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Attachment E <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />445 Minnesota St., Suite 1600, St. Paul, MN 55101 <br />(651)201-7507 FAX (651)297-5259 TTY (612)282-6555 <br />APPLICATION FOR CATERER'S PERMIT <br />PERMIT FEE $300 <br />Please check if application is an ❑ New or a ❑ renewal. Federal Tax ID # <br />To obtain a Caterer's Permit, applicant must currently hold a valid retail on -sale intoxicating liquor license at a restaurant. All liquor <br />laws and rules apply to both the on -sale license as well as this caterer's permit. Liquor liability and workers compensation insurance <br />are mandatory and a certificate showing off premises coverage must accompany this application for a caterer's permit. Cancellation <br />or suspension of the on -sale license invalidates the caterer's permit also. You, as the licensee, are required to notify the city police <br />chief or county sheriff (if located outside city limits) before any catered events take place in their jurisdiction. Only the licensee <br />holding the caterer's permit shall provide food and liquor at catered events. A pre -license inspection will be conducted by this office <br />prior to caterer's permit approval. <br />Business Name (Individual, Partnership, Corporation — ( If Corporation State full Corporate Name) (DOB) (Social Security #) <br />Trade Name or DBA of Restaurant <br />Address of Restaurant Telephone # <br />City or county where on -sale license issued Valid e-mail address <br />I certify that the above information provided by the applicant is true, complete, correct and made in good faith and agree to comply <br />with the above paragraph's requirements and all other applicable law in the use of the caterer's permit. <br />Signature - Authorized Applicant Date Print Full Name of Person Signing <br />Please attach the following documents to this form: <br />1) A copy of the applicant's valid on -sale intoxicating liquor license <br />2) A copy of the applicant's valid restaurant license issued by local Health Department <br />3) A certificate of liquor liability insurance that states "off premises coverage included" (No applications, binders or declarations) <br />4) $300.00 check or money order payable to the Alcohol and Gambling Enforcement Division <br />TO AVOID DELAYS OR DENIAL OF THIS APPLICATION, ALL ITEMS MUST BE COMPLETED IN FULL OR IT WILL BE <br />RETURNED FOR COMPLETION <br />MAKE CHECK PAYABLE TO: DIRECTOR OF ALCOHOL AND GAMBLING ENFORCEMENT <br />Cash <br />Check <br />