96-593Council File # � � �S 9 "3
Green Sheet # 34977
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Presented By
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ordinance ¥
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Referred To
RESOLVED: That application, ID #69996, for a new Gambling Manager's License by Steven
P. Tibbetts DRA Church of the Incarnation at Ace Box Bar, 2162 University
Avenue, be and the same is hereby approved.
Requested by Department of:
RESOLUTION
GiTY OF SAINT PAUL, MINNESOTA
Committee: Date
oFfsce of License Inspections and
Env+ronmental Protect+on
By: 7d�t�ece� .T ��
Form Approved by City Attorney
By' ��\ .� ��—��'-1',Q--"'ir`.�p-- — �By: / J ' L�`� ' LL.P-xv�
t�a, -��/���
Approved by Mayor: Date I�
d � --`t-t*= /���� AHProved by Mayor for Submission to
C Council
By: z
By:
Adopted by Council: Date ��(
Adoption Certi£ied by Council Secretary
r���
William G�nther - 266-9132
TOTAL # OP SIGNATURE PAGES
fOH
CREEN SHEET
BUIXiET DIHECTOR
MAYOR (OR ASSlSTANF)
ALL L4GATIONS FOR SIGNATUREj
�Y ����
N_ 34977
- J iwmumatE -
��� cin couNC��
�' CIN CLERK
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I FlN. 8 MGi: 3ERVICES DUL
Steven P. Tibbetts DBA Church of the Incamation requests Council approval
of his application for a new Gambling Manager's License, ID �69996, at Ace Box Bar,
2162 Universit Avenue.
:COMAEENDATIIXdS: Auorwe (A) or Reied fR)
_ PLpNNMG CAMMISSION _ CML SEPViCE COMMlSSION
_ CIB COFAMITTEE _
_ STAFF _
_ DISTFi1CTCOUR7 _
SUPPORT6 WHICH COUNCILO&IECTIVE?
INITIATING PROBLEA4, ISSUE, OPPOflTUNITY (Who. Wha1, When, Where,
PERSONAL SERVICE CONTRACTS MUSTANSWERTHE F011OWING QUESTIONS:
t Has this personlfirm ever worketl �nder a contract for tAis tlepartment? -
YES NO
2. Has this psrsonKrm ever been a ciry employee?
YES NO
3. Does this persoNfirm possess a ski11 not normally possessed by arry curcent eRy employes7
YES NO
Explain all yes answers on separate sheet and attach to green aheet
Cffiifc�C�B �'��p� C�Pt�
Ekli�� 7 � iv�i'�'
70TAL AMOUNT OF TRANSACTION $
COSTfREVENUE BUDGETED (CIRCLE ONE) YES
FUNDIHG SOURCE ACTIVITY NUMBER
FINANCIAL INFOFiMAT10N: (E%PL0.1N)
Greensneet # �r L.I.E.P. REVIEW CHECKLIST date: ��G -593
In Tracket? __���1'��y�� � APP'n Received / +xPP'n Processed
'��
License ID # 69996 License Type; GamblinQ Manager
CompBny Name: Steven P. Tibbetts DBA: Church of the Incarnation
Business Addresss: 2162 Universitv Ave. W. (Ace Sox) Business Phone: 822-2101
Contact Name/Address: Same Hame Phone: 822-2101
Date to Cauncil Research: 3817 Pleasant Ave. S. Mpls 55409
Public Hearing Date: .vn,+ .l I q 1�
Notice Sent to Appticant:
Notice Sent to Public:
Departmeni/
City Attorney
Environmentai
Health
Ffre
License
Police V /�-°^
5-j�/9,�
�`"
Date inspections
tabeis Ordered:
Disirict Council
Ward #: n<
Comments
Site Plan Recei�
tbase aecetve�
/�`�� rCb (d�d�°�`
LG212
(ftav. 7/2N2)
❑ New
� Renewa!
tAST NAME
Tibbetts
Minnesoia LcanficZ C.ambIing
Gambling Maaager Application
FOR OFF'1C.E USE OCiLT
BASE UC t
SEa � _�
FEE
CHK
0,1TE
INIT
Give ate 3+at fhe iwo-day SambGn9 manager sam�nar was completed. I__J
lawrion oE training
{ary}
Give date ot traini� caceived within thres years prior to dre date af 7�e appGcation {ar rene�xa). ? J20 I 90
Locavonotiraining wi11mzZ
tsi:....n,n:'..,y�y.p.:.'..: "w.y,..e.q o.,i....Pg:):::
�ita4er; �rifarnz atiort' °'
PIRST F7AME MiDOLE NA�
Stevea Patrick
4633 ISth ave. &o.
?finnesota
�z�
,
oa,e or ann
3117/51
ME3vt2E'nSHiP: Oste gambGr.g mznager becama a member ci the organizacon �? ,t I i/�
Name ot
Address
Ciryi5late Zip Code
3311 ?leasant 3ve. So. : •iiar.e:�ol is ?L� 3:409 �
':�y:,y„ifi,4,;y ,,..'e yC:1 .� y �y.�•. j �, , .��i:;;..;.�.. �:T<�^.x�.;�:,. ��:5;;�:.:t.:tt�:�±:::.C�:'E,4^`°9'< :45{;, .. ; �J�.'�.�h
�IL f�Z.�3faTmQ53on�� � \� \ Y t��";���i,4 „
` .,., :' � �:, a v .�:
-- A S10,C40 fidetity bond ia tavor of Ne organizacon must be obained tcr the gambling managet
sa. s�,��y x�mn�
47b-62'-i869
�x : �..� Mde �- "remate
* :s.,r.•'>.,',:;e�:a
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R:2?Y C,}
:,. ,�......a. .., v.: :.... .. ...m,e.._ .
Licensa Number
�0639
Phone
�b12 7 822-Z101
93
Name of insurance comFany {do not use agenry namej U S � idel i tv & Guarant8ond Number 20—�0=Q—:pi 0
�:....Y� " n ^:')Yi�i_:� . .vv: '< :ryY.:( f'Y' ..:i\ ::Y�G y
<sr,., .,....w.......:,...xz.,•:...,;rr„n...,`.�;.o..: .. ....,....�:�:.,..,
a,.k: ).o. , T. �rF:i:T.. ...r: „.S :y:.
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Y\d 'PTSy.. "tii:' )..1
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'Actrnorutedc�ent�
nb._"'�5�,;: . ,"G.... �xi.,.��tiY<.,. 54'.:f,:.:ta'y;`:.`:!}:
! dedare thaC
• i have read �his anplicadon and aii infortnation submitted to me board:
• aIi intortna6on is trve, acarate and eompkte;
• ail ocier required iniormaCOn has been lulty cisdosed;
• I am he only gamhPng manager of tha organizadon;
+ I wii! {arnil"wriza myself wi�fi the taws aE l+4nnesota goveminq iawfut gam6ling and rutes ol the boarsi and agres, i{ !'icensed. :o
;bide by those iaws and rutes. indudirg amenc'rnen+s :o theT;
• any changes in zcptiwoen infortnaucn wi11 be su6mir.ed to ;ha board snd loca! unit ot govemment wichin 70 dzys ci :he coa�
• An ai6daht for samofing ^anager has been eompieted �rd aRaei:ed, ar:d
• i uncers:and :hat failure a proride reGuired inicrmadcn cr providing fa15e intcrma�cn may resvit in �e denial nr 2vocaccn
license.
Si9namre of Gamclinq
�-""-�--- �
1 Dase
1/22/93
Sero tha nmpieted 2npiica.icn and aif requiced artachments b:
Gambling Controi Board
Suite 300 S.
1711 W. Ccunty Road S
Rosevitle, MN 551t3