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RES 2013-0187 - SDL for beer garden at The Den/Room 13 March 17 2013 APPLICATION FS R SPECIAL DESIGNATED LICENSE NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTK PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 FAX:(402)471-2814 Website:www.kre.ne.gov/ RETAIL LICENSE HOLDERS k NON PROFIT APPLICANTS©Non Profit Status(check one that best applies) MunicipalEpoliticalEyine Arts aternat[eligious❑Charitable[ublic SenriceE COMPLETE ALL QUESTIONS I. Type of alcohol to be served and/or consumed: Beer N, Wine 126 Distilled Spirits 2. Liquor license number and class(i.e.C-55441) (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: fr' t2� p� _ " �_- ADDRESS: CITY 4. Location where event will be held;name,address,city,county,zip code BUILDING NAME � -- �• / 1' e ✓Q ADDRESS: f i' ,.1 , r : r CITY Li zIP (.% COUNTY and COUNTY# a. Is this location within the city/village limits? YESIjti O❑ b. Is this location within the 150' of church,school,hospital or home for aged/indigent or for veterans their wives? YEsa t�dhl c. Is this location within 300'of any university or college campus? YESE1vo FORM 103 RE'V10111 Paget cifS &Zt 1TE, 011CL (;,11/F1:141,.0ddRYL:d d"_,-,.:VL 0_,Olig, Date — Date Date — Date Date Date Hours HQ M.'S Hours Hours Hours From 6 F.,ii From From From From To_ To To To To To i'-‘‘Sieb.atate Alternate location: (Alternate date elf lbeation must he speeifivil ALA&tee,approval) indicate type of activ,b,to be carried on during event: Dance DReception Uri:mid Raiser gBeer Garden DSampling/TastingOOthe: i)escription of area to be licensed inside building,dimensions of ese2;to be coveze a FEET Outdoor area dimensions of area to be covereb EN FEET (not square feet or c,ores',, lakTCIL ,tE SKETCH FiF 0' 'il.-001k AREA If outdoor area,how will premises be enclosed? Fence D type of fence; snow fence) 4 chain link D cattle panel J other Tent Other , explain 1.-iovv many attendees do you=pea event? __- • If over 50 attendees. Indicate the steps dial,will de taken to prevent underage persons from obtaining alcohol beverage,s. (Attach separate sheet ifneaded) • „ IG, Will premises to be covered by license comply with all Nebraska sanitarnlaws?YES1NOE] a. Are there separate toilets for both men and women?YES NINO Where will you be purchasing your alcohol?Wholesaler LI Retailer [iBoth Li BYO o Will there be any games of chance operating during the event?'Li-ESE:1\10X 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. 3. Any other information or requests for exemptions: FORM 108 • REV 10/11 Fago,Zoi'S _ _ d a I ,I 4 t rH \- i F , ) 1 1 1 ' l' IV1 r i 1 I.,_-- I ! ) ,+ v 1 SU DAY c MARCH 27 2013 a ® o he liquir se serve . sefore noon 14. Name and telephone tuna ericelE phone se=1+iser of immediate se ;revisor. This person will be at the location of the event when it occurs, le to answer any questions from CommiSsiOt 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. Print name of Event Supervisor ) )1i , Signature of Event Supervisor Phone of Event Supervisor: Before ( O 9— r3 c During 66 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. sign here sUJDate (A:2-Dt Print N e 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 10/11 Page 4of5 No. ! '7 Radka, Inc., dba The Den/Room 13", 711 North 114th Street, requests permission for a Special Designated License for a beer garden on March 17, 2013 from 6:00 a.m. to 1:00 a.m. No Music. 02-05-13;cj RECEIVED Presented to Council: February 5, 2013 Approved *' Buster Brown City Clerk