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00-1149ORIGINAL Presented B} Refened To RESOLUTION Council File # 00 �-11 y4 Green Sheet # �Q � 99�1 2 RESOLVED, that the Massage Practitioner's license (License ID No. 990005749) held 3 by Gina Boots and located at 14334 Utica Avenue South, Savage, Minnesota is hereby 4 suspended until the licensee (1) submits payment of the license renewal fee, (2) provides proof 5 of general and professional liability insurance, and (3) provides proof of affiliation with a City of 6 Saint Paul licensed massage center or state license health facility, to the City of 3aint Paul 7 licensing office. This Resolution and the action taken above are based upon the facts contained 8 in the October 24, 2000 Notice of Violation letter to the licensee. The licensee does not dispute 9 the facts of the violation. Requested by Department of: Adoption Certified by Council Secretary ay: Apps By: B Y � lu/ /isa X � Form Approved by City Attorney � By: G " itt-LC � � Approved by Mayor for Submission to Council By: CITY OF SAINT PAUL, NIINNESOTA ...� Adopted by Council: Date t]e.e.. ��J �d-oGa GREEN SHEET Virginia Palmer 266-8710 T BE ON CWNCILAGBJON BY IDAT� December 13, 2000 - Consent TOTAL # OF SIGNATURE PAGES m�e..e�.o.w,a ao - l 1Y,9, No 105994 � m.��. ❑ arcw*mear ❑ arcucu ❑ wu�cu�a�eiaoa ❑ wurouaunmeero �wvaie�enamiwnl ❑ (CLIP ALL LOCATIONS FOR SIGNATURE) Resolution suspending the Massage Practitioner's license held by Gina Boots at 134 Western Avenue North. PIANNING CAMMISSION CIB COMMITTEE CNIL SERVICE CAMMISSION ITAGES IF APPROVED ITAGES IF NOT APPROVED I�UM OF TRANSACTION S SOURCE �oawaiotr (owwM Hee mre pew«�rxm everw«wee uiaer a� toraac aepamnenrr VES No tles thb D�sorJfirm e�er been a dlY anWoYee7 YES NO Doec this D��m D� e sldN not tarmallYO� M' �Y �urtent dA' emWoYee7 YE3 NO b Mis pe�awJfirm a tarpefetl verdoY7 res nw yain an Vea anawe�s m semrafe she� aM aKeeh ro arcen ahcet COtTIREVENUE BUDQETED (GRCLE ON� I_�d i i7i i J`PI' �=3 �:1 YEE NO r CITY OF SAINT PAUL Norm Colemnn, Ma}•or November 21, 2000 OFFICE OF THE CITY ATTORNEY Clnyton M. Robiuon, Jr., Ciry Altorney b �� tu q {. cr.�rt o«�rsro„ 400CiryHal! Telepl+one:651266-87l0 /SWestKe!loggBlvd. Fnaimile:6.i1298S6/9 Saint Paut, Minrsuom 55/02 NOTICE OF COUNCIL MEETING Gina Boots 14334 Utica Avenue South Savage, Minnesota 55378 RE: Massage Practitioner License # 990005749 Deaz Ms. Boots: � ,s. � A � :s'°.. ^.�3G4°'.. . ^�.�.. As�rs ;�e � U�.`�� G�c �.: 4' �' � Please take notice that this matter has been set on the Consent Agenda for the Council meeting scheduled for 3:30 p.m., Wednesday, December 13, 2000 in the City Council Chambers, Third Floor, Saint Paul City Hail and Ramsey County Courthouse. Enclosed are copies of the proposed resolution and other documents which will be presented to the City Council for their consideration. This is an uncontested matter in that the facts contained in the Notice of Violation concerning the failure to pay the license renewal fee, provide proof of insurance, and provide proof of affiliation have not been denied. The recommendation of the license office will be for the suspension of your license. If you have any questions, please call me at 266-8710. Very truly yours, �� L C'� Virginia D. Palmer Assistant City Attorney cc: Nancy Anderson, Assistant Council Secretary Robert Kessler, Director, LIEP Christine Rozek, LIEP ao- � ►y.q UNCONTESTED LICENSE MATTER Licensee Name: Council Hearing Date: Violation: Gina Boots Wednesday, December 13, 2000 (1) Pay license renewal fee, (2) Failure to provide proof of general and professional liability insurance coverage for September 30, 1999 - September 30, 2000 license period (3) Failure to provide proof of affiliation from a City of Saint Paul license massage center or state licensed health facility Recommendation of Assistant City Attorney on behalf of client, Office of License, Inspections and Environmental Protection: Suspension of massage practitioner's license Attachments: 1. Proposed resolution 2. Notice.of Violation 3. License Information Report 4. 9/1/00 letter from Christine Rozek to Gina Boots 5. License information CITY OF SAINT PAUL Norni Colemnn, hIn}�or October 24, 2000 OFFICE C�F THE CITY ATTORNEY Clnylors M. , Jc, Ciry Attorney 00-►1�1g Civil Dicision 400 Ciq• Nnll Telephone.� 651166-87/0 lSWUtKe!loggBh�d_ Fncsimile:651393-56/9 Snint Pme{ Nlinnesota 55101 NOTICE OF VIOLATION Gina Boots 14334 Utica Avenue South Savage, Minnesota 55378 RE: Massage Practitioner License # 990005749 Deaz Ms. Boots: The Office of License, Inspections and Environmental Protection has recommended adverse action against your massage practitioner's license. The basis for the recommendation is as follows: Your license expired on July 26, 2000. You were advised that you needed to pay the $66 renewal fee for your license, provide proof of insurance and proof of affiliation with a City of Saint Paul licensed massage center or state licensed health facility by September 11, 2000. No response has been received, nor have renewal fees been paid. If you do not dispute the above facts, you must submit proof of insurance and proof of affiliation along with payment of the license renewal fee to the licensing office by Wednesday, 1Vovember 1, 2000 to take care of the matter now without any further action. If you w�ish to dispute the above facts, I will schedule an evidentiary hearing before an Administrative Law Judge (ALJ). If you cvish to have such a hearing, please send me a letter stating that you are contestin� the facts. You will then be sent a"Notice ofHearing," so you wi11 know when and where to appear, and what the basis for the hearing will be. Please let me know in writing no later than Wednesday, November 1, 2000 ho�v you would like to proceed. If I have not heard from you by that date, I wiil assume that you are not contestin; the facts. The matter will then be scheduled for the St. Paul City Councii and placed on the Consent Agenda during which no public discussion is ailow�ed and the recommended penalty, the immediate suspension of your license untii the information is provided and the license fee paid, will be imposed. Page 2 GinaBoots 00 —\1y`� October 24, 2000 If you have any questions, feel free to call me or have your attomey call me at 266-8710. Sincerely, -/ �� 1�� ,� �`^ Virginia D. Palmer Assistant City Aftorney cc: Gina Boots, 134 Western Ave. N., St. Paul, MN 55102 Robert Kessler, Director, LIEP Christine Rozek, LIEP co-��y`� STATE OF MINNESOTA ) ) ss. COUNTY OF RAMSEY ) AFFIDAVIT OF SERVICE BY MAIL JOANNE G. CLEMENTS, being first duly sworn, deposes and says that on October 24, 2000, she served the attached NOTICE OF VIOLATION on the following named person by placing a true and correct copy thereof in an envelope addressed as follows: Gina Boots 14334 Utica Avenue South Savage, MN. 55378 Gina Boots 134 Western Avenue North St. Paul, MN. 55102 (which is the last known addresses of said person) and depositing the same, with postage prepaid, in t�ited States mails at St. Paul, Minnesota. � � � � �� G\ CLEMENTS Subscribed and sworn this 24th da f O �' �-- //�Ci Notary Publ to before me be� 2000. PETER P. pANG80RN NOTARY PUBLIC - MINNE90TA MY COMMI5510N EXPIftES JAN. 31. 2065 ao. \\�l`� � � 0 a X W `� � o � �' o .- � o d V N � J � �p N a � _o N � O � � C N N C7 N � � c � C U '� � J � R � L � C d N C d d _c U p J m " � U Q @ � a � � N � C � U N N J � 0 o — N a o E a� � � � Z � 4�i O U � J � � � � Z W Q Z K N W N ~ "a W a ¢ � o M � � � N F z O m Cf1 Q � Z _ C9 N � E F m � Z 0 C m O � ¢ � Z — � U c � 0 U U y � � o � N � Q x W o N � C � – N m N � O N � � � Z T U d t`') a� r U 0 � o m N y N c_U m F E – @ Z Z � >+ W c � �. Z � W o U V z � m a W w U c U _ Q N � � � Z N � O O � L � a o � N " o N � C � � � m � � � N �`] F- o v _ V N C O a C, O U y c N � E' O U G � O _ Q � U � m a N � C X O Q N a c�o U � � � � V O �n O – - m @a�i�> � p y�W U �— N U �� L y -� C @ O"ON N Z O,.. c6 3t � �' C � m W O �s c� Q ¢ �a�is z Ud�� U W H �u F.., oocqZo � ooZ�o W NNrnrn� � �ON� � M O�N� � _ _ � _ �0��'O OFFICE OF LICENSE, INSPECTIONS AND ENVIRONMENTALPROTECTION C'O��I�� Rober[ Kusler, Dirutor CITY OF SAINT PAUL Narm Co[emnn, Mayor September 1, 2000 19990005749 Gina Boots 14334 Utica Ave S Savage MN 55378 LOWRYPROFESSIONALBUTLDING Telephone:651-266-9090 Suire 300 F¢ccimile: 651-266-9099 350 St Peter Street 651-266-9114 Saint Pau1, Minr+esota S�102-I570 RE: Expired License and Expired Certificate of Insurance Deaz Licensee: tlfter reviewing your business license for Massage Practirioner at 134 Westem Avenue North, our office has determined that your certificate of insurance and License has not been renewed. In order to remove the hold that has been placed on your license, the following requirements must be met: Pay your 07/26/2000 - 07/26/2001 license renewal fee of $66.00. Submit proof of general and professional liability insurance coverage during the period of 07/26/2000 through 07/26/2001. (Proof should not have a lapse in coverage. If there is a lapse, a letter should be submitted stating that you were not performing massage therapy during the lapsed period.) Submit proof of affiliation from a City of Saint Paul licensed massage center (commercial or home location) or state licensed health facility. You have until Monday, September 11, 2000 to respond by submitting the required paperwork and/or payment. If there is no response by Monday, September 11, this office will begin the administrafive hearing process to suspend your license unril all requirements are met. You have the opportunity to appeal the City's decision through this proceeding. If you have any questions, please contact Corinne at 651-266-9106. Regazds, �� Christine Rozek LIEP Deputy Director CAR/caa License Group Comments Text Licensee: GINA BOOTS �BA� GINA BOOTS License #: 1g990005749 tOT79/2000 To CAO for a verse acUon. CAR 09/01/2000 letter sent for delinquent lic and exp ins. CAA 12-2-99 NSF check paid in fuII.ES 1130-99 NSF check #2461 received for $66.00. Totai amount due 581.00.ES '10l79/2000 ao-�►4�. �6 �114`� Address Licensee � Contad � License � Cardhoider ( Licensee Name: INA BOOTS DBA Ssles iaz Id� � �� m �� „_`..:�.�,d. '�i`� � �� _...'s" r�- �.a-.�_—:..�-..,.'a�� ,:, �r�.. ��. tZ73 Oo -1t�{9 Lice DBP Sale ; �'°� �"' '�''�°�}"" � �4� Licensee INA BOOTS i ��"`� � `' ''�� "�' � " DBA INA BOOTS License � Licensee � Lic. Types � Insurance , Bond , RequiremeMS � i�° Property �' Licensee L" Unofficial Projec[ Facldator. ASUNqON, CORINNE � � t Street #; _ 34 _ Adverse Adion CommeMs � Street Name: STERN j Street Type: AVE Diredion: d — Unit Ind: r Unit #; r � Cdy: T PAUL , License Group C omments: �! OM 92000 To CAO for adverse action. CAR ; i SYffie: riN Zip: 55102 A� n000letter serR tor definqueM lic and exp ins. Ward: � Dist Council: �8 2-2-99 NSF check paid in fuII.ES __ _ �-3Q99 N5F check #2461 receiv f or $66.U�. Total ,__ __-- _ _._ �� Licensee: INA BOOTS Licensee � _... ..... _ .._.. _ _. �..... _..___._, DBA: ,itin annrs CommeMs: . ��,'�' � Sales Tax '�Ei" eei "'�`-- 4�e=� � MassageF ; License # � �.i 4 Bus Phone:�651) 602-0350 �ner R 09CLOM999 i 07J2672000 _ _ .__._ .____�..��,___..._.._..�.._. ______. -- - - _ __.—_ --- �-'------�- - —Tatal:- — TA9 _ Save Changes to History � N � 886.00 __ _ s _ __ $66.00 � 1218Phi oc - ��'�`l � Adtlre _. p V � e . . Licensee INA BOOTS �^�,'.:..�rA°^^ .. , . �-.:'.,'.s°-.°°.• DBA WABOOTS DBP� Sale� License i Licensee � Lic.Types Nsurence � Bond lRequiremeMs1 � License 7ype: assage Aract3iwier lnsurance Type: �Profe Policy #: L2�: , Company; CCEP� Address: �� Phone #: �_ Effedive: � Expiration: � CoMinuous _ + Citq fnsured i , E INDEMNITY INS CO �� 1 af 1 �. TR7M 999 Liabildy Lfmi[s Insurance Rec'd 7/LGROpp �r$ 1,000,000 - Ed,qi OCCURRENCE Deys Ta CanceF. r 3,000,�00 - PROF & GENERAL AGG Canceled: � : Cancel Rec'd: Agency. SSOC 80D`MlORfC & MASSAGE PROF ' Address 8677 BUFFALO PARK RD, E YERGREEN, C O 80439-7347 Phone #: 303J 674-8478: � Contact OBERT GIBS � , {� . � I'.,� ��,�'.�,�� License # 90005749 30 Save Changes to History 1 of � 72:18 PM aa -ti�� Lice DBP Licensee INA 600TS DBA INA BOOTS Sale License Licensee � Lic. Types l Insurance � Bond � ReqUiremeMs � b `:r. �.-,�..�..,.- Licensee Name: INA BOOTS :r:.rB�y}�_r.,_, OBA: INR BOO7S , , Sales Tax Id; 440314 I+kn-Profd: r dVaker's Comp: 'D000 .,-��,.�� ' �� AA Corrtrad Rec'd: Ott10n0000 Ad Train'u�g ReCd: OR7010000 � AA Fee Calleded: OA70�0000 , Discourrt Rec'd: (- . ` Other A ency Licenses Financial Hold Reasons " _; :�� .. s��f��ti��°."�S�€i�G,��l� Y„��4`e'�._�� 'p ° �' "°' k��i t 9.' �..��''�$��*��t'��.'�'''�'�4:��a�,S:� t_'e�'.. , NSF ;N �11f30f1999 �„ MaBTo OONONOOUOONO+UOO�.BOOTS _ GINA µ__ C2i7R:7 -' ---�------ -- Background Check Requtretl [ ��;� Save Changes to History License # -Mail License To: -- i t` Mail Ta Contact �� f"' License Rddress L —___. __�__� -Mail Invoice To: ---; � � Mail To Corrtact ' t' License Address ' 12:1 S PM oo- �i�`1 Invoice ❑ Cfieck this box if making any name, mailing address or phone # correctians. Please write the changes on fhis form. If your business license address is changing, please request a new business license applicatio�. September 27, 2000 To: GINA BOO'fS '14334 UT1CA AVE 5 SAVAGE MN 55378 CITY OF SAtNT PAUL O�ce of License, lnspections & Environmental Protection 350 St. Peter Street, Suite 300 Saint Paul, MN 55102-1510 PHONE; (651)266-9090 FAX: (651) 266-9124 Invoice # : 25Q243 Invace Due Date: Upon Receipt Account8alance: 587.00 Pay this Amotfit: $87.00 HOME PHONE :612-447-3392 BUS�NESS PHONE : 651-602-0350 Transactian Description lnv: 238291 990005749 Massage Practitioner Expires: 07/26/2000 @ 134 W ESTERN AVE N inv: 245343 Late Fee 7-30 days late {10%) inv: 247319 Late Fee 31-60 days late (10%) Late Fee 61-90 days late (10%) Requirements Transaction Total 66.00 7.00 7.00 7.00 Your accrount is overtlue. Please mail payment today!! Submit proof of affiliation from a City of Saint Paul licensed therapeutic massage center (commercial or home locaYion); or, state licensed heaith facility {ie. physician's office, chiropractors office, nursing home,...j. Ali centers must be located within the City of Saint Paui. Submit insurance certificate showing coverage of $1,000,000 general liabilify and $1,000,000 professional liability; with the City of Sainf Paul named as an additional insured and a 30-day notice of cancellation. Insurance certificate forms must be made out in the name that the Iicense is in and show a policy number. The license expiration date will run concurreni with the insurance expiration date. DOG L/CENSE AND COMPETENCY CARD RENEYYALS DO NOT NEED TO COINPLETE THE WORKERS COMPFNSA770NlNFORMATION �1 FOR BUSINESS LICENSE RENEWAL ONLY: CERTIFICATIQN OF WORKERS' COMPENSATION COVER,4GE PURSUANT TO MiNNESOTA STATUTE §176.186 I here6y certity that i, or my campany, am in compiiance with the workers' compensation insurance coverage requiremenis of Minnesota statute §776.182, subdivision 2. I also understand that provision of false informa8an in this cer6fication constitutes sufficient grounds for adverse acfion against all licenses held, i�cluding revocation and suspension of said licenses. Name of insurance Company: Policy Number: Coverage from to Remit Payment to:The Ciry or saint Paul Office of LIEP 350 St. Peter Street, Suite 300 Saint Paul, MN 55102-1510 Make Checks Payabie to:The City of Saint Paui `***************** PAYMENT CAN NOW BE MADE BY CREDIT CARD!!! `*�'�*"`�*****`*'*' IF PAYING BY CREDIT CARD PLEASE COMPLETE THE FOLLOWING INFORMATION: � MasterCard � Visa EXPIRATION DATE: ACCOUNT NUMBER: ❑�/0❑ ❑�0�-�L7�0-0[��Cl-O��❑ Name of Cardholder (please print} Signature of Card Holder {required for atl cha Date: Amount of Charge: $ ORIGINAL Presented B} Refened To RESOLUTION Council File # 00 �-11 y4 Green Sheet # �Q � 99�1 2 RESOLVED, that the Massage Practitioner's license (License ID No. 990005749) held 3 by Gina Boots and located at 14334 Utica Avenue South, Savage, Minnesota is hereby 4 suspended until the licensee (1) submits payment of the license renewal fee, (2) provides proof 5 of general and professional liability insurance, and (3) provides proof of affiliation with a City of 6 Saint Paul licensed massage center or state license health facility, to the City of 3aint Paul 7 licensing office. This Resolution and the action taken above are based upon the facts contained 8 in the October 24, 2000 Notice of Violation letter to the licensee. The licensee does not dispute 9 the facts of the violation. Requested by Department of: Adoption Certified by Council Secretary ay: Apps By: B Y � lu/ /isa X � Form Approved by City Attorney � By: G " itt-LC � � Approved by Mayor for Submission to Council By: CITY OF SAINT PAUL, NIINNESOTA ...� Adopted by Council: Date t]e.e.. ��J �d-oGa GREEN SHEET Virginia Palmer 266-8710 T BE ON CWNCILAGBJON BY IDAT� December 13, 2000 - Consent TOTAL # OF SIGNATURE PAGES m�e..e�.o.w,a ao - l 1Y,9, No 105994 � m.��. ❑ arcw*mear ❑ arcucu ❑ wu�cu�a�eiaoa ❑ wurouaunmeero �wvaie�enamiwnl ❑ (CLIP ALL LOCATIONS FOR SIGNATURE) Resolution suspending the Massage Practitioner's license held by Gina Boots at 134 Western Avenue North. PIANNING CAMMISSION CIB COMMITTEE CNIL SERVICE CAMMISSION ITAGES IF APPROVED ITAGES IF NOT APPROVED I�UM OF TRANSACTION S SOURCE �oawaiotr (owwM Hee mre pew«�rxm everw«wee uiaer a� toraac aepamnenrr VES No tles thb D�sorJfirm e�er been a dlY anWoYee7 YES NO Doec this D��m D� e sldN not tarmallYO� M' �Y �urtent dA' emWoYee7 YE3 NO b Mis pe�awJfirm a tarpefetl verdoY7 res nw yain an Vea anawe�s m semrafe she� aM aKeeh ro arcen ahcet COtTIREVENUE BUDQETED (GRCLE ON� I_�d i i7i i J`PI' �=3 �:1 YEE NO r CITY OF SAINT PAUL Norm Colemnn, Ma}•or November 21, 2000 OFFICE OF THE CITY ATTORNEY Clnyton M. Robiuon, Jr., Ciry Altorney b �� tu q {. cr.�rt o«�rsro„ 400CiryHal! Telepl+one:651266-87l0 /SWestKe!loggBlvd. Fnaimile:6.i1298S6/9 Saint Paut, Minrsuom 55/02 NOTICE OF COUNCIL MEETING Gina Boots 14334 Utica Avenue South Savage, Minnesota 55378 RE: Massage Practitioner License # 990005749 Deaz Ms. Boots: � ,s. � A � :s'°.. ^.�3G4°'.. . ^�.�.. As�rs ;�e � U�.`�� G�c �.: 4' �' � Please take notice that this matter has been set on the Consent Agenda for the Council meeting scheduled for 3:30 p.m., Wednesday, December 13, 2000 in the City Council Chambers, Third Floor, Saint Paul City Hail and Ramsey County Courthouse. Enclosed are copies of the proposed resolution and other documents which will be presented to the City Council for their consideration. This is an uncontested matter in that the facts contained in the Notice of Violation concerning the failure to pay the license renewal fee, provide proof of insurance, and provide proof of affiliation have not been denied. The recommendation of the license office will be for the suspension of your license. If you have any questions, please call me at 266-8710. Very truly yours, �� L C'� Virginia D. Palmer Assistant City Attorney cc: Nancy Anderson, Assistant Council Secretary Robert Kessler, Director, LIEP Christine Rozek, LIEP ao- � ►y.q UNCONTESTED LICENSE MATTER Licensee Name: Council Hearing Date: Violation: Gina Boots Wednesday, December 13, 2000 (1) Pay license renewal fee, (2) Failure to provide proof of general and professional liability insurance coverage for September 30, 1999 - September 30, 2000 license period (3) Failure to provide proof of affiliation from a City of Saint Paul license massage center or state licensed health facility Recommendation of Assistant City Attorney on behalf of client, Office of License, Inspections and Environmental Protection: Suspension of massage practitioner's license Attachments: 1. Proposed resolution 2. Notice.of Violation 3. License Information Report 4. 9/1/00 letter from Christine Rozek to Gina Boots 5. License information CITY OF SAINT PAUL Norni Colemnn, hIn}�or October 24, 2000 OFFICE C�F THE CITY ATTORNEY Clnylors M. , Jc, Ciry Attorney 00-►1�1g Civil Dicision 400 Ciq• Nnll Telephone.� 651166-87/0 lSWUtKe!loggBh�d_ Fncsimile:651393-56/9 Snint Pme{ Nlinnesota 55101 NOTICE OF VIOLATION Gina Boots 14334 Utica Avenue South Savage, Minnesota 55378 RE: Massage Practitioner License # 990005749 Deaz Ms. Boots: The Office of License, Inspections and Environmental Protection has recommended adverse action against your massage practitioner's license. The basis for the recommendation is as follows: Your license expired on July 26, 2000. You were advised that you needed to pay the $66 renewal fee for your license, provide proof of insurance and proof of affiliation with a City of Saint Paul licensed massage center or state licensed health facility by September 11, 2000. No response has been received, nor have renewal fees been paid. If you do not dispute the above facts, you must submit proof of insurance and proof of affiliation along with payment of the license renewal fee to the licensing office by Wednesday, 1Vovember 1, 2000 to take care of the matter now without any further action. If you w�ish to dispute the above facts, I will schedule an evidentiary hearing before an Administrative Law Judge (ALJ). If you cvish to have such a hearing, please send me a letter stating that you are contestin� the facts. You will then be sent a"Notice ofHearing," so you wi11 know when and where to appear, and what the basis for the hearing will be. Please let me know in writing no later than Wednesday, November 1, 2000 ho�v you would like to proceed. If I have not heard from you by that date, I wiil assume that you are not contestin; the facts. The matter will then be scheduled for the St. Paul City Councii and placed on the Consent Agenda during which no public discussion is ailow�ed and the recommended penalty, the immediate suspension of your license untii the information is provided and the license fee paid, will be imposed. Page 2 GinaBoots 00 —\1y`� October 24, 2000 If you have any questions, feel free to call me or have your attomey call me at 266-8710. Sincerely, -/ �� 1�� ,� �`^ Virginia D. Palmer Assistant City Aftorney cc: Gina Boots, 134 Western Ave. N., St. Paul, MN 55102 Robert Kessler, Director, LIEP Christine Rozek, LIEP co-��y`� STATE OF MINNESOTA ) ) ss. COUNTY OF RAMSEY ) AFFIDAVIT OF SERVICE BY MAIL JOANNE G. CLEMENTS, being first duly sworn, deposes and says that on October 24, 2000, she served the attached NOTICE OF VIOLATION on the following named person by placing a true and correct copy thereof in an envelope addressed as follows: Gina Boots 14334 Utica Avenue South Savage, MN. 55378 Gina Boots 134 Western Avenue North St. Paul, MN. 55102 (which is the last known addresses of said person) and depositing the same, with postage prepaid, in t�ited States mails at St. Paul, Minnesota. � � � � �� G\ CLEMENTS Subscribed and sworn this 24th da f O �' �-- //�Ci Notary Publ to before me be� 2000. PETER P. pANG80RN NOTARY PUBLIC - MINNE90TA MY COMMI5510N EXPIftES JAN. 31. 2065 ao. \\�l`� � � 0 a X W `� � o � �' o .- � o d V N � J � �p N a � _o N � O � � C N N C7 N � � c � C U '� � J � R � L � C d N C d d _c U p J m " � U Q @ � a � � N � C � U N N J � 0 o — N a o E a� � � � Z � 4�i O U � J � � � � Z W Q Z K N W N ~ "a W a ¢ � o M � � � N F z O m Cf1 Q � Z _ C9 N � E F m � Z 0 C m O � ¢ � Z — � U c � 0 U U y � � o � N � Q x W o N � C � – N m N � O N � � � Z T U d t`') a� r U 0 � o m N y N c_U m F E – @ Z Z � >+ W c � �. Z � W o U V z � m a W w U c U _ Q N � � � Z N � O O � L � a o � N " o N � C � � � m � � � N �`] F- o v _ V N C O a C, O U y c N � E' O U G � O _ Q � U � m a N � C X O Q N a c�o U � � � � V O �n O – - m @a�i�> � p y�W U �— N U �� L y -� C @ O"ON N Z O,.. c6 3t � �' C � m W O �s c� Q ¢ �a�is z Ud�� U W H �u F.., oocqZo � ooZ�o W NNrnrn� � �ON� � M O�N� � _ _ � _ �0��'O OFFICE OF LICENSE, INSPECTIONS AND ENVIRONMENTALPROTECTION C'O��I�� Rober[ Kusler, Dirutor CITY OF SAINT PAUL Narm Co[emnn, Mayor September 1, 2000 19990005749 Gina Boots 14334 Utica Ave S Savage MN 55378 LOWRYPROFESSIONALBUTLDING Telephone:651-266-9090 Suire 300 F¢ccimile: 651-266-9099 350 St Peter Street 651-266-9114 Saint Pau1, Minr+esota S�102-I570 RE: Expired License and Expired Certificate of Insurance Deaz Licensee: tlfter reviewing your business license for Massage Practirioner at 134 Westem Avenue North, our office has determined that your certificate of insurance and License has not been renewed. In order to remove the hold that has been placed on your license, the following requirements must be met: Pay your 07/26/2000 - 07/26/2001 license renewal fee of $66.00. Submit proof of general and professional liability insurance coverage during the period of 07/26/2000 through 07/26/2001. (Proof should not have a lapse in coverage. If there is a lapse, a letter should be submitted stating that you were not performing massage therapy during the lapsed period.) Submit proof of affiliation from a City of Saint Paul licensed massage center (commercial or home location) or state licensed health facility. You have until Monday, September 11, 2000 to respond by submitting the required paperwork and/or payment. If there is no response by Monday, September 11, this office will begin the administrafive hearing process to suspend your license unril all requirements are met. You have the opportunity to appeal the City's decision through this proceeding. If you have any questions, please contact Corinne at 651-266-9106. Regazds, �� Christine Rozek LIEP Deputy Director CAR/caa License Group Comments Text Licensee: GINA BOOTS �BA� GINA BOOTS License #: 1g990005749 tOT79/2000 To CAO for a verse acUon. CAR 09/01/2000 letter sent for delinquent lic and exp ins. CAA 12-2-99 NSF check paid in fuII.ES 1130-99 NSF check #2461 received for $66.00. Totai amount due 581.00.ES '10l79/2000 ao-�►4�. �6 �114`� Address Licensee � Contad � License � Cardhoider ( Licensee Name: INA BOOTS DBA Ssles iaz Id� � �� m �� „_`..:�.�,d. '�i`� � �� _...'s" r�- �.a-.�_—:..�-..,.'a�� ,:, �r�.. ��. tZ73 Oo -1t�{9 Lice DBP Sale ; �'°� �"' '�''�°�}"" � �4� Licensee INA BOOTS i ��"`� � `' ''�� "�' � " DBA INA BOOTS License � Licensee � Lic. Types � Insurance , Bond , RequiremeMS � i�° Property �' Licensee L" Unofficial Projec[ Facldator. ASUNqON, CORINNE � � t Street #; _ 34 _ Adverse Adion CommeMs � Street Name: STERN j Street Type: AVE Diredion: d — Unit Ind: r Unit #; r � Cdy: T PAUL , License Group C omments: �! OM 92000 To CAO for adverse action. CAR ; i SYffie: riN Zip: 55102 A� n000letter serR tor definqueM lic and exp ins. Ward: � Dist Council: �8 2-2-99 NSF check paid in fuII.ES __ _ �-3Q99 N5F check #2461 receiv f or $66.U�. Total ,__ __-- _ _._ �� Licensee: INA BOOTS Licensee � _... ..... _ .._.. _ _. �..... _..___._, DBA: ,itin annrs CommeMs: . ��,'�' � Sales Tax '�Ei" eei "'�`-- 4�e=� � MassageF ; License # � �.i 4 Bus Phone:�651) 602-0350 �ner R 09CLOM999 i 07J2672000 _ _ .__._ .____�..��,___..._.._..�.._. ______. -- - - _ __.—_ --- �-'------�- - —Tatal:- — TA9 _ Save Changes to History � N � 886.00 __ _ s _ __ $66.00 � 1218Phi oc - ��'�`l � Adtlre _. p V � e . . Licensee INA BOOTS �^�,'.:..�rA°^^ .. , . �-.:'.,'.s°-.°°.• DBA WABOOTS DBP� Sale� License i Licensee � Lic.Types Nsurence � Bond lRequiremeMs1 � License 7ype: assage Aract3iwier lnsurance Type: �Profe Policy #: L2�: , Company; CCEP� Address: �� Phone #: �_ Effedive: � Expiration: � CoMinuous _ + Citq fnsured i , E INDEMNITY INS CO �� 1 af 1 �. TR7M 999 Liabildy Lfmi[s Insurance Rec'd 7/LGROpp �r$ 1,000,000 - Ed,qi OCCURRENCE Deys Ta CanceF. r 3,000,�00 - PROF & GENERAL AGG Canceled: � : Cancel Rec'd: Agency. SSOC 80D`MlORfC & MASSAGE PROF ' Address 8677 BUFFALO PARK RD, E YERGREEN, C O 80439-7347 Phone #: 303J 674-8478: � Contact OBERT GIBS � , {� . � I'.,� ��,�'.�,�� License # 90005749 30 Save Changes to History 1 of � 72:18 PM aa -ti�� Lice DBP Licensee INA 600TS DBA INA BOOTS Sale License Licensee � Lic. Types l Insurance � Bond � ReqUiremeMs � b `:r. �.-,�..�..,.- Licensee Name: INA BOOTS :r:.rB�y}�_r.,_, OBA: INR BOO7S , , Sales Tax Id; 440314 I+kn-Profd: r dVaker's Comp: 'D000 .,-��,.�� ' �� AA Corrtrad Rec'd: Ott10n0000 Ad Train'u�g ReCd: OR7010000 � AA Fee Calleded: OA70�0000 , Discourrt Rec'd: (- . ` Other A ency Licenses Financial Hold Reasons " _; :�� .. s��f��ti��°."�S�€i�G,��l� Y„��4`e'�._�� 'p ° �' "°' k��i t 9.' �..��''�$��*��t'��.'�'''�'�4:��a�,S:� t_'e�'.. , NSF ;N �11f30f1999 �„ MaBTo OONONOOUOONO+UOO�.BOOTS _ GINA µ__ C2i7R:7 -' ---�------ -- Background Check Requtretl [ ��;� Save Changes to History License # -Mail License To: -- i t` Mail Ta Contact �� f"' License Rddress L —___. __�__� -Mail Invoice To: ---; � � Mail To Corrtact ' t' License Address ' 12:1 S PM oo- �i�`1 Invoice ❑ Cfieck this box if making any name, mailing address or phone # correctians. Please write the changes on fhis form. If your business license address is changing, please request a new business license applicatio�. September 27, 2000 To: GINA BOO'fS '14334 UT1CA AVE 5 SAVAGE MN 55378 CITY OF SAtNT PAUL O�ce of License, lnspections & Environmental Protection 350 St. Peter Street, Suite 300 Saint Paul, MN 55102-1510 PHONE; (651)266-9090 FAX: (651) 266-9124 Invoice # : 25Q243 Invace Due Date: Upon Receipt Account8alance: 587.00 Pay this Amotfit: $87.00 HOME PHONE :612-447-3392 BUS�NESS PHONE : 651-602-0350 Transactian Description lnv: 238291 990005749 Massage Practitioner Expires: 07/26/2000 @ 134 W ESTERN AVE N inv: 245343 Late Fee 7-30 days late {10%) inv: 247319 Late Fee 31-60 days late (10%) Late Fee 61-90 days late (10%) Requirements Transaction Total 66.00 7.00 7.00 7.00 Your accrount is overtlue. Please mail payment today!! Submit proof of affiliation from a City of Saint Paul licensed therapeutic massage center (commercial or home locaYion); or, state licensed heaith facility {ie. physician's office, chiropractors office, nursing home,...j. Ali centers must be located within the City of Saint Paui. Submit insurance certificate showing coverage of $1,000,000 general liabilify and $1,000,000 professional liability; with the City of Sainf Paul named as an additional insured and a 30-day notice of cancellation. Insurance certificate forms must be made out in the name that the Iicense is in and show a policy number. The license expiration date will run concurreni with the insurance expiration date. DOG L/CENSE AND COMPETENCY CARD RENEYYALS DO NOT NEED TO COINPLETE THE WORKERS COMPFNSA770NlNFORMATION �1 FOR BUSINESS LICENSE RENEWAL ONLY: CERTIFICATIQN OF WORKERS' COMPENSATION COVER,4GE PURSUANT TO MiNNESOTA STATUTE §176.186 I here6y certity that i, or my campany, am in compiiance with the workers' compensation insurance coverage requiremenis of Minnesota statute §776.182, subdivision 2. I also understand that provision of false informa8an in this cer6fication constitutes sufficient grounds for adverse acfion against all licenses held, i�cluding revocation and suspension of said licenses. Name of insurance Company: Policy Number: Coverage from to Remit Payment to:The Ciry or saint Paul Office of LIEP 350 St. Peter Street, Suite 300 Saint Paul, MN 55102-1510 Make Checks Payabie to:The City of Saint Paui `***************** PAYMENT CAN NOW BE MADE BY CREDIT CARD!!! `*�'�*"`�*****`*'*' IF PAYING BY CREDIT CARD PLEASE COMPLETE THE FOLLOWING INFORMATION: � MasterCard � Visa EXPIRATION DATE: ACCOUNT NUMBER: ❑�/0❑ ❑�0�-�L7�0-0[��Cl-O��❑ Name of Cardholder (please print} Signature of Card Holder {required for atl cha Date: Amount of Charge: $ ORIGINAL Presented B} Refened To RESOLUTION Council File # 00 �-11 y4 Green Sheet # �Q � 99�1 2 RESOLVED, that the Massage Practitioner's license (License ID No. 990005749) held 3 by Gina Boots and located at 14334 Utica Avenue South, Savage, Minnesota is hereby 4 suspended until the licensee (1) submits payment of the license renewal fee, (2) provides proof 5 of general and professional liability insurance, and (3) provides proof of affiliation with a City of 6 Saint Paul licensed massage center or state license health facility, to the City of 3aint Paul 7 licensing office. This Resolution and the action taken above are based upon the facts contained 8 in the October 24, 2000 Notice of Violation letter to the licensee. The licensee does not dispute 9 the facts of the violation. Requested by Department of: Adoption Certified by Council Secretary ay: Apps By: B Y � lu/ /isa X � Form Approved by City Attorney � By: G " itt-LC � � Approved by Mayor for Submission to Council By: CITY OF SAINT PAUL, NIINNESOTA ...� Adopted by Council: Date t]e.e.. ��J �d-oGa GREEN SHEET Virginia Palmer 266-8710 T BE ON CWNCILAGBJON BY IDAT� December 13, 2000 - Consent TOTAL # OF SIGNATURE PAGES m�e..e�.o.w,a ao - l 1Y,9, No 105994 � m.��. ❑ arcw*mear ❑ arcucu ❑ wu�cu�a�eiaoa ❑ wurouaunmeero �wvaie�enamiwnl ❑ (CLIP ALL LOCATIONS FOR SIGNATURE) Resolution suspending the Massage Practitioner's license held by Gina Boots at 134 Western Avenue North. PIANNING CAMMISSION CIB COMMITTEE CNIL SERVICE CAMMISSION ITAGES IF APPROVED ITAGES IF NOT APPROVED I�UM OF TRANSACTION S SOURCE �oawaiotr (owwM Hee mre pew«�rxm everw«wee uiaer a� toraac aepamnenrr VES No tles thb D�sorJfirm e�er been a dlY anWoYee7 YES NO Doec this D��m D� e sldN not tarmallYO� M' �Y �urtent dA' emWoYee7 YE3 NO b Mis pe�awJfirm a tarpefetl verdoY7 res nw yain an Vea anawe�s m semrafe she� aM aKeeh ro arcen ahcet COtTIREVENUE BUDQETED (GRCLE ON� I_�d i i7i i J`PI' �=3 �:1 YEE NO r CITY OF SAINT PAUL Norm Colemnn, Ma}•or November 21, 2000 OFFICE OF THE CITY ATTORNEY Clnyton M. Robiuon, Jr., Ciry Altorney b �� tu q {. cr.�rt o«�rsro„ 400CiryHal! Telepl+one:651266-87l0 /SWestKe!loggBlvd. Fnaimile:6.i1298S6/9 Saint Paut, Minrsuom 55/02 NOTICE OF COUNCIL MEETING Gina Boots 14334 Utica Avenue South Savage, Minnesota 55378 RE: Massage Practitioner License # 990005749 Deaz Ms. Boots: � ,s. � A � :s'°.. ^.�3G4°'.. . ^�.�.. As�rs ;�e � U�.`�� G�c �.: 4' �' � Please take notice that this matter has been set on the Consent Agenda for the Council meeting scheduled for 3:30 p.m., Wednesday, December 13, 2000 in the City Council Chambers, Third Floor, Saint Paul City Hail and Ramsey County Courthouse. Enclosed are copies of the proposed resolution and other documents which will be presented to the City Council for their consideration. This is an uncontested matter in that the facts contained in the Notice of Violation concerning the failure to pay the license renewal fee, provide proof of insurance, and provide proof of affiliation have not been denied. The recommendation of the license office will be for the suspension of your license. If you have any questions, please call me at 266-8710. Very truly yours, �� L C'� Virginia D. Palmer Assistant City Attorney cc: Nancy Anderson, Assistant Council Secretary Robert Kessler, Director, LIEP Christine Rozek, LIEP ao- � ►y.q UNCONTESTED LICENSE MATTER Licensee Name: Council Hearing Date: Violation: Gina Boots Wednesday, December 13, 2000 (1) Pay license renewal fee, (2) Failure to provide proof of general and professional liability insurance coverage for September 30, 1999 - September 30, 2000 license period (3) Failure to provide proof of affiliation from a City of Saint Paul license massage center or state licensed health facility Recommendation of Assistant City Attorney on behalf of client, Office of License, Inspections and Environmental Protection: Suspension of massage practitioner's license Attachments: 1. Proposed resolution 2. Notice.of Violation 3. License Information Report 4. 9/1/00 letter from Christine Rozek to Gina Boots 5. License information CITY OF SAINT PAUL Norni Colemnn, hIn}�or October 24, 2000 OFFICE C�F THE CITY ATTORNEY Clnylors M. , Jc, Ciry Attorney 00-►1�1g Civil Dicision 400 Ciq• Nnll Telephone.� 651166-87/0 lSWUtKe!loggBh�d_ Fncsimile:651393-56/9 Snint Pme{ Nlinnesota 55101 NOTICE OF VIOLATION Gina Boots 14334 Utica Avenue South Savage, Minnesota 55378 RE: Massage Practitioner License # 990005749 Deaz Ms. Boots: The Office of License, Inspections and Environmental Protection has recommended adverse action against your massage practitioner's license. The basis for the recommendation is as follows: Your license expired on July 26, 2000. You were advised that you needed to pay the $66 renewal fee for your license, provide proof of insurance and proof of affiliation with a City of Saint Paul licensed massage center or state licensed health facility by September 11, 2000. No response has been received, nor have renewal fees been paid. If you do not dispute the above facts, you must submit proof of insurance and proof of affiliation along with payment of the license renewal fee to the licensing office by Wednesday, 1Vovember 1, 2000 to take care of the matter now without any further action. If you w�ish to dispute the above facts, I will schedule an evidentiary hearing before an Administrative Law Judge (ALJ). If you cvish to have such a hearing, please send me a letter stating that you are contestin� the facts. You will then be sent a"Notice ofHearing," so you wi11 know when and where to appear, and what the basis for the hearing will be. Please let me know in writing no later than Wednesday, November 1, 2000 ho�v you would like to proceed. If I have not heard from you by that date, I wiil assume that you are not contestin; the facts. The matter will then be scheduled for the St. Paul City Councii and placed on the Consent Agenda during which no public discussion is ailow�ed and the recommended penalty, the immediate suspension of your license untii the information is provided and the license fee paid, will be imposed. Page 2 GinaBoots 00 —\1y`� October 24, 2000 If you have any questions, feel free to call me or have your attomey call me at 266-8710. Sincerely, -/ �� 1�� ,� �`^ Virginia D. Palmer Assistant City Aftorney cc: Gina Boots, 134 Western Ave. N., St. Paul, MN 55102 Robert Kessler, Director, LIEP Christine Rozek, LIEP co-��y`� STATE OF MINNESOTA ) ) ss. COUNTY OF RAMSEY ) AFFIDAVIT OF SERVICE BY MAIL JOANNE G. CLEMENTS, being first duly sworn, deposes and says that on October 24, 2000, she served the attached NOTICE OF VIOLATION on the following named person by placing a true and correct copy thereof in an envelope addressed as follows: Gina Boots 14334 Utica Avenue South Savage, MN. 55378 Gina Boots 134 Western Avenue North St. Paul, MN. 55102 (which is the last known addresses of said person) and depositing the same, with postage prepaid, in t�ited States mails at St. Paul, Minnesota. � � � � �� G\ CLEMENTS Subscribed and sworn this 24th da f O �' �-- //�Ci Notary Publ to before me be� 2000. PETER P. pANG80RN NOTARY PUBLIC - MINNE90TA MY COMMI5510N EXPIftES JAN. 31. 2065 ao. \\�l`� � � 0 a X W `� � o � �' o .- � o d V N � J � �p N a � _o N � O � � C N N C7 N � � c � C U '� � J � R � L � C d N C d d _c U p J m " � U Q @ � a � � N � C � U N N J � 0 o — N a o E a� � � � Z � 4�i O U � J � � � � Z W Q Z K N W N ~ "a W a ¢ � o M � � � N F z O m Cf1 Q � Z _ C9 N � E F m � Z 0 C m O � ¢ � Z — � U c � 0 U U y � � o � N � Q x W o N � C � – N m N � O N � � � Z T U d t`') a� r U 0 � o m N y N c_U m F E – @ Z Z � >+ W c � �. Z � W o U V z � m a W w U c U _ Q N � � � Z N � O O � L � a o � N " o N � C � � � m � � � N �`] F- o v _ V N C O a C, O U y c N � E' O U G � O _ Q � U � m a N � C X O Q N a c�o U � � � � V O �n O – - m @a�i�> � p y�W U �— N U �� L y -� C @ O"ON N Z O,.. c6 3t � �' C � m W O �s c� Q ¢ �a�is z Ud�� U W H �u F.., oocqZo � ooZ�o W NNrnrn� � �ON� � M O�N� � _ _ � _ �0��'O OFFICE OF LICENSE, INSPECTIONS AND ENVIRONMENTALPROTECTION C'O��I�� Rober[ Kusler, Dirutor CITY OF SAINT PAUL Narm Co[emnn, Mayor September 1, 2000 19990005749 Gina Boots 14334 Utica Ave S Savage MN 55378 LOWRYPROFESSIONALBUTLDING Telephone:651-266-9090 Suire 300 F¢ccimile: 651-266-9099 350 St Peter Street 651-266-9114 Saint Pau1, Minr+esota S�102-I570 RE: Expired License and Expired Certificate of Insurance Deaz Licensee: tlfter reviewing your business license for Massage Practirioner at 134 Westem Avenue North, our office has determined that your certificate of insurance and License has not been renewed. In order to remove the hold that has been placed on your license, the following requirements must be met: Pay your 07/26/2000 - 07/26/2001 license renewal fee of $66.00. Submit proof of general and professional liability insurance coverage during the period of 07/26/2000 through 07/26/2001. (Proof should not have a lapse in coverage. If there is a lapse, a letter should be submitted stating that you were not performing massage therapy during the lapsed period.) Submit proof of affiliation from a City of Saint Paul licensed massage center (commercial or home location) or state licensed health facility. You have until Monday, September 11, 2000 to respond by submitting the required paperwork and/or payment. If there is no response by Monday, September 11, this office will begin the administrafive hearing process to suspend your license unril all requirements are met. You have the opportunity to appeal the City's decision through this proceeding. If you have any questions, please contact Corinne at 651-266-9106. Regazds, �� Christine Rozek LIEP Deputy Director CAR/caa License Group Comments Text Licensee: GINA BOOTS �BA� GINA BOOTS License #: 1g990005749 tOT79/2000 To CAO for a verse acUon. CAR 09/01/2000 letter sent for delinquent lic and exp ins. CAA 12-2-99 NSF check paid in fuII.ES 1130-99 NSF check #2461 received for $66.00. Totai amount due 581.00.ES '10l79/2000 ao-�►4�. �6 �114`� Address Licensee � Contad � License � Cardhoider ( Licensee Name: INA BOOTS DBA Ssles iaz Id� � �� m �� „_`..:�.�,d. '�i`� � �� _...'s" r�- �.a-.�_—:..�-..,.'a�� ,:, �r�.. ��. tZ73 Oo -1t�{9 Lice DBP Sale ; �'°� �"' '�''�°�}"" � �4� Licensee INA BOOTS i ��"`� � `' ''�� "�' � " DBA INA BOOTS License � Licensee � Lic. Types � Insurance , Bond , RequiremeMS � i�° Property �' Licensee L" Unofficial Projec[ Facldator. ASUNqON, CORINNE � � t Street #; _ 34 _ Adverse Adion CommeMs � Street Name: STERN j Street Type: AVE Diredion: d — Unit Ind: r Unit #; r � Cdy: T PAUL , License Group C omments: �! OM 92000 To CAO for adverse action. CAR ; i SYffie: riN Zip: 55102 A� n000letter serR tor definqueM lic and exp ins. Ward: � Dist Council: �8 2-2-99 NSF check paid in fuII.ES __ _ �-3Q99 N5F check #2461 receiv f or $66.U�. Total ,__ __-- _ _._ �� Licensee: INA BOOTS Licensee � _... ..... _ .._.. _ _. �..... _..___._, DBA: ,itin annrs CommeMs: . ��,'�' � Sales Tax '�Ei" eei "'�`-- 4�e=� � MassageF ; License # � �.i 4 Bus Phone:�651) 602-0350 �ner R 09CLOM999 i 07J2672000 _ _ .__._ .____�..��,___..._.._..�.._. ______. -- - - _ __.—_ --- �-'------�- - —Tatal:- — TA9 _ Save Changes to History � N � 886.00 __ _ s _ __ $66.00 � 1218Phi oc - ��'�`l � Adtlre _. p V � e . . Licensee INA BOOTS �^�,'.:..�rA°^^ .. , . �-.:'.,'.s°-.°°.• DBA WABOOTS DBP� Sale� License i Licensee � Lic.Types Nsurence � Bond lRequiremeMs1 � License 7ype: assage Aract3iwier lnsurance Type: �Profe Policy #: L2�: , Company; CCEP� Address: �� Phone #: �_ Effedive: � Expiration: � CoMinuous _ + Citq fnsured i , E INDEMNITY INS CO �� 1 af 1 �. TR7M 999 Liabildy Lfmi[s Insurance Rec'd 7/LGROpp �r$ 1,000,000 - Ed,qi OCCURRENCE Deys Ta CanceF. r 3,000,�00 - PROF & GENERAL AGG Canceled: � : Cancel Rec'd: Agency. SSOC 80D`MlORfC & MASSAGE PROF ' Address 8677 BUFFALO PARK RD, E YERGREEN, C O 80439-7347 Phone #: 303J 674-8478: � Contact OBERT GIBS � , {� . � I'.,� ��,�'.�,�� License # 90005749 30 Save Changes to History 1 of � 72:18 PM aa -ti�� Lice DBP Licensee INA 600TS DBA INA BOOTS Sale License Licensee � Lic. Types l Insurance � Bond � ReqUiremeMs � b `:r. �.-,�..�..,.- Licensee Name: INA BOOTS :r:.rB�y}�_r.,_, OBA: INR BOO7S , , Sales Tax Id; 440314 I+kn-Profd: r dVaker's Comp: 'D000 .,-��,.�� ' �� AA Corrtrad Rec'd: Ott10n0000 Ad Train'u�g ReCd: OR7010000 � AA Fee Calleded: OA70�0000 , Discourrt Rec'd: (- . ` Other A ency Licenses Financial Hold Reasons " _; :�� .. s��f��ti��°."�S�€i�G,��l� Y„��4`e'�._�� 'p ° �' "°' k��i t 9.' �..��''�$��*��t'��.'�'''�'�4:��a�,S:� t_'e�'.. , NSF ;N �11f30f1999 �„ MaBTo OONONOOUOONO+UOO�.BOOTS _ GINA µ__ C2i7R:7 -' ---�------ -- Background Check Requtretl [ ��;� Save Changes to History License # -Mail License To: -- i t` Mail Ta Contact �� f"' License Rddress L —___. __�__� -Mail Invoice To: ---; � � Mail To Corrtact ' t' License Address ' 12:1 S PM oo- �i�`1 Invoice ❑ Cfieck this box if making any name, mailing address or phone # correctians. Please write the changes on fhis form. If your business license address is changing, please request a new business license applicatio�. September 27, 2000 To: GINA BOO'fS '14334 UT1CA AVE 5 SAVAGE MN 55378 CITY OF SAtNT PAUL O�ce of License, lnspections & Environmental Protection 350 St. Peter Street, Suite 300 Saint Paul, MN 55102-1510 PHONE; (651)266-9090 FAX: (651) 266-9124 Invoice # : 25Q243 Invace Due Date: Upon Receipt Account8alance: 587.00 Pay this Amotfit: $87.00 HOME PHONE :612-447-3392 BUS�NESS PHONE : 651-602-0350 Transactian Description lnv: 238291 990005749 Massage Practitioner Expires: 07/26/2000 @ 134 W ESTERN AVE N inv: 245343 Late Fee 7-30 days late {10%) inv: 247319 Late Fee 31-60 days late (10%) Late Fee 61-90 days late (10%) Requirements Transaction Total 66.00 7.00 7.00 7.00 Your accrount is overtlue. Please mail payment today!! Submit proof of affiliation from a City of Saint Paul licensed therapeutic massage center (commercial or home locaYion); or, state licensed heaith facility {ie. physician's office, chiropractors office, nursing home,...j. Ali centers must be located within the City of Saint Paui. Submit insurance certificate showing coverage of $1,000,000 general liabilify and $1,000,000 professional liability; with the City of Sainf Paul named as an additional insured and a 30-day notice of cancellation. Insurance certificate forms must be made out in the name that the Iicense is in and show a policy number. The license expiration date will run concurreni with the insurance expiration date. DOG L/CENSE AND COMPETENCY CARD RENEYYALS DO NOT NEED TO COINPLETE THE WORKERS COMPFNSA770NlNFORMATION �1 FOR BUSINESS LICENSE RENEWAL ONLY: CERTIFICATIQN OF WORKERS' COMPENSATION COVER,4GE PURSUANT TO MiNNESOTA STATUTE §176.186 I here6y certity that i, or my campany, am in compiiance with the workers' compensation insurance coverage requiremenis of Minnesota statute §776.182, subdivision 2. I also understand that provision of false informa8an in this cer6fication constitutes sufficient grounds for adverse acfion against all licenses held, i�cluding revocation and suspension of said licenses. Name of insurance Company: Policy Number: Coverage from to Remit Payment to:The Ciry or saint Paul Office of LIEP 350 St. Peter Street, Suite 300 Saint Paul, MN 55102-1510 Make Checks Payabie to:The City of Saint Paui `***************** PAYMENT CAN NOW BE MADE BY CREDIT CARD!!! `*�'�*"`�*****`*'*' IF PAYING BY CREDIT CARD PLEASE COMPLETE THE FOLLOWING INFORMATION: � MasterCard � Visa EXPIRATION DATE: ACCOUNT NUMBER: ❑�/0❑ ❑�0�-�L7�0-0[��Cl-O��❑ Name of Cardholder (please print} Signature of Card Holder {required for atl cha Date: Amount of Charge: $