89-1457 W111TE - C�TV CLERK
PINK - FINANCE G I TY OF SA I NT PA U L Council
CANARV - DEPAR7MENT
BI.UE - MAYOR F1Ie NO. _ /�7
Counci Resolution ����
C�
Presented By
Referred To Committee: Date ��`��
Out of Committee By Date
RESOLVED: That application (ID # 1429) for a State Class B Gambling
License by Cystic Fibr sis Foundation at Vogels Parkside
Lounge, 1181 Clarence t. , be and the same is hereby approved/
detrre�
I
COUNCIL MEMBERS
Yeas Nays Requested by Department of:
Dimond
�ng In Favor
Goswitz -
Rettman B
�he1�� � __ Against Y
Sonnen
Wilson
AUG � 5 Form Approved by City Attorney
Adopted by Council: Date . .
Certified Pass ouncil , t BY ��� ���
By
Approved �Vlavor: Date
AUG i 6 1989 Approved by Mayor for Submission to Council
By BY
�otiRi�� �'�� 2 n 1989 '
. � . , � � (,,��-��s�
DEPARTMENT/OFFICEICOUNqL � , DATE IN IATE
F- GREEN SHEET No. 4 3 8 6
CONTACT PERSON�PHONE IMITIAU DATE INITIAUDATE
�DEPARTMENT DIRECTOH �CITY COUNqL
Christine Rozek/298-5056 � � �CIT1'ATi'OFiNEY �CITYCLERK
MUST BE ON COUNqL ACiENDA BY(DATE) ROU71 �BUDOET DIRECTOR �FIN.A MOT.SERVICES DIR.
B-ZS-H9 �MAYOR(ORA3313TMIT) Q Cnunril R
TOTAL N OF SICiNATURE PA6E3 (CLIP L L ATIONS FOR SIGNATURE7
ACi10N REQUESTED:
Approval of an application fo a tate Class B Gambling License.
Notification Date: 7-18-89 Hearing Date: 8-15-89
RECOMMENDATIONS:Approve(A)a Rsject(R) COUNCI CO MITTEElRESEARCH REPORT OPTIONAL
-PLANNINO COMMIS810N _CML SERVICE COMMIS310N ��YST PHONE NO.
_CIB COMMITTEE _
COMME 8:
_STAFF _
_DISTRICT COURT _
SUPPORT3 WHICH COUNqL OBJECTIVE9
INITL4TIN0 PROBLEM.IS8UE.OPPORTUNITY(Who,What,Whsn,Where,Why):
Paul Schleicher on behalf of C st c Fibrosis Foundation requests City
Council approval of their appl'ca ion for a State Class B Gambling License
at Vogels Parkside Lounge at 1 81 Clarence. Proceeds from the pulltab
sales will be used for medical re earch and care centers for Cystic
Fibrosis patients. All fees a d pplications have been submitted.
ADVANTAGiES IF APPROVED:
If Council approval is given, he Cystic Fibrosis Foundation will operate
a pulltab booth at Vogels Park id Lounge.
This will be the second locati n or the Cystic Fibrosis Foundation, a large
organization. They currently av a pulltab location at Patrick McGovern's,
225 W. 7th Street.
DISADVANTAOES IF APPROVED:
DI8ADVANTAGES IF NOT APPROVED:
Counc�i F�esearch Center
JUL 2�c i�89
TOTAL AMOUNT OF TRANSACTION = COST/REVENUE BUDOETED(CIRCLE ON� YES NO
FUNDIN(i SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN)
i o ♦ �' ' .. .
\
NOTE: COMPLETE DIRECTIONS ARE INCIUDED IN THE C3REEN 3HEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO.298-4225). ,
ROUTING ORDER:
Below are preferred routings for the flve most frequent types of documents:
CONTRACTS (asaumes authorized COUNCIL RESOLUTION (Amend, Bdgts./
budget exists) Accept.Cirants)
1. Outside Agency 1. Department Director
2. Initiating Department 2. Budget Director
3. City Attorney 3. Ciry Attorney
4. Mayor 4. MayoNAssistaM
5. Finance&Mgmt Svcs. Director 5. Ciry Council
6. Fnance Axounting 6. Chief/iccountaM, Fin&Mgmt Svcs.
ADMINISTRATIVE ORDER (Budget COUNGL RESOLUTION (all othera)
Revision) and ORDINANCE
1. Activiy Maneger 1. Initiating DepanmeM Director
2. DepertmeM AccountaM 2• City Attornsy
4. Bud�Directo�or 4. Ciry Cou��t
5. City Clerk
6. Chief AccountaM, Fin&Mgmt Svcs.
ADMINISTRATIVE ORDERS (all others)
1. Initiating Depertment
2. Cfty Attomey
3. MayoNAasistant .`
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and paperclip
each of these pages•
ACTION REQUESTED
Describe what the proJectlreque�eeeks to accomplish in either chrp�0logi-
cal order or order of ImpoRance,whiche�rer is most appropriate for the-
issue. Do not write complete sentences. Begin each kem 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 projecUrequest supports by listing
the key woM(s)(HOUSING, RECREATION, IdEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET, SEWER SEPARATION).(SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
COUNCIL COMMITTEE/RESEARCH REPORT-OPTIONAL AS REQUESTED BY OOUNCIL
INITIATIN(3 PROBLEM, ISSUE,OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request.
ADVANTAC3ES IF APPROVED
_Indicate whether this is simply an annual budget procedure required by Iaw/
chaRer or whether there are speciflc wa in which the Gry of Saint Paui
and its citizens will beneflt from thia pro�ecUaction.
DISADVANTAGES IF APPROVED
What negative effects or major changes to exiating or past processes might
this projecUrequest produce if it is passed(e.g.,traffic delays, noise,
tax increaaes or aaseasments)?To Whom?When4 For how bng?
DISADVANTA(iES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved?Inabflity to deliver ae►vice?Continued high traffic, rwiae,
accideM rate? Loas of revenue?
FINANqAL IMPACT
Akhough you must tailor the information you provide here to the isaue you
are�dressing, in general you must answer two questions: How much is it
going to coat?Who is going to pay?
. . . . . . ��- ����
. �
DiVISION 0 LICENSE AND PERMIT ADMINIS RATION llATE � R �I / �Q Ti0 g�
INTERDF.PARTMFNTAL REVIEW CHECKLIST , A.ppn r essed/Received by
' Lic Enf Aud
A licant ` �j � I -[3� ��-� �1r0�
pp (� � �p5 S Home Address
Rusiness Name � I,JQ ��s /�Sr ! �Home Phone lP gt � 7 �� oZ
i �
Eusiness Address r � C�V�QhCQ� Type of License(s) ��q�5
p 'I �
Business Phone �~] (— 075� �„� �`lQ/-n cj��►'1( �IC.Q//'1S�
Public Hearing Date g ��� License I.D. 4F �-����
at 9:00 a.m. in the Counci Ch mbers, ���
3rd floor City Hall and Courthouse State Tax I.D. �t
llate Nutice Sent; Dealer 4� �J ,�"
to Applicant ��
Pederal I'irearms �� � '/�
Public Hearing
DATE TI�SPE TIUN
REVtEW VERFIED (CO UTER) CUMMENTS
Approved 'No A roved
�
Bldg I & D �
� � , ''
Health Divn.
' N �� �
�
Fire Dept. �
� N �, �
�
Police Dept. I s��'���4 �a
` � ��� � � o ��.
�
License Divn. '
� ,,��, � �%
City Attorney �
� �r� ' � K-
Date Received:
Site Plan � �
To Council Research � (
Lease or Letter D te
from Landlord �
. . . �c�C_��s7
City f Saint Paul
Department of Fina ce and Management Services
Division of Licen e and Permit Registration
INFORMATION RE UIRED WITH APPLICATION FOR PERMIT TO CONDUCT PULLTAB/TIPBOARD SALES IN
SAINT PAUL (Class B Gambling License in iquor Establishments - New Application)
1. Full and complete name of organizati n which is applying for license
b �s-,
2. Does your organization meet the defi ition of a "large" organization as outlined in
the November, 1988�revision of Secti n 409.21 of the Legislative Code? eS
Attach to this application pertinent financial and/or organizational info ation to
support your answer to this question NOTE: Only 5 large organizations will be allow-
ed to open pulltab operations under he revised city ordinance. If more than 5 organi-
zations apply, qualified applicants ill be selected randomly by the City Council.
3. Address where games will be held C r S 5 (o
Number Street City Zip
4. Name of manager signing this applica ion who will conduct, operate and manage
Gambling Games � J�, Date of Birth (p
(a) Length of time manager has been ember of applicant organization eq y
S. Address of Manager S� t' �GC c�
Number Street ty Zip
6. Day, dates, and hours this applicati n is for �j - {,�✓��/����_/�:3da,,n,�
7. Is the applicant or organization org nized under the laws of the State of MN? _��
8. Date of incor�oration ..�v�n �
9. Date when registered with the StaCe f Minnesota /'l0✓_�W1� l�,�s
10. How long has organization been in ex stence? 3 y t�,Q�„r�
11. How long has organization been in ex stence in St. Paul? (�� ��„ �°S�. v��',Q,
12. What is the purpose of the organixat on? ��-��� ���,rQ�,,� (,vy� �' ,•,� ��
C � ` �i (�
13. Officers of applicant organization:
Name � {� Name �p� �.�lj' l/j
1Q�yy�l ?ri�� kG� 51'1 �I..�vriaric �r;�
Address Address E�Q,��.�,o•, /{'1i!/' S5N_35
Title �r go�d� DOB () � Title �p�,,,r�N�DOB �V //
Name Name
3yo1 K�n Cv�.,.-1-
Address } s � 7 Address
Title i�OCsYr� /�/�-aw►�✓ DOB '7 a1 Title DOB
- . . � . � � �r/,�-- ���
14. Give names of officers, or any other persons who paid for services to the
organization. � _
Name Name
� Address Address
Title Title
(Attach separat sheet for additional names.)
15. Attached hereto is a list of name� a d addresses of all members of the organization.
16. In whose custody will organization's records be kept? Lvr`�� �� K U��Q �L,/_
���
Name �(.,fL,� Address L��J Cx.1t G rou-� Q ��v
/lit��n e�pa/;s� �,y ssvv.�
17. List all persons with the authoriCy o sign checks for dispersal of gambling proceeds:
Name � C S Name
Address �3 � ��e�$ Covr-f � �SY� (oy Address
Member of Member of
DOB !� Organization? DOB Organization?
Name Name
Address Address
Member of Member of
DOB Organization? DOB Organization?
18. Have you read and do you thoroughly derstand the provisions of all laws, ordinances,
and regulations governing the operat n of Charitable Gambling games?
19. Will your organizatfon's pulltab ope tion be operated/managed solely by members of
your organization? yes no
20. Has your organization signed, or does it intend to sign, a consulting agreement or a
managerial agreement with any person r company to assist your organization with the
pulltab sales and/or recording keepi ? yes no x
If answer is yes, give the name and a dress of the person and/or company contracted.
Name Address
� Name Address
If answer is yes, how will such a con ultant be paid? (percentage, flat fee, gambling
funds, general funds, etc.) Attach a copy of said contract to this application.
2I. Operator•af premises where games will be held:
Name d e '- t,J S
Business Address � C G.� �. . �t/� O(o
Home Address a`Z�o(v Z c.J
SG��j �N SSIb g
. . . . . ��s��s�
22. a) Does your organization pay or int d to pay accounting fees out of gambling funds?
yes no
b) If you do pay accounting fees, to hom will such fees be paid?
Name Addzess
DOB Member of 0 ganization?
c) How are the accounting fees char ed out? (flat fee, hourly, etc.)
d) What do you anticipate will be y ur average monthly deduction for accounting fees?
23. Amount of rent paid by applicant org nization for rent of the hall:
`� � o 0
24. The proceeds of the games will be �di bursed after deducting prize layout costs and
operating expenses for the following purposes and uses:
�.�.` �
25. Has the premises where the games are to be held been certified for occupancy by the
. Citq of Saint Paul? s
26. Has your organization filed federal orm 990—T? If answer is yes, please "attach
a copy with this application. If an wer is no, explain why:
Any changes desired by the applicant a so iation may be made only with the consent of the
City Council.
�C. i OS�S 4
Organization Name
� l /
Date By: , �� i,11.C��
Manager in charge of game
�
Organization President or CEO
, . _ TO BE COMPLETED BY THE ORGANIZATION C�j,�'��`�S'J
. MINNESO TA7C IDENTIYICATION NUMBER O �
Pursuant to Lavs of Hinneeota. 1984, pter 502. Artlele 8, Seetion 2 (270.72) (iax Clear-
anee; Is�uanee of Lic�nsas), licen�ing uthoriti�i ar� required to provide co the yinn�sota
Co�iasion�r of Revenue the riinnesots b siness tax identification nuuber and ehe eoeial
saeuriCy nusbet of each Lieense apPlie t.
Undar th� rilnnesota Cov�r�ant Data Pr tice• Act aad che Federal Privacy Aet of 1974, ve
ara requlr�d to advis� you ot th� Eoll ing rsgarding tM usa of thls Snformation:
l) This inEormaeion may b� usad to d� th� issuaaee or reneval of your licent• !n che
ev�nt you ov� Minn�sota eal�a, mp •r's vithholding or motor vehicle excise eaxes;
2) Upon teceiving this Lnformatlon. C lie�naing authority vill supply !t only eo the
Minnasota Dapartnent oE Revenue. v�r, und�r the Federal Exehang� of Informatlon
Agr��ent ths Depart��at ot Rereau say supply thi� inforsatlo� to the Internal Revenue
Service;
3) FAILURE TO SUPPLY TNIS INFORMATION ILL JEOPARDLZE OR DELAY 'fHC PROCESSING OF YOUR
LICENSE LSSUANCE OR RENEiIAL APPLIC ION.
Mian�sota Tax Ind�neification dumb�zs i •le� 6 U�� 1'ax Nusb�r) may be obeained froa ehe
Stat• of lllnnesota - Business Recotds partm�nt - 10 Itiver Park Pl�za. Phone: 296-2863
Appiieanta Laat Nama First Naee Hiddle Initial
Applieants Addreas ity, Seau, 21p Code Phone No.
Applieants Social Security No. Position (Offie�r, Partn�r, ete.)
Bu�in��� Nam�
Bustnens Addresa ity, State, Zip Code Phone No.
Hinnsaota Tax Id�ntifieation pumb :
(Lf a ![innesota iax Identificacio Nusb�r is not required for tha `r"—'
business b�ing operat�d, indleat th�t by plaeins an R Sn tha bo:.)
��+H�►*r�*r,►�,►,t r*w,►**�w*�,►*,►tr�*:ie��: :,t�w,t,►��►�***,t�rf��3**,t�*r*�i::,e,t�e�+r�ti**,►�e�����*i*►�
- i -- � -- —
WO R$' COl�ElISATIq(
Pursuanc �o ehe Minnesota Stat� L� isl ur� by Chapter �32, Sectioa 47, Lava of 1987, every
scat• and loeal liaensing ageney i req ir�d to rithhold th� issuance or renaval of a
11e�ns� or pecsit to op�rat• a bu� eass ia Minn�iota uutil eh� applieant psesents accapc-
abl� �vid�a¢� of coaplianes vith t • vo k�r�' co�p�n��tioa in�uranee covarage requireaanes
of Ssetioa 1�6.181, Subdiviaioa 2.,
?his lator�tion i� r�quir�d by 1 , an lie�na�� aad p�csit■ to op�rat• a bu�in�rs may noe
b� is�u�d or ranav�d if it ii noc�rovi ed aad/or 1� Eal��ly report�d. Furch�rmore, if ehe
infoceation is not provided nM/or'fals ly report�d, !t �ay r�sult !n a 31,000.00 penalt°
a���s��d a`ainst th� applieant by Ch� s�ioo�r ot ts� D�p�rta�nt o[ Laboe end Industry
parabl� �o che Spacial Co�p�nsacioa Fu
Upoa request, licensing authoritie� ar reauir�d to fnrni�h votk�rs' eomp�nsation insuranee
covera`e inforsatlon to th� D�parcf�ent E Labor and Iadnstry co eheek for eosplianee vith
ltien�soca Statut• Section 176.181, Sub vi�ion 2. �
An� qu�stions regarding votker�' co�p� atioa should bs dlreet�d to eh� Hinnesota D�paztment r���� �
o! Labor add Industry - Sqecial Fupd Se tion - 297-477T. `
�,�� w ���s�- �-a` ��
Lnwrane� Co�pany Naa �p
(NO2 th� lnsuranu a`ent) �r �s �"1'� i1�'65y3 /.
Poliey N�Mr ot S�lt-Insuraae• Petsit u�ber L (� �' �
Datas oE Coverag� Effaetive: �` Expiration: �
- OR -
I a� noc cequir�d to hwve vork�rs';c nsation liability eov�rag� Deuus�:
( ) I hav� no e�loy��• eovez�d by th� lar.
( ) Other (Specify)
I NAVE READ MID LRID6RSTAND HT RIGHTS OELIGA'fIONS fiITB REGARD TO 6USINESS LICENSES.
PERMI2S, AIfD 1tORKERS' COl�ENSATION'CO E. AND I CERTIYY '17IAT 17tB INFORlMTION PROVIDED
LS TRUE AND CORRE
6"Zo -�f �.
sign tur• dat•
, . _ . � C��" iy�?
TO BE OMPLETED BY
ORGANIZATION PRESID NT AND GAMBLING MANAGER
I understand and will uphold Sain Paul Ordinance 409, Sections 409.21
and 409.22 relating to pulltabs a d tipboards in bars.
Further, I understand that my jar ar must�meet city standards; that 10%
of the net profit from pulltab sa es must be returned to the City-Wide
Youth Fund on a monthly basis; th t monthly financial statements must be
filed with the City; and that 1� of net proceeds must remain in St. Paul
or be used to support St. Paul re idents.
;�� -
Signature - Manager
ignature - Organization Presiden
� ,
� '
rga za �on ame - �
`cxu C Gv-�'wt.� S�-, �� 'L1N SS/06
Gambli g Location ,
Date
Please retain the a tached ordinance for your records.
� . - � � . - � ���-����
State of Minnesota )
) ss
County of Ramsey )
-.:. 1
� y S
being duly sworn, say _that he is
(are) the petitioner _in tfhe above appli-
cation; that he has �ea the forego-
ing petition and know the cont nts thereof;
that the same is true of _t�_ own knowledge.
Subscribed and sworn to bef�re me this
��� day of 19 �
�
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I Miy 1;� � J4 '
rv��rvwvvwvvwvv+nn�n �n�wvwwwvw��
. - � I
Notary Pu Iic, Ramsey Countx,G n esota
My commission expires � "!