HomeMy WebLinkAbout7 - Lone Pine Golf Course Liquor License
AGENDA ITEM:
PREPARED BY:
SUBJECT:
DATE:
INTRODUCTION:
BACKGROUND:
DISCUSSION:
RECOMMENDATION:
..,6''1
Laurie Friedges/License Clerk
On-Sale Intoxicating Liquor License
May 3, 1993
The owners of Lone pine Country Club, Don and
Betty Lou McKush, are requesting an On-Sale
Intoxicating Liquor License and Sunday License
for their golf course at 15451 Howard Lake Road
NW, Shakopee, Minnesota. They have requested
that the license fees be pro-rated from 5/04/93
to 6/30/93, which is a usual and customary
consideration by the City council, at which time
they will reapply for the yearly license.
Lone pine Country Club currently has an On-Sale
Non-Intoxicating Liquor License. The City
currently has twelve (12) On-Sale Liquor
Licenses available as established by state
Statute. Of this number, six licenses have been
previously issued leaving a balance of an
additional six licenses. The Prior Lake Police
Department has conducted it's investigation and
found no existing problems.
Attached is the application for On-Sale
Intoxicating liquor, the license fee and
licenses. The cost as indicated on the
appropriate licenses has been prorated from
$5150.00 to $817.80 for the On-Sale License and
$31.32 for the Sunday Liquor License. The
investigation fee of $500.00 has been paid and
the insurance certificate provided as required.
Staff
Council
License
5/04/93
recommends that the Prior Lake City
approve the On-Sale Intoxicating Liquor
for Lone pine Country Club effective
subject to renewal.
ACTION REQUIRED: Motion to approve the issuance of an
Intoxicating Liquor License and Sunday
License to Lone pine Country Club.
On-Sale
Liquor
4629 Dakota S1. S.E., Prior Lake, Minnesota 55372 I Ph. (612) 447-4230 I Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPlDYER
RECEIPT
DATE
CITY OF
PRIOR LAKE
4629 DAKOTA STREET S.E., PRIOR LAKE. MN 55372
4,- ~. 9..3
ttJ20833
Rece; ved of t1)t>1LL p~ ~ ~
wh05e address and/or legal description IS
the sum of
dollars
Reference Invoice No.
$ gr.;'1 I ~
~
Receipt Clerk for the City of Prior Lake
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...... .... ClIo\I.
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cotJNTY C)F.......~........................
,
MUNICIPALITY OF.....~Mi:c.....o{~..................__.._...
Ilhtunr llittU!it-..Ql)u ~ult~~
PURSUANT TO APPlICATION THEREFOR. payment of. fee of $......~1...7...~the filing _ .pprov.J of. bond in the __ of $...........................
... IIpOft ilwesHgt1fion _ utisfactory evicIence of the q.....tfic:t1fion of the licensee........ herein named to receive .... same .nd tMt the pI.ce of ....
....... cIescn'bed Is . proper .nd Ieg.I pIKe thet .for ,
LICENSE IS HEREBY GRANTED
TO
............................__......................................-Jt~_'-:.!!~.....~...f!Iuk......_........_....._..._....._............_.._...........
... tIoo _ "'........5..K...f:f:;-,.............- tIoo.....~.:f.A...dor '" .......':d.'11Mf..... l,q3. TO SElL INTOXlCAnN6 LIQUORS
:..~..~..~..~~..~~~........~~..~~..~~~~..~~~~~.~~~.'h~..7.;:::::::::::::::::::;;~:::;::::::::::::::::::::::::::::::::::::::::::
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..... ......~~~~....~.......................................... ......................... ............ ................................... ...... ............... ........ ..... .................... .-......... ... ..... ..-.... ...
M defi~;': subject, howevw, to the I.ws of.... United St.... the laws of the State of Minnesot., the regulations .nd orGtnanCIM of uid munic-
ipality. _ the rules .nd regul.tions of the UQUOR CONTROL COMMISSIONER. relating to the sale.nd distribution of intoJric:ating rlqUOf'lo a..r.by
.... . part hereof. .nd subject to revocafion accorcrlncj to law for ....ion thereof.
This license is non-tr..... except by consent of the authority -inCJ fhJQ~. J L J Ad.
WITN THE BODY OF THE MUNIClPAUTY OF........~~..,:p-:~....ud the .... ther.of this....~.C.:'::..............
..., of........... .... i. .... ................................................ 19..Q3 Tt..........~..~_..._.::::I-.....L..~-...._--
AH.t:........................ c:jjIj;,.:;.~.~i-;"......:............................ of the......~.............................of......~~...~.._.
. . .......1.. ... '~"~r"~'''' ............... a.... ~ Jr....... ..... ................. ...... . -... ......... ..-.........-.......... ....... ......- .........................."..
I$eIII .........-.... ......-..-...--- ......::::I..~~.<?:ff................_......_................_..............
r-.;.. :U~-l.lqujlr 1.11'4"IM' ""()n ~alt, "' ~f)4" ...1 Sundin. I -In''lI1'lf'
AlJS'NES~ f.4ECOHDS COAPOR".110N U,.......E.SOTA
i...~lt~~~':~~.-..t""""lo~~~~~~,"/~~;'~~~.:ir:~~>.J:~:.t-:'l~'Q~'.:;'~~~';"-:~:~":'"..-i<<~~~~~..~~..t~.~~~~~.~
iftj~ ~.~~--.;::"~~~-~~~ ....- ~~-..._~ ~.~--.- ~..~~~-.~~~~~~ ~j~\
I $ .313d ~'fJW-~) ~ t/~~ ~/$O/93 ~O. /
State of innesota,
County of ~~ MUNICIPALITY OF '-fJ~ ~
SPECIAL SUNDAY
Liquor License - "On Sale"
PURSU ANT TO APPLICATION THEREFOR, payment of a fee oU . ~/. .5:2 ,and upon investigation and satisfactory evidence of
the qualification of the licensee herein named to recei ve the same and that the place of sale herein.after described is a proper
and legal place therefor,
SPECIAL LICENSE IS HEREBY GRANTED
TO
for the term of
as defined by law AT RET
on Sundays as provided by La~67, ~Pl691,
IN THE MUNICIP LITY OF 1.1"'" 0 1 -J in said County and State, at which premises said licensee - control s.... and
operate .s.... a as defined by law, and which has facilities for serving not less than 30 guests at one time;
subject, howeve ,t the laws of the United States, the laws of the State of Minnesota, the regulations and ordinances of said
municipality, and the rules and regulations of the LIQUOR CONTROL COMMISSIONER, relating to the sale and distribution of
intoxicating liquors, hereby made a part hereof, and subject to revocation according to law for violation thereof.
day of
Attest:
This license is non-transferable except by consent of the authority issuinlj,th~ ~a~e. '
WITNESS THE GOVERN G BODY OF THE MUNICIPALITY OF ~ ~ and the seal thereof this . 4f1.-
~.- ._~
The ~
of the ~ of ~~
q3
,19_
~
By
(Seal
~1Lc.f~ .
Minnesota Workers' Compensation Assigned Risk Plan
Contract Admini.trator
Berkley Administrators
P.O. Box 59143 Minneapolis, Minnesota 55459-0143
Phone (612) 544-0311
NAME AND ADDRESS OF INSURED
LONE PINE COUNTRY CLUB
DON MCKUSH DBA:
15451 HOWARD LAKE RD NW
SHAKOPEE MN 55379
Date of Meiling
A'loci,tion Fi/. No. 1259130
Policy I 04 041262-3
Effective Date 06/30/1992
RW APR 1 2 '93
Past due premium: $0.00
for unaudited policy period: FROM 06/30/1992 TO 06/30/1993
OFFER OF RENEWAL
This is an offer of renewal of your Workers' Compensation Policy issued in accordance with the provisions of
the Minnesota Workers' Compensation Assigned Risk Plan. Your present Workers' Compensation Policy will expire on
06/30/1993 at 12:01 a.m., and coverage under that policy will terminate as of that date. Assuming that continuous
coverage is needed, an offer of renewal has been prepared. However, a renewal policy will be issued only if the indi-
cated renewal deposit premium AND any past due premium shown above is received prior to the effective date of the
policy.
The required renewal deposit premium for this policy as stated below is based on payrolls of your present policy
or last completed audit that have been increased by an inflation factor. This prevents a large additional premium from
developing on the final audit. If your operations have changed materially in the meantime and such changes will affect
your payroll for the coming year, we will consider revising the deposit premium upon receipt of a complete explanation
of the changes that have been made. (If such a revision is necessary, please advise us 20 days prior to the expiration
of your current policy.)
The indicated renewal deposit AND any past due premium shown above must be received prior to the effective
date of the renewal policy or no coverage will be afforded. Statutory notice requirements in the Workers' Compensa-
tion Law require a notice of termination of your present policy be sent to the Department of Labor and Industry. (This
notice is sent if we have not received payment 35 days prior to the expiration date.) If the indicated deposit premium
AND any past due premium shown above is received prior to the effective date of the renewal policy, the Department
of Labor and Industry will be notified that the policy is being renewed. Timely payment of the premium will assure you
of continued coverage.
PREMIUM BASIS ESn- RATES ENTRIES 1\1 THIS ITEM. EXCEPT AS SPECFICAU. Y PROVIDED ESTMATED
MATED TOTAL ANNUAL PER $100 OF CODE ELSEWHERE III THIS POUCY; DO NOT MOOlFY ANY OF TtE ANNUAL
REMUNERA noN REMUNERATION NO. OTHER PROVISIONS OF THIS POlICY. PREMIUM
16142. 4.21 9060 CLUB - COUNTRV/GOLF/FISH/VACHT ~ CLER 680.
Manual Premium 680.
Experience Modification N/A 680.
9885 Credit I Debit Plan 0.90 <68.
Expense Constant as.
F-410916992 Estimated Annual Premium 697.
· Agency Name and Addre.. Initial Payment 697.
CASUALTV ASSURANCE
101 W 3RD ST BOX 38
CHASKA, KN 55318
>
.
Please remit your payment to Berkley Administrators with a copy of this letter. SA 351CG (3/92)
<A-
Insurance
CHESTNUT AT 3RD
CHASKA, MN 55318
612/448-3800
1240 3RD AVENUE EAST
SHAKOPEE, MN 55379
612/445-2124
2800 EAST CLIFF ROAD
BURNSVILLE, MN 55337
612/894-8409
Casualty Assurance Group
04-21-93
To: City of Prior Lake
RE: Betty Lu McKush
dba: Lone Pine Country Club
15451 NW Howard Lake Road
Shakopee, MN 55379
LIQUOR LICENSE
The above insured will be able to obtain a liquor liability
policy with a liquor license. However, a policy cannot be
issued without a liquor license. Please accept this letter
as proof that a policy will be issued when a license is
obtained.
If you have any questions or concerns~ please contact
BraG Flaagan at either 445-2124 or 44~-3800.
Sincerely,
~ ~--'
/' /j;;'. '"
:?!~. f%d'~-~?
Brad Flaagan / Co
PROOF OF WORKERS' COMPENSATION INSURANCE COVERAGE
Minnesota Statute Section 176.182 requires every state and local licensing
agency to withhOld the issuance or renewal of a license or permit to operate a
business in Minnesota until the applicant presents acceptable evidence of
compliance with the workers' compensation insurance coverage requirement of Section
176.181, Subd. 2. The information reQuired is: The name of the insurance company,
the policy number, and dates of coverage or the permit to self-insure. This
information will be collected by the licensing agency and put in their company
file. It will be furnished, upon request, to the Department of Labor and Industry
to check for compliance with Minnesota Statute Sec. 176.181, Subd. 2.
This information is required by law, and licenses and permits to operate a
business may not be issued or renewed if it is not provided and/or is falsely
reported. Furthermore, if this information is not provided and/or falsely
reported, it may result in a S1,000 penalty assessed against the applicant by the
Commissioner of the Department lof labor and Industry payable to the Special
Compensation Fund.
Provide the information specified above in the spaces provided, or certify the
precise reason your business is excluded from compliance with the insurance
coverage requirement for workers' compensation.
"
P1 /A/A/,,6:5 t?lT;9 k./"t?/Z,K'E /2 S c: L?~ PL::::-N 54//0N
ri.5 $ /G,uE iJ ;<;5 K PL/9N
Insurance Company Name: C?-c:>,AJr /9>>"",. BE/2/C'L6Y ~.D/J'1/..J/.5r/,?;?tT&:7/e5'
(NOT the insurance agent)
Pol icy Number or Sel f-Insurance Permit Number: oL( oLl /202 - 3
Oates of Coverage: 6 - ;3 0 - 7'.2' ~ b - .s?J - -9 3
(or)
1 am not required to have workers' compensation liability coverage because:
( ) 1 have no employees covered by the law.
( ) Other (Specify)
1 HAVE READ AND UNDERSTAND MY RIGHTS AND OBLIGATIONS WITH REGARDS TO BUSINESS
LICENSES, PERMITS AND WORKERS' COMPENSATION COVERAGE, ANQ I CERTIFY THAT THE
INFORMATION PROVIDED IS TRUE AND CORRECT.
44 h--C;{..lj~.
~)
JAIl c (J) 1187
~lC~HSE QUESTIONNAIRE
TYPE OF LICENSE
TYPE OF OWNERSHIP
HUKlEI OF EMPLOYEES
NAME OF !STABLISIODT L..L?A/.6 P/dL 6-LJL F
P/2~A;;);;~ ~'7z~;;f/,
e..<:?a~ .sf
NAMES OF EMPLOYEES
.z:;> 0 A.J rY/ e.. /<:: (./ J I-t'
6-IZE(",... m~ KU:5H'
a I I'lli DA T!S
I - /$"- 4/0
4/-;Z~ - b~
lWe OF MANAGER
08-<5 ~V .La Lb In'~ /COS- rI
MAHES OF OWNERS Pleue re turn to:
BErrV,LOLb
/H L /<:::v.fl-j
Cl ty of Prior Lake
4629 Dakota Street SI
P.O. loa 359
Prior LaJce, Kinnelota SS372
..;::Jo~
/Yl c.. 1< u .5 H
. .
...
f or.. $PIC'
LICEHSl APPliCANT:
Pursuant to "innesot. ~t.tute 270.12 lax Clear.nce: Issuance of Licenses,
the 'lcensln9 authority Is reQuired to provide to the "Innesotl
Commissioner of Revenue your "Innesota business tax IdentIfication numDer
and the social security numoer of each license aoollcant.
Under tne "innesota Government Data Practices Act and the Federa' Privacy
Act of 1974, we are reQuired to advise you of the fOllowing reoardlng the
use of this Informatlonl
I. This Information may De used to deny the Issuance, renewal or
transfer of your license In the event you owe the "Innesota
DePartment of Revenue delinQuent taxes, penalties or Interest:
2. Upon receiVing this Information, the licensing authority wIll
supoly It only to the "Innesota Department of Revenue. However.
under the Federal Exchange of Information Agreement the
Deoartment of Revenue may supply this Information to the 'Internal
Revenue Service:
3. Failure to supply this Information may Jeooardlze or delay the
processing of your licensing Insuance or renewal apollcatlon.
Please supply the fotlowlng Information and return along with your
application to the agency Issuing the license. 00 NOT RETURN TO THE
DEPARTftENT Of REVENUE.
LICENSE BEING APPLIED FOR OR RENEWED: 0,,<) ..:f'/7~.6
I,J /cJ X I t.. ~ r/ v LJ:..
LICENSING AUTHORITY: C:./TV v ~ Pt?/ ~ 12 ,/... A 1(" ~
j/cname of city, county or state agency Issuing license)
,fLICENSE RENEWAL DATE: s-- ,- (L~
PERSONAL I NFORAA TJ ON (t f aOP I I cab Ie) :
rE6" riYLo?& ,,6., /Y1C:-IC'I/~H'
Appllcan't's Aoorus: /52rJ c? HL:Jb~A)i2.D ~/7JGE p>>
.:5f1 ,LiKe; P~E )/>"/# 56'.7'7t:j'
CI~y State Zip Cooe
Social, Secl.::"1~y Nu;:-~e:": 33 '7 - 412; - c:>.3 S-O
BUSINESS INfORAATION ctf applicable):
Bus I ness Name: L' ./:J ~.; p./,.u E &0 L ;::-
Business Acorns: /:>4/5" / HLJ~A,e.o LAI<'E
3rl/9KoPEE /VJAI
City State
"' nnesota Tax I dent If I cat Ion No.: ~ ) :::;- <9 LJ / L)
Federal Tax Jdent I ftcat Ion No.: 411- )L,Lo 3 /) 9 I
If a "Innesota Tax Identification number Is not reQu1red, please explain
Apolicant's Name:
C--L?a/Z SE
. 12D.
55".:3?9
Z1p Coae
on tne reverse side.
4001 ~
SIQnature
c- ~~~ (~/
Posltton (OffIcer. Partner. etc.)
%0/9..3
Date
o
\5'
~ to.. 1""1
MINNESOTA DEPARTMENT OF PUBlIC SAFETY
UaUOR CONTROl DIVISION
ROOM 440 333 SIBlEY ST.
ST. ~UL. MN 55101
PHONE 812.298-8159
CERTIFICATION OF AN ON SALE AND/OR A SUNDAY lIaUOR LICENSE
ISSUING AUTHORITY (Check only one)
CITY OF ~0 .0 ic
LA/("E
COUNTY OF
~' ~tJ if
If . P."ne,ship. 5111. the Name .nd Add.... 01 Each P."ne,; II . COlpot.lion. Stll' the Neme .nd Add,... of Eoch 011_,
PlUITNEAIOfFICER NAME ADDRESS
PlUITNEAlOfFICER NAME
AOOAESS
""'RTNEAlOfFICER NAME
AOORESS
The Licensee must have one of the following:
~ONE
IY1 A. UqIJO( Uability Insurance (Dram Shop) - $50.000 per person; $100,000 more than one person; $10.000
property destruction; $50.000 and $100.000 for loss of means of support. ATTACH "CERTIFICATE OF INSUR-
ANCE" TO THIS FORM
011
o B. A Surety bond from a surety company with minimum coverages as specified above in A.
011
o C. A certificate from the State Treasurer that the Ucensee has deposited with the State. Trust Funds having a
market value of $100.00001 $100.000 in cash or securities.
I CERTIFY THAT THIS LICENSE WAS APPROVED IN AN OFFICIAL MEETING BY THE GOVERNING BODY OF THE CITY
OR COUNTY.
Given Under My Hand and the Corporate
CITYICOUNTY
Seal this
day of
19_
SEAL
During the past license year has a summons been issued under the UqIJO( Civil Uability
Law (DRAM SHOf'll 0 YES 0 NO If yes, attach a copy of the summons.
COMPlETE THOSE ITEMS T T APPLY
TlIANSACT10N 'IYP( NEW
o RENEWAL 0 TRAHSfER
DATI Of RE'iOCATIOHJCANCEUATION
o REVOKE/CANCEL
o SUSPENSION
AOORE55CHANGE FflOM
OATES SUSl'fN$lON
fflOM
TO
TlWISFER Of OWNERSHIP fflOM 1_ AND _551
IMPORTANT NOTICE
All RETAIL LIOUOA LICENSEES MUST HAVE A CURRENT FEDERAL SPECIAL OCCUPATIONAL STAMP. THIS STAMP IS ISSUED BY THE
BUREAU OF ALCOHOL FIREARMS AND lOBACCO, FOR INFORMATION CALL 612-290-3496.
.