RES 2012-0680 - SDL for beer garden at Welcome Inn Tavern June 9 2012 1
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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/
RETAIL LICENSE HOLDE!"S •
NON PROFIT APPLICANTS _Non Profit Status (check one that best applies)
Municipal _Political _Fine Arts._Fraternal _ i"elligious Charitab➢e�1Pub➢ic Service,
COMPLETE ALL QUESTIONS
1. Type of alcohol to be served and/or consumed: Beer Wine Distilled Spirits"
2. Liquor license number and class (i.e. C-55441) (
3. Licensee name (last, first,middle) or corporate name or limited liability company (LLC)
(as it reads on your liquor license) •
NAME: (,4) 6pC day . ...c T
ADDI!:ESS: f 3 b I/ •
CITY l r1iq , 01"— ZIP ,4Y s,
4. Location where event will be held; name, address, city, county, zip code •
!WILDING NAME C n /' r/ tic vet (el'
I� 1
ADDRESS: �.� 3 3 7 5/5 . .% �"� 577. CITY
• ZIP A g/ COUNTY and COUNTY # 6✓ 'z.)
a. Is this location within the city/village limits? YES> NO._
b. Is this location within the 150' of church, school, hospital or home
for aged/indigent or for veterans their wives? YES _NO
c. Is this location within 300' of any university or college campus? YES_NO °
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•
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FORM 108
• REV 6/11
Page 2 of 5
bject to cancellation if the information contained herein is incomplete, inaccurate, or
fraudulent.
p Signature of Manager Applicant Signature of Spouse
ACKNOWLEDGEMENT
State of Ne
County of O V The foregoing instrument was acknowledged before me this
l c,/p/z by _ � WesI r-n �k -Dnzt/
Uname of person ac owledged
Affix Seal
No Public signature
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 1/2011
• Page 5 of 5
sole
discretion of the Landlord are considered lewd,obscene,pornographic.or otherwise not in keeping with the standards of the Real
Estate.
(h) The sidewalks,entry ways, loading areas, other common areas and other outside areas immediately adjoining the
Premises shall be kept clear of debris and snow at all times by Tenant and Tenant shall not place or permit any obstructions.
garbage,refuse,merchandise or displays in those areas.
(1) Tenant and Tenant's employees shall park their cars only in those portions of the parking area designated by Landlord.
Tenant shall furnish landlord with automobile license numbers assigned to Tenant's car or cars of Tenant's employees,and shall
notify Landlord of any changes within five days. in the event Tenant or its employees fail to park their cars in the designated
parking areas as aforesaid, then Landlord at its option may charge Tenant $10.00 a day(plus any administrative cost and
liquidated damages)for each car parked in any area other than those designated.
(j) Tenant,its employees and/or its agents,shall not solicit business in the common areas.nor shall Tenant,its employees
and/or its agents distribute any handbills or other advertising matter in the common areas or on automobiles parked in the
common areas.
(k) Tenant shall not carry on any trade or occupation or operate any instruments.apparatus,or equipment which emits an
odor or causes a noise discernible outside of the Premises or which may be deemed offensive in nature.
(l) Tenant shall keep the Premises at a temperature sufficient to prevent water from freezing in pipes and fixtures.
(nt) Tenant shall not place or maintain any temporary fixture for the display of merchandise outside the Premises or within
six feet of any entrances to the Premises,and Landlord shall have the right.without giving prior notice to Tenant and without any
liability for damage,to remove any such display from the Premises,except as shall have first received the written approval of
Landlord as to size,color.location,nature and display qualities.
(n) 'tenant shall use its best efforts to complete all deliveries,loading.unloading and services to the premises prior to
10:00AM of each day.Tenant shall attempt to prevent delivery trucks or other vehicles servicing the premises from parking or
standing in front of or at the rear of the premises from 10:00AM to 9:00PM of each day.
(o) Tenant shall not,without the prior consent of the Landlord,allow any vending.amusement or gaming machines on the
premises.or use or permit any person to use the premises or any part thereof for conducting a second-hand store,auction,
distress,fire,bankruptcy or going-out-of-business sale,or for any use or purpose in violation of any federal.state.or local laws,
ordinances,regulations and requirements and that during the term of this Lease the premises.and every part thereof,shall he kept
by Tenant in a clean and sanitary condition.free from any objectionable noises,odors and nuisances.
(p) Landlord may amend or add new rules and regulations not inconsistent with the terms of Tenant's lease.
�1)1 z12y1IZ I
r , Printed:2/22/2012
Main Street Plaza Port Corn Lease due.doe Page 8 fps' /24)1
f the Stainless Steel Hood System,inside walk-in cooler and Freezer attached to the
premise. Tenant shall he responsible during the term of the lease to maintain,repair and service the restaurant equipment as
needed. All replacement costs shall be also the responsibility of the Tenant. Tenant shall have the right to maintain
ownership of any new replacement equipment upon termination. .
,
/ Printed:2/22/2012
Main Street Playa Port Corp Lease doc.doc Pagc 5 �/Z,F�/(�2#-
f any subsequent breach or default of any of such terns,conditions.and agreements. The doing of anything by Landlord
which landlord is not obligated to do hereunder shall not impose any future obligation on Landlord nor otherwise amend any
provisions of this Lease.
(d) No Surrender. No surrender of the Premises by Tenant shall be effected by Landlord's acceptance of the keys to
the Premises or of the rent due hereunder,or by any other means whatsoever.without Landlord's written acknowledgment that
such acceptance constitutes a surrender. `I z�Z
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7 4�IZ
// J( )/2 l/1 Printed:2/22/2012
Main Street Plaza Port Corp Lease doc.doe Page 4 //l/{� `^/�
l Estate.land.
street.or alley,and during such operations to take into and through the Premises or any part of the Real Estate all materials
required.and to temporarily close or suspend operation of entrances.doors,corridors.elevators.or other facilities as necessary.
(c) Possess passkeys to the Premises.
(I) Show the Premises to prospective tenants at reasonable times.
V\\). 21Z4jlZ
Main Street Plaza Port Corp Lease doe.doc Page 2 Printed:2/22/2012
I - •
•/ •
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5. Date(s) and Time(s) of event(no more than six (6) consecutive days on one application)
Date --447-11, Date Date Date Date Date
Hours Om Hours Hours Hours Hours Hours
From l From From From From From
To?*4"dv— To To To To To
a. Alternate date:
b. Alternate location: -
(Alternate date or location must be approved by local)
6. Indicate type of activity to be carried on during event �7 � -a "1
Dancb_Reception Fund Raise0Beer Garden Sampling/Tasting_Other s, ,eK d
7. Description of area to be licensed I er,1 i $__
Inside building, dimensions of area to be covered IN FEET—A-I.—, x.
Name of building (not square feet or acres)
•
Outdoor area dimensions of area to be covered IN FEET /`%
C�a x %C "�
(not square feet or acres)
INCLUDE SKETCH OF OUTDOOR AREA
If outdoor area, how will premises be enclosed?
Fenc?' , type of fence; snow fence„gchain link cattle panel_other 41". --ry„C�,
Tent
Other_, explain
*If both inside and outdoor area to be licensed include simple sketch C C.f7'CGC"fil 'd Pi" 176.7,7
8. How many attendees do you expect at event? /5 6
9. If over 150 attendees. Indicate the steps that will be taken to prevent underage persons from
obtaining alcohol beverages.
" lacr 71p
(attach separate sheet if needed)
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10. Will premises to be covered by license comply with all Nebras sanitation laws?YE NO_
a. Are there separate toilets for both men and women? YES NO_
11. Where will you be purchasing your alcohol? Wholesaler Retailer Both BYO
12. Will there be any games of chance operating during the event? YES NO_
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.
FORM 108
REV 6/11
Page 3 of 5
•
not in keeping with the standards of the Real
Estate.
(h) The sidewalks,entry ways, loading areas, other common areas and other outside areas immediately adjoining the
Premises shall be kept clear of debris and snow at all times by Tenant and Tenant shall not place or permit any obstructions.
garbage,refuse,merchandise or displays in those areas.
(1) Tenant and Tenant's employees shall park their cars only in those portions of the parking area designated by Landlord.
Tenant shall furnish landlord with automobile license numbers assigned to Tenant's car or cars of Tenant's employees,and shall
notify Landlord of any changes within five days. in the event Tenant or its employees fail to park their cars in the designated
parking areas as aforesaid, then Landlord at its option may charge Tenant $10.00 a day(plus any administrative cost and
liquidated damages)for each car parked in any area other than those designated.
(j) Tenant,its employees and/or its agents,shall not solicit business in the common areas.nor shall Tenant,its employees
and/or its agents distribute any handbills or other advertising matter in the common areas or on automobiles parked in the
common areas.
(k) Tenant shall not carry on any trade or occupation or operate any instruments.apparatus,or equipment which emits an
odor or causes a noise discernible outside of the Premises or which may be deemed offensive in nature.
(l) Tenant shall keep the Premises at a temperature sufficient to prevent water from freezing in pipes and fixtures.
(nt) Tenant shall not place or maintain any temporary fixture for the display of merchandise outside the Premises or within
six feet of any entrances to the Premises,and Landlord shall have the right.without giving prior notice to Tenant and without any
liability for damage,to remove any such display from the Premises,except as shall have first received the written approval of
Landlord as to size,color.location,nature and display qualities.
(n) 'tenant shall use its best efforts to complete all deliveries,loading.unloading and services to the premises prior to
10:00AM of each day.Tenant shall attempt to prevent delivery trucks or other vehicles servicing the premises from parking or
standing in front of or at the rear of the premises from 10:00AM to 9:00PM of each day.
(o) Tenant shall not,without the prior consent of the Landlord,allow any vending.amusement or gaming machines on the
premises.or use or permit any person to use the premises or any part thereof for conducting a second-hand store,auction,
distress,fire,bankruptcy or going-out-of-business sale,or for any use or purpose in violation of any federal.state.or local laws,
ordinances,regulations and requirements and that during the term of this Lease the premises.and every part thereof,shall he kept
by Tenant in a clean and sanitary condition.free from any objectionable noises,odors and nuisances.
(p) Landlord may amend or add new rules and regulations not inconsistent with the terms of Tenant's lease.
�1)1 z12y1IZ I
r , Printed:2/22/2012
Main Street Plaza Port Corn Lease due.doe Page 8 fps' /24)1
f the Stainless Steel Hood System,inside walk-in cooler and Freezer attached to the
premise. Tenant shall he responsible during the term of the lease to maintain,repair and service the restaurant equipment as
needed. All replacement costs shall be also the responsibility of the Tenant. Tenant shall have the right to maintain
ownership of any new replacement equipment upon termination. .
,
/ Printed:2/22/2012
Main Street Playa Port Corp Lease doc.doc Pagc 5 �/Z,F�/(�2#-
f any subsequent breach or default of any of such terns,conditions.and agreements. The doing of anything by Landlord
which landlord is not obligated to do hereunder shall not impose any future obligation on Landlord nor otherwise amend any
provisions of this Lease.
(d) No Surrender. No surrender of the Premises by Tenant shall be effected by Landlord's acceptance of the keys to
the Premises or of the rent due hereunder,or by any other means whatsoever.without Landlord's written acknowledgment that
such acceptance constitutes a surrender. `I z�Z
1��p
7 4�IZ
// J( )/2 l/1 Printed:2/22/2012
Main Street Plaza Port Corp Lease doc.doe Page 4 //l/{� `^/�
l Estate.land.
street.or alley,and during such operations to take into and through the Premises or any part of the Real Estate all materials
required.and to temporarily close or suspend operation of entrances.doors,corridors.elevators.or other facilities as necessary.
(c) Possess passkeys to the Premises.
(I) Show the Premises to prospective tenants at reasonable times.
V\\). 21Z4jlZ
Main Street Plaza Port Corp Lease doe.doc Page 2 Printed:2/22/2012
•
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•
hibited 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.
FORM 108
REV 6/11
Page 3 of 5
•
not in keeping with the standards of the Real
Estate.
(h) The sidewalks,entry ways, loading areas, other common areas and other outside areas immediately adjoining the
Premises shall be kept clear of debris and snow at all times by Tenant and Tenant shall not place or permit any obstructions.
garbage,refuse,merchandise or displays in those areas.
(1) Tenant and Tenant's employees shall park their cars only in those portions of the parking area designated by Landlord.
Tenant shall furnish landlord with automobile license numbers assigned to Tenant's car or cars of Tenant's employees,and shall
notify Landlord of any changes within five days. in the event Tenant or its employees fail to park their cars in the designated
parking areas as aforesaid, then Landlord at its option may charge Tenant $10.00 a day(plus any administrative cost and
liquidated damages)for each car parked in any area other than those designated.
(j) Tenant,its employees and/or its agents,shall not solicit business in the common areas.nor shall Tenant,its employees
and/or its agents distribute any handbills or other advertising matter in the common areas or on automobiles parked in the
common areas.
(k) Tenant shall not carry on any trade or occupation or operate any instruments.apparatus,or equipment which emits an
odor or causes a noise discernible outside of the Premises or which may be deemed offensive in nature.
(l) Tenant shall keep the Premises at a temperature sufficient to prevent water from freezing in pipes and fixtures.
(nt) Tenant shall not place or maintain any temporary fixture for the display of merchandise outside the Premises or within
six feet of any entrances to the Premises,and Landlord shall have the right.without giving prior notice to Tenant and without any
liability for damage,to remove any such display from the Premises,except as shall have first received the written approval of
Landlord as to size,color.location,nature and display qualities.
(n) 'tenant shall use its best efforts to complete all deliveries,loading.unloading and services to the premises prior to
10:00AM of each day.Tenant shall attempt to prevent delivery trucks or other vehicles servicing the premises from parking or
standing in front of or at the rear of the premises from 10:00AM to 9:00PM of each day.
(o) Tenant shall not,without the prior consent of the Landlord,allow any vending.amusement or gaming machines on the
premises.or use or permit any person to use the premises or any part thereof for conducting a second-hand store,auction,
distress,fire,bankruptcy or going-out-of-business sale,or for any use or purpose in violation of any federal.state.or local laws,
ordinances,regulations and requirements and that during the term of this Lease the premises.and every part thereof,shall he kept
by Tenant in a clean and sanitary condition.free from any objectionable noises,odors and nuisances.
(p) Landlord may amend or add new rules and regulations not inconsistent with the terms of Tenant's lease.
�1)1 z12y1IZ I
r , Printed:2/22/2012
Main Street Plaza Port Corn Lease due.doe Page 8 fps' /24)1
f the Stainless Steel Hood System,inside walk-in cooler and Freezer attached to the
premise. Tenant shall he responsible during the term of the lease to maintain,repair and service the restaurant equipment as
needed. All replacement costs shall be also the responsibility of the Tenant. Tenant shall have the right to maintain
ownership of any new replacement equipment upon termination. .
,
/ Printed:2/22/2012
Main Street Playa Port Corp Lease doc.doc Pagc 5 �/Z,F�/(�2#-
f any subsequent breach or default of any of such terns,conditions.and agreements. The doing of anything by Landlord
which landlord is not obligated to do hereunder shall not impose any future obligation on Landlord nor otherwise amend any
provisions of this Lease.
(d) No Surrender. No surrender of the Premises by Tenant shall be effected by Landlord's acceptance of the keys to
the Premises or of the rent due hereunder,or by any other means whatsoever.without Landlord's written acknowledgment that
such acceptance constitutes a surrender. `I z�Z
1��p
7 4�IZ
// J( )/2 l/1 Printed:2/22/2012
Main Street Plaza Port Corp Lease doc.doe Page 4 //l/{� `^/�
l Estate.land.
street.or alley,and during such operations to take into and through the Premises or any part of the Real Estate all materials
required.and to temporarily close or suspend operation of entrances.doors,corridors.elevators.or other facilities as necessary.
(c) Possess passkeys to the Premises.
(I) Show the Premises to prospective tenants at reasonable times.
V\\). 21Z4jlZ
Main Street Plaza Port Corp Lease doe.doc Page 2 Printed:2/22/2012
•
.
13. Any other inform n or requests for exemptio's: ,' (/�j �' 7 7� /p'L). "•
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.
`--� /iO17( K Phone: Before Al ,...,fie/-0f5ZDuring76!-3 e-,f 5 3
Print name of Event Supervisor
Signature of event Supervisor/// L�..
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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.
le
sign
here n` • y ;� �� 1 a
Authorized Representative/Applicant`'; " Title Date
•
V It, L, , 6, ( 1
Print Name
This individual must be listed oh 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 6/11
Page 4 of 5
The sidewalks,entry ways, loading areas, other common areas and other outside areas immediately adjoining the
Premises shall be kept clear of debris and snow at all times by Tenant and Tenant shall not place or permit any obstructions.
garbage,refuse,merchandise or displays in those areas.
(1) Tenant and Tenant's employees shall park their cars only in those portions of the parking area designated by Landlord.
Tenant shall furnish landlord with automobile license numbers assigned to Tenant's car or cars of Tenant's employees,and shall
notify Landlord of any changes within five days. in the event Tenant or its employees fail to park their cars in the designated
parking areas as aforesaid, then Landlord at its option may charge Tenant $10.00 a day(plus any administrative cost and
liquidated damages)for each car parked in any area other than those designated.
(j) Tenant,its employees and/or its agents,shall not solicit business in the common areas.nor shall Tenant,its employees
and/or its agents distribute any handbills or other advertising matter in the common areas or on automobiles parked in the
common areas.
(k) Tenant shall not carry on any trade or occupation or operate any instruments.apparatus,or equipment which emits an
odor or causes a noise discernible outside of the Premises or which may be deemed offensive in nature.
(l) Tenant shall keep the Premises at a temperature sufficient to prevent water from freezing in pipes and fixtures.
(nt) Tenant shall not place or maintain any temporary fixture for the display of merchandise outside the Premises or within
six feet of any entrances to the Premises,and Landlord shall have the right.without giving prior notice to Tenant and without any
liability for damage,to remove any such display from the Premises,except as shall have first received the written approval of
Landlord as to size,color.location,nature and display qualities.
(n) 'tenant shall use its best efforts to complete all deliveries,loading.unloading and services to the premises prior to
10:00AM of each day.Tenant shall attempt to prevent delivery trucks or other vehicles servicing the premises from parking or
standing in front of or at the rear of the premises from 10:00AM to 9:00PM of each day.
(o) Tenant shall not,without the prior consent of the Landlord,allow any vending.amusement or gaming machines on the
premises.or use or permit any person to use the premises or any part thereof for conducting a second-hand store,auction,
distress,fire,bankruptcy or going-out-of-business sale,or for any use or purpose in violation of any federal.state.or local laws,
ordinances,regulations and requirements and that during the term of this Lease the premises.and every part thereof,shall he kept
by Tenant in a clean and sanitary condition.free from any objectionable noises,odors and nuisances.
(p) Landlord may amend or add new rules and regulations not inconsistent with the terms of Tenant's lease.
�1)1 z12y1IZ I
r , Printed:2/22/2012
Main Street Plaza Port Corn Lease due.doe Page 8 fps' /24)1
f the Stainless Steel Hood System,inside walk-in cooler and Freezer attached to the
premise. Tenant shall he responsible during the term of the lease to maintain,repair and service the restaurant equipment as
needed. All replacement costs shall be also the responsibility of the Tenant. Tenant shall have the right to maintain
ownership of any new replacement equipment upon termination. .
,
/ Printed:2/22/2012
Main Street Playa Port Corp Lease doc.doc Pagc 5 �/Z,F�/(�2#-
f any subsequent breach or default of any of such terns,conditions.and agreements. The doing of anything by Landlord
which landlord is not obligated to do hereunder shall not impose any future obligation on Landlord nor otherwise amend any
provisions of this Lease.
(d) No Surrender. No surrender of the Premises by Tenant shall be effected by Landlord's acceptance of the keys to
the Premises or of the rent due hereunder,or by any other means whatsoever.without Landlord's written acknowledgment that
such acceptance constitutes a surrender. `I z�Z
1��p
7 4�IZ
// J( )/2 l/1 Printed:2/22/2012
Main Street Plaza Port Corp Lease doc.doe Page 4 //l/{� `^/�
l Estate.land.
street.or alley,and during such operations to take into and through the Premises or any part of the Real Estate all materials
required.and to temporarily close or suspend operation of entrances.doors,corridors.elevators.or other facilities as necessary.
(c) Possess passkeys to the Premises.
(I) Show the Premises to prospective tenants at reasonable times.
V\\). 21Z4jlZ
Main Street Plaza Port Corp Lease doe.doc Page 2 Printed:2/22/2012
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