96-906����;���.(�';�
Council File $ � � W
ordinance �
Green Sheet # 35241
CITY
Presented By
Referred To
Committee: Date
;
1
2
3
RESOLVED: That application, ID #99603, for a new Gambling Manager's License by
Gergory J Lendway DBA Star Swim Club, Inc. at The Buttery at 395 No.
Robett Stteet, be and the same is hereby approved.
4
5 Requested by Department of:
6 Ye a e Absent
7 B a e �
9 Harris Off�ce of Licenae InspPCtions and
10 Me a� � Environmental Protection
12 Thune
!i
l
I. id �� . �
BY� � \ ��--� � . 1-�S �v-=�
/
Approved by Mayor: Date QE
By: l�l �� ,7Vi'4t,G�
RESOLIlTION
SAINT PA,tJL, �VIINNESOTA
Form Approved by City Attorney
By: c.,/ f � ��
(/th�e.ws R�
Approved by Mayor £or Submission to
Council
By:
Adopted by Council: Date �
Adoption Certified by Council Secretary
aG -qoc
DEPARTMENT/OFFICElCOUNCR, DATEINl�IATED N� 3 5 2 41
LIEP 7 1� q�, GREEN S - _ ,NmA�A�
CANTACf PEq50N 8 PHONE � DEPARTMEM DIFECTOR � CITV COUNCIL
William Gunthez - 266-9132 "`'S � CITYATfORNEY � CrtYCLEflK
MUST BE ON CAUNCIL AGEN�A BY (DATEj pUO`Ym8�i0R Q BUOGET DIRECTOR � FIN. S MCaT. SERVICES OW.
Hearin : "'� q ORDER � MpyOF (OR ASSISTANT) �
TOTAL # OF SIGNATUR PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACfION REQUESTED:
Gregory S. Lendway DBA Star Swim Club, Inc. requests Council appxoval of his application for
a new Gambling Manager's License, ID 9�99603, at The Buttery, 395 N. Robert Street.
XECAMMEN�ATI�NS: hppeove (A) av Rejact(R) pERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING QUESTIONS:
_ PLANNING CAMMISSION _ CIVIL SERVIC.E COMMISSION 1. Has Nis person/firm ever worketl under a conVact for this departrnent? -
_ CIBCOMMfiTEE _ YES NO
_ S7AFF 2. Has this parsonKrm ever been a city emplqee?
— YES NO
_ o15TRIC7 CAUR7 _ 3. Does this person/firm possess a skill not normally possessed by any cunent city employee?
SUPPOqTSWNIGNCQUNCILOBJECCIVE4 YES NO
Explain all yes answers on separate sheet and ettaeh to green sheet
INITIATING PROBLEM. ISSUE, OPPORTUNITV (Who. Whffi, When, Where, Why):
ADVANTAGES IFAPPROVED:
DISADVANTAGES IPAPPROVED:
���€a:�� t'�����'(�I �l�t9'
��� � � ����
--__. ___ . . ._�ss�: �
DISADVANTA('iES IF NOT APPROVEO:
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (qHCLE ONE) VES NO
FUNDING SOURCE ACTIVITV NUMBER
FINANCIAL INfORMATION: (EXPLAIN)
Greensheet #=��
in Tracker? �/� fqi,
License ID #
Company
Business ,
L.I.E.P. REVIEW CHECKLIST �ate: � q�- 90�
App'n Received / App'n Processed
License Type:
Contact Name/Address: �oC %� Vu /��� /'T�
Date to Council Research: 7�d`-�4���7
Pubiic Hearing Date:��r�'t� �-�, 7��
Notice Sent to Applicant:
Notice Sent to Public:
�3�iness Phone: � �� 0�o2�1,b
F{ome Phone: � �l �a-a-7.6
Labels Ordered: T/�
District Council #: ! 7
Ward #: � �
Department/ Date Inspections Comments
City Attorney /
'Z��-s�9 6 �l �-�'� 9�
Environmenial
Health �
/lo�/ /
Fire
�/ �
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License Sise p�an t3eceived:
tease aeceived:
/ ✓ /�
Police
'� . S-� 7��.���,6 ���/re� �n�
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Zoning
N1�--
LG212
(Rev. 7/2/92)
�nnesota LawfuI Gambting
Gambling Manager Apglication
FOR OFFiCE
&4SE LIC u _
SEQ #
FEE
CHK
DATE
INIT
�, t3ew Give date shat ihe two-day gambGng manager seminar was completed. N t 1 ? ) 9G
location of traininy F AGAn�
(dry}
❑ Renewal
Gdm�tina �
LAST NAME
�E�vd w A Y
ONLY
Give date of trainirg received within three years prior m the date of the appliaaon for renewal. _/ /
Location of
z7Z JuciEr AvE.
..,... . . . . ... _; .. ,. , -:. . _. _ . ,.:. ..,: :. .� •.
LE NAME MAIDEN Date of Birth Sot. Securiry Numhar
sEQH b.s-oY-S S/73-��-3:
N SS/oS � (6�z) �)z-
MEMSEFiSHiP: Date garnbYng manager beeame a member of the organizaaon ,�/10 /�
of
Address
/S36 �`/Ew i 7l f]V
Sex : � Male ❑ Female
license
CirylState Zip Gode Phorte
SrPAvL SS/oy � 6y�'ZZ76
Bond I �orniafion
-- A$10,000 fideliry bond in favor of the organization must be obtained for the gambling manager.
Name of insurence company (do not use agency name)�nrtt/EfT SuQfT;' �iUJ. Cor, . Bortd Number O/9 oa 8y2 �
�Ackriowiedbmerit
I dedare that:
• 1 have read this application and aff intottnation submitted to the board;
• all informaGon is true, accurate and complete;
• all oNer required information has been futly disdosed;
• 1 am the only gambting manager ot the wganization;
• i will familiarize myself with ihe laws of kLnnesota governing lawful gamb�ing and rules of the board and agree, if licensed, to
abide by ffiose iaws and rules, induding amendments to them; -
• any changes in application information will be submitted to the board arni bcal unii of govemment within 50 days of the change;
• An affidavit for gambiing manager has been completed and attached, and
• 1 understand that failure to provide required information or providing false information may result in the deniai or revocauon of the
license.
ot Gambting
Date
Send the completed ap¢tic�tion and a1I required ariachments to:
Gamhting Control Board
Suite 300 S.
17tt W. County Road B
Rosevttle. MN 55173
�
�j �jC��C ;
��2,3 � Minnesota Gambling Cpntrol Board �
oa�, arss Gamb/ing Manager Affidavit / n(
Attach to the Gambiing ManagerApplication, Form LG212 � t0"�
STATE OF NJINNfSoTfj ) qFFIDAVIT OF QUALIFICATION
) s.s. FOR GAMBLING MANAGER LICENSE
COUNTY OF RA�vis EY � AND CONSENT STATEMENT
(Pursuant to Minnesota Statutes and Rules)
I, GREGoRY � 1�,vd /A Y , under oath state tnat:
(type/print name)
1. i have never been convicted of a fetony or a crime invoiving gambling.
2. t have not, within five years before the date of the license appiication, committed a vioiation of law or
6oard rule that resuited in the revoCation of a license issued by tAe Board.
3. t have neveP been convicted ofi a criminal vioiation invoiving fraud, theft, tax evasion, misrepresen:;ticr,
or gambting.
4. i have never been convicted of �) assault, (ii) a criminaf viotation involving the use ot a firearm, or (iii)
making terzoristic threats.
5. I am not, nor ever have been connected with or engaged in art iilegai business.
6. I do not owe $500 or more in delinquent taxes as defined in section 270.72.
7. i have not had a sales and use tax permit revoked by the commissioner of revenue within the past two
years.
8. �`�V@ i.C'icf, a,`t�i Gd(Y+B;iG failed [o t. —� -e^:*�-nd �^ the commiss'oner of revenue.
In addition, i understand, agree and hereby irrevocably consent that suits and actions relating to the subject
matter of the attached gambfing manager license appiication, or acts or omissions arising from such appiica-
tion, may be commenced against my organization and I wiil accept the service of process for my organiza-
tion in any court of competent jurisdidion in Minnesota by service on the Minnesota Secretary of State of any
summons, process ar p{eading authorized by the taws of Minnesota.
By signature of this docume�t, the undersigned authorizes the Department of Pubiic Safety to conduct a
criminal background check or review a�d to share the resuits with the Gambling Controi Board.
Failure to provide required infortnation or providing fa(se or misieading information may result in the denia! or
revocation ofthe license.
FURTHER AFFIANT SAYETH NOT, except that this A�davit and Consent Statement are submitted in
support of the application for a gambting manager license from the Gambiing Control Board. ,
NOTARY PUBUC lNFORMATtON
Seai may not be aftered.
Subscribed and swo to before me this
�day of �
ORGANIZATfON INFORMATlON
or�coraoamm
�r�bo.»mr.xao
of Organization
STfj�Q Sw I wi �� V��rriC,
License Number