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RES 2014-1304 - Appoint Kevin P Matras manager of AVP Energy #3 {) �. CEIVED �t STATE OF NEBRASKA i 6 A Dave Heineman 20II SEP 24 p� 9: 45 NEBRASKA LIQUOR CONTROL COMMISSION Governor 7 Hobert B. Rupe 9Rctr�"*a�� Executive Director CITY 301 Centennial Mall South.5th Floor R K P.O.Box 95046 OMAHA, N E B R A S K`, Lincoln,Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 or(402)471-2374 September 24, 2014 TRS USER 800 833-7352 CITY) web address:http://cvww.lcc.ne.gov/ OMAHA CITY CLERK 1819 FARNAM STREET LC-1 OMAHA NE 68183 RE: Manager Application Kevin Matras LICENSE -88430 Dear Clerk: Enclosed is a copy of a manager application for Kevin Matras in connection with the AVP Energy#3 located in Omaha. Please present this application for manager to your City/Village Council or County Commissioners and send us the results of their action. Sincerely, Jacqueline Rodriguez Licensing Division NEBRASKA LIQUOR CONTROL COMMISSION 402-471-2571 encl. Janice M.Wiebusch Robert Batt William F.Austin Commissioner Chairman Commissioner An Equal Opportunity Employer Pruned with son Ink on receded paper' MANAGER APPLICATION Office Use INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH S E P I s 2014 PO BOX 95046 LINCOLN,NE 68509-5046 NEBRA'S'M'A, L t y U PHONE:(402)471-2571 1 FAX:(402)471-2814 CONTROLrMLS Website:www.kc.ne.gov MUST BE: ✓ Citizen of the United States. Include copy of US birth certificate,naturalization paper or current US passport ✓ Nebraska resident. Include copy 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 mail check only. ✓ 21 years of age or older C' ratioiLLC information n 1. Name of Corporation/LLC:AV P Energy, LLC formation a. �88�9 / 088430 -B-/ D Liquor License Number: Class Type (if new application leave blank) Premise Trade Name/DBA:AVP Energy #5 / AVP Energy #3 Premise Street Address: 1 10505 Pacific St La-Vista// Omaha Douglas 68114 City: County: ? / zip Code: 40 '33 " 1 " 5 / 402-393-2956 Premise Phone Number: C, Email address:shendrix@avpenergy.com 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 v/license searchflicsearch.cgi x SIGNATURE REQUIRED BY CORPORATE OFFICER I MANAGING MEMBER (Faxed signatures are acceptable) Form 103 Rev 9/2013 Page 2 of G 1400021908 Manager's information must be completed below PLEASE PRINT CLEARLY Last Name: Matras First Name: Kevin Ml: P Home Address(include PO Box if applicable):8540 Granville pkwy Apt # 919 City: Lavista County:Sarpy Zip code:68128 Home Phone Number:402 350 1380 Business Phone Number:402 331 4145 Social Security Number. Drivers License Number& State: NE Date Of Birth: Place Of Birth: Kearney NE Email address: Kmatras©yahoo.com Are you married?If yes,complete spouse's information(Even if a spousal affidavit has been submitted) ❑ YES •NO tr's v` . 1 spouse's information C. TROLCOMMISal0 4 Spouses Last Name: First Name: MI: Social Security Number: Drivers License Number& State: Date Of Birth: Place Of Birth: APPLICANT&SPO SE MUST LIS "RESIDENCE(S)FOR THE PAST TEN(I0)�.:YEARS APPLICANT SPOUSE CITY& STATE YEAR YEAR CITY & STATE YEAR YEAR FROM TO FROM TO Lavista NE 2011 Present Papillion NE 1990 2011 Form 103 Rev 9/2013 Page 3 of 6 MANAGER'S LAST TWO EMPLOYERS YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER May 2014 Present AVP Energy Sandy Wetzel 402 331 4145 2013 2014 First Data Mat 402 777 3934 I. 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 anv 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 th cart ivA th of the conviction or plea. Also list any charges pending at the time of this application. If m W.nb #.1.1. please list charges by each individual's name. [2] YES H NO a; d If yes, please explain below or attach a separate page. i KrAo,TiTilica,fit;OsoN Date of Where Desc h Name of Applicant Conviction Convicted of Disposition (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? DYES [LINO IF YES, list the name of the premise(s): 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? EYES ONO Form 103 Rev 9/2013 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: Name on Certificate: Date Applicant Name Name of program(attach copy of course completion certificate) ( mm/yyyy) V Er -1 ._ n �*a i rat *For list of NLCC Certified Training Programs see wwww.lcc.ne.aov/trainineinfo.html Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: Kevin Matras Assistant Manager May 2014 Avp Energy 8307 Parkview Blvd Lavista Ne 68128 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$38.00 per person) ©YES ENO Form 103 Rev 9/2013 Page 5 of 6 PERSONAL OATH AND CONSENT OF INVESTIGATION 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 incomplete, inaccurate, or fraudulent. , ) ig at re of Man plicant Signature of Spouse , - E itt . \ ACKNOWLEDGEMENT State of Nebraska County of .( 9 j,/ The foregoing instrument was acknowledged before me this Al V-Y 'l,. Di4 by IK AlP IV l date name of person acknow edged ji\fit) `{ )L0 Affix Sealla Y otary Public signature A S GE L NOTARYSta;�vi^ ruaxa ' NANCY M JOE3EL My Comm.Exp.December 11,2015 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. Form 103 Rev 9/2013 Page 6 of 6 4® AHA, NF8 City ofOmaha, Webras&a `. 1 to, C7,06.74.411L4COINk* WIT1819 Farnam—Suite LC 1 ���� �. ���t a Omaha, Nebraska 68183-0112 o Buster Brown (402) 444-5550 0 .*kti' City Clerk FAX (402) 444-5263 4,4 FEW'�4 October 8, 2014 AVP Energy, L.L.C. Application to appoint Kevin P. Matras Dba"AVP Energy#3" manager of your present Package Liquor 10505 Pacific Street License location Omaha,NE 68114 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 October 21, 2014 . 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, rt Ae;Cel 414:24e Buster Brown City Clerk BJB:clj ol'hAHA• N City ofOmaha, Ne bras a �tlir �8.� Eketa, r 1819 Farnam—Suite LC 1 2 g ,`J -jk a"'""' ��. , � ► �, Omaha, Nebraska 68183-0112 0��-, rM•�•••-•• ��; :., �' Buster Brown (402) 444-5550 � ry' City Clerk FAX (402) 444-5263 0'�� 1- AWU FEB03 October 8, 2014 Kevin P. Matras Application to be appointed manager of 8540 Granville Pkwy the present Package Liquor License Apt. #919 location for AVP Energy, L.L.C., dba LaVista,NE 68128 "AVP Energy#3", 10505 Pacific 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 October 21, 2014 . 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, ,,e‘t16.4 Buster Brown City Clerk BJB:clj No. /L3 C AVP Energy, LLC, dba "AVP Energy #3", 10505 Pacific Street, requests permission to appoint Kevin P. Matras manager of their present Package Liquor License location. 10-21-14;cj 6 RECEIVED Presented to Council: October 21, 2014 - Approved 7 O Buster Brown City Clerk 1