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RES 2015-0050 - Appoint Travis J Kuhlman manager of Doubletree by Hilton Omaha Southwest STATE OF NEBRASKA (,%. 1",-;:ri,Z—il Dave Heineman Z0114 DEC "7 PM 4: 3U NEBRASKA LIQUOR CONTROL, COMMISSION { Governor Hobert B. Rupe ry4�*r1 f If r `0,1 Executlpe Director CITY CLERK 301 Centennial Mall South,51h Floor 6 1 H; HA, NEBRASK r, P.O Box -504 Lincoln,NebraskaaG8505Onr1-5046 Phone(402)471.2571 December 9,2014 Fax(402)471.2814 or(402)471 2374 TRS USER 800 833 7352(TTY) web address:http://wmv.Icc.ne.gov/ City Clerk 1819 Farnam Street LC-1 Omaha NE 68183 RE: Doubletree by Hilton Omaha Southwest- License #C-103333 Dear Clerk: Enclosed is a copy of a manager application for 72nd Street Hospitality LLC in connection with Doubletree by Hilton Omaha Southwest located at 3650 S 72 Street,Omaha NE 68124. The applicant that filed with the pending retail application is no longer the manager. Please present this application for manager to your City/Village Council or County Commissioners and send us the results of their action. Sincerely, ALeiteltRd)-ttc_ Mic elle Porter Licensing Division Enclosure cc: file Janice M.Wiebusch Robert Batt William F.Austin Commissioner Chairman Commissioner An Equal Opportunity Employer Prinled with soy ink on recyrh"I parer 1 RECEIVED 1J23J14 DEC -2 2014 Nebraska Liquor Control Commission, NEBRASKA LIQUOR CONTROL COMMISSION Please except this letter as notification to remove Michael Stockman from License#103333 for DoubleTree Omaha Southwest located at 3650 S.72m Street,Omaha,NE 68124. Travis Kuhlman(acting GM)is submitting paperwork to be added on the on premise license holder. Sincerely, Rob rt Pagan 72n0 Street Hospitality LLC 605-381-1883 • 1400026356 Porter, Michelle From: Travis Kuhlman <Travis.Kuhlman@Hilton.com> Sent: Tuesday, December 02, 2014 3:16 PM To: Porter, Michelle Cc: Travis Kuhlman Subject: DoubleTree Omaha Southwest -72nd Street Hospitality LLC application Attachments: Liquor License App -Travis Kuhlman 12.2.14.pdf Hi Michelle, Please see the attached application with supporting documentation and the request letter to have Michael Stockman removed as the manager on file. Please let me know if there are any questions and the next step in the process. Thank you • RECEIVED Travis Kuhlman - Genera/Manager DEC -2 2014 DoubleTree by Hilton Omaha Southwest 3650 S. 72nd Street Omaha, NE 68124 NEBRASKA LIQ P: (402)905 9414IC: (402)681 6070 CONTROL comm UO UOR travis.kuhlmanOhilton.corn This transmission is not a digital or electronic signature and cannot be used to form,document,or authenticate a contract.Hilton and its affiliates accept no liability arising in connection with this liansmission.Copynght 2014 Hilton Worldwide Proprietary and Confidential • • • • MANAGER APPLICATION Office Use INSERT-FORM3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION DEC -2 �l�14 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE68509-5046 NEBRASKA L'QUOR PHONE:(402)471.2571 CONTROL COMMISSION FAX:(402)471-2814 Website:www.lcc,ne.eov MUST BE: ✓ Citizen of the United States. Include cony of US birth certificate.naturalization paper or current US passport ✓ Nebraska resident. Include cony of voter registration in the State of Nebraska ✓ Fingerprinted.Two cards per person,fees of$38 per person,made payable to Nebraska State Patrol.If printed at NSP mall check only. ✓ 21 years of age or older .P?P.o 00.W.L;LC.int6r. 14.0On Name of Co 56 `rporation/LLC• Irtet LLC lPremtsetnormatlon.,.�...._... . .7777. r....__ ..�. Liquor License Number: 103333 Class Type (if new application leave blank) Premise Trade Name/DBA: 77.;e0 �t�rt c.. t��t•+birt a„eta.- Premise Street Address: a.05cz, 5 . '7�"J - City: OrrYAVO County: de , ��5 Zip Code: ViS%24 Premise Phone Number: L41U1-•cte6 - cv-v4 ' Email address: +vv. . t'11.41+1r+ao4 ct k i tior) • Coeft. + The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a or 3b or listed with the Commission. Click on this link to see authorized individuals. http://www.lcc.ne.env/license search/[icsearch.cgi SIGNA RE REQUIRED BY CORPORATE OFFICER/MANAGING MEMBER (Faxed signatures are acceptable) Form 103 Rev 9/2011 Page 2 of 6 RECEIVED aneget's oformatlon must-t>e completed ielow PLEASE titiNT;CLEARLY "DEC"` 2 2014 .. Last Name: 1s1YWL1t First Name: ViyNEBRASIO.IT UOR CONTROL COMMISSION Home Address(include PO Box if applicable): 5q City: 0t elt.31 ..) County:Doux3Vu5 Zip Code: COS l Ots Home Phone Number: 462.- La010 Business Phone Number: gal- -qy ti-/ Social Security Number: vers License Number&State: Date Of Birth: __ Place Of Birth: L c;t gtAlfse Email address: •-h-Mvi5, kv1,%1rnc„v‘ Ifun , c,cwi r u ma.1.MrTe comp e e 1 sin orm t on" yen Ta s ousai t t ;a-„ ens nit RY (J YES ❑NO . .. 7.. 7..._....._7.7rr.rr• 1 .r T,.r.. Spouses Last Name: IA uiWvync h First Name: ,ci8e..c MI: It, Social Security Number: Drivers License Number&State: Date Of Birth: , _ Place Of Birth: St o CA TA iirft TIT�g-tiO SI N U isynSIDLNC s mi-T t igf- EI ui SEARS Y."-...."--• .. .... : . :n .. ...• CITY&STATE YEAR YEAR CITY&STATES YEAR FROM TO FROM TO Cwlate% !fE 9 013 cu amarri a 01 3 nrrwho,! 4E 2?O I 1 Form 103 Rev 9f20I3 Page 3orb YEAR TELEPHONE FROM TO NAME OF EMPLOYER NAME OF SUPERVISOR NUMBER o(3 ado _ L)c.; .4 1 pc6-1. M' C .Lk IA,ls ql3 30t- 7s40 acss .2013 1,1(04:1, GC,n4�1 Cep �� p,U «r t�0t5-332-Iact3 1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. Must be completed by both applicant and spouse, unless spouse has filed an affidavit of non- participation. Has anyone who is a party to this application,or their spouse,EVER been convicted of or plead guilty to any charge. Charge means any charge alleging a felony,misdemeanor,violation of a federal or state law;a violation of a local law, ordinance or resolution. List the nature of the charge, where the charge occurred and the year and month of the conviction or plea. Also list any charges pending at the time of this application. If more than one party,please list charges by each individual's name. ❑ YES TO NO RECEIVED If yes,please explain below or attach a separate page. DEC 2014 Date of Where Description NEBRASKA LIQUOR Name of Applicant Conviction Convicted of CONTRQiis,QJ SSlON (mm/yyyy) (City&State) Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? KYES ONO IF YES,list the name of the premise(s):ajksiirtc,arild10- n' i ' f cbctr' 3. Do you,as a manager,qualify under Nebraska Liquor Control Act(§53-131.01)and do you intend to supervise,in person,the management of the business? YES ONO Form t0l Rev 912013 Page 4 of 6 4. List the alcohol related training and/or experience(when and where)of the person making application. 'NLCC Training Certificate Issued: NA' Name on Certificate: Applicant Name Date Name of pp (mmirnY) pro gram(attach copy of course completion certificate) 0 _.41:: eir›) lrjuxs rivhlwevt _ cafe) 5 'ro S Q r//ci k 4c t,+�o ► Ix'cud& 1.., t AM -MECEI1!E1) DEC 2 20HH NEBRASKA LIQUOR CONTROL COMMtSS!ON 'For list of NLCC Certified Training Programs see www.Icc,ne.gny/Irnininginfo.html Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: -7;u Viol,1.,k0 eifich t �rLws Viu�,Irro4/ erR, 61-tA s}�p,r..i t.�.�,►.► 4- 5,,qs t Icem % -Gt4W14 1►,LS v / c 1%."-) - a7b°'s-02o11 Ft� ]�+� nw +tz. O 1'�cwr 5. Have you enclosed the required fingerprint cards and PROPER FEES with this application? (Check or money order made payable to the Nebraska State Patrol for S38.00 per person) EYES KNO t�+ r rik cv� t;t� � c t3/Liuxtisc �Dc,Ia T� e.t.a 77 ^ Form 103 Rev 9/20I 3 Par Sof6 Porter, Michelle From: Hiland, Brenda Sent: Wednesday, December 03, 2014 9:02 AM To: Porter, Michelle Subject: RE: DoubleTree Omaha Southwest-72nd Street Hospitality LLC application es,they are on file 11/21/2013. Brenda-Hilan Enforcement Division Nebraska Liquor Control Commission (402) 471-2735 (402) 471-2814 fax web: htto://www.lcc.ne.gov https://www.facebook,com/NebraskaLiquorControlCommission From: Porter, Michelle Sent: Wednesday, December 03, 2014 8:56 AM To: Hiland, Brenda Subject: FW: DoubleTree Omaha Southwest- 72nd Street Hospitality LLC application Can you see if you find his prints? I did not see them where I looked. Thanks! From: Travis Kuhlman [rnailto:Travls,KuhlmanOHilton.com] Sent: Wednesday, December 03, 2014 8:55 AM To: Porter, Michelle Subject: RE: DoubleTree Omaha Southwest-72nd Street Hospitality LLC application It was in September of 2013 and have verified license at home for the DoubleTree Omaha Downtown. I did this at the downtown police station If that helps. Thank you Travis Kuhlman - General Manager DoubleTree by Hilton Omaha Southwest 3650 S. 72nd Street Omaha, NE 68124 P: (402) 905 9414IC: (402) 681 6070 trayls.kuhlmarKahilton,corn From: Porter, Michelle [michelle.porter©nebraska.govj Sent: Wednesday, December 03, 2014 8:42 AM To: Travis Kuhlman Subject: RE: DoubleTree Omaha Southwest-72nd Street Hospitality LLC application Travis, I also was unable to find fingerprints for you on file from September 2013? g►ficliefre Porter licensing Division The above individual(s), being first duly sworn upon oath, deposes and states that the undersigned is the applicant and/or spouse of applicant who makes the above and foregoing application that said application has been read and that the contents thereof and all statements contained therein are true. If any false statement is made in any part of this application, the applicant(s) shall be deemed guilty of perjury and subject to penalties provided by law. (Sec §53-131.01)Nebraska Liquor Control Act. The undersigned applicant hereby consents to an investigation of his/her background including all records of every kind and description including police records, tax records (State and Federal), and bank or lending institution records, and said applicant and spouse waive any rights or causes of action that said applicant or spouse may have against the Nebraska Liquor Control Commission and any other individual disclosing or releasing said information to the Nebraska Liquor Control Commission. If spouse has NO interest directly or indirectly,a spousal affidavit of non participation may be attached. The undersigned understand and acknowledge that any license issued, based on the information submitted in this application, is subject to cancellation if the information contained herein is incomptiEtraEwED fraudulent. DEC - 2 2014 NEE3RASKA LIQUOR J4NTROLOMMISSN Signature of anager Applicant Slgtyafure of SpouseCt- �f ' AC WLEDGEMENI' State of Nebrasla County of i xx��C�S . The foregoing instrument was acknowledged before me this MUPA ir U ti�1 , Ao12-1 by —TVr%d 15 , 1 dale name of person acknowledged I-Mk1r'€.4.c El r akr --- Affix Seat Notary Public signature MICHAEL A SHEVER General Notary 6tife of N.b,..1. ` My Commission Expires Dio 4.2018 In compliance with the ADA,this application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. Forth 103 Rev 9/2013 Page 6 of 6 Print Form SPOUSAL AFFIDAVIT OF OfficeU.e [RECEIVED NON PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION DEC -2 2014 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE68509-5046 NEBRASKA LIQUOR PHONE:(402)471-2571 FAX:(402)471-2814 CONTROL COMMISSION website: www.Ice ne Qm I acknowledge that I am the spouse of a liquor license holder. My signature below confirms that I will have not have any interest,directly or indirectly in the operation or profit of the business(§53-125(13))of the Liquor Control Act. I will not tend bar,make sales,serve patrons,stock shelves,write checks,sign invoices or represent myself as the owner or in any way participate in the day to day operations of this business in any capacity. I understand my fingerprint will not be required;however,I am obligated to sign and disclose any information on all applications needed to process this application. 1 .� �d d Kuklrn&n Signature of s sotz a asking for waiver Printed nn of s ouse askin for waiver 8m P g rI! P g (Spouse o individual listed below) State of N('_I?rC�51Z� County of bnL t�)c.0 . The foregoing instrument was acknowledged before me this Klo ► tbo., (1 a() LI by #BR,i C�cl'24 1 MC.., l date ' 1 gofItersQn ask owlt_dg` . 4' "]T11""- f� O�Y�41-„1�1�I — Affix Seal MICHAEL A SHYER lh General Notary Notary Public signature State of Nebraska My CommIselon Expires Dec 4,2018 I acknowledge that I am the spouse of the above listed individual. I understand that my spouse and I are responsible for compliance with the conditions set out above. If it is determined that the above individual has violated(§53-125(13))the Commission may cancel or revoke the liquor license. s)t �lnkIvAntvl Signature of in ividual involved with applicatio n Printed name of applying individual (Spouse of individual listed above) State of N'h r00. I .c County of ()otx1G,S . The foregoing instrument was acknowledged before me this lover ..-- f—i l4 by -1-12.14viS J i ul'1[FYYMJ data ' name of person acknowledged Notary ublic signature In compliance with the ADA,this spousal affidavit of non participation is available In other • is for persons wgMVIAMtlOPaka A ten day advents period le requested in writing to produa.the alternate rnrm.t. My Commission Expires Dec 4.2018 FORM 35.417E Revised 1/20011 EDUCATIONAL INSTITUTE AMERICAN HOTEL&LODGING ASSOCIATION ' Phone.511-372-8800 • Fox:517.372-S141 • E-mail:contoctOei-ohla.or9 • www.el-aha.org 2113 N.High St.,Lansing,MI 48906,USA RECEIVED January 28,2008 DEC - 2 2014 NEBRASKA LIQUOR CONTROL COMMISSION Dear Travis J.Kuhlman: Congratulations on successfully completing Controlling Alcohol Risks Effectively(CARE)for Servers,the Educational Institute's responsible alcohol service program.Your score of 84 percent or greater on the CARE exam shows that you are well aware of the issues and concerns involved in the responsible service of alcohol.Your CARE for Servers card is attached.You can present this card as proof of your training to those who request it.This letter also includes verification of your training for your employee file.Please detach the Verification Record,located at the lower left of this letter,and give it to your employer or other appropriate person.If you have any questions,please contact your instructor or the Educational Institute. Once again,congratulations on your achievement,and best of luck to you in your hospitality career. Roy Kennington President&Chief Operating Officer (Detach this lower part and give to your employer) e WWinneVerification Record for Employee File uI WON ACARE®for Servers w mos ttssrlas leld I tegltl Etitsllenl• tilitlits EducatIonal Institute of the The recipient of this card.Travis J.Kuhlman American Hotel and Lodging Association has successfully completed the Controlling Alcohol Risks Effectively(CARE)Program on December 28,2007 Hereby confirms that Travis J.Kuhlman Explres:17128r2010 has successfully completed the Controlling Alcohol Risks Effectively(CARE)Program on December 28,2007 Expires:12/21l/2010 aat. Ofiker Prs...4ti 4 Chi O./aims 011.e MAHA, 1V4,g Cityof Omaha, Webraska (I°. ' / �rRr lla f 'l, I. �?,t 1819 Farnam—Suite LC 1 2 i L� i7riiir ow; Omaha, Nebraska 68183-0112 �0 Buster Brown (402) 444-5550 o qti City Clerk FAX (402) 444-5263 Q o FEBR�t'1 December 29, 2014 72❑d Street Hospitality, LLC Application to appoint Travis J. Kuhlman Dba"DoubleTree by Hiltion Omaha Southwest" manager of your pending Class "C" Liquor 3650 South 72nd Street License location Omaha, NE 68124 Dear Liquor License Applicant: This letter is notification that a hearing before the Omaha City Council on your application to appoint a manager to the liquor license has been set for January 13, 2015 . The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4), Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council Liquor Rule No. 6 states, "Each applicant or his/her representative for any type of license shall be personally present in the Council Chambers, in order that the Council may make inquiries, on the date of public hearing of the application for said license". Failure to be present at this Council Meeting is grounds to recommend denial of your application to the Nebraska Liquor Control Commission. Sincrely,yours,.:- Buster Brown City Clerk BJB:clj t2AAHA, NF6 City ofOmaha, Webraska „ imp'? ' 1819 Farnam—Suite LC 1 ® 'o'\ -t f Omaha, Nebraska 68183-0112 o�� a ^�.W.� :' -1' '� Buster Brown (402) 444-5550 414) n,. City Clerk FAX (402) 444-5263 0414 1. ED FEBR‘rALA December 29, 2014 Travis J. Kuhlman Application to be appointed manager of the 5911 Pierce Street pending Class "C" Liquor License location Omaha, NE 68106 for 72nd Street Hospitality, LLC, dba "DoubleTree by Hilton Omaha Southwest", 3650 South 72nd Street Dear Liquor License Manager Applicant: This letter is notification that a hearing before the Omaha City Council on your application to be appointed manager of the liquor license has been set for January 13, 2015 . The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4), Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council Liquor Rule No. 6 states, "Each applicant or his/her representative for any type of license shall be personally present in the Council Chambers, in order that the Council may make inquiries, on the date of public hearing of the application for said license". Failure to be present at this Council Meeting is grounds to recommend denial of your application to the Nebraska Liquor Control Commission. Sincerely yours, ‘4.14f 4°.04e'-‘ Buster Brown City Clerk BJB:clj z. // 72"d Street Hospitality, LLC, dba "DoubleTree by Hilton Omaha Southwest", 3650 South 72"d Street, requests permission to appoint Travis J. Kuhlman manager of their pending Class "C" Liquor License location. 01-13-15;cj - 1 RECEIVED Presented to Council: January 13, 2015 - Approved Buster Brown City Clerk