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98-33S.�bS�-,-�� Ame..r• a � � - �I�� l�g - a� �8� �°1 �' RESOLUTION CITY OF SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date RBSOLVSD: 1 That application (ID ¥19970000023) £or a Malt Off Sale, Grocery 2 (C), Cigarette/TObacco License(s) by AHMAD HAMADA ALROUSA DBA 3 RINGS MARKET at 920 SELBY AVE be and the same is hereby approved 4 with the following conditions: 5 1) Maintain monitoring system that is currently in place. 6 2) Remove and pick up trash on the perimeter of the licensed 7 establishment daily. Council File� 9 g- 33 Ordinance # Green Sheet #` LP50337 �0 3) The license holder agrees to take appropriate action to address loitering immediately adjacent to the licensed premises. This sh include camera surveillance and making a reasonable effort to cal e when excessive or unlawful licensee or his employees. the Requested by Department of: Office of License, Inspectiona and Environmental Protection By: �/�lil..le�/u �/"'�� Bye App: By: Form Approved by City Attorney B �`� �J ��i'G�.cc 2 -r o - 98� Approved by Mayor for Submission to Council By: Adopted by Council: Date .�. ��_��,8' Adoption Certified by Council Secretary N° 502�62 ry 6 ' /�( OEMR7MENVJFFICE/COUNCI� � DATE INITIqTED ' b �J"'� LIEP GREEN SHEE CONTACi PERSON 8 PHONE INITIAUDATE INITIAV�ATE aDEPAFTMENTDIRE OCITYCOUNpL Christit�e A. Rozek — 266-9108 nssicx �CITYATiORNEV �QTVCLERK MUST BE ON COUNCiI AGENOA BY (�ATEI N�MBER FOR O BUDGET DIRECiOR O FIN & MGT SERVICES �IR iIOUSING ORDEF � MAVOR (OR ASSISiANn � Hearing: � TOTAL # OF SIGNATURE PAG S (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED' Ahmad Alkousa DBA Kings Market (Ahmad H. Alkousa, Owner) requests Council approval of their application for an Off-Sale Malt, Cigarette & Grocery (C) at 920 Selby Avenue. (ID ��36792) PECOMMENDATIONS. Approve (A) a Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/Firm ever wo�ked under a contract for this departmen[� _ CIB CAMMITTEE _ VES NO _ S7AFF 2. Has this personRirm ever been a city employee? — VES NO _ DISTRICT COUai _ 3. Does this person/Firm possess a skill not no�mally po55esseA by any curreM aty employee� SUPPORTS WHICH COUNCIL OBJECTIVE'+ YES NO . Ezplain eli yes answers on aeparate sheet entl ettaeM to green shaet INITIATING PROBLEM, ISSUE, OPPORTUNITV (Who, What, When. Whare. Why): ADVANTAGES IF APPRWED: , DISADVANTAGES IFAPPROVED � �� JAN 0 7 E�S� DISADVANTAGESIFNOTAPPROVED_ ..�„�__ ,._ �� l�� ' U�V � e iJJ1 TOTAL AMOUNT OF 7RANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDING SOURCE ACTIVITV NUMBER FINANCIAI INFOROfiAT10N: (EXPlA1N) q�-33 The license holder agrees to take appropriate action to address loitering immediately adjacent to the licensed premises. This shall include camera surveillance and making a reasonable effort to call the police when excessive or unlawful loitering is observed by the licensee or his employees. � .r� �� Date: �—�---- AY�mad Alkousa / / / �/��` � � �� - ,, � � ,, �� ` i� =� � Council File � �� ~ 33 4R�GINAL Ordinance $ Green Sheet #` RESOLUTION CITY OF SAINT PAUL, MINNESOTA 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Presented By Referred To Date �j RESOLVED: That application, ID #36792, for an Off-Sale Malt, igarette & Grocery (C) Licenses by Ahmad Alkousa DBA &ings Market (Ahmad Alkousa, Owner) at 920 Selby Avenue, be and the same is hereby approved Adopted by uncil Adoption ertified By: Approved by Mayor: BY ' - - . Date by Council Secretary Date Requested by Department of: Off;c of r.' nse Tn pgctions and Environmental Protection $Y: l "�,n�.R, �" „"'� Form Approved by Cit A or� By: Approved b ayor for Submiasion to Council By: 7 Cn JC�� Company Name: If t1U$lI1CSS 1S 1I1C0I� Doing Business As: Susiness Address: THIS APPLICATION IS SUBJECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT IN INK Coipotation / Partnership / Sale Propri<Wrship ied, ¢ive date of incomoratios CITY OF SAPv T PAUL Qffice of Licensq Inspec[ions and Emvonmeniz] proteaion 3S� St?ra Sc Sv�e 3�0 Sz�:Pnvi,MUmaoin 55102 (611)�6b-9090 fzY(61��66-911d S S �'�/ D �"� � s 21�.= s f ` os`- s j��, , .i Business Phane: Street Address � � Between what cross streets is the 6usiness located7 �� Are tl�e premises now occupied? What Type of Business? Mail To Address: � C A� �Q � � .� � .� �. . Applic�t Name and Home Address: � 9�'� City State Z _ ip � [ � Which side of the street� �CX.t�-/ Street Addrees eiTy - _ � state zip Date of Birth: Q� — a�n � �P � Piace of Birth: c J�� ' (/ 1 Home Phone: �2� Have you ever been convicied of any fe]ony, crime or violation of any city ordinance other than traffic? YES NO Date of azrest: Where� Charge: Conviction: Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refetred to as to the applicani's chazacter; i`''9ME ; , ADDRESS PHONE List licenses which you currently hold, formerly' � �%v� P ��_, C Have any of the above named licenses eva been , » S't f�`�� CLASS III �/� � � LICENSB APPLICATION ;�-. \�� or may have ajt interest YES .)c�Jj � � g�0 — 7�"� — s ��— r� NO If yes, list the dates and reasons for revocation: Stzeet Addiw � CiTy State Zip you going to operate this husiness personally? � YES Name 0 , ddress: Sitcet \ame Midd3c Initis( (VSsidrn) 'nr� � � ��' -t� � a-f r2 !;. CiN XES Areyou going tohzve a manager or assistant in this business? plezse complete Lhe follow:ng infonnation: Fint?�amc x� aaa��s: s+�, ::�� Cirv Please list your emplo}ment history for the previous five (5) } ear geriod: List all other o�cers of the corporation: OFFICER TTTLE HOME NAME (OfficeHeld) ADDRESS NQ if not, who �n�ill operate iY? f�_��./ � � I !/n � �c Il , ._ '1 n ; .w � State Date ofBirih 5��' P /�{�✓' I(�r`, Zip Phone I�nmb¢ NO If the manager is not the szme as the operator, Las[ State Zip HOME BUSIiv`ESS PHONE PHONE If business is a partnership, please include the following infonnation for each parnier (use additional pages if necessary): First Tame Home Addless: Simet l�ame First Name HomeAddxcss: Sveetl�ame Initisl (!J.aidrn) Dau of Birth Phonci�'umbcr DATE OF BII2TH Middle Initial (Maidrn) City (.Maidrn) CiTy Last catc Zip I.aR Stau Zip Date of Birth Phane \'umbec Phone Number MQ�TNESOTA TAX IDENTIFICATION NCJIvfBER - Pursuant w the Laws of Minnesota,1984, Chapter 502, Article 8, Section 2(270.72) (T� Clearence; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business taY identification number and the social securiry number of each license applicant Under the Minnesota Crovemment Data Practices Act and the Federal Privacy Act of 1974, we aze required to ad�rise you of the following regarding the use of the Nfinnesota Tar ldentiScation Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's wzthholding or motor velticle �cise taxes, - ITpon receiving tlus infomlaiion, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Departmrnt of Revenue may suppiy this information to the Internal Revenue Sercrice. Minnesota Tax I�ntificaIIan Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Pazk P1aza (6 ] 2-296-61 S 1). Social SecurityNumber: 1vlumesota Ta�c Identification Number:CZO �) � I q �� ^ If a Minnesota Tax 7demification Number is not requued for the business being operated, indicate so by placing an "X" in the box. ` � 2/18/97 . : . °�� 33 CERTIFICATION OF WORKERS' COMPENSATION COVERAGE PIIRSUANT TO MINNESOTA STATUTE 176.182 I hereby cer[ify that I, arm}' company, am in cotapliance with the uorkers' compensation insurance cocerage requirements of Mi.-mzsota Statute 176.182, subdivision 2. I also uade�tand that pro��ision of false infortnation in this ccrti&cation constitutes sufficient a ounds for adcerse zclion agau�st all licenses he1d, includir.g revocation and suspension of said licznses. Name of Insurarce Company: PolicyNumber: Coveraezfro to I have no emplo} zes coverzd under workers' compensation inswance (INITIALS) ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMTi"TED WILL RESULT IN DEIv'IAL OF THIS APPLICATION I hereby state that I h2ve answered all of the preceding questions, and that the information contained herein is hue and cosut to the best of my knowledge and belief. I hereby state fiuther that I have received no money or other consideration, by way of loan, gift, conh or otheniise, other than alreac�� disclosed in the application which I he; ewith submired. I also understand ihis premise may be inspected by police, fire, health and other city officials at any and all times when the business is in operation. �-- f'- Signature (REQUIRED for all applications) We wzll accept payment by casb, check (made pa}'abie to City of Saiot Paul) or credit card (MJC or Visa). IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLOWINGINFORDIATION �ivlasterCard ❑ Visa EXPIl2ATION DATE: ACCOUNI' NUMBER: 0[�/[7� • DOC��] ��0 Co7�Jla��1 fl�l[�7�7 cazm,o�ae� of Cazd Date G � * xNote: If this application is FoodlLiquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re��iew pians. If any substantial changes to shucture are anticipated, please contact a City of Saint Paul Plan Exazniner at 266-9007 to appl}' for buiiding permiu. If there are any changes to the parking ]ot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. All applicafions require the folloRing documents. Please attach these documents w�hen submitting your application: 1. A detailed description of the design, Iceation and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferabiy on an S 1/2" x 11" or 8 I/2" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicated toward the top. - Placemrnt of all pertinent features of the interior of the licensed facility such as seating azeas, kitchens, offices, repair azea, parking, rest rooms, etc. - If a request is for an addition or expansion of the ]icensed fac$ity, indicate both the current azea and the proposed expansion. 2. A copy of your lease agreement or proof of ownership o£ the property. SPECIFIC LICENSE AFPLICATIONS REQUIRE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> i_; S.�bS�-,-�� Ame..r• a � � - �I�� l�g - a� �8� �°1 �' RESOLUTION CITY OF SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date RBSOLVSD: 1 That application (ID ¥19970000023) £or a Malt Off Sale, Grocery 2 (C), Cigarette/TObacco License(s) by AHMAD HAMADA ALROUSA DBA 3 RINGS MARKET at 920 SELBY AVE be and the same is hereby approved 4 with the following conditions: 5 1) Maintain monitoring system that is currently in place. 6 2) Remove and pick up trash on the perimeter of the licensed 7 establishment daily. Council File� 9 g- 33 Ordinance # Green Sheet #` LP50337 �0 3) The license holder agrees to take appropriate action to address loitering immediately adjacent to the licensed premises. This sh include camera surveillance and making a reasonable effort to cal e when excessive or unlawful licensee or his employees. the Requested by Department of: Office of License, Inspectiona and Environmental Protection By: �/�lil..le�/u �/"'�� Bye App: By: Form Approved by City Attorney B �`� �J ��i'G�.cc 2 -r o - 98� Approved by Mayor for Submission to Council By: Adopted by Council: Date .�. ��,8' Adoption Certified by Council Secretary N° 502�62 ry 6 ' /�( OEMR7MENVJFFICE/COUNCI� � DATE INITIqTED ' b �J"'� LIEP GREEN SHEE CONTACi PERSON 8 PHONE INITIAUDATE INITIAV�ATE aDEPAFTMENTDIRE OCITYCOUNpL Christit�e A. Rozek — 266-9108 nssicx �CITYATiORNEV �QTVCLERK MUST BE ON COUNCiI AGENOA BY (�ATEI N�MBER FOR O BUDGET DIRECiOR O FIN & MGT SERVICES �IR iIOUSING ORDEF � MAVOR (OR ASSISiANn � Hearing: � TOTAL # OF SIGNATURE PAG S (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED' Ahmad Alkousa DBA Kings Market (Ahmad H. Alkousa, Owner) requests Council approval of their application for an Off-Sale Malt, Cigarette & Grocery (C) at 920 Selby Avenue. (ID ��36792) PECOMMENDATIONS. Approve (A) a Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/Firm ever wo�ked under a contract for this departmen[� _ CIB CAMMITTEE _ VES NO _ S7AFF 2. Has this personRirm ever been a city employee? — VES NO _ DISTRICT COUai _ 3. Does this person/Firm possess a skill not no�mally po55esseA by any curreM aty employee� SUPPORTS WHICH COUNCIL OBJECTIVE'+ YES NO . Ezplain eli yes answers on aeparate sheet entl ettaeM to green shaet INITIATING PROBLEM, ISSUE, OPPORTUNITV (Who, What, When. Whare. Why): ADVANTAGES IF APPRWED: , DISADVANTAGES IFAPPROVED � �� JAN 0 7 E�S� DISADVANTAGESIFNOTAPPROVED_ ..�„�__ ,._ �� l�� ' U�V � e iJJ1 TOTAL AMOUNT OF 7RANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDING SOURCE ACTIVITV NUMBER FINANCIAI INFOROfiAT10N: (EXPlA1N) q�-33 The license holder agrees to take appropriate action to address loitering immediately adjacent to the licensed premises. This shall include camera surveillance and making a reasonable effort to call the police when excessive or unlawful loitering is observed by the licensee or his employees. � .r� �� Date: �—�---- AY�mad Alkousa / / / �/��` � � �� - ,, � � ,, �� ` i� =� � Council File � �� ~ 33 4R�GINAL Ordinance $ Green Sheet #` RESOLUTION CITY OF SAINT PAUL, MINNESOTA 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Presented By Referred To Date �j RESOLVED: That application, ID #36792, for an Off-Sale Malt, igarette & Grocery (C) Licenses by Ahmad Alkousa DBA &ings Market (Ahmad Alkousa, Owner) at 920 Selby Avenue, be and the same is hereby approved Adopted by uncil Adoption ertified By: Approved by Mayor: BY ' - - . Date by Council Secretary Date Requested by Department of: Off;c of r.' nse Tn pgctions and Environmental Protection $Y: l "�,n�.R, �" „"'� Form Approved by Cit A or� By: Approved b ayor for Submiasion to Council By: 7 Cn JC�� Company Name: If t1U$lI1CSS 1S 1I1C0I� Doing Business As: Susiness Address: THIS APPLICATION IS SUBJECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT IN INK Coipotation / Partnership / Sale Propri<Wrship ied, ¢ive date of incomoratios CITY OF SAPv T PAUL Qffice of Licensq Inspec[ions and Emvonmeniz] proteaion 3S� St?ra Sc Sv�e 3�0 Sz�:Pnvi,MUmaoin 55102 (611)�6b-9090 fzY(61��66-911d S S �'�/ D �"� � s 21�.= s f ` os`- s j��, , .i Business Phane: Street Address � � Between what cross streets is the 6usiness located7 �� Are tl�e premises now occupied? What Type of Business? Mail To Address: � C A� �Q � � .� � .� �. . Applic�t Name and Home Address: � 9�'� City State Z _ ip � [ � Which side of the street� �CX.t�-/ Street Addrees eiTy - _ � state zip Date of Birth: Q� — a�n � �P � Piace of Birth: c J�� ' (/ 1 Home Phone: �2� Have you ever been convicied of any fe]ony, crime or violation of any city ordinance other than traffic? YES NO Date of azrest: Where� Charge: Conviction: Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refetred to as to the applicani's chazacter; i`''9ME ; , ADDRESS PHONE List licenses which you currently hold, formerly' � �%v� P ��_, C Have any of the above named licenses eva been , » S't f�`�� CLASS III �/� � � LICENSB APPLICATION ;�-. \�� or may have ajt interest YES .)c�Jj � � g�0 — 7�"� — s ��— r� NO If yes, list the dates and reasons for revocation: Stzeet Addiw � CiTy State Zip you going to operate this husiness personally? � YES Name 0 , ddress: Sitcet \ame Midd3c Initis( (VSsidrn) 'nr� � � ��' -t� � a-f r2 !;. CiN XES Areyou going tohzve a manager or assistant in this business? plezse complete Lhe follow:ng infonnation: Fint?�amc x� aaa��s: s+�, ::�� Cirv Please list your emplo}ment history for the previous five (5) } ear geriod: List all other o�cers of the corporation: OFFICER TTTLE HOME NAME (OfficeHeld) ADDRESS NQ if not, who �n�ill operate iY? f�_��./ � � I !/n � �c Il , ._ '1 n ; .w � State Date ofBirih 5��' P /�{�✓' I(�r`, Zip Phone I�nmb¢ NO If the manager is not the szme as the operator, Las[ State Zip HOME BUSIiv`ESS PHONE PHONE If business is a partnership, please include the following infonnation for each parnier (use additional pages if necessary): First Tame Home Addless: Simet l�ame First Name HomeAddxcss: Sveetl�ame Initisl (!J.aidrn) Dau of Birth Phonci�'umbcr DATE OF BII2TH Middle Initial (Maidrn) City (.Maidrn) CiTy Last catc Zip I.aR Stau Zip Date of Birth Phane \'umbec Phone Number MQ�TNESOTA TAX IDENTIFICATION NCJIvfBER - Pursuant w the Laws of Minnesota,1984, Chapter 502, Article 8, Section 2(270.72) (T� Clearence; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business taY identification number and the social securiry number of each license applicant Under the Minnesota Crovemment Data Practices Act and the Federal Privacy Act of 1974, we aze required to ad�rise you of the following regarding the use of the Nfinnesota Tar ldentiScation Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's wzthholding or motor velticle �cise taxes, - ITpon receiving tlus infomlaiion, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Departmrnt of Revenue may suppiy this information to the Internal Revenue Sercrice. Minnesota Tax I�ntificaIIan Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Pazk P1aza (6 ] 2-296-61 S 1). Social SecurityNumber: 1vlumesota Ta�c Identification Number:CZO �) � I q �� ^ If a Minnesota Tax 7demification Number is not requued for the business being operated, indicate so by placing an "X" in the box. ` � 2/18/97 . : . °�� 33 CERTIFICATION OF WORKERS' COMPENSATION COVERAGE PIIRSUANT TO MINNESOTA STATUTE 176.182 I hereby cer[ify that I, arm}' company, am in cotapliance with the uorkers' compensation insurance cocerage requirements of Mi.-mzsota Statute 176.182, subdivision 2. I also uade�tand that pro��ision of false infortnation in this ccrti&cation constitutes sufficient a ounds for adcerse zclion agau�st all licenses he1d, includir.g revocation and suspension of said licznses. Name of Insurarce Company: PolicyNumber: Coveraezfro to I have no emplo} zes coverzd under workers' compensation inswance (INITIALS) ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMTi"TED WILL RESULT IN DEIv'IAL OF THIS APPLICATION I hereby state that I h2ve answered all of the preceding questions, and that the information contained herein is hue and cosut to the best of my knowledge and belief. I hereby state fiuther that I have received no money or other consideration, by way of loan, gift, conh or otheniise, other than alreac�� disclosed in the application which I he; ewith submired. I also understand ihis premise may be inspected by police, fire, health and other city officials at any and all times when the business is in operation. �-- f'- Signature (REQUIRED for all applications) We wzll accept payment by casb, check (made pa}'abie to City of Saiot Paul) or credit card (MJC or Visa). IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLOWINGINFORDIATION �ivlasterCard ❑ Visa EXPIl2ATION DATE: ACCOUNI' NUMBER: 0[�/[7� • DOC��] ��0 Co7�Jla��1 fl�l[�7�7 cazm,o�ae� of Cazd Date G � * xNote: If this application is FoodlLiquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re��iew pians. If any substantial changes to shucture are anticipated, please contact a City of Saint Paul Plan Exazniner at 266-9007 to appl}' for buiiding permiu. If there are any changes to the parking ]ot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. All applicafions require the folloRing documents. Please attach these documents w�hen submitting your application: 1. A detailed description of the design, Iceation and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferabiy on an S 1/2" x 11" or 8 I/2" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicated toward the top. - Placemrnt of all pertinent features of the interior of the licensed facility such as seating azeas, kitchens, offices, repair azea, parking, rest rooms, etc. - If a request is for an addition or expansion of the ]icensed fac$ity, indicate both the current azea and the proposed expansion. 2. A copy of your lease agreement or proof of ownership o£ the property. SPECIFIC LICENSE AFPLICATIONS REQUIRE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> i_; S.�bS�-,-�� Ame..r• a � � - �I�� l�g - a� �8� �°1 �' RESOLUTION CITY OF SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date RBSOLVSD: 1 That application (ID ¥19970000023) £or a Malt Off Sale, Grocery 2 (C), Cigarette/TObacco License(s) by AHMAD HAMADA ALROUSA DBA 3 RINGS MARKET at 920 SELBY AVE be and the same is hereby approved 4 with the following conditions: 5 1) Maintain monitoring system that is currently in place. 6 2) Remove and pick up trash on the perimeter of the licensed 7 establishment daily. Council File� 9 g- 33 Ordinance # Green Sheet #` LP50337 �0 3) The license holder agrees to take appropriate action to address loitering immediately adjacent to the licensed premises. This sh include camera surveillance and making a reasonable effort to cal e when excessive or unlawful licensee or his employees. the Requested by Department of: Office of License, Inspectiona and Environmental Protection By: �/�lil..le�/u �/"'�� Bye App: By: Form Approved by City Attorney B �`� �J ��i'G�.cc 2 -r o - 98� Approved by Mayor for Submission to Council By: Adopted by Council: Date .�. ��,8' Adoption Certified by Council Secretary N° 502�62 ry 6 ' /�( OEMR7MENVJFFICE/COUNCI� � DATE INITIqTED ' b �J"'� LIEP GREEN SHEE CONTACi PERSON 8 PHONE INITIAUDATE INITIAV�ATE aDEPAFTMENTDIRE OCITYCOUNpL Christit�e A. Rozek — 266-9108 nssicx �CITYATiORNEV �QTVCLERK MUST BE ON COUNCiI AGENOA BY (�ATEI N�MBER FOR O BUDGET DIRECiOR O FIN & MGT SERVICES �IR iIOUSING ORDEF � MAVOR (OR ASSISiANn � Hearing: � TOTAL # OF SIGNATURE PAG S (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED' Ahmad Alkousa DBA Kings Market (Ahmad H. Alkousa, Owner) requests Council approval of their application for an Off-Sale Malt, Cigarette & Grocery (C) at 920 Selby Avenue. (ID ��36792) PECOMMENDATIONS. Approve (A) a Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/Firm ever wo�ked under a contract for this departmen[� _ CIB CAMMITTEE _ VES NO _ S7AFF 2. Has this personRirm ever been a city employee? — VES NO _ DISTRICT COUai _ 3. Does this person/Firm possess a skill not no�mally po55esseA by any curreM aty employee� SUPPORTS WHICH COUNCIL OBJECTIVE'+ YES NO . Ezplain eli yes answers on aeparate sheet entl ettaeM to green shaet INITIATING PROBLEM, ISSUE, OPPORTUNITV (Who, What, When. Whare. Why): ADVANTAGES IF APPRWED: , DISADVANTAGES IFAPPROVED � �� JAN 0 7 E�S� DISADVANTAGESIFNOTAPPROVED_ ..�„�__ ,._ �� l�� ' U�V � e iJJ1 TOTAL AMOUNT OF 7RANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDING SOURCE ACTIVITV NUMBER FINANCIAI INFOROfiAT10N: (EXPlA1N) q�-33 The license holder agrees to take appropriate action to address loitering immediately adjacent to the licensed premises. This shall include camera surveillance and making a reasonable effort to call the police when excessive or unlawful loitering is observed by the licensee or his employees. � .r� �� Date: �—�---- AY�mad Alkousa / / / �/��` � � �� - ,, � � ,, �� ` i� =� � Council File � �� ~ 33 4R�GINAL Ordinance $ Green Sheet #` RESOLUTION CITY OF SAINT PAUL, MINNESOTA 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Presented By Referred To Date �j RESOLVED: That application, ID #36792, for an Off-Sale Malt, igarette & Grocery (C) Licenses by Ahmad Alkousa DBA &ings Market (Ahmad Alkousa, Owner) at 920 Selby Avenue, be and the same is hereby approved Adopted by uncil Adoption ertified By: Approved by Mayor: BY ' - - . Date by Council Secretary Date Requested by Department of: Off;c of r.' nse Tn pgctions and Environmental Protection $Y: l "�,n�.R, �" „"'� Form Approved by Cit A or� By: Approved b ayor for Submiasion to Council By: 7 Cn JC�� Company Name: If t1U$lI1CSS 1S 1I1C0I� Doing Business As: Susiness Address: THIS APPLICATION IS SUBJECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT IN INK Coipotation / Partnership / Sale Propri<Wrship ied, ¢ive date of incomoratios CITY OF SAPv T PAUL Qffice of Licensq Inspec[ions and Emvonmeniz] proteaion 3S� St?ra Sc Sv�e 3�0 Sz�:Pnvi,MUmaoin 55102 (611)�6b-9090 fzY(61��66-911d S S �'�/ D �"� � s 21�.= s f ` os`- s j��, , .i Business Phane: Street Address � � Between what cross streets is the 6usiness located7 �� Are tl�e premises now occupied? What Type of Business? Mail To Address: � C A� �Q � � .� � .� �. . Applic�t Name and Home Address: � 9�'� City State Z _ ip � [ � Which side of the street� �CX.t�-/ Street Addrees eiTy - _ � state zip Date of Birth: Q� — a�n � �P � Piace of Birth: c J�� ' (/ 1 Home Phone: �2� Have you ever been convicied of any fe]ony, crime or violation of any city ordinance other than traffic? YES NO Date of azrest: Where� Charge: Conviction: Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refetred to as to the applicani's chazacter; i`''9ME ; , ADDRESS PHONE List licenses which you currently hold, formerly' � �%v� P ��_, C Have any of the above named licenses eva been , » S't f�`�� CLASS III �/� � � LICENSB APPLICATION ;�-. \�� or may have ajt interest YES .)c�Jj � � g�0 — 7�"� — s ��— r� NO If yes, list the dates and reasons for revocation: Stzeet Addiw � CiTy State Zip you going to operate this husiness personally? � YES Name 0 , ddress: Sitcet \ame Midd3c Initis( (VSsidrn) 'nr� � � ��' -t� � a-f r2 !;. CiN XES Areyou going tohzve a manager or assistant in this business? plezse complete Lhe follow:ng infonnation: Fint?�amc x� aaa��s: s+�, ::�� Cirv Please list your emplo}ment history for the previous five (5) } ear geriod: List all other o�cers of the corporation: OFFICER TTTLE HOME NAME (OfficeHeld) ADDRESS NQ if not, who �n�ill operate iY? f�_��./ � � I !/n � �c Il , ._ '1 n ; .w � State Date ofBirih 5��' P /�{�✓' I(�r`, Zip Phone I�nmb¢ NO If the manager is not the szme as the operator, Las[ State Zip HOME BUSIiv`ESS PHONE PHONE If business is a partnership, please include the following infonnation for each parnier (use additional pages if necessary): First Tame Home Addless: Simet l�ame First Name HomeAddxcss: Sveetl�ame Initisl (!J.aidrn) Dau of Birth Phonci�'umbcr DATE OF BII2TH Middle Initial (Maidrn) City (.Maidrn) CiTy Last catc Zip I.aR Stau Zip Date of Birth Phane \'umbec Phone Number MQ�TNESOTA TAX IDENTIFICATION NCJIvfBER - Pursuant w the Laws of Minnesota,1984, Chapter 502, Article 8, Section 2(270.72) (T� Clearence; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business taY identification number and the social securiry number of each license applicant Under the Minnesota Crovemment Data Practices Act and the Federal Privacy Act of 1974, we aze required to ad�rise you of the following regarding the use of the Nfinnesota Tar ldentiScation Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's wzthholding or motor velticle �cise taxes, - ITpon receiving tlus infomlaiion, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Departmrnt of Revenue may suppiy this information to the Internal Revenue Sercrice. Minnesota Tax I�ntificaIIan Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Pazk P1aza (6 ] 2-296-61 S 1). Social SecurityNumber: 1vlumesota Ta�c Identification Number:CZO �) � I q �� ^ If a Minnesota Tax 7demification Number is not requued for the business being operated, indicate so by placing an "X" in the box. ` � 2/18/97 . : . °�� 33 CERTIFICATION OF WORKERS' COMPENSATION COVERAGE PIIRSUANT TO MINNESOTA STATUTE 176.182 I hereby cer[ify that I, arm}' company, am in cotapliance with the uorkers' compensation insurance cocerage requirements of Mi.-mzsota Statute 176.182, subdivision 2. I also uade�tand that pro��ision of false infortnation in this ccrti&cation constitutes sufficient a ounds for adcerse zclion agau�st all licenses he1d, includir.g revocation and suspension of said licznses. Name of Insurarce Company: PolicyNumber: Coveraezfro to I have no emplo} zes coverzd under workers' compensation inswance (INITIALS) ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL SUBMTi"TED WILL RESULT IN DEIv'IAL OF THIS APPLICATION I hereby state that I h2ve answered all of the preceding questions, and that the information contained herein is hue and cosut to the best of my knowledge and belief. I hereby state fiuther that I have received no money or other consideration, by way of loan, gift, conh or otheniise, other than alreac�� disclosed in the application which I he; ewith submired. I also understand ihis premise may be inspected by police, fire, health and other city officials at any and all times when the business is in operation. �-- f'- Signature (REQUIRED for all applications) We wzll accept payment by casb, check (made pa}'abie to City of Saiot Paul) or credit card (MJC or Visa). IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLOWINGINFORDIATION �ivlasterCard ❑ Visa EXPIl2ATION DATE: ACCOUNI' NUMBER: 0[�/[7� • DOC��] ��0 Co7�Jla��1 fl�l[�7�7 cazm,o�ae� of Cazd Date G � * xNote: If this application is FoodlLiquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re��iew pians. If any substantial changes to shucture are anticipated, please contact a City of Saint Paul Plan Exazniner at 266-9007 to appl}' for buiiding permiu. If there are any changes to the parking ]ot, floor space, or for new operations, please contact a City of Saint Paul Zoning Inspector at 266-9008. All applicafions require the folloRing documents. Please attach these documents w�hen submitting your application: 1. A detailed description of the design, Iceation and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferabiy on an S 1/2" x 11" or 8 I/2" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicated toward the top. - Placemrnt of all pertinent features of the interior of the licensed facility such as seating azeas, kitchens, offices, repair azea, parking, rest rooms, etc. - If a request is for an addition or expansion of the ]icensed fac$ity, indicate both the current azea and the proposed expansion. 2. A copy of your lease agreement or proof of ownership o£ the property. SPECIFIC LICENSE AFPLICATIONS REQUIRE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> i_;