95-797ORIGINAL
Council File # /�
Green Sheet # 29341
RESOLUTION
SAINT PAUL, M�INESOTA 6�
Presented
Referred To
Committee: Date
RESOLVED: That application, ID #80160, for a new Gambling
Manager's License by Judy Fosslanii DBA Cystic Fibrosis
Foundation at Easy Street West, 616 Como Avenue, be
and the same is hereby approved.
�--� ___ _ _ ___ Requested by Department of:
Office of License, Insoections and
Environmental Protection
By: \�'"_"`-� � �
Form Approved by City Attorney
B %����.2��1'k�.� 5'�'��
Approved by Mayor for Submission to
Council
By:
9S�g�
DEPARTMENT/OFFICE/COUNCIL DATE INITIATED N� 2 9 3 41
LIEP GREEN SHEE
CONTACT PERSON & PHONE INITIAVDATE INRIAUDATE
� DEPAFiTMENT DIRECTOR � qTV COUNG�L
Christine Rozek - 266-9108 A�IGN �CI7YATfORNEY �CINCLERK
NUYBERFOH
MUST BE ON COUNCIL AGENDA BY (DATE) ROUTING � BUDGEf �IRECTOP. � PIN. & MGT. SERVICES DIR.
Hearin : �1 f�' �� OROER a MAYOR(ORASSISTANn �
TOTAL # OF SIGNATt1RE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION RERUESTED:
Judy_Fossland DBA Cystic Fibrosis Foundation requests Council approval of her
application for a new Gambling Manager's License (ID 4680160) at Easy Street West,
616 Como Avenue.
RECAMMENDATIONS: Approve (A) or Ae�ec[ (R) PERSONAL SERVICE CONTflACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever worketl under a contract for this department?
_ CIB COMMITfEE YES NO
— 2. Has this person/firm ever been a city employee?
_ STAFF
— YES NO
_ DiSTRIC7 CouFr _ 3. Does this person/firm posse55 a skill not normally possessed by any current city employee?
SUPPORTSWNICHCOUNCILOBJECTIVE? YES NO
Explain all yes answers on separate sheet and aneeh to green sheet
INITIATING PR08LEM, ISSl1E, OPPORTUNIT' (Who, What, When, Whece, Why).
ADVANTAGE$ IFAPPROVED
DISADVANTAGES IF APPROVED:
DISADVANTAGES IG NOTAPPROVED:
JUN 2 � 1995
70TAL AMOUNT OF 7HANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) VES NO
FUNDIfJG SOURCE ACTNITY NUMBER
FINANqAL INFORMATION (EXPLAIN)
�5���'y
Greensheet # 29341 L.I.E.P. REVIEW CHECKLIST
{n Tracke(?
LiCenselD # 80160 NEW Gambling Manager`s License
E+PP'n Received / APP'n Processed
CompBny NBme: Judy Fossland DBA: Cvstic Fibrosis Foundation
Business Addresss: 616 Como Ave. (Easv Street Westl Business Phone: 338-0885
Contact Name/Address: 1111 3rd Ave. S 11370 liome Phone: 338-0885
Minneapolis, MN 55404
Date to Council Research:
Public Hearing Date: � l�t �Q 5
Notice Sent to Applicant:
Notice Serrt to Public:
Labels Ordered:
District Council #: 6
Ward #:
Department/ Date Inspections Comments
City Attorney
S/�/�� o �
Environmental
Health
/..��A
Fire
�1 � �
License Site Pian Receivad:
' Lease Received:
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Police //
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Zoning y
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LG212
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FOR OFFiCE USE ONLY
cASE UC Y �= 0 34 '�
SEO s OC3
FEE �Ci�i C
CHK �x-"r � �
DATE �;"�/��S
❑ New Give da� that 6ie two-day garnblirg manzger serninar was compla[ed. �1�/�.� Y c{,
LDCation of L'aming /l L' SC !J/ t_ L C
(c+tY)
[� Renewal Give �fe of trairung received within three years prior to ihe date of ihe applica5on for renewd. _/ /
Locatim of tra6ing
IAST NAME FtRST NA4.SE MtDDLE NAME MAfDEN ( Dam of BicL`t
�f/� 7 �A�mES �de= /lia /��"�/s /I'J�. SSy
MEMBERSHIP: Da� gambfing manager became a member of the organization �12�i_L
Organization
Address
City/St2te
Soc. Ser„i�iry Numbe[
— Y�o — �/U
re Phone
��� ����
Sex : L7 Male �� Femaie
License Number
Zip Code Phone
SS�04< < l0/3 � ��C�'
-•- ,: , .
�3nnrT7�p7'7i'iQt1o�.�'. .--._;: ---.. ,:: .. �: _... _.,: �-< ,.. :-=
-- A$10,000 fidefity bond in fava of the uganiza�on must be obtained for ifie gambGng manager.
Name of insurance company (do rot use agency name)( /J/!/T//UENTAL ��S . Bond Number C-�PD����o���� / 5
...._.Ji,�k�;,.....c; . : _ _ a� - , _ : -. .
AckrioitiTerTgmenr : .� ,<. ; � � � <
_. .
i dedare t,ae
• f nave read �is app7caGori and ai niorma5on submined co �e board,
• all intorma5on is true, acara� and complete;
• all other requirad infortnation has been fuliy disdosed;
• 1 am the only garnbling manager of tlie organization;
- 1 wiH famii'iarize mysetf with the favrs of ASnnesota goveming fawfu{ gambling and tules of the board and agree, if fcensed, to
abide by those Iaws and rvies, indudaig amendments tn them;
• any changes in applica�on informaUOn will be submitted to the board and bcal unit of govemment within 70 days of the change;
• An afSCavit for gamb(ing manager has been completed and aitached, and
• I understand that failure w provde required informa6on or providirg faise information may result in the denial or revocabon of the
license.
d
Date
_ai _y 5"
t � S Send the �mpleted application and all required attachments to:
. s � ,3s�
(, Gambling Control Board
9 Sulte 300 S.
., �
�� ��\ 1711 W. County Road B
�� � x � / � �,��
` ,1 � ,�✓ C `� ) Rosevllie, MN 55113 � �
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