Loading...
RES 2012-0632 - SDL for beer garden at Brass Monkey June 23 2012 • • -'Print Form • APPLICATION FOR SPECIAL DESIGNATED LICENSE RETAIL LICENSE HOLDERS NEBRASKA LIQUOR CONTROL COMMISSION =01 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN.NE 68509-5046 PHONE:(402)471-2571 FAX (402)471-2814 Websitc'www.Icc.ne.govi BEFORE SUBMITTING APPLICATION TO THE LIQUOR CONTROL COMMISSION O Include approval from the City, Village or County Clerk where the event is to be held Q A license fee $40 (payable to Nebraska Liquor Control Commission) for each day/event to be licensed (i.e. if you have two separate areas at one event they both need to be licensed) (unless licensed as a K Caterer no fees required) O Application MUST be received at the Liquor Control Commission Office no later than 10 working days prior to event (excluding weekends, Federal and State observed holidays) COMPLETE ALL QUESTIONS • I. Type of alcohol to be served and/or consumed Beer 0 Wine El Distilled Spirits • �. Liquor license number and class (i.e. C-55441) 3. Licensee name (last, first, middle), Corporate name, Limited Liability Company (LLC) NAME: 0iti,JotreV K&i. I'lJ1./ — ADDRESS: Stoll -CO, ,.? sl • CITY (1,10414 ZIP 7 4. Location where event will be held; name, address, city, county, zip code ADDRESS: ,Sfs'=F( Jtf . ,13 .�/, 3 i/iqd A t -C. y , CITY Oevt At4 ZIP (/) � REV 6/09 Page 1 statement describing all types of business or activities that will be operated on the premises in conjunction with the proposed license. Attached is the statement to be signed and returned (hand deliver, mail or fax) to the City Clerk's Office 7 days in advance of the public hearing. Sincerely yours, .4 ‘61 X;a10°‘'.4 Buster Brown City Clerk BJB:clj 12-14- 1 4-1 -y Nt � (State aw) DISTANCE OF PROPOSED LICENSE TO ANY CHURCH PD NL -�0 m SCHOOL U✓ HOSPITAL b4E FOR THE AGED, DIGENT OR VETERANS R UNIVERSITY .6 i 513 .20 2 (Authorized Signature) (Date) any omission to take any action on account of such default if such default persists or is repeated,and no express waiver shall affect any default other than the default specified in the express waiver and that only for the time and to the extent therein stated. One or more waivers by Landlord or Tenant shall not be construed as a waiver of a subsequent breach of the same covenant,term or condition. 23. Memorandum of Lease. The parties hereto contemplate that this Lease should not and shall not be filed for record, but in lieu thereof,at the request of either party,Landlord and Tenant shall execute a Memorandum of Lease to be recorded for the purpose of giving record notice of the appropriate provisions of this Lease. 24. Headings. The headings used in this Lease are for convenience of the parties only and shall not be considered in interpreting the meaning of any provision of this Lease. 25. Successors. The provisions of this Lease shall extend to and be binding upon Landlord and Tenant and their respective legal representatives,successors and assigns. Page 5 of 6 ocably constitutes Landlord as its attorney-in-fact to execute such instrument in Tenant's name,place and stead,it being agreed that such power is one coupled with an interest. Tenant agrees that it will from time to time upon request by Landlord execute and deliver to such persons as Landlord shall request a statement in recordable form certifying that this Lease is unmodified and in full force and effect(or if there have been modifications,that the same is in full force and effect as so modified),stating the dates to which rent and other charges payable under this Lease have been paid,stating that Landlord is not in default hereunder (or if Tenant alleges a default stating the nature of such alleged default)and further stating such other matters as Landlord shall reasonably require. 19. Security Deposit. The Security Deposit shall be held by Landlord without liability for interest and as security for the performance by Tenant of Tenant's covenants and obligations under this Page 4 of 6 Page 3 of 6 s. • is this location within the city/village limits? [ -YES ONO b. Is this location within the 150' of church. school, hospital or home aged/indigent or for veterans their wives? ,YES ONO c. Is this location within 300' of any university or college campus? DYES ONO tilust be consecutive days Date(s) and Time(s) of event (no more then six (6) consecutive da s on one application) Date • Date Date Date Date i -2•02• • Date 1-lours From WI Hours From Hours From Flours From Hours From Hours From 11.01 To i I To To To To a. Alternate date: b. Alternate Iocation: - (Alternate date or location must be approved by local) 6. Indicate type of activity to be carried on during event Dance®ReceptionD Fund Raiser .Becr Garden 0 Sampling/Tasting0 Other 7. Description of area to be licensed 0 Inside building, dimensions of area to be covered IN FEET x Name of building 1442. en* C.. DPA 8 , (not square feet or acres) Monkey sue° 111�1 - �� Outdoor area dimensions of area to he covered FEET 79 x (not square feet or acres) l f.outdoor area_ how will premises he enclosed © fence; type of fence 'snow fenceD chain link© cattle panels0 other .tent 0 other, explain *If both inside and outdoor area to be licensed include simple sketch 8. How many attendees do you expect at event? 00 t1. If over 150, indicate the steps that will he taken to prevent underage persons from obtaining alcohol r beverages. Ck*.4,9 9 5 3At4 Sorg-kill 10. Will premises to be covered by license comply with all Nebraska sanitation laws? EYES 0 NO a. Are there separate toilets for both men and women? YES© NO 11. Where will you be purchasing your alcoholat wholesaler: retailer0 both 13. `\'iIl there be any games of chance operating during the event? 0 YES NO If so, describe activity NOTE: Only games of chance approved by the Department of Revenue.Charitable Gaming Division are permitted. AU other forms of gambling are prohibited by State Law: There arc 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 :3ermit application. 44744 tYlkAS / C— %Coo/44e'/(z2 6/09 / / //y1e.'!G ea n/f4 eete?age 2 A/e. lir3z c7T d7/0 /.2. sCO The parties hereto contemplate that this Lease should not and shall not be filed for record, but in lieu thereof,at the request of either party,Landlord and Tenant shall execute a Memorandum of Lease to be recorded for the purpose of giving record notice of the appropriate provisions of this Lease. 24. Headings. The headings used in this Lease are for convenience of the parties only and shall not be considered in interpreting the meaning of any provision of this Lease. 25. Successors. The provisions of this Lease shall extend to and be binding upon Landlord and Tenant and their respective legal representatives,successors and assigns. Page 5 of 6 ocably constitutes Landlord as its attorney-in-fact to execute such instrument in Tenant's name,place and stead,it being agreed that such power is one coupled with an interest. Tenant agrees that it will from time to time upon request by Landlord execute and deliver to such persons as Landlord shall request a statement in recordable form certifying that this Lease is unmodified and in full force and effect(or if there have been modifications,that the same is in full force and effect as so modified),stating the dates to which rent and other charges payable under this Lease have been paid,stating that Landlord is not in default hereunder (or if Tenant alleges a default stating the nature of such alleged default)and further stating such other matters as Landlord shall reasonably require. 19. Security Deposit. The Security Deposit shall be held by Landlord without liability for interest and as security for the performance by Tenant of Tenant's covenants and obligations under this Page 4 of 6 Page 3 of 6 • 't Ofte-i Qi 79 Pi- , -r. ciy C.A.) Cri ciN c --c a 40 (vides +- Fe,vicR_ ) =:3 2 :‘, \ \ N n ' � O� WOE O „, t" r O t!, CAD CCDD P O NC CA • • l 3. Any other information or requests for exemptions: 1.4. Name and telephone number/cell phone number of immediate supervisor. This person will be at t 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 Jaws, ordinances, rules and regulations are adhered to. if Phone: Before (0,3 7 '• J 7 During Print name of Event Supervisor ;&,/ Signafure Of Event Supervisor 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 <l ,, .- here � cr-?2`1..51-/ (,)1:4.' 6/t._ � -2 01 2. Authorized Representative/Applicant Title Date r' Nt 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 q 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. REV 6/09 Page 3 an application for a Special Designated License under the Liquor Control Act and is not a gambling :3ermit application. 44744 tYlkAS / C— %Coo/44e'/(z2 6/09 / / //y1e.'!G ea n/f4 eete?age 2 A/e. lir3z c7T d7/0 /.2. sCO The parties hereto contemplate that this Lease should not and shall not be filed for record, but in lieu thereof,at the request of either party,Landlord and Tenant shall execute a Memorandum of Lease to be recorded for the purpose of giving record notice of the appropriate provisions of this Lease. 24. Headings. The headings used in this Lease are for convenience of the parties only and shall not be considered in interpreting the meaning of any provision of this Lease. 25. Successors. The provisions of this Lease shall extend to and be binding upon Landlord and Tenant and their respective legal representatives,successors and assigns. Page 5 of 6 ocably constitutes Landlord as its attorney-in-fact to execute such instrument in Tenant's name,place and stead,it being agreed that such power is one coupled with an interest. Tenant agrees that it will from time to time upon request by Landlord execute and deliver to such persons as Landlord shall request a statement in recordable form certifying that this Lease is unmodified and in full force and effect(or if there have been modifications,that the same is in full force and effect as so modified),stating the dates to which rent and other charges payable under this Lease have been paid,stating that Landlord is not in default hereunder (or if Tenant alleges a default stating the nature of such alleged default)and further stating such other matters as Landlord shall reasonably require. 19. Security Deposit. The Security Deposit shall be held by Landlord without liability for interest and as security for the performance by Tenant of Tenant's covenants and obligations under this Page 4 of 6 Page 3 of 6 • o ... .nor z b . 1':.: • •.\V,i,‘h,.' sc.4I11Q...o1)1)‘- inar,nrf2Dr p n W YE 0 N ,, Ua t/) 1• o--• Nc r ,; o ' \,y 0 n ►, N. , , O bd 8 ,� N ,c.D, q . cm. ,-1 01 01 _ I Q ,, . • . . 1