96-530Council File # q`� 5 3 �
OR1G1�!AL
RESOLUTION
CITY OF SAINT PAUL, MiNNESOTA
Presented By
Referred To
1 RESOLVED:
2
3
ordinance #
Green Sheet #` 34944
a�
Committee: Date
That application, ID #87336, for a new Gambling Manager's License by
Lauta M. De Mike DBA Harding Axea Hockey Association at Holiday Inn St.
Paul East, 2201 Burns Avenue, be and the same is hereby approved.
4
5 Requested by Department of:
6 Yea Navs Absent
7 B a� �
3 Harris �° Office of Liaense. Zns_pections and
) e � � Environmental Protection
? Thu}tatan - - - ✓,
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Form Approved by City Attorney
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Approved by Mayor: Date � � ��
�� G �� A „ Approved by Mayor £or Submission to
� �'U Council
3y: �
By:
Adopted by Council: Date �i �
Adoption Certified by Council Secretary
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Rozek -
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GREEN SHEET N° 3494d
IMTIAIlDATE INITIAVDATE
DEPARTMETIT �fRECTON � CRY COUNGL
CITY A1T�RNEY � CT' CI.ERK
BUDGET OIpECiOR � FlN. & MGT. SEflVIGES �IR.
MAYOH (OR ASSI5TANn o
TOTAL # OF S{GNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
Laura M. DeMike DBA Harding Area Hockey Association requests Council approval
of her application for a new Gambling Manager's License, ID 1�87336, at Holidap Inn St. Paul
East, 2201 Surns Avenue.
_ PLANNMG COMMISSION _ CIYiI SERVICE
_ qB CORiMATEE _
__ 5TAFF _
__ DISTRICTCOURT _
SUPPORTS WHICH COUNpL O&1ECTYE?
IF APPROYE�'
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DISADVANTAGES IF NOTAPPRWED:
OTAL AMOUNT OF TRANSACTION
PEHSONAL SERVICE CONTiiACTS MUST ANSWEN THE FOLLOWING QUESTfONS:
1. Nas this perwMrm ever worketl under a contract Por Mis depertment? -
YES NO
2. Has this person/firm ever been a city employee?
YES NO
3. �oes this persondirtn possess a skill not normally possessed 6y any current ciry employee?
YES NO
Expfain all yas answers on separeta sheet and eHech to groen aheet
COST/REYENUE BUDGETED (CIRCLE ONE) YES TIO
1NDING SOURCE ACTIVfTY NUMBER
VANCIAL INFORMATION' (EXPLAIN)
Greensheet # 34944
In Tracker?
L.I.E.P. REVIEW CHECKLIST
9G-s3o
App'n Received j app'n Processed
Lioense 1D # $� License Type: Gambline Manag.er
COmpBny Name: Laura M. DeMike DBA: Hardin� Area Hock v nGC�r_
Business AddressS: Z201 Surns Ave, jflolidav Inn St. Pau1 Ea�usiness Phone: 733-936R
Contact Name/Address: 1806 Mechanic Ave. 55119 Home Phone: 734-q3FR
Date to Council Research:
Public Hearing Date:� ' �1�i9L
Notice Sent to Applicant:
Notice Sern to
Date Inspections
Ciry Attorney
Environmental
Health
Fire
License
'olice
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����g,�7 ` /�-�'
I
Labels Ordered:
District Councii #:
Ward #: 7
Gomments
Site Plan Receivetl:_
Lease Receivatl:
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ming
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ht{nnesota Lwqfut Gambt{n�1
Garz�biing Manager Applioation
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Gtv� daW rh�t fhi IwadaY 9+atibOrp maneCef wminu wlu compbted. _�..._.1— a y,'i n�,�
waum o� o-�in�nq �6SE U r /fw .�/1 A1 dla� 3i9S r-� ��r� Y
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•• A S10,W01'�deAy bond in lavor ol tho organf2adon mu�t be obtaincd br the pembRn mansqol. ,
Nama ol in6uranca oompuny (do noi u�e aqeney name) � �` �,,,,� �h� ��Q� Bcnd NumDOr o_i �o ��{�a-q
++, : "":',"."K.:`e»)::o«v�a�i.:a.:.;.'i,Y''�Sa°.:;«rw�t5:. �,:y,...,^.,'V„�„"�'J'�.riJ�'. ^' �
- °:�:`^'`�' �;l; � rv' .w�e c"*..n t� :e �a..T"r�5 ,..�.. ���. rY {'�nn
I tivdaB thal:
� I ha�e read lhl6 sppNaaUOa arid eII inbrmaGon iubmitted lo tlte boetd�
� all iMorma6on Is we, accvrete ond oompleta;
� aIlOU+at raqulred InlamaGon ha� bean tu11y diadosed;
• � Am U�¢ only ypmb6np mnneger ol tha orpanizalron;
• I w�N Iemitiari:o my�atf w;4 uw tiws ol Mionusota qoverning tawtul qnmb4nq and rulat ol �ha Ooerd and aQroe, lf liobntad, to �
abidp 6y U+o�a lawt and rubr, inUudinQ amondmonie Io I�om;
• ony cbAngaa In nvGk�o6un Inlwmation w�N be yubmpWd to the board and beai'untl ol qovommanl wlNin f0 day� v� tha Ma�pe;
• Aa nHidemt tvr gamblinq manapCr he� b9en eomp�nted bnd eiuenod. Pnd
• i uMaralan6lhat tAdWY lo piovWa raav+�ad intormaUOn M prGVWM19 �a�te tnlormAUon may tlWll In IAa denlol of nvoe�Gon ol lhB
GCYnCa.
S�qn ro Ot Oambllny Mnnaqer � /����//'�,
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Send ihe complctad �pp�foaibn and all raquRraC altachmentt to:
Oambtlng Controt Board
Suha 300 8.
1711 W. County Roed B
RoeevUfo, MN 55113
8 �33,�,
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MBMHERSNIP: Deia 9u�b9nq manaqar becams a mambw of tl+e orpaM:a4on ��t_y..r -6aK :❑ Mda � Famde
�o:tis Dtinrtesota 7.w�1 �uI oambiir�
ia.�, a,�,vz� p�blin� Maniager Affidavit .
(Attach to !hn OunbltaR MartaQer AppLc�po� Fonn L02121
STATE OF •� '%� C' t ) AFFIDAVIT OF pUALIFICAT40N
. � ) �,�. FOR QAMBLiNO MANA6ER LtCENSE
COUNTY OF "" ��' t � ANd CONSEK7 &TATEMENT
(Purauant to Mlnnaso4� Stetuto 34�.18 8ubd.2(�)
in6 Mlnnviou ftuk 786t.003q,8ui�t, t2B(3))
�� !'I�c�ie. �.�1YlP� _,underoaihatafethat:
(typ@ rl�t name) '
1. { have nevsr been convided ot a telo�y.
2. 1 hava no1, wtihin five years. Commltted e viotation o( law or board ru18 lhat resulted Yn Ihe
revoCalbn oi a ticense i88ued py the lawiul 0ambifnq Controt Soa[d. . .
3. 1 have nevet been convicted oi a criminal vi0ia11on Involvinp iraud, ihafi, lax evasion,
mtereprasenlapon, or pambUnq.
4. ! have never been convicled ol assault, a ertminal vlolatbn Invoivinp ihe usa 01 a tirearm,
or makin9 tertoriat� thr8ata.
5. I am cwl fln assistanl gamblirtq ma�ager lor any other orgenlasUon.
8. i am not a gamb�tng manaper tor any oiher or9aniz811on.
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In addilion,l understand, aprea and hereby irtevocsbly consem that ouNs atul sctbne relaiing Ro the aubject
matter ot the aftachea gamblinp mansper Ilcense, or avis or omissfons arislnq trom 6uch applkatbn, may
be oommencad agains! my orgunlzaUon and I w{A accept tne servtce ol prooeea tor my ocaanizaUon ln any
courl ol competent �uristlictfon in Minnesota by servlce on lhe Minnesola Seoretary vi State ot arry/ summone,
process or pleading authorfzed by ihe taws ol Mfnnesola, '
By signature of Ihls docume�t, lhe undersigned autho�izas ihe Department oi Pubtic Safety to conduct a
criminai background check or raview and !o sha�e the rasults wfih tho Lawfui Qamblinp Controf Bvsrd,
Paffura to prov(de requ(red inlormalfon or provkling Ia�ea oc misieading Inlvrmation may reautt in tha denial
or revocatfon of ihe iicense,
Subscribed and sworn to be(ors me this
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�'• � d8yo1� 7rLticllt •• t9 .�
1.- � . , . ,, . , v
,` .}�,,, �. �.�R 7/Lt,1Z2.1
{Si nalure ot applicanl • Qamb�inp manager}
��i�11�.C� r ".S�c�Cr/�!'�orV
( ame ot o�gaNzatbn)�
,�.�sntt
(�� SIA;
License number
Notary Pu61ic : , .., „•,,. . :..::... ........_..
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�•..� .:�i... ur.ql:qltqy.lOn.bl�1��s�it
My commission exptres, • �Y —
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