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Minnesota Department of Public Safety <br /> Alcohol and Gambling Enforcement <br /> I am@: 445 Minnesota Street,Suite 222 <br /> MachoMr-mblingFiftwom St.Paul, MN 55101 <br /> 651-201-7500 <br /> RENEWAL OF LIQUOR, WINE, CLUB OR % LICENSES <br /> A <br /> Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City <br /> Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the <br /> new license period. City Clerk/County Auditor are also required by NLS.340A.404 S.3 to report any license cancellation. <br /> License Code ONSS License Period Ending 12/31/2018 ID# 42277 <br /> ISSUING AUTHORITY Centerville �... <br /> Licensee Name JV Summit Corp. <br /> Trade Name Southern Rail <br /> City, State,Zip Code 7082 Centerville Rd <br /> Centerville MN 55038 <br /> Business Phone 6514936626 <br /> License Fees: Off Sale On Sale $2,500.00 Sunday $200.00 <br /> By signing this renewal application,applicant certifies that there has been no change in ownership on the above named <br /> licensee. For changes in ownership,the licensee named above,or for new licensees, full applications should be used. Si <br /> back of this application for further information needed to complete this renewal. <br /> licant°s si a re on this ewal confi the folio °n o failure to re ort an of the followin a result in civil enalties. <br /> I. Licensee confirms it has no interest whatsoever,directly or indirectly in any other liquor establishments in Minnesota. <br /> If so,give details on back of this application. <br /> 2. Licensee confirms that it has never had a liquor license rejected by any city/township/county in the state of Minnesota. <br /> If ever rejected, please give details on the back of this renewal, then sign below. <br /> 3. Licensee confirms that for the past five years it has not had a liquor license revoked for any Iiquor law violation <br /> (state or local). If arevocation has occurred,please give details on the back of this renewal,then sign below. <br /> 4. Licensee confirms that during the past five years it or its employees have not been cited for any civil or criminal <br /> liquor law violations. If violations have occurred, please give details on back of this renewal,then sign below. <br /> 5. Licensee confirms that during the past Iicense year, a summons has not been issued under the Liquor Liability <br /> Law(Dram Shop)MS 340A.802. If yes,attach a copy of the summons,then sign below. <br /> 6. Licensee confirms that Workers Compensation insurance will be kept in effect during the license period. <br /> Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/county where <br /> license is issued. $100,000 in cash or securities or$100,000 surety bond may be submitted in lieu of liquor liability. <br /> (3.2&liquor licenses are pt if Sal 4;afire 1 s than$25,000 at on sale,1 21 ��0,000 at off sale). <br /> Licensee <br /> (Signature lcerhfies all above information to correct and license has been approved by1ci city/county , Date <br /> ty ty) <br /> City Clerk/County Auditor Signature Date <br /> (Signature certifies that renewal of a liquor,wine or club license has been approved by the city/county as stated above.) <br /> County Attorney Signature _ Date <br /> County Board issued licenses only(Signature cMies licensee is eligible for license)- <br /> ]Police/Sheriff Signature late ,/ <br /> 8i certifies Signature ceres liee or associates have been checked fair y st /local liquor law violati s(cr ina ccivU)duarin thefi e 4years, Report <br /> violations on back then sign he <br /> 42 <br />