RES 2014-1021 - SDL for beer garden at Crescent Moon Ale House APPLICATION FOR SPECIAL
DESIGNATED LICENSE
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH
PO BOX 95046
LINCOLN,NE 68509-5046
PHONE:(402)471-2571
FAX:(402)471-2814
Website:www.lcc.ne.gov/
DO YOU NEED POSTERS? YES[ NO n
RETAIL LICENSE HOLDERS Pir
NON PROFIT APPLICANTS 0
Non Profit Status (check one that best applies)
MunicipalcPolitical0Fine Arts0Fraternal ckeligious0CharitablecPublic Service()
COMPLETE ALL QUESTIONS
1. Type of alcohol to be served and/or consumed: Beer Q iner✓ Distilled Spirits n
2. Liquor license number and class (i.e. C-55441) CK033476
(If you're a nonprofit organization leave blank)
3. Licensee name (last, first,), corporate name or limited liability company(LLC) name
(As it reads on your liquor license)
NAME: Second Wind, Inc
ADDRESS: 3578 Farnam St
CITY Omaha ZIP 68131
4. Location where event will be held; name, address, city, county,zip code
BUILDING NAME Crescent Moon Ale House
ADDRESS: 3578 Farnam St CITY Omaha
ZIP 68131 COUNTY and COUNTY1 Douglas 1
a. Is this location within the city/village limits? YE"0 O n
b. Is this location within the 150' of church, school, hospital or home
for aged/indigent or for veterans and/or wives? YEITO J
c. Is this location within 300' of any university or college campus? YESn1O { 1
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5. Date(s) and Time(s) of event (no more than six (6) consecutive days on one application)
Date Date I Date Date Date Date
09/26/2014 09/27/2014
Hours Hours Hours Hours Hours Hours
From From From From From From
12 PM(Noon) 11:00 AM
To To To To To To
2:00 AM 2:00 AM
a. Alternate date:N/A
b. Alternate location:N/A
(Alternate date or location must be specified in local approval)
6. Indicate type of activity to be carried on during event:
0 Dance 0 Reception 0 Fund Raiser 0 Beer Garden 0 Sampling/Tasting
Other
7. Description of area to be licensed
Inside building, dimensions of area to be covered IN FEET x
(not square feet or acres)
*Outdoor area dimensions of area to be covered IN FEET 160 x70
*SKETCH OF OUTDOOR AREA (or attach copy of sketch) (sample sketch)
If outdoor area, how will premises be losed?
x _Fence; x snow fence Iphain link cattle panel
other
Tent
8. How many attendees do you expect at event? 2,000
9. If over 150 attendees. Indicate the steps that will be taken to prevent underage persons from
obtaining alcohol beverages. (Attach separate sheet if needed)
ID Check Points,Wristbands,Off Duty OPD
10. Will premises to be covered by license comply with all Nebraska sanitation laws? YESQI 0
a. Are there separate toilets for both men and women? YES On
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FORM 108
REV Jun-13
Page 3 of 5
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11. Retailer: Will you be purchasing your alcohol from a wholesaler? YES NO
Non-Profit: Where will you be purchasing your alcohol?
Wholesaler Retailer Both BYO
(includes wineries)
12. Will there be any games of chance operating during the event? YESD1O 1J
If so, describe activity
NOTE:Only games of chance approved by the Department of Revenue,Charitable Gaming Division are permitted. All other forms of
gambling are prohibited by State Law: There are no exceptions for Non Profit Organizations or any events raising funds for a charity.
This is only an application for a Special Designated License under the Liquor Control Act and is not a gambling permit application.
13. Any other information or requests for exemptions:
14. Name and telephone number/cell phone number of immediate supervisor. This person will be at
the location of the event when it occurs, able to answer any questions from Commission and/or law
enforcement before and during the event, and who will be responsible for ensuring that any applicable
laws, ordinances, rules and regulations are adhered to. PLEASE PRINT LEGIBLY
Print name of Event SupervisorKandaee Gladwin
Signature of Event Supervisor"
Event Supervisor phone: Before 40 598-8240 During402-598-8240
Email address ndace.g@beercornerusa.corn
Consent of Authorized Representative/Applicant
15. I declare that I am the authorized representative of the above named license applicant and that the
statements made on this application are true to the best of my knowledge and belief. I also consent to
an investigation of my background including all records of every kind including police records. I
agree to waive any rights or causes of action against the Nebraska Liquor Control Commission, the
Nebraska State Patrol or any other individual releasing said information to the Liquor Control
Commission or the Nebraska State Patrol. I further declare that the license applied for will not be
used by any other person, group, organization or corporation for profit or not for profit and that the
event will be supervised by persons directly responsible to the holder of this Special Designated
License.
A4I1
) Owner 7/23/2014
Au orizeepresentative/Ap licant Title Date
William Baburek
Print Name
This individual must be listed on the application as an officer or stockholder unless a letter has been filed appointing an individual
as the catering manager allowing them to sign all SDL applications.
The law requires that no special designated license provided for by this section shall be issued by the Commission without the approval of the
local governing body. For the purposes of this section,the local governing body shall be the city or village within which the particular place for
which the special designated license is requested is located,or if such place is not within the corporate limits of a city or village,then the local
governing body shall be the county within which the place for which the special designated license is requested is located.
FORM 108
REV Jun-13
Page 4 of 5
No. /G
Second Wind, Inc., dba "Crescent Moon Ale
House", 3578 Farnam Street, requests
permission for a Special Designated License for
a beer garden on September 26, 2014 from
12:00 noon to 2:00 a.m. and September 27,
2014 from 11:00 a.m. to 2:00 a.m. with music
until 12:00 midnight each night.
08-19-14;cj
RECEIVED
Presented to Council:
August 19, 2014 - Approved 7 'C
Buster Brown
City Clerk