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Home My WebLink About2014-04-23 CC Packet CITY OF CENTERVILLE COUNCIL MEETING & EXECUTIVE SESSION AGENDA Wednesday, April 23, 2014 6:30 p.m. or shortly thereafter OPEN FORUM 6:30 P.M.: An opportunity for members of the public to address the City Council on items not on the current agenda. Items requiring Council action may be deferred to Staff or Boards and Commissions for research and future Council Agendas if appropriate. You will be limited to two (2) minutes and we ask that you conduct yourself in a professional, courteous manner and refrain from the use of profanity. Failure to abide by this policy may result in the loss of your privilege to speak. Persons wishing to speak will be required to complete a sign-up sheet and give it to the Mayor or a Staff person prior to 6:00 p.m. COUNCIL MEETING I. CALL TO ORDER 1. Roll Call III. AWARDS/PRESENTATIONS/APPEARANCES 1. Sergeant Pat Aldrich, Centennial Lakes Police Department (2013 Annual Report and 2014 Management Plan & Quarterly Update) (Pages 1-39) IV. PUBLIC HEARING 1. None. V. APPROVAL OF AGENDA VI. APPROVAL OF MINUTES 1. April 9, 2014 City Council Meeting Minutes (Pages 40-47) 2. April 9, 2014 City Council Joint Work Session Meeting Minutes **Email** VII. CONSENT AGENDA 1. City of Centerville April 10, 2014 through April 23, 2014 Claims (Check #28631- 28640) & Voided Checks #28592 & 28605 (Page 48) 2. Centennial Police Department Claims through April 10, 2014 (Check #9856-9871) (Page 49) 3. Centennial Fire District Claims through April 4, 2014 (Check #6326-6334) w/Check #6318-6325 Payroll (Page 50-51) 4. Res. #14-0XX – Reserving Unpspent Budget & and Revenue Excesses from Year 2013 & Committing Them for Park Purposes to Be Expended in 2014 (Pages 52- 54) 5. P & R Recommendation to Approve Special Event Permit Application ~ Centennial Baseball Booster 5K/8K Run, Anoka County Trails w/Laurie LaMotte Park – September 27, 2014 (6:30 a.m. – 11:00 a.m.) w/Park Use Fee Waiving but not $100 Deposit (They have submitted permit to Anoka County for Rice Creek Chain of Lakes Permit, will Provide Police at Intersections, Trash Removal, Port- a-Potties, First-Aid & Etc.) (Pages 55-66) 6. P & R Recommendation to Approve Special Event Permit Application ~ Hmong Flag Football Tournament, Laurie LaMotte Park – May 31 – June 1, 2014 (5:00 p.m. May 30 – 7:00 p.m. June 1, 2014) w/$50 Usage Fee and $500 Deposit (Pages 67-76) 7. Encroachment Agreement ~ Mr. & Mrs. Zachary Handahl, 1937 Eagle Trail - Fence & After the Fact Pool (Installed by Previous Owner) in Drainage/Utility Easement (Page 77) VIII. OLD BUSINESS 1. Anoka County Fire Protection Council Joint Powers Agreement (Pages 78-93) 2. Downtown Concrete Intersection 3. Hugo Request for Funding Assistance – Bald Eagle Lake Dam (Pages 94-95) IX. NEW BUSINESS 1. Consider Entering into Agreement with Minnesota Department of Health for Source Water Protection Implementation Grant. (Pages 96-105) 2. Centerville Road - Utilities X. ANNOUNMENTS/UPDATES 1. Administrator Larson XI. CLOSED EXECUTIVE SESSION (Administrator Performance Review) (Closed unless otherwise Opened) XII. ADJOURNMENT **REMINDERS** Planning & Zoning Commission Meeting – May 6, 2014, 6:30 p.m. (Council Chambers) Parks & Recreation Committee Meeting – May 7, 2014, 6:30 p.m. (Council Chambers) City Council Meeting – May 14, 2014, 6:30 p.m. (Council Chambers) City Council Meeting – May 28, 2014, 6:30 p.m. (Council Chambers) PARK USAGE RESERVATIONS Centennial Little League, Ball field #3, #4 and possibly #5, LaMotte Park ~ April 1 through August 1, 2014, Monday through Fridays from 4:00 p.m. to dark Centennial Soccer Club, Fields #1, #2 and 11, LaMotte Park ~ April 1 through July 26, 2014, 5:30 p.m. to sunset Ms. Jaci Smetana, Fitness Classes, Parking Lot, Football/Soccer Fields/Shelter, LaMotte Park ~ April 28 through October 31, 2014, Monday through Thursdays from 5:30-6:30 a.m. Centennial Baseball Boosters, 5K/8K Run - LaMotte Park Trails ~ September 27, 2014, 6:30 a.m. to 11:00 a.m. CITY OF CENTERVILLE SPECIAL CITY COUNCIL MEETING Apri19, 2014 6:00 p.m. Pursuant to due call and notice thereof, the City of Centerville held a Special Council Meeting of April 9, 2014 at City Hall, 1880 Main Street which are contained in these minutes. PRESENT: Mayor Tom Wilharber Council Member Ben Fehrenbacher Council Member D. Love Council Member Jeff Paar (Arrived 6:04) ABSENT: Council Member Steve King Not A]P]P1r(MVk/1K D ll L r STAFF: City Administrator a as a so n City Engineer Mark Statz Legal Counsel Kurt Glaser Public Work Director Paul Palzer L SPECIAL MEETING CALL TO ORDER Mayor Wilharber called the meeting to order at 6:00 p.m. II. PLEDGE OF ALLEGIANCE III. AWARDS /PRESENTATIONS /APPEARANCES 1. ABDO, Eick & Meyers — 2013 Annual Audit Mr. Steve McDonald introduced Mr. Kevin Knopik, CPA stating that he is the lead auditor for the City of Centerville and that he would be providing most of the presentation. Mr. McDonald stated that their audit found that the City is in sound financial condition, consistency in internal controls, noted that one very minor year end capital asset was not classified correctly, minimal need for audit adjustments and that the City is transitioning well from a full -time Finance Director to a part-time Finance Director. Mr. McDonald stated that there were no problems interacting with staff and that preparation by Finance Director Ellie Paulseth for the audit was excellent. Mr. Knopik concurred with Mr. McDonald and reviewed the provided audit stating that the City's General Fund balance increased $52,776 from 2012 exceeding requirements of 40 -50% of the 2014 budgeted expenditures while setting aside funding for capital equipment and future debt services, stated that property taxes are 80% of the total general fund revenue while public safety is 48.9% of the expenditures, stated that ongoing evaluation of projects will assist in determining whether to close a fund or if additional funding sources are needed for deficits, reviewed debt 40 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 service funds; enterprise funds (water, sewer, and storm water). Mr. Knopik stated that the City is fairly consistent and below peer groups (communities similar in population and size) and that the City's spending and debt leverage has decreased. Mr. Knopik also stated that there will be future accounting practices that will be required (GASB67 and 68) but feels that they will not have a significant impact. Administrator Larson stated that he felt satisfied with the report, staff had worked hard throughout the year and that Finance Director Paulseth desired to be at the meeting but she was ill. The Mayor closed the Special City Council meeting at 6:20 p.m. Page 2 of 8 41 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 CITY OF CENTERVILLE CITY COUNCIL MEETING April 9, 2014 6:30 p.m. Pursuant to due call and notice thereof, the City of Centerville held a Council Meeting of April 9, 2014 at City Hall, 1880 Main Street which are contained in these minutes. PRESENT: Mayor Tom Wilharber Council Member Ben Fehrenbacher Council Member Steve King Council Member D. Love NOt A Council Member Jeff Paar ABSENT: None STAFF: City Administrator Dallas Larson City Engineer Mark Statz Legal Counsel Kurt Glaser Public Work Director Paul Palzer I. REGULAR MEETING CALL TO ORDER Mayor Wilharber called the meeting to order at 6:30 p.m. II. AWARDS /PRESENTATIONS /APPEARANCES 1. None. III. PUBLIC HEARING Mayor Wilharber Opened the public hearing at 6:31 p.m. 1. Amending Assessments — Backage Road /Commerce Drive Project (Sheehy Property /City of Centerville) City Attorney Glaser reviewed his submitted Memorandum regarding Sheehy Construction and the calculation of principal and accrued interest with Council. Attorney Glaser stated that in 2009, Council adopted special assessments against the Sheehy parcel in the amount of $379,000; in February of 2013, following the appeal the court ordered the City to adjust the original amount to $249,000; two payments were received toward satisfying the debt (one in 2010 and one in 2013 following the adjusted assessment adopted by Council); in 2013, Sheehy filed suit against the City requesting the Court to issue an order effectively barring the City from imposing accrued interest for the debt and the Court granted the City's motion and dismissed Sheehy's suit. Attorney Glaser stated that the law states "the assessment, with accruing interest, shall be a lien upon all private and public property including therein, from the date of the resolution Page 3 of 8 42 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 adopting the assessment." Attorney Glaser stated that Council needed to consider whether to proceed with determining the amount of unpaid principal and /or accrued interest necessary to satisfy the assessment debt owed and certify that amount to the County for payment according to the presented table submitted by the Finance Director by adopting the resolution contained in their packet. Attorney Glaser reviewed the presented table with Council and amended that Year 1 of the assessment roll commence in 2015 rather than 2014 with the term of the assessment being 10 years at 5.75% interest and ending in 2024 rather than 2023. Council Member Love questioned whether interest had been adjusted accordingly to their payments and Attorney Glaser concurred. Ms. Julie Douglass, Attorney Representing Sheehy Construction, introduced herself to Council and stated that her client has two objections to paying accrue interest on unpaid principal due to: The City adopted Res. #13 -009 which specifically addresses interest and repayment (February 13, 2013), that "no interest will be charged on any amount paid within 30 days of the resolution and that the City reassessed the Sheehy property in the amount of $249,000 and did not include any assessment for interest between June 10, 2014 and February 13, 2013 and Sheehy paid the February 13, 2013 reassessment amount in full within 30 days. Ms. Douglass' and Sheehy's arguments are that Minnesota State Statutes 429 specifically 429.061, subd 2, subd 3, 429.071, subd 2 and 429.081 address the Courts decision, assessment/reassessment payment in full without interest as in the City's re- assessment resolution and her interpretation of Judge Larson's order and intent. Lengthy discussion ensued regarding the judges intent, definition of set aside, at what time does interest being to accrue /at the time of benefit, special assessment law vs. property tax law, and valuation and benefit to property. Mr. Dean Luxenburg, 1697 Peltier Lake Drive, stated that Council has expended in excess of $100,000 on this litigation to date, questioned how much more of his tax dollars they were going to spend and requested Council stop any future action. Mr Blair Juliar, Vice President, Sheehy Construction, stated that the Council has taken bad advice in the past and has lost every time that this item has been taken to court. Mr. Juliar questioned why Council desires to continue wasting taxpayer money and being poor stewards of citizen's money. Attorney Glaser stated that Mr. Juliar's comments were incorrect and that the Courts have found in favor of the City on two occasions and that he is confident that the Judge could not address the interest issue due to the fact that the law is clear. Page 4 of 8 43 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 Motion by Council Member Love seconded by Council Member Fehrenbacher to close the public hearing at 7.05 p m All in favor. Motion carried. IV. APPROVAL OF AGENDA 1. Mayor Wilharber added Centerville Claims (Check #28600 - 28625), a Special Event Permit Application for an Easter Egg Hunt at LaMotte Park under New Business, Item #5 and a Request for Participation in Repairs to Bald Eagle Lake Dam by City of Hugo under New Business, Item #4. Motion by Council Member Fehrenbacher, seconded by C ouncil M ember Love to approve t he Agenda as amended All in favor. Mo tion p assed. V. APPROVAL OF MINUTES 1. March 26, 2014 City Council Meeting Minutes The Mayor provided Council Members with an opportunity to amend the presented minutes. Mayor Wilharber desired that the minutes reflect that Engineer Statz would address the drainage issues that Ms. McGown stated during the Public Input — 2014 Royal Meadows Municipal Improvements on Page 4 of 7. Mayor Wilharber also desired that under Updates, Item #10, second sentence add "from Dupre Road to City limits" after municipal sewer and water and that a typo in the last sentence, "Consensus was thaot staff' be corrected. Motion by Council Member Paar, seconded by Coun Mem ber King to approve the minutes of the March 26 2014 City Council Meeting as amended. Council Member Love Abstained. Motion passed. VI. CONSENT AGENDA I. City of Centerville March 27, 2014 through April 9, 2014 Claims (Check #28600 - 28625) & Voided Check #28606 & (Check #28626- 28630) 2. Centennial Police Department Claims through March 28, 2014 (Check #9839 -9855) w /Check #9772 Voided 3. Centennial Fire District Claims through March 21, 2014 (Check #6305 -6317) 4. Res. #14 -OXX — Establishing a Local Board of Appeals & Equalization, Pursuant to Minnesota Statute 274.014, Subd. 3(c) 5. P & R Recommendation to Approve Special Event Permit Application Easter Egg Hunt, Laurie LaMotte Park — April 19, 2014 (8:00 a.m. — 2:00 p.m. Mayor Wilharber provided Council Members with an opportunity to remove any item that they desired additional information on. Mayor Wilharber desired to pull Item #5 for additional discussion. Page 5of8 44 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 Motion by Council Member Fehrenbacher, seconded by Council Member Love to approve the Consent Agenda Items #1 -4 as presented All in favor. Motion passed Mayor Wilharber questioned Mr. Palzer regarding the use of the fields at Laurie LaMotte Memorial Park. Building Official/P.W. Director Palzer stated that the fields are quite saturated and will be opening April 21, 2014 (weather dependent). Mayor Wilharber stated that Mr. John Ficcadenti had requested a waiver of fees, stated that he was a non -profit and desired to have his company's inflatables at the event. Discussion ensued regarding waiving of fees or deposit; legal, non -profit status versus community event and a City sponsored event. Mayor Wilharber stated that the Lions felt that the monies that they had been spending on plastic eggs, stuffing time and candy could be better spent on alternative avenues such as food baskets for families in need, etc. and that is why they are no longer providing the event. Building Official /P.W. Director Palzer was instructed to contact Mr. Ficcadenti on Friday prior to the event to inform him whether use was permitted on the fields at LaMotte Park. Motion by Council Member Pa r, seconded by Council Member Fehrenbacher to approve Consent Agenda Item #5. Special Event Permit Appfication for an Easter Egg Hunt scheduled for April 19. 2014 at Laurie LaMotte Park subiect to the Building Official/P.W. Director's approval the Friday prior, waiving of the permit fee and a deposit of $500 All in favor. Motion passed VIII. OLD BUSINESS 1. None. IX. NEW BUSINESS 1. Approval of the 2013 Annual Audit & Management Letter Previously discussed. Motion by Council Member Fehrenbacher, seconded by Council Member Love to approve the 2013 Annual Audit & Mana ement Letter as presented. All in favor. Motion inssed. 2. Res. #14 -020 — Amending Special Assessments — Backage Road/Commerce Drive (Sheehy Property /City of Centerville) Attorney Glaser again stated that the City has prevailed in the last two litigations, he has attempted to work with the firm toward a settlement and they have refused. Attorney Glaser stated that Sheehy had requested a declaratory judgment, however, it was improperly filed and it was dismissed by the judge. Page 6of8 45 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 _Motion by Council Member Fehrenbacher, seconded by C ouncil Me mber Paar to approve Res #14 -020 as presented. Discussion ensued regarding negotiations to settle, both sides desiring for a conclusion, the City's believe that the assessment outweighs the legal costs and Sheehy's potential for preserving their right to appeal Council's action this evening. Attorney Glaser stated that the assessment roll tax year one should be 2015 rather than the presented 2014. Council Member Fehrenbacher amended his motion to modify the assessment roll commenci year 2015 rather than the presented 2014 an statin that the assessment wou run through the year 2024 All in favor. Motio passed. 3. City of Hugo's Request for Participation in Cost Share of Repairs to Bald Eagle Lake Dam Administrator Larson stated that the City of Hugo is requested that neighboring communities that potentially could be affected if the dam where to fail assist them in making needed repairs even though the dam is not in their communities. The City of Hugo stated that there was a potential for grant funding and reimbursement of expenditures once they have submitted application to the Department of Natural Resources. The City of Hugo also stated that they have secured funding through the Minnesota Department of Transportation in the amount of $252,000 to be utilized for replacement of the dam. Lengthy discussion ensued regarding ownership of the dam, reciprocation in the City of Centerville's projects, Hugo's desire for repairing/replacing the dam due to potential roadway flooding, homeowner /County and lake association assistance and other resources that the cities have worked together on (salt storage, etc.) Motion by Council Member Fehrenbacher, seconded by Council Member Paar to table this item to th next regularly scheduled Council meeting i an a ttempt to provide Staff with ample time to obtain additional information All in favor. Motion passed. X. ANNOUNCEMENTS/UPDATES 1. Administrator Larson stated that the City of Centerville was successful in receiving a grant for $10,000 to assist in sealing wells associated with the Royal Meadows Municipal Improvement Project from the Minnesota Department of Health. Administrator Larson stated that there is a potential for submission of another grant in the fall. 2. Engineer Statz stated that staff has researched elevations of basements of homes along CSAH21 /Centerville Road from Dupre Road to the City limits can be served by municipal (gravity) sewer except 6709 Centerville Road unless additional interior equipment is utilized. Administrator Larson stated that he would be forwarding a survey to those residents in an attempt to ascertain their desires for connection and Page 7of8 46 City of Centerville Special & Regular Council Meeting Minutes April 9, 2014 provide that information to Council at their next meeting. Administrator Larson stated that this would assist Council in making their decision to contain this item along with the reconstruction of the County road -way project. 3. Council Member King reported that the P & R Committee desired a signature line be added to the Special Event Permit Application Form, that the Committee was unaware that Staff had met with representatives from the Bald Eagle Water Ski Club and their desire to potentially assist in funding for the purchase of property owned by St. Paul Board of Water that abuts Centerville Lake and Trailside Park. Administrator Larson stated that he would address this item more in depth during the Joint Work Session following the Council meeting. 4. Council Member Fehrenbacher stated that the Centennial Lakes Police Department has completed their annual report and will be presenting it at Council's next meeting. Council Member Fehrenbacher stated that it is available on their web site along with their strategic plan. 5. Council Member Paar stated that the Fire Steering Committee would be meeting the following date to consider appointing an interim Chief and discussings appraisals of the current district's equipment. Council Member Paar stated that Chief Streich accepted the position as Chief in Andover and his last day would be April 21, 2014. Mayor Wilharber read Chief Streich's resignation letter. XI. ADJOURNMENT Motion by Council Member Fehrenbacher, seconded by Council Member Paar to Adiourn the regularly scheduled Council meeting of Aari19 2014 at 7.47 p.m. All in favor. Motion passed. Transcribed by City Staff Member Teresa Bender, City Clerk Page 8 of 8 47 CITY OF CENTERVILLE 04/17/14 9:05 AM Check Detail - April 23, 2014 Page 1 Check Date Check # Vender Name Comments Amount 4/15/2014 000580E MINNESOTA DEPT OF REVENUE USE TAX - GO KEYLESS INV #69217 $98.00 4/15/2014 000580E MINNESOTA DEPT OF REVENUE SALES TAX FOR 1ST QRT 2014 $289.0 0 Check Nbr 000580 MINNESOTA DEPT OF REVENUE $387.00 4/23/2014 028631 ALL COVERED INC. PRE -PAID RENEWAL BLOCK $1,100.00 4/23/2014 028631 ALL COVERED INC. PRE -PAID RENEWAL BLOCK $1,100.00 4/23/2014 028631 ALL COVERED INC. PRE -PAID RENEWAL BLOCK $1,100.00 4/23/2014 028631 ALL COVERED INC. PRE -PAID RENEWAL BLOCK $1,100.00 Check Nbr 028631 ALL COVERED INC. $ 4,400.00 4/23/2014 028632 ANOKA COUNTY CENTRAL COMMUNICA 2014 ANNUAL MOTOROLA 800 MHZ RADIO SERVICE CONTRACT Check Nbr 028632 ANOKA COUNTY CENTRAL COMMUNICA $145.92 4/23/2014 028633 ANOKA COUNTY TREASURY DEPT. 2014 MAY BROADBAND $37.50 4/23/2014 028633 ANOKA COUNTY TREASURY DEPT. 2014 MAY BROADBAND $37.50 4/23/2014 028633 ANOKA COUNTY TREASURY DEPT. 2014 MAY BROADBAND $37.50 Check Nbr 028633 ANOKA COUNTY TREASURY DEPT $112.50 4/23/2014 028634 BLAINE BROTHERS, INC. HYDRAULIC SYSTEM REPAIR - PLOW Check Nbr 028634 BLAINE BROTHERS INC. 256.85 4/23/2014 028635 DO -GOOD BIZ, INC. POSTAGE FOR 2ND UTILITY BILLING $184.38 4/23/2014 028635 DO -GOOD BIZ, INC. POSTAGE FOR 2ND UTILITY BILLING $184.38 4/23/2014 028635 DO -GOOD BIZ, INC. POSTAGE FOR 2ND UTILITY BILLING $184.3 8 Check Nbr 028635 DO -GOOD BIZ INC. 553.14 4/23/2014 028636 HEALTH PARTNERS MAY 2014 HEALTH INSURANCE Check Nbr 028636 HEALTH PARTNERS $ 3,967.67 4/23/2014 028637 MET. COUNCIL ENV. SERV. (SDS) MAY 2014 WASTE WATER Check Nbr 028637 MET COUNCIL ENV. SERV. (SDS) $16,252.55 4/23/2014 028638 METRO SALES INCORPORATED MAINTENANCE - SERV THRU 3 -26 -13 THRU 3 -25 -14 l Jbr 028638 METRO SALES INCORPORATED 470.25 4/23/2014 028639 NATIONWIDE RETIREMENT SOLUTION DEF COMP - PAY PERIOD 8 Check Nbr 028639 NATIONWIDE RETIREMENT SOLUTION $400.28 4/23/2014 028640 XCEL ENERGY 1682 MAIN ST - SERV THRU 4 -7 -14 $122.46 4/23/2014 028640 XCEL ENERGY STREET LIGHTS - SERV THRU 4 -7 -14 $2,232.91 4/23/2014 028640 XCEL ENERGY 6879 LAMOTTE DR - SERV THRU 4 -7 -14 $249.88 4/23/2014 028640 XCEL ENERGY 1880 MAIN ST - CITY HALL /FIRE STAT - SERV THRU 4 -7 -14 $584.49 4/23/2014 028640 XCEL ENERGY 1880 MAIN ST - SERV THRU 4 -7 -14 $1,080.93 4/23/2014 028640 XCEL ENERGY 1600 LAMOTTE DR - SERV THRU 4 -7 -14 $29.72 4/23/2014 028640 XCEL ENERGY 7300 MILL RD - SERV THRU 4 -7 -14 $183.96 4/23/2014 028640 XCEL ENERGY 1889 CENTER ST -SEWER LIFT - SERV THRU 4 -7 -14 $22.79 4/23/2014 028640 XCEL ENERGY 7285 MAN ST - SERV THRU 4 -7 -14 $57.35 4/23/2014 028640 XCEL ENERGY 1754 MAIN ST - SERV THRU4 -7 -14 $11.60 4/23/2014 028640 XCEL ENERGY 1601 LAMOTTE DR - SERV THRU 4 -7 -14 $24.95 4/23/2014 028640 XCEL ENERGY 7098 CENTERVILLE RD - SERV THRU 4 -7 -14 $11.60 4/23/2014 028640 XCEL ENERGY 1875 FOX RUN - PUMP - SERV THRU 4 -7 -14 $161.03 4/23/2014 028640 XCEL ENERGY 1600 LAMOTTE DR - BALLFIELD LIGHTS - SERV THRU 4 -7 -14 $114.0 4 _heck Nbr 028640 XCEL ENERGY $4,887.71 Total checks $31,833.87 ✓oided check #28592 and check #28605 48 CENTENNIAL LAKES POLICE DEPT Check Register - Police GL without invoice numbers Page: 1 Check Issue Dates: 3/29/2014 - 4/10/2014 Apr 10, 2014 12:17PM Report Criteria: Report type: Summary GL Check Ck No Description Check Period Issue Date Payee Amount 04/14 04/10/2014 9856 ANOKA COUNTY FEB INTERNET 365.23 04/14 04/10/2014 9857 ANOKA COUNTY SOLID WASTE FEE 155.53 04/14 04/10/2014 9858 BCA CJTE CRIME PREVENTION COURSE 700.00 04/14 04/10/2014 9859 BCA/MNJIS SECTION 1ST QTR CJDN 390.00 04/14 04/10/2014 9860 CENTURY LINK COMMUNICATIONS 116.98 04/14 04/10/2014 9861 COVERALL OF THE TWIN CITIES APRIL CLEANING SERVICE 796.22 04/14 04/10/2014 9862 DELTA DENTAL MAY DENTAL 1,303.65 04/14 04/10/2014 9863 FRATTALLONES HARDWARE, INC. CLEANING /BLDG SUPPLIES 27.19 04/14 04/10/2014 9864 NEAL A. NOREN BLDG MTC HOURS 90.00 04/14 04/10/2014 9865 OFFICE OF MN IT SERVICES WAN SERVICES 458.34 04/14 04/10/2014 9866 O'REILLY AUTOMOTIVE, INC VEH SUPPLIES WIPER FLUID 39.60 04/14 04/10/2014 9867 QUILL CORPORATION FLASH DRIVES 441.30 04/14 04/10/2014 9868 SHRED -N -GO, INC SHREDDING SERVICE 35.00 04/14 04/10/2014 9869 TELECIDE PRODUCTIONS, INC COMPUTER MTC /SUPPORT 1,449.96 04/14 04/10/2014 9870 TOP GREEN SNOW REMOVAL SERVICE 671.98 04/14 04/10/2014 9871 VERIZON WIRELESS CELL PHONES 577.17 Grand Totals: 7,618.15 M = Manual Check, V = Void Check 49 CENTENNIAL FIRE DISTRICT Check Register - FIRE GL Page: 1 Check Issue Dates: 4/1/2014 - 4/4/2014 Apr 04, 2014 02:40PM Report Criteria: Report type: Summary GL Check Check Vendor Description Check Period Issue Date Number Number Payee Amount 04/14 04/04/2014 6326 10800 ANOKA CO FIRE PROTECT. CO 2014 MEMBERSHIP DUES 210.00 04/14 04/04/2014 6327 11565 ASPEN MILLS, INC UNIFORMS 172.25 04/14 04/04/2014 6328 30490 CENTERPOINT ENERGY STATION 2 GAS CHARGES 901.72 04/14 04/04/2014 6329 50121 EMERGENCY AUTOMOTIVE TE VEHICLE MTC 243.09 04/14 04/04/2014 6330 70578 GRAINGER BLDG MTC 990.35 04/14 04/04/2014 6331 131500 MY ALARM CENTER, LLC STATION 1 QTRLY MONITORIN 108.48 04/14 04/04/2014 6332 180600 CITY OF ROSEVILLE APRIL PHONE 1,155.00 04/14 04/04/2014 6333 190850 JERRY STREICH JAN -MAR CELL PHONE REIMB 150.00 04/14 04/04/2014 6334 220200 VERIZON WIRELESS COMMUNICATIONS 96.04 Grand Totals: 4,026.93 M = Manual Check, V = Void Check 50 CENTENNIAL FIRE DISTRICT Check Register - FIRE GL Page: 1 Check Issue Dates: 3/22/2014 - 3/31/2014 Apr 04, 2014 08:45AM Report Criteria: Report type: Summary GL Check Check Vendor Description Check Period Issue Date Number Number Payee Amount 03/14 03131/2014 2014004 210300 US BANK VISA ACH -BLDG & CLEANING S 1,827.16 Grand Totals: 1,827.16 M = Manual Check, V = Void Check 51 CITY OF CENTERVILLE RES. #14 -0 A RESOLUTION RESERVING UNSPENT BUDGET AND REVENUE EXCESSES FROM YEAR 2013 & COMMITTING THEM FOR PARK PURPOSES TO BE EXPENDED IN 2014 WHEREAS, the City Council of the City of Centerville, Minnesota does hereby support the Parks & Recreation Committee of the City, WHEREAS, the Governmental Accounting Standards Board's Statement No. 54 defines committed fund balance as amounts that can only be used for specific purposes pursuant to constraints imposed by formal action of the Council, WHEREAS, Council action is required immediately subsequent to year end to formalize the commitment of fund balance to specified purposes, WHEREAS, those committed amounts cannot be used for any other purpose unless the City removes or changes the specified use by taking the same type of action it employed to previously commit those amounts. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF CENTERVILLE, MINNESOTA: 1) That unspent budget and revenue excesses in the amount of $1,039.27 be committed to funding the purchase and installation of park benches along with previously dedicated funds (Res. #13 -25 - $3,041.26 — a copy attached) and the purchase and installation of equipment associated with a basketball court utilizing the existing Laurie LaMotte Memorial Park Hockey Rink to be expended in 2014. Adopted by Council this 23 day of April, 2014 Tom Wilharber, Mayor Attest: Teresa Bender, City Clerk 52 Parks and Recreation Programs Year Ended December 31, 2013 2013 2013 REVENUE ACTUAL BUDGET VARIANCE 101 - 45201 -34781 8K Run Fees 4,631.00 2,300.00 2,331.00 101 - 45202 -36230 Donations 500.00 - 500.00 TOTAL RECEIPTS S,131.00 2,300.00 2,831.00 EXPENDITURES 101 - 45200 -100 Wages and Salaries 678.00 (678.00) 101 -45200 -122 FICA 51.87 (51.87) 101 -45200 -438 Per Diem 1,460.00 2,800.00 1,340.00 101 - 45201 -100 Wages and Salaries 3,825.01 3,000.00 (825.01) 101 - 45201 -122 FICA 292.61 200.00 (92.61) 101 - 45201 -151 Workers Comp 215.58 200.00 (15.58) 101- 45201 -370 Park Programs 1,768.67 3,100.00 1,331.33 101 - 45201 -371 Music in the Park 2,368.99 2,200.00 (168.99) 101 - 45201 -373 8K Run 1,889.74 2,300.00 410.26 TOTAL EXPENDITURES 12,550.47 13,800.00 1,249.53 UNSPENT BUDGET AND EXCESS REVENUE 4,080.53 Res. #13 -025 - Committed revenue funds of $3,041.26 for the purchase and installation of 5 park benches. A sponsorship of $200 in additional funding was received subsequent to this resolution. Excess 4,080.53 Committed 3,041.26 Uncommitted Remaining Excess 1,039.27 53 CITY OF CENTERVILLE Res. #13 -0,Z6" A RESOLUTION COMMITTING FUND BALANCES FOR SPECIFIC PURPOSES WHEREAS, the City Council of the City of Centerville, Minnesota does hereby find as follows: WHEREAS, the Governmental Accounting Standards Board's Statement No. 54 defines committed fund balance as amounts that can only be used for specific purposes pursuant to constraints imposed by formal action of the Council, WHEREAS, Council action is required before year end to formalize the commitment of fund balance to specified purposes, WHEREAS, those committed amounts cannot be used for any other purpose unless the City removes or changes the specified use by taking the same type of action it employed to previously commit those amounts. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF CENTERVILLE, MINNESOTA: 1) That proceeds from the 2013 5 & 8K Walk Run in the amount of $2,541.26 and a cash donation of $500 from the Centerville Lions be committed for the 2014 purchase of (5) park benches. Adopted by the Council this /. day of November, 2013. Tom Wilharber, Mayor Wiest: �`, , �� J , l Teresa Bender, City Clerk 54 0 4 C o m e t Centerville Special Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: CL `7 CL V 0 U " C_ La r'a vY1 New Application: Y — Renewal of or Change in Application: CONTACT PERSON: P--�+1 n C Cr° E'V�(►. � CC�v� C J TELEPHONE: OR Le S L ° ` I — ( C 4 ' r Ll+a- @, C0 Ywus' 2. IDENTIFYING INFORMATION: Attach a written communication from the organization(s) in whose name the event will be advertised which authorizes you, the applicant, to apply for this special event permit on its /their behalf. Applicant's Name: 'C n in i y �)r, I 2 -A' ITitle: Address: `i 'l `'11 N i` f hL� VC i �.. �- i ► , Mailing Address: Affiliation: �Z V* r " Q Day Phone: Evening Phone: Emergency Phone: 3. EVENT PRINCIPALS: Following, please list the names, addresses and telephone numbers of all the principals involved in any of the proposed special event. Include professional event organizers, event promoters, financial underwriters, commercial sponsors, charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the event is being advertised, and all others administratively, financially and organizationally involved as principals in the production of the proposed special event. Make additional copies of the following as needed to include as of the principals involved in the proposed special event. Name: Organization/Business/Agency'/Affiliation: C,P ('lhl l't 1 � ` Is this a non - profit organization? Yes No Ck. p(A <«." L'' 1rx't: v 5 11 If you are making application under non - profit status, proof of non - profit status must be attached to this application " Mailing Address: r� wV +hC L c lam' SZ' Day Phone: U `5 — C1 J �N C Evening Phone: Title and functional responsibility with regard to the event: !�'1�.� � QUA b1} � ►rC� n �Zc' !� C�- '.eL V\'\v\\Q- C i C ' CL & W Page 1 of 10 55 4. REQUESTED EVENT COMPONENTS: Date requested: 9 12-7 / y Alternate date: Requested hours of operation: j 3L • 4t& O./p.m.) To: : i C, T (�p,in Set up beginning date and time: ( �—' Complete dismantle date and tim Q 7-9 — 10 � '50 �� '✓L - Describe the number and type of animals (� any) to be used in this event: Attach a draft of the entry form for participants and /or spectators. Anticipated number of participants: Spectators: 5. INSURANCE: Attach to this application either an insurance policy or a certificate of insurance including the policy number, amount, and the provisions that the City of Centerville is included as an additional insured. (Please note that insurance requirements depend upon the risk level of the event. Also, if your event can be classified as first amendment expressive activity, insurance requirements can be waived under certain circumstances.) 6. SANITATION: Attach your "Plan for clean- up/Material Preservation ". Include number, type and location of trash containers to be provided for the event. Indicate who and how man will be responsible for emptying and cleaning up around containers during the event. Indicate who and how many will be responsible for cleaning up after animals if they are present during the event. Indicate who and how many will be responsible for cleaning up after the event. Describe the number, type and location of portable toilets to be provided for the event (or permanent toilets to be used in the event.) Include any other plan you have for ensuring post -event cleanliness and material preservation of city facilities, equipment, premises and streets A deposit of $500 will be required for clean -up and restoration If P remises are left in satisfactory condition this deposit will be refunded in full following inspection 7. LOCATION: Please attach a map of your event land design. Check off below items that apply to your event and indicate them on the attached map. Use, where necessary, a "to scale" drawing. A. If a route is involved, the beginning and finish area with arrows. B. If a route is involved, the places where buses, autos or other motorized vehicles need to be considered. C. If a route is involved, attach separate maps giving two or more alternate routes. D. Entertainment or stage locations (grandstand operators should provide you with a "to scale" drawing.) E. Alcoholic beverage concession area. F. Non - alcoholic concession area. G. Food concession area. H. General Merchandise concession areas. I. _b__ Portable toilet facilities (indicate number). J. ✓ Event participant and/or spectator parking areas. K. Event organizer's command post. Page 2 of 10 56 L. y� First aid facilities. M. Fireworks or pyrotechnics site. N. Vehicle fuel handling sit. O. Cooking areas. P. Electrical sources to be used for cooking. Q. tables, enclosures, etc. R. Temporary or permanent structures constructed for the event. S. Site of electrical wiring to be installed for the event. T. d Trash receptacles (indicate number) U. Other - Please describe. 8. AVAILABILITY OF FOOD, BEVERAGES AND /OR ENTERTAINMENT: If there will be music, sound amplification or any other noise impact, please describe, including the intended hours of the music, sound or noise: Will alcoholic beverages be served? Yes No PLEASE NOTE THAT SALES OF LIOUOR/ALCOHOL IS PROHIBITED IN CITY PARKS UNLESS THE EVENT IS A CITY CELEBRATION AND PRIOR APPROVAL AND APPROPRIATE LICENSES ARE OBTAINED BY CITY COUNCIL ACTION. If yes, describe what system will be used to ensure that alcoholic beverages will be consumed by persons 21 years and older: If yes, describe how, where, when and by whom the alcoholic beverages will be served: If a casino party, a dance, or live entertainment is part of your event, please describe: Please describe all of the activities of your event for which a license is required, for example: a cabaret license, etc. Attach all required licenses to this application Please note that certain licensing may be required by City, County and State agencies, such as a Large Assembly _License for gatherings over 1,000 people, some types of food handling licensing, Gambling License, Cabaret License, etc. It is your responsibility to check with the City Clerk or local authorities to determine what licensing is required prior to submitting this application. Page 3 of 10 57 Will food and /or non - alcoholic beverages be served? Yes 4 / No If yes, describe sanitation measures, food handling procedures and the nature of the food (such as pre - packaged foods, hot dogs, pre -mixed soda, unpeeled fruit, raw meats, vegetables, fish or peeled and cut fruit.) If yes, you will need a permit from the Anoka County Department of Environmental Health. Please attach a copy of the permit to this application 9. SECURITY AND SAFETY PROCEDURES: Describe your proposed procedures for set up, operation, i temal security and crowd control: _ ' LL ,n-, f, n 4- .k t'� 11ri�e r C1 X31'1 �L ��Lt ✓Q j e c�j �c If the event is to occu# at night, describe how you are going to light the etsnt` area in order to increase the safety of participants and spectators coming to and leaving the event: If your event includes vehicles or animals, describe the minimum and maximum speeds of the event and the minimum and maximum intervals of space to be maintained between units: Attach to this application a copy of your building permit(s) if you are installing any electrical wiring on temporary or permanent basis and /or if you are building any temporary or permanent structures such as bleachers, scaffolding, a grandstand, stages or platforms. Attach a copy of your fire department permit(s) to this application if you will use parade floats; an open flame; fireworks or pyrotechnics; vehicle fuel; cooking facilities; enclosures (and tables within those closures); tents, air supported structures, canopies, or fabric shelters. Give the name, address and phone numbers of the agency or agencies which will provide first aid staff and equipment if required. Attach additional sheets if necessary. Name of agency: Name of Representative: Address: Day phone: Evening phone: Indicate medical services (if required) that will be provided for this event: Page 4 of 10 58 Ambulances: Doctors: Nurses: Paramedics: 10. VENDORS OR CONCESSIONAIRES: r f P- Describe what vendors /concessionaires you will allow in conjunction with the event, and the purpose of these concessions: Describe how you intend to regulate, monitor and control the type, number and quality of vendors /concessionaires whom you may permit to operate in conjunction with the event: 11. CITY SERVICES/EQUIPMENT: Describe city services and /or equipment requested for this event: City barricades, cones, signs, picnic tables and other equipment which may be borrowed on an as- available basis. You should make advance arrangements to pick up and return this equipment. If you or any volunteers cannot pick up and return this equipment, please attach a letter requesting these services and explaining why your organization cannot perform them. This will be reviewed, then approved or denied by the public works foreman. �� E�� c In►�` Ve ":'i`r[- C'y '-S ^ 60 1' u - ' v \ - t O t� 1 CA-<- C A 12. OTHER PERTINENT INFORMATION: Please list below any other miscellaneous information you feel would be important and have a bearing on the approval of this Special Event Permit request: 13. FEE STRUCTURE / EVENT CHARGES: If there is a fee or donation required as a condition of attendance or participation of this event, please describe the amounts to be collected from various categories of participants or spectators: Z ` TV,( "� k__ 4 ) �r 1 D L 14. If a donation is requested on a purely voluntary basis, describe how you intend to inform participants /spectators or others that they may participate in the event whether they make a donation or not: Page 5 of 10 59 Centerville Special Event Permit k%Cd VlIL. NAME AND TYPE OF EVENT: k-- V.} S 1 6( tt �S DAY, DATE AND TIME: �_ /2_r7 I ) L I • OL) 1. PARKS RECREATION DEPARTMENT FINAL AP OVAL AND SI !ice � — C----g a..._ Signat re Title Date: Please check or use N/A (not applicable) where appropriate: 1. Final check has been made of application requirements. 2. Event is approved by City Council. 3. All required permits are issued and on file. 4. Refundable clean up fee has been paid. 5. Insurance Certificate is on file with City Clerk 6. Surety Bond is on file to secure payment for applicant's obligation to the City. 7. Application is complete. 8. Special conditions are attached. REVOCATION: Upon mutual consent, the City Council may revoke a special event permit if the conditions set fourth in the permit application are not being followed. Permit is hereby revoked: Signature Title Date: Reason(s) for revocation: TO BE REVIEWED /APPROVED AND SIGNED BY AFFECTED CITY DEPARTMENT HEADS Page 6 of 10 60 2. PARKS AND RECREATION DEPARTMENT Special Events Coordinator: Date: Initial /sign -off: 3. POLICE DEPARTMENT Approved by: Signature Title Date: 1. Emergency vehicle access. 2. Traffic /safety street closures. 3. Appropriate barricades. (# Required) 4. Police personnel required /available. 5. Portable toilet facilities. (# Required) 6. First aid facilities. 7. Internal security and crowd control. 8. nighttime lighting. 9. Other provisions as may be required by this department. 4. LICENSING AND INSURANCE Approved by: Signature Title Date: 1. Dance and /or live entertainment. List types or permits or licenses required: 2. Alcoholic beverages. 3. Peddlers. 4. Noise abatement. 5. Other provisions as may be required: INSURANCE: Your insurance coverage must be reviewed and approved by the City's insurance carrier. Page 7 of 10 61 1. Public liability insurance naming City of Centerville and other public agencies additionally insured is required. 2. Hold harmless forms executed and failed. 3. List and approve /disapprove other insurance coverage as may be required. 5. FIRE DEPARTMENT Approved by: Signature Title Date: 1. Emergency vehicle access. 2. Use of fireworks, pyrotechnics, vehicle fuel, open flame. 3. Cooking facilities. 4. Occupancy and spacing of tables, enclosures. 5. Parade, floats. 6. Tents, air supported structures, canopies. 7. Other provisions as my be required by this department: 6. BUILDING DEPARTMENT Approved by: Signature Title Date: Electrical: 1. Plan check/inspection of any wiring installed on a temporary or permit basis. 2. Permit(s) attached. Structural Plan: 1. Plan check/inspection of any temporary or permanent structures, including bleachers, scaffolding, grandstand, reviewing stands, stages, or platforms. 2. Permit(s) attached. 3. Other provisions as may be required by this department: Page 8 of 10 62 7. PARKS AND RECREATION DEPARTMENT Approved by: Signature Title Date: 1. Park permit(s) required. (to be attached) 2. Ballfield Usage Permit. 3. Beach permit required. (to be attached) 4. Trash containers required. (# 5. Portable toilets required. (# ) 6. Applicant's plan for cleanup, site restoration and material preservation (recycling) required and attached. 7. Other provisions as may be required by this department: 8. PUBLIC WORKS DEPARTMENT Approved by: Signature Title Date: 1. Trash containers required. (# ) 2. Portable toilets required. (# 3. Special animal clean up required. 4. Barricades provided, as available. (# 5. Cones provided, as available. (# 6. No parking signs provided, as available. (# ) 7. Applicant's plan for clean up and material preservation (recycling) required and attached. 8. Other provisions as may be required by this department: 9. STATE, COUNTY AND CITY HEALTH DEPARTMENT Approved by: Signature Title Date: 1. Food and /or beverage served. 2. Permit(s) attached. Page 9 of 10 63 3. Food cooked. 4. Permit(s) attached. 5. List other health licensing obligations as may be require: Page 10 of 10 64 MapMyRun run Mapping Editor I MapMyRun Page I of 2 (/my home /1 (http://Mvp.mapmyrun.rom-1 Mary (/my home /1 MY HOME (/) DISCOVER (/US/) IMPROVE (/IMPRQNE/) Choose map location PP TryRoute Genius for fres local routes of your tanget distancet ( /maps /auto route/) 3'd St Centerville lake, center SEARCH 2 A pmne or Get Directions import (tworkout1impgrt/dashboardl HeID DISTANCE L MA ► Route Details F- Ru� • Log as a Workout N • Directions/ Notes certiorwoe Elem"tery 7 0 m Head north toward Lamotte Q edit 001 m I Turn right onto Lamotte Dr zilt j Main St F211, Main St 104 Head west on Heritage St towa Goiffon Rd 1 0.21 m i % centorvift Heritage St turns right and #*Ptage s' E cy 0 24 mi becomes Goiffon Rd 2.dA LOW ,y 3aY0 CTI 031 mi Turn left onto Sorel 51: edit Head east on Sorel St toward 0,32 mi edit Goiffon Rd 0 37 mi Head west on Sorel toward Goiffon Rd i aimr t emoffe 4 • 0 38 mi Turn right onto Goiffon Rd 9A111 PwA 0.47 mi Turn right onto Main St edit 4 0.48 mi Head northwest on Main St 902 M�0 a)pciient=apiv3&skstale=actionmps-dialog$apirefl&06tput=classic) — (http://Mapfi,ag,. 0 49 mi Slight left to stay on Main St -P9JA (http:/ ► Elevat Show elevation with iziadu http., w.mapmyrun.com/routes/create/ 8/2014 iviaprviynuu iuu tviappiue, zuttw I iviaPivlytcuii rage 1 of L fhttp: / /mvp mapmyrun coma Mary ( /my home /) Choose ma location /m h P oRoute Genius fresh local rout ofyourtargetdistan c!Umaos /auto rotte/) Centerville lake, center SEARCH MY HOME (/) - DISCOVER ( /US /) IMPROV ( /IMPROVE/) C Get Directions Imoort ( /workouthmo rt/da hboard /) Help , Route Details DISTANCE Log as a Workout 5.2 M Directions/ Notes - - ;k 0 mi Head north toward Lamotte Dr dg_t i yr 0.01 mi Tern right onto Lamotte Dr edit y + 0.21 mi Head west on Hentagg 2 o' L toward Goiffon Rd edit Heritage S[ turns right and t °` 0.24 mi - becomes Goiffon Rd ! w 031 mi Turn left onto Sorel St edit 0.32 mi Hgad east on Sorel St toward "• k `N Goiffon Rd edit t A K C S 0.37 mi Head west on Sorel St toward ff Rd gdit 0.38 mi Turn right onto Goiffon Rd edit �� Y 0.47 mi Turn nght onto Main St ( 0.48 mi Head northwest on Main St g r-� 4 *� i 0 49 mi Sight left to stay on Main St edit 1 ha i t iv3 (htto: /i ► Elevation Show elevation with grades http: / /WWw.mapmyrun.com/routes /create/ 66 3/18/2014 7 f t I`. R Centerville Special Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: Hmonq Flaq Football Tournament to help fundraise and pay off the damaqe that was occured at the Centerville Lamotte Memorial Park in June of 2013 New Application: Yes Renewal of or Change in Application: CONTACT PERSON: Tenq Moua TELEPHONE: (763) 398 - 9191 O 2. IDENTIFYING INFORMATION: Attach a written communication from the organization(s) in whose name the event will be advertised which authorizes you, the applicant, to apply for this special event permit on its /their behalf. Applicant's Name: Tenq Moua Title: Address: 6641 Jersey Ave N, Brooklyn Park, MN 55428 Mailing Address: 6641 Jersey Ave N, Brooklyn Park, MN 55428 Affiliation: Day Phone: (763) 398 - 9191 Evening Phone: Emergency Phone: (763) 398 - 9191 3. EVENT PRINCIPALS: Following, please list the names, addresses and telephone numbers of all the principals involved in any of the proposed special event. Include professional event organizers, event promoters, financial underwriters, commercial sponsors, charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the event is being advertised, and all others administratively, financially and organizationally involved as principals in the production of the proposed special event. Make additional copies of the following as needed to include as of the principals involved in the proposed special event. Name: P 1 G E —'ucl OrganizationB iness /Agency /Affiliation: - I r, 4 I -4 cjA Is this a non -profit organization? Yes No If you are making application under non -profit status, proof of nonprofit status must be attached to this application Mailing Address: A:XX I 'LSr Day Phone: - — S \�N Evening Phone: X61 Title and functional responsibility with regard to the event: Page 1 of 10 67 s 4. REQUESTEfE Date request 31st and June 1st Alternate date: June 14th and June 15th Requested hera ion A. : M. (a.m. /p.m.) To: 6 P.M. (a.m. /p.m.) Set up beginning date and time: May 30th Friday 5 PM * *alternate(June 13th 5 PM) Complete dismantle date and time: June 1st Sunday 7 PM * *alternate (June 15th 7 PM) Describe the number and type of animals (if any) to be used in this event: Attach a draft of the entry form for participants and/or spectators. Anticipated number of participants: 200+ Spectators: 200+ 5. INSURANCE: Attach to this application either an insurance policy or a certificate of insurance including the policy number, amount, and the provisions that the City of Centerville is included as an additional insured. (Please note that insurance requirements depend upon the risk level of the event. Also, if your event can be classified as fast amendment expressive activity, insurance requirements can be waived under certain circumstances.) 6. SANITATION: Attach your "Plan for clean- up/Material Preservation ". Include number, type and location of trash containers to be provided for the event. Indicate who and how man will be responsible for emptying and cleaning up around containers during the event. Indicate who and how many will be responsible for cleaning up after animals if they are present during the event. Indicate who and how many will be responsible for cleaning up after the event. Describe the number, type and location of portable toilets to be provided for the event (or permanent toilets to be used in the event.) Include any other plan you have for ensuring post -event cleanliness and material preservation of city facilities, equipment, premises and streets A deposit of $500 will be required for clean -up and restoration If premises are left in satisfactory condition, this deposit will be refunded in full following inspection 7. LOCATION: Please attach a map of your event land design. Check off below items that apply to your event and indicate them on the attached map. Use, where necessary, a "to scale" drawing. A. If a route is involved, the beginning and finish area with arrows. B. If a route is involved, the places where buses, autos or other motorized vehicles need to be considered. C. If a route is involved, attach separate maps giving two or more alternate routes. D. Entertainment or stage locations (grandstand operators should provide you with a "to scale" drawing.) E. Alcoholic beverage concession area. F. Non - alcoholic concession area. -G- -- — - Food concession area. H. General Merchandise concession areas. I. ortable toilet facilities (indicate number). J. � i P ent participant and/or spectator parking areas. K. , �vent organizer's command post. Page 2 of 10 68 5 L. First aid facilities. M. Fireworks or pyrotechnics site. N. Vehicle fuel handling sit. O. Cooking areas. P. Electrical sources to be used for cooking. Q. tables, enclosures, etc. R. Temporary or permanent structures constructed for the event. S. Site of electrical wiring to be installed for the event. T. Trash receptacles (indicate number) U. Other - Please describe. — -- AVA OE TQ 0 , ID,- E_V FRA GESA.NXOR.-EN__TERTAINMENT-:_- If there will be music, sound amplification or any other noise impact, please describe, including the intended hours of the music; sound or noise: No Will alcoholic beverages be served? Yes No PLEASE NOTE THAT SALES OF LIOUOR/ALCOHOL IS PROHIBITED IN CITY PARKS UNLESS THE EVENT IS A CITY CELEBRATION AND PRIOR APPROVAL AND APPROPRIATE LICENSES ARE OBTAINED BY CITY COUNCIL ACTION. If yes, describe what system will be used to ensure that alcoholic beverages will be consumed by persons 21 years and older: If yes, describe how, where, when and by whom the alcoholic beverages will be served: If a casino party, a dance, or live entertainment is part of your event, please describe: Please describe all of the activities of your event for which a license is required, for example: a cabaret license, etc. Attach all required licenses to this application Please note that certain licensing may be required by City, County and State agencies, such as a Large Assembl License for gatherings over 1,000 people, some tomes of food handling licensing. G ambling License, Cabaret License, etc It is your responsibility to check with the City Cler or local authorities to determine what licensing is required prior to submitting this applica Page 3 of 10 69 r Will food and/or non - alcoholic beverages be served? Yes No If yes, describe sanitation measures, food handling procedures and the nature of the food (such as pre - packaged foods, hot dogs, pre -mixed soda, unpeeled fruit, raw meats, vegetables, fish or peeled and cut fruit.) _ , r, ,tw If yes, you will need a hermit from the Anoka County Department of Environmental Health. Please attach a copy of the permit to this application 9. SECURITY AND SAFETY PROCEDURES: Describe your proposed procedures for set up, operation, internal security and crowd control: _ Settinq up two fields of 80 yards by 40 yards. Crowd control will be controlled by us, the host, referrees and police (if necessary). 1 r)a e If the event is to occur at night, describe how you are going to light the event area in order to increase the safety of participants and spectators coming to and leaving the event: The event is not qoinq to occur at night. The latest it will qo until will be til 6 P.M. If your event includes vehicles or animals, describe the minimum and maximum speeds of the event and the minimum and maximum intervals of space to be maintained between units: Attach to this application a copy of your building permit(s) if you are installing any electrical wiring on temporary or permanent basis and/or if you are building any temporary or permanent structures such as bleachers, scaffolding, a grandstand, stages or platforms. Attach a copy of your fire department permit(s) to this application if you will use parade floats; an open flame; fireworks or pyrotechnics; vehicle fuel; cooking facilities; enclosures (and tables within those closures); tents, air supported structures, canopies, or fabric shelters. Give the name, address and phone numbers of the agency or agencies which will provide first aid staff and equipment if required. Attach additional sheets if necessary. Name of agency: Name of Representative: Address: Day phone: Evening phone: Indicate medical services (if required) that will be provided for this event: Page 4 of 10 70 Ambulances: Doctors: Nurses: Paramedics: 10. VENDORS OR CONCESSIONAIRES: Describe what vendors/concessiwialres y ou will allow in conjunction with the event, and the purpose of these concessions: Describe how you intend to regulate, monitor and control the type, number and quality of vendors /concessionaires whom you may permit to operate in conjunction with the event: 11. CITY SERVICES/EQUIPMENT: Describe city services and/or equipment requested for this event: City barricades, cones, signs, picnic tables and other equipment which may be borrowed on an as- available basis. You should make advance arrangements to pick up and return this equipment. If you or any volunteers cannot pick up and return this equipment, please attach a letter requesting these services and explaining why your organization cannot perform them. This will be reviewed, then approved or denied by the public works foreman. City barricades for admission fee 12. OTHER PERTINENT INFORMATION: Please list below any other miscellaneous information you feel would be important and have a bearing on the approval of this Special Event Permit request: 13. FEE STRUCTURE / EVENT CHARGES: If there is a fee or donation required as a condition of attendance or participation of this event, please describe the amounts to be collected from various categories of participants or spectators: A couple of dollar fee for the attendants 14. If a donation is requested on a purely voluntary basis, describe how you intend to inform participants /spectators or others that they may participate in the event whether they make a donation or not: Page 5 of 10 71 s Centerville Special Event Permit NAME AND TYPE OF EVENT: "FINEST OF FINEST" Hmonq Flag Football Toumameni DAY, DATE AND TIME: May 31st and June 1st, 2014. 9 AM to 7 PM 1. PARKS AND RECREATION DEPARTMENT FINAL APPROVAL AND SIGN OFF Signature Title Date: Please check or use N/A (not applicable) where appropriate: 1. Final check has been made of application requirements. 2. Event is approved by City Council. 3. All required permits are issued and on file. 4. Refundable clean up fee has been paid. 5. Insurance Certificate is on file with City Clerk 6. Surety Bond is on file to secure payment for applicant's obligation to the City. 7. Application is complete. 8. Special conditions are attached. REVOCATION: Upon mutual consent, the City Council may revoke a special event permit if the conditions set fourth in the permit application are not being followed. Permit is hereby revoked: Signature Title Date: Reason(s) for revocation: TO BE REVIEWED /APPROVED AND SIGNED BY AFFECTED CITY DEPARTMENT HEADS Page 6 of 10 72 2. PARKS AND RECREATION DEPARTMENT Special Events Coordinator: I�l —WR Date: ' 2 Iq Initial/sign -off: v <<-4:5 3. POLICE DEPARTMENT Approved by: Signature Title Date: 1. Emergency vehicle access. 2. Traffic /safety street closures. 3. Appropriate barricades. (# Required) 4. Police personnel required/available. 5. Portable toilet facilities. (# Required) 6. First aid facilities. 7. Internal security and crowd control. 8. nighttime lighting. 9. Other provisions as may be required by this department. 4. LICENSING AND INSURANCE Approved by: Signature Title Date: 1. Dance and/or live entertainment. List types or permits or licenses required: 2. Alcoholic beverages. 3. Peddlers. 4. Noise abatement. 5. Other provisions as may be required: INSURANCE: Your insurance coverage must be reviewed and approved by the City's insurance carrier. Page 7 of 10 73 C 1. Public liability insurance naming City of Centerville and other public agencies additionally insured is required. 2. Hold harmless forms executed and failed. 3. List and approve /disapprove other insurance coverage as may be required. 5. FIRE DEPARTMENT Approved by: Signature Title Date: 1. Emergency vehicle access. 2. Use of fireworks, pyrotechnics, vehicle fuel, open flame. 3. Cooking facilities. 4. Occupancy and spacing of tables, enclosures. 5. Parade, floats. 6. Tents, air supported structures, canopies. 7. Other provisions as my be required by this department: 6. BUILDING DEPARTMENT Approved by: Signature Title Date: Electrical: 1. Plan check/inspection of any wiring installed on a temporary or permit basis. 2. Permit(s) attached. Structural Plan: 1. Plan check/inspection of any temporary or permanent structures, including bleachers, scaffolding, grandstand, reviewing stands, stages, or platforms. 2. Permit(s) attached. 3. Other provisions as may be required by this department: Page 8 of 10 74 7. PARKS AND RECREATION DEPARTMENT Approved by: Signature Title Date: 1. Park permit(s) required. (to be attached) 2. Ballfield Usage Permit. 3. Beach permit required. (to be attached) 4. Trash containers required. (# 5. Portable toilets required. (# 6. Applicant's plan for cleanup, site restoration and material preservation (recycling) required and attached. 7. Other provisions as may be required by this department: 8. PUBLIC WORKS DEPARTMENT Approved by: Signature Title Date: 1. Trash containers required. (# 2. Portable toilets required. (# 3. Special animal clean up required. 4. Barricades provided, as available. (# 5. Cones provided, as available. (# 6. No parking signs provided, as available. (# 7. Applicant's plan for clean up and material preservation (recycling) required and attached. 8. Other provisions as may be required by this department: 9. STATE, COUNTY AND CITY HEALTH DEPARTMENT Approved by: Signature Title Date: 1. Food and/or beverage served. 2. Permit(s) attached. Page 9 of 10 75 3. Food cooked. 4. Permit(s) attached. 5. List other health licensing obligations as may be require: Page 10 of 10 76 N it s TO: Honorable Mayor and Council Members FROM: Staff SUBJECT: 1937 Eagle Trail DATE: October 3, 2013 The property owner has submitted all applicable permit application for the deck, sketch plan showing the deck and pool, agreements and fees. The Building Official has concluded that the construction of the deck and after the fact location of the pool in their desired location(s) will not impose harm on neighboring properties. 77 MEMORADNUM To: Anoka County Fire Departments Dallas Larson, City Administrator, Centerville Jerry Streich, Fire Chief, Centennial Lakes Fire Department From: Kurt B. Glaser, City Attorney, Centerville Date: April 14, 2014 Re: Proposed Joint Powers Agreement — Anoka County, Fire Protection Council Analysis and Comments 1. General Comments a. Policy Considerations L The proliferation on various joint powers entities within Anoka County is a wonderful example of forward thinking and efficient use of taxpayer monies. However, this proliferation of joint powers entities is also creating an expanding bureaucracy within the County that may begin to burden municipal resources, or erode the powers and responsibilities of our elected officials. Deciding to create the proposed Fire Protection Council has long -term implications for all of the member Cities who may participate. One question for consideration is whether the purposes envisioned by the FPC should be unique to its own joint powers entity or whether using existing resources might be a more efficient means to accomplish these purposes. Other than creating a new entity, a policy question for consideration should be whether the existing governance structure of the Joint Law Enforcement Council could be transformed to include Fire Department operations. Having a single governance structure for all emergency services in the County may be beneficial for simplicity's sake and save the potential duplication of efforts. Given how both the Joint Law Enforcement Council and the proposed Fire Protection Council require participation by administrative staff and elected officials from each participating City and Township, a single joint powers entity for emergency services could be more efficient than two separate entities. Given the turmoil surrounding the member Cities of the Centennial Fire District, an alternate strategy should be considered in the event they cannot adopt the proposed Joint Powers Agreement. One of these potential strategies could include consideration of having the existing (or a transformed) Joint Law Enforcement Council manage emergency services (fire and law enforcement) and /or the new computer system using its existing countywide governance structure. 1 78 b. Expiration/ Reauthorization Of Joint Powers Entity - Article III, Term i. Please consider using a twilight date by which the joint powers entity will expire unless reauthorized. The expiration date could be set out five, ten or twenty - years. The reason to consider an expiration date is not to close the entity but to require the member Cities and Fire Departments to reexamine their needs on a periodic basis. Periodic review could be a helpful means to ease the growing pains sometimes associated with this type of entity. As the population of Cities change, the needs of communities shift, or as other unforeseen circumstances arise, using a long -term expiration date mandates periodic review of the operation of the entity and the needs of its member Cities. c. Best Practices when drafting a Joint Power Agreement i. Purpose of the 1PA. Generally, it is a best practice to define the scope of a joint powers entity to a specific purpose or scope of purpose. Article II, Purpose is a broad statement which could allow the scope of this new joint powers entity to grow well beyond its initial purpose. Two considerations: There is a political consideration here because creation of this entity includes a delegation of responsibilities entrusted to elected officials and City Councils. Careful consideration should be given before constructing a joint powers entity with an open -ended purpose. Also, an undefined scope could lead to legal liability of both the joint powers entity and individual member Cities. One of the benefits of a joint powers entity is to insulate the individual member Cities for the actions of the joint powers entity. Using a specifically stated purpose helps to draw the boundaries for potential legal liability. Likewise, Article IV, Delegation of Authority, delegates sweeping authorities to the joint powers entity normally the responsibility of only a City or a City Council. Careful consideration should be given to the reason why a City may wish to delegate "all authority necessary and convenient" to accomplish the goals of the entity. Cities and /or City Councils may wish to reserve some manner of authority. For example, Cities could reserve decisions about large capital expenditures for City Council review. However, some of these types of operating restrictions could also be defined in the entity's Bylaws. ii. Bylaws. The Bylaws of a joint powers entity are as important as the joint powers agreement. No Bylaws were attached to the proposed JPA sent for review. Please consider adopting Bylaws that are very similar to the Bylaws of the Joint Law Enforcement Council. Having similar governance structures will make it easier for City staff and elected officials to learn the rules and operations of the various joint powers entities that they must manage and track. 2 79 2. Specific Comments a. 7.2 Termination, subdivision. 1 i. This subdivision allows the joint powers entity (the FPC) to dissolve itself. Only the member Cities who authorize a joint powers entity can dissolve a joint powers entity. Certainly, the FPC can recommend to the member Cities that the entity should be dissolved. Alternatively, the joint powers agreement can set specific standards that trigger termination. For example, termination could occur if 50% of Cities drop out. Accounting principles could be used to trigger termination. For example, if net expenses exceed net revenue without budgetary supplementation for the member Cities, then termination is triggered. This subdivision could be revised to clarify intent. I suggest stating that the FPC should recommend termination to the member Cities when it determines that continued operation of the FPC becomes impractical or uneconomical to continue. b. 8.2 Insurance i. Please change the first sentence as follows: "The FPC fffay is required to maintain such insurance as will protect FPC ... ". Coverage is a fundamental requirement for a joint powers entity. Whether that insurance coverage comes from a policy purchased by the FPC, or coverage comes from the County or the Joint Law Enforcement Council's policy, does not need to be determine by this agreement. c. 10.4 Independent Contractor i. I have questions regarding both the intent and the need for this paragraph. This paragraph classifies "the parties" as independent contractors and not as employees. Since a City cannot be an employee, I presume this phrase is meant to say that the employees of the member Cities are reclassified as independent contractors ?? One of the great benefits of a joint powers agreement and entity is to concentrate potential legal liability in the joint powers entity while shielding the member Cities from liability. Here are three concepts to consider before deciding to either redraft this paragraph or simply delete this paragraph: 1. So long as an employee working under the joint powers entity is acting within the scope of the joint powers agreement, the member Cities should enjoy a shield from liability regardless if that person is an employee or independent contractor; 3 80 2. Joint powers entities and their employees enjoy the benefits of "governmental immunity" from liability for its operations. In court, it is easier to prove governmental immunity of an employee than it is for independent contractors; and, 3. The Department of Labor and judicial precedent truly has the last word about who is, or is not, an independent contractor. So placing this term in a joint powers agreement has little legal effect unless an individual truly fits within the State's legal definition of an independent contractor. d. Use of the term "the parties" or "party" Section 10 i. I question the intent of using the term "the parties." The term "governmental units" is used most other parts of the agreement. Use of the term "the parties" must be defined, or else revised to use the term "governmental units." As discussed above, the intent of using this term may be different in paragraphs 10.4 from paragraphs 10.3, 10.5 to 10.6 because sometimes it appears to apply to the employees of a governmental unit, and in other paragraphs it appears to apply to the governmental units themselves. KBG 4 81 ANOKA COUNTY FIRE PROTECTION COUNCIL JOINT POWERS AGREEMENT THIS AGREEMENT is made and entered into this_ day of , 2014, by and between the following governmental units: the cities of Anoka, Champlin, Andover, Bethel, Centerville, Lino Lakes, Circle Pines, Coon Rapids, Columbia Heights, East Bethel, Fridley, Ham Lake, Hilltop, Lexington, Nowthen, Oak Grove, Ramsey, St. Francis, Spring Lake Park, Blaine, Mounds View and the Township of Linwood (collectively "Governmental Units "). WHEREAS, the above named governmental units have determined that it is mutually beneficial for the governmental units to cooperatively address their long term needs for fire- fighting equipment, fire records data systems, fire - fighter training, fire prevention, inspection and public education; and WHEREAS, the above named governmental units may enter into this joint powers agreement pursuant to the authority set forth in Minn. Stat. § 471.59; and WHEREAS, the above named governmental units have previously participated in mutual aid agreements which have been successful in light of encouraging cooperation among the group but do not provide sufficient legal authority for the group to meet upcoming needs and desires; and WHEREAS, the creation of a joint powers agreement will meet the legal needs for the group to accomplish the goals as set forth herein, including interaction with the Anoka County Joint Law Enforcement Council on the public safety data system; and WHEREAS each of the governmental units have considered the alternatives and agreed that creation of this joint powers agreement is in the governmental unit's best interest, THEREFORE, in consideration of the mutual promises and benefits that each party shall derive herefrom, and other good and valuable consideration, the parties agree as follows: ARTICLE I Definitions In the interpretation of this Agreement, the following definitions shall have the meanings given to them. (1) "Governmental unit" shall have the meaning ascribed in Minn. Stat. § 471.59. (2) "Anoka County Fire Protection Council" or "FPC" is the name of the cooperative body created by this Joint Powers Agreement. D -1 82 (3) "Centennial Fire District" is an entity created by a joint powers agreement among the cities of Centerville, Lino Lakes and Circle Pines. (4) The "Spring Lake Fire Department, Inc." (also "SBM Fire Board ") is a duly formed Minnesota non - profit corporation providing contractual firefighting services to the cities of Spring Lake Park, Blaine and Mounds View, Minnesota. (5) "Anoka /Champlin Fire District" is a joint powers entity, created by a joint powers agreement between the cities of Anoka and Champlin, Minnesota on ARTICLE II Purpose This Agreement has been executed for the purpose of joining together to improve the efficiency and effectiveness of fire and emergency services to the public within the geographic service area of the members. ARTICLE III Term The term of this Agreement shall commence on , 2014, notwithstanding the dates of the signatures of the parties, and shall continue in full force and effect until any party terminates their membership in this Agreement. The termination by any party, however, shall not affect the validity of this Agreement as to the remaining parties. ARTICLE IV Delegation of Authority The Governmental Units hereby delegate to the Fire Protection Council (FPC) all authority necessary and convenient including, but not limited to, the ability to obtain grant monies, finance, develop, design, construct, equip, own, staff and operate the mutual programs in accordance with the terms of this Agreement. The FPC shall have all authority necessary or convenient to accomplish the purpose of this Agreement in accordance with law. ARTICLE V Composition of the FPC Each municipality, who is a party hereto, shall be a member of the FPC, except the cities of Centerville's, Lino Lakes' and Circle Pines' memberships' shall be represented only by the Centennial Fire District. The cities of Anoka's and Champlin's memberships' shall be represented only by the Anoka /Champlin Fire District. The cities of Spring Lake Park's, Blaine's and Mounds View's memberships' shall be represented only by the SBM Fire Board. D -2 83 The cities of Ramsey's and Nowthen's memberships' shall be represented only by a representative of the Nowthen /Ramsey joint powers agreement. Each member shall be represented by one of its elected officials and its fire chief, or their designee in the fire chief's absence, and each elected official and each fire chief shall have one vote. ARTICLE VI By -laws The by -laws of the FPC shall be as set forth in Attachment A, and incorporated herein. ARTICLE VII Withdrawal and Termination 7.1 Withdrawal. A member city may withdraw from this Agreement effective on January 1, upon at least one year's written notice to the President of the FPC. In the event of withdrawal by any party, this Agreement shall remain in full force and effect as to all remaining member cities. Withdrawal shall not act to discharge any liability incurred or chargeable to any member city or township before the effective date of withdrawal. Such liability shall continue until appropriately discharged by law or agreement. 7.2 Termination. This Agreement shall terminate upon the occurrence of any one of the following events: (1) When parties withdraw pursuant to Article VIII, so that it becomes impractical or uneconomical to continue, in the judgment of the FPC as evidenced by a majority vote. (2) When necessitated by operation of law or as a result of a decision by a court of competent jurisdiction; (3) When all of the Governmental Units agree, by resolution, to terminate the Agreement; 7.3 Effect of Termination. Termination shall not discharge any liability incurred by any of the Governmental Units prior to termination of this Agreement. ARTICLE VIII Liability and Insurance 8.1 Liability Each party shall be responsible for its own acts and those of its elected officials, employees, agents, and subcontractors and the results thereof, and shall not be responsible for the acts of any other party, its elected officials, employees, agents, or subcontractors and the results thereof, except as otherwise provided in this Agreement. Claims, liabilities, obligations, losses, D -3 84 expenses (including reasonable attorney and other professional fees), judgments, and costs paid or incurred by FPC, which arise out of its performance or failure to perform its duties under this Agreement, shall be included in the annual operating budget for the next calendar year, to the extent not covered by insurance proceeds or a self- insurance risk pool dedicated to the Facility. Amounts included in the annual operating budget under this section shall be pro -rated so that the total costs passed through to the member cities and township do not exceed 10% of the annual operating budget. 8.2 Insurance The FPC may purchase and maintain such insurance as will protect FPC and other member Governmental Units against risk of loss or damage to the FPC, and to any FPC property, personal or real, and any improvements located thereon and against claims which may arise from the construction, operation, use or maintenance of the FPC property and any other activities contemplated by this Agreement. The cost of any such insurance shall be included in the annual operating budget established pursuant to Attachment A hereto. ARTICLE IX FPC Property [Need to describe any property owned by the FPC] ARTICLE X General Provisions 10.1 Entire Agreement, Amendment. This Agreement contains the entire agreement of the member cities and township and shall supersede all oral and written agreements and negotiations by the parties relating to the subject matter of this Agreement. This Agreement may be amended only by written agreement of all member Governmental Units. 10.2 Severability. The provisions of this Agreement are severable. If any paragraph, section, subdivision, sentence, clause, or phrase of the Agreement is for any reason held to be contrary to law, or contrary to any rule or regulation having the force and effect of law, such decision shall not affect the remaining portions of this Agreement. 10.3 Notice. All notices or communications required or permitted pursuant to this Agreement shall be either hand delivered or mailed by U.S. Mail, at the following addresses: Anoka /Champlin Fire District: Fire Chief Charlie Thompson 275 Harrison Street Anoka Minnesota 55303 763- 576 -2860 D-4 85 City of Andover Fire Chief Dan Winkel 13875 Crosstown Blvd. Andover, Minnesota 55304 763 -755 -9825 City of Bethel Fire Chief Dave Arcand 139 Broadway Street NW Bethel, Minnesota 55005 763- 434 -4366 Centennial Fire District Fire Chief Jerry Streich 7741 Lake Dr. Lino Lakes, Minnesota 55014 763- 784 -7472 City of Columbia Heights Fire Chief Gary Gorman and Hilltop 825 -41 Avenue NE Columbia Heights, Minnesota 763- 706 -8152 City of Coon Rapids Fire Chief John Piper 11155 Robinson Drive NW Coon Rapids, Minnesota 763 - 767 -6471 City of East Bethel Fire Chief Mark DuCharme 2241 -221 Avenue NE East Bethel, Minnesota 55011 763 - 367 -7886 City of Fridley Fire Chief John Berg 6431 University Avenue NE Fridley, Minnesota 55432 763- 572 -3602 City of Ham Lake Fire Chief Don Krueger 15544 Central Avenue NE Ham Lake, Minnesota 55304 763 - 434 -9555 City of Lexington Fire Chief Gary Grote 9180 Lexington Avenue Lexington, Minnesota 55014 763- 784 -2792 D -5 86 Township of Linwood Fire Chief Darryl Ballman 22817 Typo Creek Drive NE Stacy, Minnesota 55079 651- 462 -0502 City of Oak Grove Fire Chief Curt Hallerman 19900 Nightingale Street NW Cedar, MN 55011 763 - 404 -7000 Cities of Ramsey and Nowthen Fire Chief Dean Kapler 7550 Sunwood Drive NW Ramsey, Minnesota 55303 763 - 433 -9886 City of St. Francis Fire Chief Dean Kapler 23340 Cree Street NW St. Francis, Minnesota 55070 763- 441 -4452 Spring Lake Park Fire Dept., Inc. Fire Chief Nyle Zikmund (SBM Fire Board) 1710 County Hwy 10 Spring Lake Park, MN 55432 763 - 786 -4436 The addressees listed in this section shall be the authorized representatives of the parties for purposes of sending and receiving notices and communications required or permitted pursuant to this Agreement. Any party may change its address or authorized representative by written notice delivered to the other parties pursuant to this section. 10.4: Independent Contractor. For the purposes of the Agreement, each of the parties shall be deemed to be independent contractors and not employees of any of the other parties. Any and all agents, servants, or employees of a party or other persons, while engaged in the performance of any work or services required to be performed by a party under the Agreement, shall not be considered employees of any other party for any purpose. 10.5 Damages. In the event of a party's failure to perform obligations under this Agreement, that party shall be liable to the other parties for any and all damages reasonably sustained by the other parties as a result of such failure. 10.6 Remedies Cumulative. D -6 87 All remedies provided for herein or otherwise available at law or equity shall be cumulative. The election of any remedy shall not bar other remedies available to the party. 10.7 Waiver of Default. The waiver of any default by any party, or the failure to give notice of any default, shall not constitute a waiver of any subsequent default or be deemed to be a failure to give such notice with respect to any subsequent default. The making or acceptance of a payment by any party with knowledge of the existence of a default shall not operate or be construed to operate as a waiver of any subsequent default. 10.8 Subcontracts, Assignment A Governmental Unit, may not subcontract, assign or otherwise transfer its obligations under this Agreement. 10.9 Successors. Each Governmental Unit binds itself and its successors, legal representatives, and assigns to the other parties and to the partners, successors, legal representatives, and assigns of such other parties, in respect to all rights and obligations under this Agreement. IN WITNESS WHEREOF, the parties to this Agreement have hereunto set their hands on the dates written below. CITY OF ANOKA CITY OF CHAMPLIN By: By: Phil Rice, Mayor ArMand Nelson, Mayor Dated: Dated: ATTEST: ATTEST: By: By: Tim Cruikshank, City Manager Bret Heitkamp, City Administrator Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: By: Scott Baumgartner, City Attorney Darrell Jensen, City Attorney Dated: Dated: D -7 88 CITY OF ANDOVER CITY OF BETHEL By: By: Mike Gamache, Mayor Todd Miller, Mayor Dated: Dated: ATTEST: ATTEST: By: By: Jim Dickinson, City Administrator Ginger Berg, City Clerk Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: By: Scott Baumgartner, City Attorney Bill Goodrich, City Attorney Dated: Dated: CITY OF BLAINE CITY OF COLUMBIA HEIGHTS By: By: Tom Ryan, Mayor Gary Peterson, Mayor Dated: Dated: ATTEST: ATTEST: By: By Clark Arneson, City Manager Walt Fehst, City Manager Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: By: Patrick Sweeney, City Attorney Jim Hoeft, City Attorney Dated: Dated: CITY OF CENTERVILLE CITY OF CIRCLE PINES By: By: Thomas Wilharber, Mayor David Bartholomay, Mayor D -8 89 Dated: Dated: ATTEST: ATTEST: By: By: Dallas Larson, City Administrator James Keinath, City Administrator Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: By: Kurt Glaser, City Attorney Kim Kozar, City Attorney Dated: Dated: CITY OF COON RAPIDS CITY OF EAST BETHEL By: By: Tim Howe, Mayor Richard Lawrence, Mayor Dated: Dated: ATTEST: ATTEST: By: By: Steve Gatlin, City Manager Jack Davis, City Administrator Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: By: David Brodie, City Attorney Mark Vierling, City Attorney Dated: Dated: CITY OF FRIDLEY CITY OF HAM LAKE By: By: Scott Lund, Mayor Mike Van Kirk, Mayor Dated: Dated: D -9 90 ATTEST: ATTEST: By: By . Wally Wysopal, City Manager Doris Nivala, City Administrator Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution By: By . Darcy Erickson, City Attorney Wilbur Dorn, City Attorney Dated: Dated: CITY OF HILLTOP CITY OF LEXINGTON By: B Jerry Murphy, Mayor Michael Pitchford, Mayor Dated: Dated: ATTEST: ATTEST: By: B Ruth J. Nelson, City Clerk Bill Petracek, City Administrator Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: B Carl J. Newquist, City Attorney Kurt Glaser, City Attorney Dated: Dated: CITY OF LINO LAKES TOWNSHIP OF LINWOOD By: B Jeff Reinert, Mayor Phillip Osterhus, Chair, Board of Supervisors Dated: Dated: ATTEST: ATTEST: By: B D -10 91 Jeff Karlson, City Administrator Judy Hanna, Town Clerk Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: By: Kurt Glaser, City Attorney Mike Haag, City Attorney Dated: Dated: CITY OF MOUNDS VIEW CITY OF NOWTHEN By: By: Joe Flaherty, Mayor William Schulz, Mayor Dated: Dated: ATTEST: ATTEST: By: By: James Ericson, City Administrator Corrie LaDoucer, City Clerk Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution: By: BY: Scott Riggs, City Attorney Robert Ruppe, City Attorney Dated: Dated: CITY OF OAK GROVE CITY OF RAMSEY By: BY: Mark Korin, Mayor Sarah Strommen, Mayor Dated: Dated: ATTEST: ATTEST: By: By: Rick Juba, City Administrator Kurt Ulrich, City Administrator Approved as to Form and Execution: Approved as to Form and Execution: D -11 92 By: By . Robert Vose, City Attorney Joseph Langel, City Attorney CITY OF SPRING LAKE PARK CITY OF ST. FRANCIS By: By . Cindy Hansen, Mayor Jerry Tveit, Mayor Dated: Dated: ATTEST: ATTEST: By: By . Daniel Buchholtz, City Administrator Matthew Hylen, City Administrator Dated: Dated: Approved as to Form and Execution: Approved as to Form and Execution By: By . Jeffrey Carson, City Attorney James Hoeft, City Attorney Dated: Dated: D -12 93 City of ugo 14669 Fitzgerald Avenue North, Hugo, MN 55038 (651) 762 -6300 www 6hugo.mn.us March 25, 2014 To: Bill Short, White Bear Township Clerk Treasurer Jeff Karlson, Lino Lakes City Administrator Dallas Larson, Centerville City Administrator Phil Belfiori, Rice Creek Watershed District Administrator Jim Moore, Bald Eagle Lake Association President Re: Bald Eagle Lake Dam For the past several years, the dam at the north end of Bald Eagle Lake has been in need of replacement. The City of Hugo, although not the owner of the actual dam, has taken steps toward replacing the dam in the interest of public safety and welfare. At this point, the following activities have occurred: • Construction plans were completed by the City and were approved by MnDot. • The estimated cost of the replacement is $600,000. 0 Funding was secured from MnDot in the amount of $252,000. • An application for funding through the DNR Dam Safety program was submitted to fund the remainder of the project cost. This funding will be dependent on the actions of the 2014 legislature regarding the bonding bill. In the meantime, the dam itself remains in a state of disrepair, and requires regular inspections and escalating maintenance activities to minimize the risk of failure. To date, the City of Hugo's Public Works staff has completed inspections, and City funds have been expended on repairs that took place last year. We anticipate that there will be significant flow through the outlet this spring, which will create a fair amount of stress on the dam and outlet structure. Based on field inspections by our Public Works staff, we believe that additional maintenance activities should be performed in order to minimize risk. This would consist of placing large rip -rap at the downstream end of the dam to shore up the weir wall and minimize undermining of the dam itself. The cost estimate for the work is approximately $20,000. You are receiving this letter because a portion of the lake may be within an area you represent, you may be impacted by downstream impacts, or you may have an interest in maintaining levels in the lake for water quality, recreation, or other purposes. We are asking for assistance in performing the short -term maintenance activities. The City of Hugo will coordinate the work using our own staff; however, we request funding assistance from you to help defray the cost of the work. Thank you for your consideration of this request. The City of Hugo remains committed to finding a funding solution so that the dam can be replaced, again despite the fact that the 94 structure does not belong to the City. We appreciate the support of all organizations that have an interest in maintaining Bald Eagle Lake as a resource. Following the legislative session and following any action from the DNR on our application for Dam Safety Funds, we may be in touch with you again to discuss replacement of the structure. if you have questions, please feel free to contact me at 651- 762 -6320, or the City Engineer, Jay Kennedy at 763 - 287 -7192. Sincerely, 'W n Bryan J. Bear City Administrator cc: Hugo Mayor and Council Jay Kennedy, City Engineer Scott Anderson, Public Works Director Steve Duff, Senior Engineering Technician 95 i Encumbrance Worksheet G r ( Attach to all contracts, grants, and amendments Vendor Name: Vendor Number: City of Centerville Address: Federal Employer I.D. or Social Security #: 1880 Main Street 41- 1267014 City, State, Zip: Minnesota Tax I.D. No. (if applicable): Centerville, MN 55038 Starting Fiscal Year: 2014 1 Total Amount of Agreement: $ 10,000 Start Date: 6/1/2014 End Date: 6/30/2015 Accounting Information Fiscal Year 1 Fund Dept ID Appr ID Project ID Activity ID Amount 2302 H123 2139 H12555P $ 10,000 H123 $ H123 $ CFDA # (if Federal $) Fiscal Year 2 Fund Dept ID Appr ID Project ID Activity ID Amount H123 $ H123 $ H123 $ CFDA # (if Federal $) Fiscal Year 3 Fund Dept ID Appr ID Project ID Activity ID Amount H123 $ H123 $ H123 $ CFDA # (if Federal $) Financial Management Onl Authorized 5J nature for Encumbra Date Contract Number in code Purchase tDfrNOr Number Source'Fype ca - w'" .Coot Accaurd 10 NOTE: This page of the Agreement Contract contains confidential information and should not be reproduced or distributed externally without written permission from the Vendor. Internal circulation of this page should only be to individualsioffices signing this Agreement Contract and those that require access to the tax identification number. Financial Management (651) 201 -4622 7126111 96 Standard Grant Template Version 1.2 Grant Agreement Number -- (, 51 7 , Between the Minnesota Department of Health and City of Centerville Minnesota Department of Health Grant Agreement This grant agreement is between the State of Minnesota, acting through its Commissioner of the Department of Health ( "State ") and City of Centerville ( "Grantee "). Grantee's address is 1880 Main Street, Centerville, MN 55038. Recitals 1. Under Minnesota Statutes §1 14D.50 Clean Water Fund, the State is empowered to enter into this Grant Agreement. 2. The State is in need of assisting public water suppliers to protect the source of drinking water. 3. The Grantee represents that it is duly qualified and will perform all the duties described in this agreement to the satisfaction of the State. Pursuant to Minnesota Statutes §1613.98, subd. 1, the Grantee agrees to minimize administrative costs as a condition of this grant. Grant Agreement 1. Term of Agreement 1.1 Effective date June 1, 2014, or the date the State obtains all required signatures under Minnesota Statutes § 16C.05, subd. 2, whichever is later. The Grantee must not begin work until this contract is fully executed and the State's Authorized Representative has notified the Grantee that work may commence. 1.2 Expiration date June 30, 2015, or until all obligations have been fulfilled to the satisfaction of the State, whichever occurs first. 1.3 Survival of Terms The following clauses survive the expiration or cancellation of this grant contract: 8. Liability; 9. State Audits; 10.1 Government Data Practices; 10.2 Data Disclosure; 14.1 Publicity; 14.2 Endorsement; and 15. Governing Law, Jurisdiction, and Venue. 2. Grantee's Duties The Grantee, who is not a State employee, shall: - Complete to the satisfaction of the State all of the following duties: - Seal wells on private property located within the City DWSMA - Grantee agrees that no system of water supply for public use shall be installed, altered or extended until complete plans and specifications for the installation, alteration or extension have been submitted and approved by the State, and no construction shall take place except in accordance with the approved plans; no grant funds can be used prior to approval of the plans. - The Grantee shall use the Clean Water Land and Legacy Amendment logo on all materials that are purchased or produced under this Grant Agreement (equipment, reports to the public, publications, displays, videos). An electronic copy of the logo will be made available to the Grantee. Failure to 97 display the logo may render the Grantee ineligible for reimbursement. - Upon completion of the project Grantee shall submit a Grant Narrative Report (Exhibit A) and a Grant Invoice (Exhibit B). The Grant Narrative Report and the Grant Invoice shall be due no later than the expiration day of this Grant Agreement. - On or before the end date of this Agreement, the Grantee shall provide the State with one electronic copy of all final products produced under this Grant Agreement, including reports, publications, software and videos. - The Grantee shall pay in full any licensed contractor hired for the purpose of completing any work under this Grant Agreement within 10 days of receiving payment from the State. - The Grantee shall submit an itemized invoice for the total cost of the project. - In the event the Grantee is unable to begin grant activities or to satisfactorily perform the duties specified in this grant agreement, including but not limited to paying the licensed contractor in full for all work performed by the contractor, the Grantee shall remit to the State within five days of demand all amounts paid to the Grantee pursuant to this Grant Agreement minus any actual expenses incurred and specifically authorized, in advance, by the State and which are documented by adequate invoices acceptable to the State. 3. Time The Grantee must comply with all duties within the time requirements described in this Grant Agreement. The State is not obligated to extend this Agreement. In the performance of this Grant Agreement, time is of the essence, and failure to meet a deadline may be a basis for a determination by the State's Authorized Representative that the Grantee has not complied with the terns of the Grant Agreement and require the Grantee to remit to the State all amounts previously paid to the Grantee. 4. Consideration and Payment 4.1 Consideration The State will pay for all services performed by the Grantee under this Grant Agreement as follows: (a) Compensation The Grantee will be paid according to the following breakdown of costs: Activity Grant Amount Seal wells on private property $10,000 TOTAL $10,000 (b) Travel Expenses The Grantee shall not be reimbursed for any travel or subsistence expenses whatsoever (c) Total Obligation The total obligation of the State for all compensation and reimbursements to the Grantee under this Grant Agreement will not exceed $10,000 (ten thousand dollars). Fees associated with the well sealing are not eligible under this category of grants and will be deducted from the final invoice. 4.2 Terms of Payment (a) Invoices The State will promptly pay the Grantee after the Grantee presents an itemized invoice for the services actually performed and the State's Authorized Representative accepts the invoiced services. Invoices must be submitted in a timely fashion, upon completion of the services. 98 The State does not pay merely for the passage of time. (b) All the grant documentation (Grant Narrative Report, Grant Invoice, itemized invoice(s), electronic copies) must be submitted in one packet by either email or mail. The Grantee shall use the following mailing address:. Attn: Cristina Covalschi Source Water Protection Minnesota Department of Health PO Box 64975 St. Paul, MN 55164 -0975 (c) If the final invoice is not received by the State before the end date of this Grant Agreement, the Grantee may forfeit the final payment. (d) If necessitated by the nature of the project, the Grantee is allowed to reallocate up to 10% of the amount originally awarded for a given expense category to another approved category without obtaining permission from the State. Should the Grantee find it necessary to re- budget the Grant beyond the 10% reallocation allowance, a written or e -mail request must be submitted to the State for approval. S. Conditions of Payment All services provided by Grantee pursuant to this Agreement must be performed to the satisfaction of the State, as determined in the sole discretion of its Authorized Representative. Further, all services provided by the Grantee must be in accord with all applicable federal, State, and local laws, ordinances, rules and regulations. The Grantee will not be paid for work that the State deems unsatisfactory, or performed in violation of federal, State or local law, ordinance, rule or regulation. 6. Authorized Representatives 6.1 State's Authorized Representative The State's Authorized Representative for purposes of administering this agreement is Cristina Covalschi, SWP Grants Coordinator, address: 625 Robert Street N, PO Box 64975, Saint Paul, MN 55164 -0975, phone: 651 -201 -4696, email address: Cristina.Covalschi @State.mn.us, or her successor, and has the responsibility to monitor the Grantee's performance and the final authority to accept the services provided under this agreement. If the services are satisfactory, the State's Authorized Representative will certify acceptance on each invoice submitted for payment. 6.2 Grantee's Authorized Representative The Grantee's Authorized Representative is Dallas Larson, City Administrator, address: 1880 Main Street, Centerville, MN 55038, phone: 651 429 3232. The Grantee's Authorized Representative has full authority to represent the Grantee in fulfillment of the terms, conditions, and requirements of this agreement. If the Grantee selects a new Authorized Representative at any time during this agreement, the Grantee must immediately notify the State. 7. Assignment, Amendments, Waiver, and Merger 7.1 Assignment The Grantee shall neither assign nor transfer any rights or obligations under this Agreement without the prior written consent of the same parties who executed and approved this Agreement, or their successors in office. 7.2 Amendments If there are any amendments to this Agreement, they must be in writing. Amendments will not be effective until they have been executed and approved by the same parties who executed and approved the original Agreement, or their successors in office. 99 7.3 Waiver If the State fails to enforce any provision of this Agreement, that failure does not waive the provision or the State's right to enforce it. 7.4 Merger This Agreement contains all the negotiations and agreements between the State and the Grantee. No other understanding regarding this Agreement, whether written or oral, may be used to bind either party. 8. Liability Each party will be responsible for its own acts and behaviors and the results thereof. The Minnesota Tort Claims Act, Minnesota Statutes section 3.736, and other applicable laws governs the State's liability. The Grantee's liability is governed by the Minnesota Municipal Tort Claims Act, Minnesota Statutes chapter 466 and other applicable laws. 9. StateAudits Pursuant to Minnesota Statutes § 16C.05, subd. 5, the Grantee's books, records, documents, and accounting procedures and practices of the Grantee, or any other relevant party or transaction, are subject to examination by the State, the State Auditor, and the Legislative Auditor, as appropriate, for a minimum of six (6) years from the end of this Grant Agreement, receipt and approval of all final reports, or the required period of time to satisfy all State and program retention requirements, whichever is later. 10. Government Data Practices and Data Disclosure 10.1 Government Data Practices Pursuant to Minnesota Statutes Chapter 13, the Grantee and the State must comply with the Minnesota Government Data Practices Act as it applies to all data provided by the State under this agreement, and as it applies to all data created, collected, received, stored, used, maintained, or disseminated by the Grantee under this Grant Agreement. The civil remedies of Minnesota Statutes § 13.08 apply to the release of the data referred to in this clause by either the Grantee or the State. If the Grantee receives a request to release the data referred to in this clause, the Grantee must immediately notify the State. The State will give the Grantee instructions concerning the release of the data to the requesting party before any data is released. The Grantee's response to the request must comply with the applicable law. 10.2 Data Disclosure Pursuant to Minnesota Statutes § 270C.65, subd. 3, and all other applicable laws, the Grantee consents to disclosure of its social security number, federal employee tax identification number, and Minnesota tax identification number, all of which have already been provided to the State, to federal and State tax agencies and State personnel involved in the payment of State obligations. These identification numbers may be used in the enforcement of federal and State tax laws which could result in action requiring the Grantee to file State tax returns and pay delinquent State tax liabilities, if any. Il. Ownership of Materials and Intellectual Property Rights 11.1 Ownership of Materials The State shall own all rights, title and interest in all of the materials conceived or created by the Grantee, or its employees or sub - Grantees, either individually or jointly with others and which arise out of the performance of this grant agreement, including any inventions, reports, studies, designs, drawings, specifications, notes, documents, software and documentation, computer based training modules, electronically, magnetically or digitally recorded material, and other work in whatever form ( "materials "). The Grantee hereby assigns to the State all rights, title and interest to the materials. The Grantee shall, upon request of the State, execute all papers and perform all other acts necessary to assist the State to obtain and register copyrights, patents or other forms of protection provided by law for the materials. The materials created under this grant agreement by the Grantee, its employees or sub - Grantees, 100 individually or jointly with others, shall be considered "works made for hire" as defined by the United States Copyright Act. All of the materials, whether in paper, electronic, or other form, shall be remitted to the State by the Grantee. Its employees and any sub - Grantees shall not copy, reproduce, allow or cause to have the materials copied, reproduced or used for any purpose other than performance of the Grantee's obligations under this grant agreement without the prior written consent of the State's Authorized Representative. 11.2 Intellectual Property Rights Grantee represents and warrants that materials produced or used under this grant agreement do not and will not infringe upon any intellectual property rights of another including but not limited to patents, copyrights, trade secrets, trade names, and service marks and names. Grantee shall indemnify and defend the State, at Grantee's expense, from any action or claim brought against the State to the extent that it is based on a claim that all or parts of the materials infringe upon the intellectual property rights of another. Grantee shall be responsible for payment of any and all such claims, demands, obligations, liabilities, costs, and damages including, but not limited to, reasonable attorney fees arising out of this grant agreement, amendments and supplements thereto, which are attributable to such claims or actions. If such a claim or action arises or in Grantee's or the State's opinion is likely to arise, Grantee shall at the State's discretion either procure for the State the right or license to continue using the materials at issue or replace or modify the allegedly infringing materials. This remedy shall be in addition to and shall not be exclusive of other remedies provided by law. 12. Workers' Compensation The Grantee certifies that it is in compliance with Minnesota Statutes § 176.181, subd. 2, which pertains to workers' compensation insurance coverage. The Grantee's employees and agents, and any contractor hired by the Grantee to perform the work required by this Grant Agreement and its employees, will not be considered State employees. Any claims that may arise under the Minnesota Workers' Compensation Act on behalf of these employees, and any claims made by any third party as a consequence of any act or omission on the part of these employees, are in no way the State's obligation or responsibility. 13. Publicity and Endorsement 13.1 Publicity Any publicity given to the program, publications, or services provided resulting from this grant agreement, including, but not limited to, notices, informational pamphlets, press releases, research, reports, signs, and similar public notices prepared by or for the Grantee or its employees individually or jointly with others, or any sub - Grantees shall identify the State as the sponsoring agency and shall not be released without prior written approval by the State's Authorized Representative, unless such release is a specific part of an approved work plan included in this grant agreement. 13.2 Endorsement The Grantee must not claim that the State endorses its products or services. 14. Termination 14.1 Termination by the State The State or Grantee may cancel this Grant Agreement at anytime, with or without cause, upon thirty (30) days written notice to the other party. 14.2 Termination for Cause If the Grantee fails to comply with any of the provisions of this Grant Agreement, the State may terminate this Grant Agreement without prejudice to the right of the State to recover any money previously paid. The termination shall be effective five business days after the State mails, by certified mail, return receipt requested, written notice of termination to the Grantee at its last known address. 14.3 Termination for Insufficient Funding The State may immediately terminate this Agreement if it does not obtain funding from the Minnesota legislature or other funding source; or if funding cannot be continued at a level sufficient to allow for the payment of the work scope covered in this Agreement. Termination must be by written or facsimile notice to the Grantee. The State is not obligated to pay for 101 any work performed after notice and effective date of the termination. However, the Grantee will be entitled to payment, determined on a pro rata basis, for services satisfactorily performed to the extent that funds are available. The State will not be assessed any penalty if this Agreement is terminated because of the decision of the Minnesota legislature, or other funding source, not to appropriate funds. The State must provide the Grantee notice of the lack of funding within a reasonable time of the State receiving notice of the same. 15. Governing Law, Jurisdiction, and Venue This Grant Agreement, and amendments and supplements to it, shall be governed by the laws of the State of Minnesota. Venue for all legal proceedings arising out of this grant agreement, or for breach thereof, shall be in the State or federal court with competent jurisdiction in Ramsey County, Minnesota. IN WITNESS WHEREOF, the parties have caused this grant agreement to be duly executed intending to be bound thereby. APPROVED: 1. Grantee 2. STATE AGENCY The Grantee certifies that the appropriate persons(s) have executed the Grant Agreement approval and certification that STATE funds have been grant agreement on behalf of the Grantee as required by applicable encumbered as required by Minn. Stat. § §16,4.15 and 160.05. articles, bylaws, resolutions, or ordinances By: By: (with delegated authonty) Title: Title: Date: Date: By: Title: Date: Distribution: Agency — Original (fully executed) Grant Agreement Grantee State Authorized Representative 102 M - IN N E S 0 T A I Division of Environmental Health Exhibit A ' Section of Drinking Water Protection P.O. Box 64975 St. Paul, Minnesota 55164 -0975 DEPARTMFNTorHEAIT 651/201.4700 GRANT NARRATIVE REPORT TEMPLATE System Name: PWSID: Address: Contact Person Name: Phone: Email: Describe the issue Why did you apply for funding? Was there a problem? Where /When did it take place? Describe in detail the work that was performed Describe the results of this project; How did this work benefit your system? How was drinking water and public health protected? Would this work have happened in the absence of the grant program? ❑ Yes ❑ No Assistance received — How did Minnesota Department of Health (MDH) or Minnesota Rural Water Association (MR WA) help? (i.e. MDH /MRWA consulted, recommended, analyzed, educated, advised, rovided, etc.) How can the grant program be improved? 103 Pictures available? ❑Yes ❑No Publication, software, videos available? ❑Yes ❑No DISCLAIMER I declare that the data on this document is correct Authorized Grantee Signature Date R MINNESOTA DEPARTMENT OF HEALTH UW ONLY Flow much money was spent completing this work (total to include cost share) Estimate the number of people served by the PWS 104 M - IN N E S 0 T A I Division of Environmental Health Exhibit B ' Section of Drinking Water Protection P.O. Box 64975 St. Paul, Minnesota 55164 -0975 DEPARTMENTorHEALTH 651/201 -4700 Source Water Protection Plan Implementation Grant Invoice GRANTEE INFORMATION PWSID: System Name: Address: Contact Person Name: Phone: Fax: E -mail: INVOICE INFORMATION Is this the final invoice? ❑ Yes ❑ No WORK ITEMS AND EXPENDITURE DESCRIPTION — use an additional page if neoessa Total Expenditures Net Invoice Amount to be Paid Is DISCLAIMER AND SIGNATURE I declare that no part of this claim has been previously billed to MDH, and that the Total Expenditures reflect only charges related to the source water protection project. I also declare that the data on this document is correct and all transactions that support this claim were made In accordance with all applicable Federal and State statutes and regulations. Authorized Grantee Signature Date FOR MINNESOTA DEPARTMENT OF HEALTH USE ONLY Grant Manager Signature Date PO: Approved by: Period of Service: Date sent to F.S: 105