90-1657 �� �� b
. � � ^t u.oGry:'1
I G� N A L � � ~�� ouncil File # D��l/5 /
0 R � � 3� '�
�i Green Sheet # 11548
RESOLUTION
F SAINT PAUL, MINNESO A
_ � �
Presented By
Referred To Co ittee: Date
RESOLVED: Th t application (ID ��79613) for renewal of State Class B
Ga bling License by St. Bernard's High Schoo at Triviski's,
17 So. Robert Street, be and the same is he eby approved%
�ii h���he following stipulations:
1) In addition to all other requirements of Section 409 of
the legislative code, St. Bernard's High School must sub-
mit the following to the License Divisio on a monthly
basis for the term of this license:
a) a financial statement on a form prov ded by the
License Inspector �
b) a check register with cancelled chec s
c) a banlc statement reconciled to the f'nancial
statement
G� !`�"t-j t ,�/9z�,�l�/
�
a Navs P,bsent Requested by epartment of:
smon
4w"�— License & Permit Division
on
acca e —
et �m
une
z son BY�
Adopted by Council: Date Form Approved by City Attorney
Adoption Certified b Council Secretary gy: , � (��/fd
By� Approved by M yor for Submission to
Council
Approved by Mayor: Date
By: BY• �
I
.. ' , _ , � * I!/���j/i1'7 / J� I��
l�`�i �1��I �
DEPARTMENT/OFFICE/COUNCIL DATE INITIATED NOi . 115 4 8
Finance/Licen G R E E N SH E T
CONTACT PEHSON 6 PHONE INITIAUDAT INITIAUDATE
�DEPARTMENT DIRECTOR �CITY COUNCIL
Christine Roz -298-5056 A8SIGN �CITYATTORNEY �CITYCLERK
MUST BE ON COUNCIL AQENDA BY(DATE) NUAABER FOR
ty C er ROUTING �BUDGET DIRECTOR �FIN.&MGT.SERVICES DIR.
4 /3 4D 9��j 90 ORDER �MAYOR(OR ASSISTAN'n ��� R
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION RE�UESTED:
Approval of a application for renewal of a State Class B Gambling License.
Hearing: �13�90 Notification:
RECOMMENDATIONS:Approve(A)or ReJect(R) PERSONAL SERVICE CONTRACTS MUST ANS ER THE FOLLOWING QUESTIONS:
_PLANNING COMMISSION _CIVIL SERVICE COMMISSION �• Has this person/firm ever worked under a contr t for this department?
_CIB COMMITTEE _ YES NO
2. Has this personlfirm ever been a city employee
_STAFF
- YES NO
_DISTRICT COURT _ 3. Does this erson/firm
p possess a skill not norma y possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVEI YES NO
Explaln all yes answers on separate sheet and ttach to green sheet
INITIATING PROBLEM,ISSUE,OPPORTUNITY Who,Whet,When,Where,Why):
Thomas Flood n behalf of St. Bernard's High School req ests City Council
approval of t eir application for renewal of a State C1 ss B Gambling License
at Triviski's 173 S. Robert Street. Investigative fee of $373.25 has been
submitted. P oceeds from the pulltab sales are used fo educational advancement.
ADVANTAGES IF APPROVED:
If Council ap roval is given, St. Bernard's High School will continue to
operate a pul tab booth at Triviski's, 173 So. Robert S reet.
The License D vision is asking that the following stipu ations be placed on
St. Bernard's gambling license at Triviski's:
a. A financi 1 statement on a form provided by the Lic nse Inspector
b. A check r gister with cancelled checks
DISADVANTAGES IF APPROVED:
c. A bank st tement reconciled to the financial statem nt
The applicant has agreed to these stipulations.
DISADVANTAOES IF NOT APPROVED:
REC�IVED Council Research Center
SEp Q4��� �E!a 311990
crr��� c��a�c .
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETE (CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) ��
< . � . , „
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO. 298-4225).
ROUTING ORDER:
Below are correct routings for the five most frequent types of documents:
CONTRACTS(assumes suthorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept.Grants)
1. Outside Agency 1. Department Director
2. Department Director 2. City Attorney
3. City Attorney 3. Budget Director
4. Mayor(for contracts over$15,000) 4. Mayor/Assistant
5. Human Rights(for contracts over$50,000) 5. City Council �
6. Finance and Management Services Director 6. Chief Accountant, Finance and Management Services
7. Finance Accounting
ADMINISTRATIVE ORDERS(Budget Revision) COUNCIL RESOLUTION(all others, and Ordinances)
1. Activity Manager 1. Department Director
2. Department Accountant 2. Ciry Attorney
3. Department Director 3. Mayor Assistant
4. Budget Director 4. City Council
5. City Clerk
6. Chief Accountant, Finance and Management Services
ADMINISTRATIVE ORDERS(all others)
1. Department Director
2. City Attorney
3. Finance and Management Services Director
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and paperclip or flag
each of these pages.
ACTION REQUESTED
Describe what the projecUrequest seeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the issue in question has been presented before any body,public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objective(s)your projecVrequest supports by listing
the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
PERSONAL SERVICE CONTRACTS:
This information will be used to determine the city's liability for workers compensation claims,taxes and proper civil service hiring rules.
INITIATING PROBLEM, ISSUE,OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is simply an annual budget procedure required by law/
charter or whether there are specific ways in which the City of Saint Paul
and its citizens will benefit from this projecUaction.
DISADVANTAGES IF APPROVED �
What negative effects or major changes to existing or past processes might
this projecUrequest produce if it is passed(e.g.,traffic delays,noise,
tax increases or assessments)?To Whom?When?For how�ong?
DISADVANTAGES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved?Inability to deliver service?Continued high traffic, noise,
accident rate?Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addressing, in general you must answer two questions: How much is it
going to cost?Who is going to pay?
- � � � , , C��D-/Gs�
DIVISION OF LICENSE PERMIT ADMINISTRATION DATE �la� 0 / �aa 9U
INTERDEPARTMENTAL RE IEW CHECKLIST Ap Processed/Received by
Lic Enf Aud
Applicant ��• v r S � SChOo�Home Address � �, r h
Business Name � YI (i1� Home Phone
Business Address � 3 �p. p �� Type of License(s) C �4SS � �
Business Phone � �.y� b /n L z.,
Public Hearing Date q 13 �a License I.D. � 7�1 ��3
at 9:00 a.m. in the ounci Chambers,
3rd floor City Hall nd Courthouse State Tax I.D. 4� �
Date Notice Sent; Dealer � ilJ
to Applicant
Federal Firearms 4� /U�,�}
Public Hearing
DATE INSPECTION
REVIEW VERFIED (COMPUTER) COrIlKENTS
A roved Not A roved
Bldg I & D �
til�
Health Divn. I
�[A- �
Fire Dept. �
N��- ,
Police Dept. ���' $ a `� 90
�
License Divn. gl�� q � D K e�,,.����s
� q
City Attorney g, �
F15�
ate Received:
Site Plan � a� b Q` / C�
To Council Resear h v��4 �` �
Lease or Letter �O Date
f rom Landlord o� �
Ci�y of �aint Paul �����"��
. � , Department of Finance and Managemeat Servi ces
Division of License and Permit Registrat on
INFORMATION RE UIRED ITH APPLICATION FOR PERMIT TO SELL PULLTAB � TIPBOARDS IN SAINT PAUL
(Class B Gambling Lic nse in Liquor Establishments - Renew)
1. Full and complet name of organization which is applying fo license
St. Be nard' s High School
2. Address wYr�re ga es will be held -
Number Street City Zip
3. Name of manager igning this application who will conduct, perate and manage
Gambling Games Thomas Flood Dat of Birth 1 1 -7-53
(a) Length of t e manager has been member of applicant org nization 8 Ve a rs
4. Address of Manag r
Number Street C'ty Zip
5. Is the applicant or organization organized under the laws o the State of MN? Y e s
6. Date of incorpo ation
7. How long has or anization been in existence? 10 0 y ea r
8. How long has or anization been in existence in St. Paul? 0 0 ye ars
9. What is the pu ose of the organization? Religious nd Educational
Advancement
10. Officers of app icant organization:
Name Steae� J. Martin Name Ru e t Strobel
Address� 97 W. eranium Ave Address 1 97 . Geranium Ave
Title C-E-O Dpg 10-4-52 Title Treas Dpg 12-20-30
Name Fr. Brenn n Maiers, OSB Name Edw rd Mielech
Address 197 W. Geranium Ave. Address 197 W. Geranium Ave.
Title Vice r s DOB 4-27-36 Title Secr tar DOB 6-14-48
11. Give names of o ficers, or any other persons who paid for ervices to the
organization.
Name Name
Address Address
Title Title
(Attach separate sheet for additional names.)
. � . � _ �y�-��s�
12.. Attached hereto s a list of names and addresses of a11 mem ers of the organization.
13. In whose custody will organization's pulltab records be kep ?
Name St, Berna ds Church Gara e Address 197 w. Geranium Ave.
14. List all persons with the authority to sign checks for disp rsal of gambling proceeds:
Name Sha�i C ch Name Thom s Flood
Address 1 1 6 W. Lawson Ave Address 6842 Oliver Ave. S
Member of Member of
DOB 8-1 -63 Organization? e� s DOB 1 1-7-53 Organization? yes
Name Kath Wil s Name 3ane Hanson
Address 3107 J ce Ct Address 255 W. Mar land Ave
9-21-56 Member of es 1 1-5-4 Member of
DOB Organization? �' DOB Organization? Ye s
15. Have you read a d do you thoroughly understand the provisi ns of all laws, ordinances,
and regulations governing the operation of Charitable Gamb ing games? ye s
16. Attached hereto on the form furnished by the city of Saint Paul is a Financial Report
which itiemizes all receipts, expenses, and disbursements f the applicant organiza-
tion, as well a all organizations who have received funds for the preceding calendar
year which has een signed, prepared, and verified by Sh ri �Cic h
19 W. Geranium Ave. St. P�,ul, MN 55117
Address
who is the of the applicant organization.
Name
17. Wi11 your organ zation's pulltab operation be operated/man ged solely by members of
your organizati n? yes XX no
� 18. Has your organi ation signed, or does it intend to sign, a consulting agreement or a
managerial agre ment with any person or company to assist our organization with the
pulltab sales d/or recording keepiag? yes no XXX
If answer is y s, give the name and address of the person nd/or company contracted.
Name Address
Name Address
If answer is y s, how will such a consultant be paid? (pe centage, flat fee, gambling
funds, general funds, etc.) Attach a copy of said contra t to this application.
19. Operator of pr mises where games will be held:
Name
Business Addre s 1 7 3 S. Robert St
Home Address 1641 Ford Parkway
�y�"�GS��
� 20. a) Does your org nization pay or intend to pay accounting f es out of gambling funds?
yes no XXX
b) If you do pay accounting fees, to whom will such fees be paid?
Name Address
DOB Member of Organization?
c) How are the ccounting fees charged out? (flat fee, ho rly, etc.)
d) What do you nticipate will be your average monthly ded ction for accounting fees?
21. Amount of rent aid by applicant organization for rent of e pulltab sales area:
$400 . 00 p r month
22. The proceeds of the games will be disbursed after deductin prize layout costs and
operating expen es for the following purposes and uses:
Ed cational Advancement
23. Has your organi ation filed federal form 990-T? - Nn If nswer is yes, please attach
a copy with thi application. If answer is no, explain wh :
Tax Exempt #41-0757844
Anp changes desired y the applicaat association maq be made on y with the consent of the
City Council.
t. Be nard' s i h chool
• 0 ganizat N e %
Date ` ,� C By: ��N
na er n ch ge of game
Organ tion President or CEO
' ' City of Saint Paul Page ! ��D//���
Departaent�of Flnanee and Managemenc Servieee
• . Diviaion oE Licease and Yermit Administrstia '
UHIFORM CHARITAbLE GAl4bLINC FINANCIAL REYOR?
Dafe 7,/1 R�A(1
1. Nams o Orgaaization St. Bernar �
2. Addr�a whsre Chsricabl� Casblic� is eondueeed � 7
3. Rapose for period cov�rin� 1 n L1 19�. ehsau`h 19�
4. 2ota1 umber of day� play�d 6 I[l0
5. Gro�� •ceipts Eor abov pariod t 1 2 9 , 9 4 6 . S 0
6. Groaa risa payoucs for abov• psriod (ineluda caah short) ; � �3 ,6 6 9 .9 2
7. N�c re eip�s - liae S minus lin� 6 ; - 26 r 276 . 58
8. Expenn s incurred in conduecins snd op�ricing saa:
A. Cr ss vas�s paid. Atcaeh vocksr liit vieh
ns �s, addreesas, gro�s va`es, nmber of hours 3 7 094 .25
vo ked, and amount paid p�t hour.
B. Re t for veeka = 2 r 8OO .00
C. L cen9a fee �
D. I surance ;
E. B nd =
P. D ehonorad checks noc recovered =
C. A eountSn� Expea�a =
H. ploy�rs F.I.C.A. s
I. P lltab Tax Paid to D�parta�ae oL Aa��nue ; 3 �422 . 5�
J. K nn. U.C. Tu ;
R. F dsrsl Exclsa Sax 3 Stasp =
L. S at� Ga�blia� Ta�c =
Ft. ?f scellaa�ou• Expensss. Identit7 th� a�aiac
a d eo vDos paid.
1 Western Bank : 1-5^ ��^--
Z Lucky Seven Gambls 3 ,629 . 44
� Wholesale Club s 313 . 32
�. Racy Printing s 49 .96
9. ioe F.�psa,s, 'm'cnL s 1 7 ,9 4 4 .4 2
' 8 , 332 . 16
10. N�t I o�s - lin� � aina� liaa 4 f
I1. Chec ook balaace be�iaaias of psriod s �
: 8 ,332 . 16
l2. Soca of llna 10 and 11
� 13. 'foca eontributions (fros aeuehsd vorksh��e) t 1 7 ��1 3 _ 1 7
14. Chec book b�lanc• ead of reportln` p�riod - 2 I$$� . O�
line 12 leaa lias 1� ;
�. � Vf .�i . ;nv�
, � • UNIFflRM CHARITABIc G�M6liNG �i�VANC iAl RE. OR i /�"lO��G`�rf
' I.AWFUI PURPOSc CONTRIBUTIONS • WORKSHE=T (.
Line #13 - To al Lawful Purpase Contributions. S
List be1 all checks written from gambling funds wh ch are
charitab e lawful purpose contributio�s. The total ollar
amounts f these checks must match the anrount claime in
line �13. Use additional sheets as necessary.
CHEC< # �7ATE PAYEE CHECK AMOUN PURPOSc
-
I• 1 11/29 St Bernard' s $2,500 .00 E ucational Advancement
2• 4 12,l19 " 1 , 100 .00 " "
3• _ 1 005 1 /1 8 " 1 ,000 .00 " "
4• 1007 1/29 " 500 .00 " "
5 • 1010 2/13 " 400 .00 " "
6. 1011 2/21 " 800 . 00 " "
7. 1012 2/27 " 500 .00 " "
8. 1015 3/12 " 800 . 00 " "
9. 1017 3/21 " 900 . 00 " "
10. 1022 4/17 " 700 . 00 " "
11. 1023 4/23 " 900 . 00 " "
12. 1024 4/29 � " 1 ,000 . 00 " "
13. 1006 �1/20 Eas� Side YMCA 113 . 17 10� Club
TOTAL CHECK AhDUNT S 11 ,213 . 17
NOTE: These exp nditurES wi11 be provided to CouncZl Members at your Council hearing.
Be sure t at your financial report is complete and acc rate.
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