RES 2011-0538 - SDL for beer garden at Pauli's June 17-22 2011 Print Form 1
APPLICATION FOR SPECIAL
DESIGNATED LICENSE
RETAIL LICENSE HOLDERS •
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.Icc.ne.gov/
•BEFORE SUBMITTING APPLICATION TO THE LIQUOR CONTROL COMMISSION
Include approval from the City,Village or County Clerk where the event is to be held
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)
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 ( ' /7- Z z
1. Type of alcohol to be served and/or consumed
El Beer E] Wine E] Distilled Spirits
2. Liquor license number and class(i.e. C-55441) 9309 C/K
3. Licensee name(last, first,middle), Corporate name,Limited Liability Company(LLC)
Griego, Paul,John Pauli's Inc. (Pauli's Sports&Spirits)
NAME:
4014-4016-4018 Leavenworth Street
ADDRESS:
Omaha • 68105 •
CITY ZIP
•
4. Location where event will be held;name, address, city,county,zip code
4014-4016-4018 Leavenworth Street
ADDRESS:
Omaha 68105
CITY • ZIP
Douglas County
COUNTY •
REV 6/09 Page 1
a. Is this location within the city/village limits? O YES ONO
b. Is this location within the 150' of church, school, hospital or home
aged/indigent or for veterans their wives? ❑YES ENO
c. Is this location within 300' of any university or college campus? ❑YES ONO
Must be consecutive days
5. Date(s)and Time(s)of event(no more then six(6)consecutive days on one application)
Date 6/17/2011 Date 6/18/2011 Date 6/19/2011 Date 6/20/2011 Date6/21/2011 Date6/22/2011
Hours From 11AM Hours From 11AM Hours From 11 AM Hours From 11AM Hours From 11AM Hours From 11AM
To 2AM To 2AM To 2AM To 2AM To 2AM To 2AM
6/26/2011, 6/27/2011,6/28/2011
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
❑Dance❑Reception❑ Fund Raiser O Beer Garden❑Sampling/Tasting❑ Other
7. Description of area to be licensed
Inside building, dimensions of area to be covered IN FEET x
Name of building (not square feet or acres)
Outdoor area dimensions of area to be covered IN FEET 180 x100
(not square feet or acres)
If outdoor area,how will premises be enclosed
O fence,type of fenceQ snow fence El chain linkD cattle panelsD other
O tent >
El other, explain Kin -\S i ( (�J i 1 ` e, n / G vt' et Al 5
*If both inside and outdoor area to be licensed include simple sketch
500-1500
8. How many attendees do you expect at event?
9. If over 150, indicate the steps that will be taken to prevent underage persons from obtaining alcohol
beverages.
10. Will premises to be covered by license comply with all Nebraska sanitation laws?
OYES ❑ NO
a. Are there separate toilets for both men and women? O YES❑ NO
11. Where will you be purchasing your alcoholO wholesaler❑ retailer0 both
12. Will there be any games of chance operating during the event? ❑ YESO 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.
REV 6/09 Page 2
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er O Beer Garden❑Sampling/Tasting❑ Other
7. Description of area to be licensed
Inside building, dimensions of area to be covered IN FEET x
Name of building (not square feet or acres)
Outdoor area dimensions of area to be covered IN FEET 180 x100
(not square feet or acres)
If outdoor area,how will premises be enclosed
O fence,type of fenceQ snow fence El chain linkD cattle panelsD other
O tent >
El other, explain Kin -\S i ( (�J i 1 ` e, n / G vt' et Al 5
*If both inside and outdoor area to be licensed include simple sketch
500-1500
8. How many attendees do you expect at event?
9. If over 150, indicate the steps that will be taken to prevent underage persons from obtaining alcohol
beverages.
10. Will premises to be covered by license comply with all Nebraska sanitation laws?
OYES ❑ NO
a. Are there separate toilets for both men and women? O YES❑ NO
11. Where will you be purchasing your alcoholO wholesaler❑ retailer0 both
12. Will there be any games of chance operating during the event? ❑ YESO 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.
REV 6/09 Page 2
STEPS TAKEN TO PREVENT UNDERAGE ACCESS TO ALCOHOLIC BEVERAGES
THERE IS A FENCE THAT IS INSTALLED AROUND THE ENTIRE BAR.
AT EACH ENTRANCE THERE 2 OR 3 EMPLOYEES DEPENDING ON.
THE PARTICULAR NIGHT THAT CHECK EVERY PERSONS I.D.. NO"
PERSON UNDER THE AGE OF 21 IS ALLOWED TO ENTER. THIS HAS
BEEN OUR POUCY FOR THE PAST2.7YEARS.
WE WILL ALSO HAVES TO I OFF DUTY OMAHA POLICE OFFICERS
TO PROVIDE ADDED SECURITY AROUND THE PARKING LOTS EACH
NIGHT.
OUR GOAL IS TO HAVE THE BEST RUN EVENT IN OMAHA
HOPEFULLY OUR RECORD SPEAKS FOR ITSELF.
13. Any other information or requests for exemptions:
14. 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 laws,
ordinances, rules and regulations are adhered to.
Paul Griego or Chris Griego 402-212-4999 402-301-6607 402-345-7959
Phone: Before During
Print name of Event Supervisor
Signature Event Sup isor
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 7 / Owner/President 4/26/2011
here •
Authori 4 Represen we/Applicant Title Date
Paul J. Griego
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.
REV 6/09 Page 3
g 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.
REV 6/09 Page 2
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