ffiL, par, S�(brpJ�1 Thou tan' e!ere. J ( urvL# )1 nor/ PYIF>V r voM f Ltrl< S7 0rrx-- ll/Y 124am C < PAGE 4 Internal Controls Form - LG201 Page 3 of 4 11/97 Chief Executive Officer The chief executive officer (CEO) is responsible for the following: ___ Statutes and rules. Knowing the lawful gambling statutes and rules and following them. _ Information is accurate and updated. Making sure that all information in applications and other documents is true, accurate, and complete; and notifying the Board of any changes in application information. Authorizing access. Authorizing the Gambling Control Board access to your organization's records, gambling premises, and gambling bank accounts. Internal controls (operations). Along with the gambling manager, developing internal controls to protect your organization's gambling assets and maintain proper accounting. Monthly meetings. Presiding over drganization meetings where the expenditure of gambling profits and gambling issues are considered; and verifying that the gambling report is completed. Tax returns and reports. Assuring the accuracy of the Monthly Summary and Tax Return G -1 and attachments, and the monthly Schedule CID LG1010 with only authorized and approved lawful purpose contributions and allowable expenses; and signing the returns. Key areas for oversight. It is recommended that the CEO oversee the following - -with help from the organization's membership: 1. Membership meeting minutes 2. Inventory 3. Deposits 4. Auditing closed games 5. Cash variances (shortages) 6. Profit carryover reconciliation 7. Monthly reports 8. Expense calculations 9. Fund losses CEO Signature I verify that a written system of internal controls has been established, implemented, and will be available for review, and that any changes on page 2 of this form will be submitted to the Gambling Control Board within ten days of the change. CEO ,Q Date (c / / Uj PAGE 5 Internal Controls Form - LG201 Page 4 of 4 11/97 Job Description - Sample Administrative Controls - Job Description A job description for a pull -tab seller might contain these duties: • Count and verify starting cash. • Post the flare (pull -tab) with the correct serial number. • Post the house rules. • Put the entire deal into a receptacle other than the container in which the deal was received. Do not provide any insider information to customers. Check serial number on winning tickets to the game being played. If the serial numbers do not match, do not pay the winner. Fill out all prize receipt forms completely and accurately for winners valued at $50 or greater. Deface and retain all winning pull -tab tickets. Remove and retain any unsold and defective tickets. Count total cash in the cash drawer, separating the normal starting bank from the net balance. Remove receptacles and store them in a secure area at the close of the day, or properly secure receptacles. Deposit and record net balance cash or secure it until it can be deposited according to organization deposit and security procedures. It is recommended that the employee (paid or volunteer) sign their job description, ensuring that they are familiar with the duties listed. When to Use This Form • Submit with the Organization • Submit within ten days of any Send the completed form to: License Application Form LG200, or change in information. Gambling Control Board Suite 300 South 1711 West County Road B Roseville, MN 55113 This form will be made available in alternative format (i.e. large print, Braille) upon request. If you use a TTY, you can call the Board by using the Minnesota Relay Service at 1- 800 -627 -3529 and ask to place a call to (612) 639 -4000. The information requested on this form will become public information when received by the Board, and will be used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities. PAGE 6 Actions for June 27, 2001 City Council adopts RESOLUTION ACCEPTING PROPOSAL ON SALE OF 53,000,000 TAXABLE GENERAL OBLIGATION TAX INCREMENT BONDS, SERIES 2001A, PROVIDING FOR THEIR ISSUANCE, PLEDGING TAX INCREMENTS FOR THE SECURITY THEREOF AND AUTHORIZING EXECUTION OF A TAX INCREMENT PLEDGE AGREEMENT EDA adopts RESOLUTION AUTHORIZING EXECUTION OF TAX INCREMENT PLEDGE AGREEMENT PAGE 7 EXTRACT OF MINUTES OF A MEETING OF THE BOARD OF COMMISSIONERS OF THE LITTLE CANADA ECONOMIC DEVELOPMENT AUTHORITY, MINNESOTA HELD: June 27, 2001 Pursuant to due call and notice thereof, a special meeting of the Board of Commissioners of the Little Canada Economic Development Authority, Ramsey County, Minnesota, was duly called and held at the City Hall on Wednesday, June 27, 2001, at 730 o'clock P.M. The following members were present: and the following were absent: Member adoption: introduced the following resolution and moved its RESOLUTION AUTHORIZING EXECUTION OF TAX INCREMENT PLEDGE AGREEMENT A. WHEREAS, the City Council of the City of Little Canada, Minnesota (the "City "), has provided for the issuance and sale of 33.000.000 Taxable General Obligation Tax Increment Bonds, Series 2001A, dated June 29, 2001 of the City (the "Bonds ") and has accepted the sale of the Bonds; and B. WHEREAS. to provide for payment of the Bonds it is necessary that the Little Canada Economic Development Authority, Minnesota (the "Authority "). execute the Tax Increment Pledge Agreement as provided herein. NOW, THEREFORE. BE IT RESOLVED by the Board of Commissioners of the Little Canada Economic Development Authority, Minnesota. as follows: 1. Execution of Agreement. The Tax Increment Pledge Agreement on file in the office of the City Administrator is hereby approved in substantially the form submitted and the President and Secretary of the Authority are authorized and directed to execute the same (and such other agreements and documents as may be required in connection therewith) on behalf of the Authority. The approval hereby given to the document referred to above includes approval of such additional details therein as may be necessary and appropriate and such modifications thereof, deletions therefrom and additions thereto as may be necessary and appropriate and approved by the City Attorney and by the Authority officials authorized herein to execute or accept. as the case may be. said document prior to its execution; and said Authority officials are hereby authorized to approve said changes on behalf of the Authority. 2. Filing of Tax Increment Pledge Agreement. The Secretary is directed to file a fully executed copy of the Tax Increment Pledge Agreement with the County Auditor of Ramsey County pursuant to Minnesota Statutes, Section 469.178. subdivision 2. 130001 PAGE 8 The motion for the adoption of the foregoing resolution was duly seconded by member and, after full discussion thereof and upon a vote being taken thereon. the following voted in favor thereof: and the following voted against the same: Whereupon the resolution was declared duly passed and adopted. 1300080v PAGE 9 N � 0 0 0 0 0 0 0 0 0 0 80.00.00.000,0.5 Eag rorrrrrrdoo u r 0000000000000000000000 c E = o o 00000000000000000000 0§§§§§§§§§§§§§§§§§§ §§ ;nnnr�nrnnn°e�n °an .6a'a W L. B §.00§100000 9,° °00000880000° 8,88808888 es88eeeeese8eeeeee�� 000 °0 § §0 °gg §00°gM8M8 888888888888888888888 7751 Qn�n�n °r °m °ry °rveemnMa °�r_0 , 0 - -r rrr rb t mS.m m o N m 888888888888888888888 °0 n3 o a °?o o mwwn Vs v. v. v'A8 rv- 0 N •W. 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Budka VIA FACSIMILE Joel Hanson City of Little Canada City Administrator 515 East Little Canada Road Little Canada, MN 55117 Re: Creation of Pond Our File No. 9831 Dear Mr. Hanson: Sweeney, Borer & Sweeney Professional Association Attorneys at Law Suite 1200 386 North Wabasha Street St. Paul, Minnesota 55102 June 27, 2001 Telephone (651) 222-2541 Facsimile (651) 223 -5289 As you requested enclosed please find a revised agreement relative to the above matter. As you will notice, I have incorporated the revisions you requested. If you have any questions, please let me know. PJS:jm Enclosure PAGE 12 Jun 27 31 05:07p Sweeney AGREEMENT 6512235289 p.3 THIS AGREEMENT is made and entered into this day of , 2001, by and between the City of Little Canada, a political subdivision under the laws of the State of Minnesota, and /or its agents or assigns (hereinafter referred to as "Little Canada ") and William 1 Schmidt, (hereinafter referred to as "Schmidt") Paul J. Sprosty and Lura Sprosty, husband and wife, (hereinafter collectively referred to as "Sprosty") and, Larry Kerr and Denise Kerr, husband and wife, (hereinafter collectively referred to as "Kerr "). WITNESSETH: WHEREAS, Schmidt owns the property legally described on Exhibit A; and WHEREAS, Sprosty owns the property legally described on Exhibit B; and WHEREAS, Kerr owns the property legally described on Exhibit C; and WHEREAS, An infiltration pond previously existed on the Kerr property; and WHEREAS, Schmidt, Sprosty and Kerr consider it mutually desirable to improve their respective properties through the construction of a new pond on a portion of all three properties. A copy of the Site Plan for the construction of said pond is attached hereto and incorporated herein as Exhibit D. The legal description for said pond is as set forth on Exhibit E; and WHEREAS, Schmidt, Sprosty, and Kerr have agreed to work together to maintain the pond consistent with all governmental requirements; and, WHEREAS, Little Canada has agreed to assist Schmidt, Sprosty and Kerr in the creation of said pond. NO W,THEREFORE, IT IS MUTUALLY STIPULATED AND AGREED: 1. PURPOSE. The parties have joined together for the purpose of creating a pond on the Schmidt, Sprosty and Kerr properties, for the general improvement of each property to replace the former pond. 2. METHOD. Little Canada will apply for and obtain the appropriate watershed permit and any other governmental approvals for excavating said pond. Schmidt, Sprosty and Kerr will be responsible for ongoing maintenance of said pond. Little Canada will excavate the pond pursuant to the appropriate governmental permits and the Site Plan set forth on Exhibit D. Little Canada's involvement in this matter will merely consist of the movement of existing dirt on the property PAGE 13 Jun 27 01 OS:07p Sweeney 6512235289 p.4 and the creation of the basin necessary for said pond. It is understood and agreed that a portion of a drain tile system that currently exists on the Schmidt property will be removed as a result of the digging of the excavation. 3. ACCESS. Schmidt, Sprosty and Kerr shall provide access to Little Canada to their respective properties, to allow for the creation of the hole as described in paragraph 2 herein. This right of access shall include the right of ingress and egress with all machinery, equipment and materials necessary for the aforesaid purposes for Little Canada or their employees, agents, contractors and consultants. 4. COSTS. Little Canada shall bear the cost of moving the dirt and excavating the pond as described in paragraph 2 herein. Schmidt, Sprosty and Kerr shall bear any and all other costs, whether foreseen or unforeseen, relative to the creation of the pond. Specifically, the costs to be born by Schmidt, Sprosty and Kerr shall include, but are not limited to, the following: any costs associated with future compliance with government or watershed regulations relative to the pond; any costs associated with turf establishment and landscaping around the pond; any other costs associated with maintenance of the pond; and any costs associated with any future alterations to the pond or any drainage system. 5. INDEMNIFICATION. Schmidt, Sprosty and Kerr, jointly and individually, covenant and agree to indemnify, defend and hold Little Canada harmless from and against any and all claims, costs, damages, expenses and/or liability of any kind (including reasonable attorneys' fees) arising from, or as a result of Little Canada's presence on the property or involvement with this improvement. 6. RELEASE. Schmidt, Sprosty and Kerr, jointly and individually, release Little Canada from any and all causes of action, claims, suits, damages, judgments, levies and executions, whether known or unknown, liquidated or unliquidated, fixed, contingent, direct or indirect, which they ever had, have or claim to have against Little Canada relating to or arising out of past actions or inactions of Little Canada relative to their property and/or Little Canada's excavation of the pond as described in paragraph 2 herein. 7. ENTIRE AGREEMENT / REOUIREMENT OF A WRITING. It is understood and agreed that the entire agreement of the parties is contained herein and that this Agreement supersedes all oral agreement and all negotiations between the parties relating to the subject platter hereof. Any alterations, variations, or modifications of the provisions of the Agreement shall be valid only when they have been reduced to writing and duly signed by the parties. PAGE 14 Jun 27 01 05:07p Sweeney 9512235299 p.5 8. GOVERNING LAW. This Agreement shall be constructed, interpreted and enforced under the laws of the State of Minnesota. IN WITNESS WHEREOF, the parties of this Agreement have hereunto set their hands on the dates written below: CITY OF LITTLE CANADA By: By: Michael I. Fahey William J. Schmidt Mayor Dated: Dated: By: By: Joel R. Hanson Paul J. Sprosty City Administrator Dated: Dated: PAGE 15 By: Lura Sprosty Dated: By: Larry Kerr Dated: By: Denise Kerr Dated: EXHIBIT A - SCHMIDT PROPERTY PIN No. 05- 29 -22 -43 -0031 05- 29 -22 -43 -0032 Property address 2718 Edgerton Street Legal Description: 05- 29 -22 -43 -0031 That part of Lot 3, Block 1, Sprosty Addition, lying east of a line described as beginning at the most northerly comer of Subdivision Lot 3; Thence southerly to a point on the easterly line of Subdivision Lot 3 distance 142.72 feet southerly from the most easterly comer of Subdivision Lot 3 and there terminate. Ramsey County, Minnesota. 05- 29 -22 -43 -0032 Subject to easements; Lot 3, Block 1 in Sprosty Addition excluding that part thereof lying east of a line described as beginning at the most northerly corner of Subdivision Lot 3; Thence southerly to a point on the easterly line of Subdivision Lot 3 distance 142.72 feet southerly from the most easterly corner of subdivision lot and there terminate and in subdivision. Auditor's Subdivision No. 43 excluding south 751 feet Lot 26. Ramsey County, Minnesota. PAGE 16 EXHIBIT B - SPROSTY PROPERTY PIN No. 05- 29 -22 -43 -0020 Property address 633 Keller Parkway Legal Description: 05- 29 -22 -43 -0020 Subject to easements; Lot 4, Block 1, Sprosty Addition. Ramsey County, Minnesota. PAGE 17 EXHIBIT C - KERR PROPERTY PIN No. 05- 29 -22 -43 -0021 Property address 627 Keller Parkway Legal Description: 05- 29 -22 -43 -0021 Lot 2, Block 1, Sprosty Addition. Ramsey County, Minnesota. PAGE 18 EXHIBIT E Legal Description of the Pond: Commencing at the Southwest Comer of Lot 2, Block 1, SPROSTY ADDITION, according to said plat on file and of record in the office of the Registrar of Titles, Ramsey County, Minnesota; thence North 00 degrees 00 minutes 00 seconds East, an assumed bearing, along the West line of said Lot 2 a distance of 45.00 feet to the point of beginning of the pond to be described; thence North 90 degrees 00 minutes, 00 seconds East a distance of 30.00 feet; thence South 00 degrees 00 minutes 00 seconds East a distance of 80.00 feet; thence North 90 degrees 00 minutes 00 seconds West a distance of 55.00 feet; thence North 00 degrees 00 minutes 00 seconds East a distance of 80.00 feet; thence North 90 degrees 00 minutes 00 seconds East a distance of 25.0 feet to the point of beginning. PAGE 20 TYPE OR Minnesota Department of Public Safety DIVISION St. /Suite 100L MN 55101 -2156 TDD (612)232 -6555 AND PERMIT ON -SALE LIQUOR to 3 permits in a 12 month period LICENSE o" _ LIQUOR CONTROL ' °'� -.e °�* 444 Cedar z= St. Paul, (612)296 -6439 �\ 4 "',. o„ " APPLICATION FOR A 1 TO 4 DAY TEMPORARY (Organisation or location limited PRINT INFORMATION Or 1APIS NAME OF ORGANIZATION Little Canada Recreation Association DAIS ORGANIZED June, 1962 TAX EXEMPT NUMBER 29426 STREET ADDRESS 515 Little Canada Road , CITY Little Canada STATE MN ZIP CODE 55117 NAME OF PERSON MAKING APPLICATION Rick Boss BUSINESS PHONE ( ) HOME PHONE (65b 490 -3165 DAZES LIQUOR WILL BE SOLD (1 to 4 days) August 4 and 5, 2001 TYPE OF ORGANIZATION T CLUB T CHARITABLE -2 RELIGIOUS 3 OTHER NONPROFIT ORGANIZATION OFFICER'S NAME Rick Boss ADDRESS 72 E. Bryan Street, Little Canada, MN 55117 ORGANIZATION OFFICER'S NAME Katie Soucha ADDRESS 2530 McMenemv Street, Little Canada, MN 55117 ORGANIZATION OFFICER'S NAME Linda Fahev ADDRESS 2926 LaBore Road, Little Canada, MN 55109 Location Spooner where license will be used If an outdoor area. describe Park, Little Canada, MN 55117 Will the applicant contract for intoxicating liquor services'? If so. eve the name and address of the Liquor license providing the service. Will the applicant (NOTE: carte liquor liability insuranoel If so. the carrier' s name and amount of coverage. Insurance is not mandatory) MN Thins and p rear; t 1 nr) As Roc i ati on APPROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL CITY /COUNTY CITY FEE DATE DATE APPROVED LICENSE DATES AMOUNT FEE PAID SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED LIQUOR CONTROL DIRECTOR NOTE: Do not separate these two parts, send both parts to the will be returned as the license. Submit to the City or County address above and the original signed by this division at least 30 days before the event. PS- 09079(81951 PAGE 21 MINNESOTA JOINT UNDERWRITING ASSOCIATION PIONEER P.O. BOX 1760 ST. PAUL, MN 55101 1- 800 -552 -0013 OR (612) 222 -0484 APPLICATION FOR LIQUOR L.I.ABILITY COVERAGE Coverage will not be bound if the correct premium payment, written rejection, current license and required documentation of liquor receipts are not attached. Coverage cannot be bound prior to 12:01 a.m. the day following receipt of the above by the Administrator. Legal Name of Applicant Trade Name / L ' I`- . A Mailing Address C/5- i.-= 7 F'k C1.. a,, La /;rt!- L Wr >Y/t7 _Individual _Partnership _Corporation _Non- Profit < Other — If Applicant is Individual: Applicant Name N /rl Snouse Name If Applicant is a Partnership of Corporation: Name of Each Partner or Owner Percentage of Ownership Operating Location(s) - List all Locations: 1. -1,-, < 2. Classification Primary Nature of 3usiness: Check all applicable. 1. _Restaurant 2. Club 3. _Bar 4. Bowling alley 5. On /off Sales 6. _Off Sale Only 7. )(Special Event Total Gross Receipts of Entire Establishment Gross Receipts from Liquor Sales Included Above Seating Capacity Total Bar Only License in Effect? Yes No Licensing Authority • Address ( j License Number Effective Date i Expiration Date License Ever RevoicedtSuspended? Yes No If yes, date if yes, explain PAGE 22 CAUTION applicant can void coverage or Any misrepresentation made by the app result in cancellation. False or misleading answers to the following questions would constitute gross misrepresentation and void coverage. A "loss" fins not iyoudinsurercestablished a reserveooromade a receipt t of notices, y o payment in settlement of the claim. A "violation" includes any conviction on a charge brought ragainst the Applicant or any employee or agent of the Applicant out of an illegal sale of liquor. Coverage Information Liquor Liability Coverage Currently in Effect? Yes No Previous three (3) years of insurance coverage prior to effective date of coverage desired: policy Carrier Address Policy Period Losses Violations 2.. 2. 3. Has Liquor Liability Coverage Ever Been Canceled? Yes No If Yes, Reason: Applicant agrees to permit contract administrator to audit applicant's books and records during normal working hours to the extent deemed necessary to verify information relating to receipts from liquor sales and /or other matters concerning the coverage applied for. Coverage is requested to take effect at 12 :01 a.m. on wi j 1 u h c: i t Date Telephone Niimher Signature of Applicant Agent Name (Print) Z., ,ssi. Agency Name L.ki - 41A Street Address S / 5 ! , *-rra C., ti: Vic. l City, State, Zip Code L; tl e ;N 5-52/7 Agency Fed. I.D. Nnmher or Agent SSN Telephone Number PAGE 23 MINNESOTA JOINT UNDERWRITING ASSOCIATION PIONEER P.O. 30X 1760 ST. PAUL, MN 55101 1- 800 - 552 -0013 OR (612) 222 -0484 Insured and Address: LITTLE CANADA RECREATION ASSOCIATION INC DBA: RICHARD EDWARD BOSS IV. 72 E. BRYAN ST. LITTLE CANADA MN 55117 Policy Number: LL00 -8196 TO WHOM IT MAY CONCERN: Please respond to the following questions with respect to coverage provided by the Minnesota Liquor Liability Assigned Risk Plan under the above - named policy. Date of Sales Gross Liquor Sales by Day 08/04/00 08/07/00 to S Copies of deposit tickets and/or a summary Income) statement verifying :he sales figures above are recuire_^. Copies of ocher accounting ^ - -e2 may be helpful to complete _his audit should be sent. If aft__ reviet/ _4 -.e information you submit/it is determined that additional records are you will be contacted to set up an audit appointment. This form is to be filled out and signed only by a Representative of the Insured and returned to us within 15 days. Person Completing Form (PRINT) Title i€)9' St:'g ?hone No. /.uz, rr /lrt PAGE 24 .%/