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RES 2011-0607 - SDL for beer garden and live music at Starsky's June 24-29 2011 Prirrt 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.lcc.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) 0 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 1. Type of alcohol to be served and/or consumed ISZE Beer ;Wine R Distilled Spirits 2. Liquor license number and class(i.e. C-55441) _. 16S 57 3. Licensee name(last, first,middle),Corporate name, Limited Liability Company(LLC) NAME: Li b eU 1 1�`.i POL IWyi p�f� iozi. 8farsVy s ADDRESS: ► : 1 C - -5' � � • CITY ZIP eva 7 4. Location where event will be held;name,address,city,county, zip code 11i ADDRESS: ` t:1)2p t - i -01 cS+, CITY Om aria ZIPCI COUNTY .1)0h9 REV 6/09 Page 1 s directly responsible to the holder of this Special Designated License. sign here r.<"/�,�,� � C �s%� � C Y1�dljf ) fit` -7-z Authorized Representative/Applicant Title Date Jr � i l �'Ct 1 vid) 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 REV 6/09 Page 2 r may be canceled by the Company by notice to the insured in accordance with the policy conditions., This binder is canceled when replaced by a policy. Data of Issuance:April 28,2011 Sighed: 0 C Daniels . •4•61b, •.5rirei,,t.°4.,....f At,•'i '''''4•7: ...AP:.„ ., t,... • . . Spouses Last Name; First Name: MI: 10 I A Social Security Number:, • Drivers License Number& State: — . r•a:n:..4... .riac,..;Of.i.. .i.w.,.. . . Date Or Birth: pr•-..1.61=T......C. 911... .." CCLIM.1......' ..,... : 7...4•7 ./ '' t , ?'',T fk'llAWil4,i1.1X:': , ,,. . .,,,,,, ..4:.s. . r, 7 .: i.4,01,?..T•gg.,Ip.,....ul ..,..w.4*,..• • .,...k,x4:-,4.:It• .- --Trs. •,..-..i1.-,r0A7•71:t.,- 44-,32_,11..., ,,. ,-;,.. .,,A.,,. ,.. ....v..,4_,..i._,.‘;:•.„....,-.s.:. fyitr,d,,,... ,--,.,, ", ,..0.,,.., 7.4,,, - •• ' ' t"`,.4.1-..i., -P'-'1•• ...,,a,k1,,•,,,,- "d,,,fiteTWA,Mik-A,,,,.." "Z r:.;..', ,t.r..d$.... .1., ,,,,..7,..?4,... ,,, ,.. ,..,,,,z.,,,,.. ... .,..„.,,,,, .',..,,,,c,,,j.,,,,,I, t, ,44..., ,, „...4 .,. .e., . __.,,t.4...,.:„..,nrl_,a,„ ,..,„„.,v,. .444,, ,•••4:‘,.....7-,,..A•5,:,:;:j,;,4,,,,,tta=1:.....z.,. ;"....A.,0.,•,.•:f.....-,.... . 0,. ,. - ) ,i,„,,,,,,,c'V,.o.,,;•za ill.•„_.,4§3.,.‘i.,..:71..., :. "4., .,4..1.....7,..'.71........r.,...1,..1.yr.60.......k.f.i.: 1. ' .r.,74:T.,,../....*.3.X•ft. e. - :4. •4..t4.1c,.q,.............4 i,.... .4.,,i iet,r. ,...,,,,,,, ,4,,,,riltlerf 1",, •'::..,,,r,6.'epy.L.,..4 .4,p4c,.. . ,4 , ,;,--4...,,,A,:Sg4.,6*,,,,, ..ets ',.;,.4e.,,,,tt, .". 1,1,C._,Atr.i... ....,5"641 ,,thatt a,...... ,..'". •' ..... C'S'4,4,e''l)trn Ir'.;c--,Nit 4 E,..4\-17,1'1:N. t3.'5";',44"5•Moe,,,11-.:.•:4-• . ''' •::`244-',.LAt-*Zt''''I'''''' ' *-- • . . • r env & STATE . I YEAR YEAR CITY &STATE YEAR YEAR F FROM TO FROM TO ge .3/4IN As-- 4 tR -goi 0 Piwoh+ Lk ocl ow 1 1-_ Li4c..3k lc 200 o".17 i 002s- Ai mslievc.,Plazk Org462,_ . • ,33 5- c Ar 2 0E8 2 tl,ut Om 0 am D ...6t1 kj4k.oi Ce1noteab-in LinGivh, %a,tAown.51. 0 ThellIA, AAT ..._ r2— goo3 , Lilth it._ aon a.610, 1;04 0 vdit• 5+. Li.D9C•01 r2 l&C 1 1171/ /1/41. LIticAv vv Form 103 R,,,inai 1 Page 3 of 5 1 a. Is this Iocation within the city/village limits? gYES ONO b. is this location within the 150' of church, school,hospital or home aged/indigent or for veterans their wives? 0 YES NO c. Is this location within 300' of any university or college campus? ❑YES$TO Must be consecutive days 5. Date(s)and Time(s) of event(no more then six(6)consecutive days on one application) Date W 2,L1 Date (0_2J Date (G,. 24; Date („-11 Date (.,- J Date _.2.9 Hours From Hours From Hours From Hours From Hours From Hours From gplM To 111114 pM To lak gp 1/1 To IGIYYt gp,To /4i i 87pinl To )FYI To IG�lbt a. Alternate date: `'t > 7 b. Alternate location: qt.,(Alternate date or loust be approved by local) 6. Indicate type of activity to be carried n during event Dance©Reception© Fund Raiser iBeer Garden D Sampling/Tastingt Other LA 1}e, N,11,1 7. Description of area to be licensed ❑Inside building,dimensions of area to be covered IN FEET 3"e/ x )1 Q Name of building l31"caYS k ) (not square feet or acres) piOutdoor area dimensions of area to be covered IN FEET 1 fL)6 x (not square feet or acres) If outdoor area, how will premises be enclosed fence, type of fenceD snow fenceD chain linkQ cattle panels other .\1 VD'�Inn- Or 1\J ©tent other,explain /41 ( ,,� Lc '//l'" ik/0 /d-4,7 *If both inside and outdoor area to be licensed include simple sketch 8. How many attendees do you expect at event? 1'2l 9. If over 150, indicate the steps that will be taken to prevent underage persons from obtaining alcohol beverages. ,r?etW iflj Ut.)1 i (`O✓( At. entrance. ()awe, winsthh rd5. NNA) QQrS is 1�i11 b� ill Gs-abilshvyt.y1t cckY 10. Will premises to be covered by license comply with all Nebraska sanitation laws? BYES D NO a. Are there separate toilets for both men and women? 1 YESO NO 11. Where will you be purchasing your alcohol Z`I wholesaler0 retailerO both 12. Will there be any games of chance operating during the event? © YES,$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. REV 6/09 Page 2 d by the Company by notice to the insured in accordance with the policy conditions., This binder is canceled when replaced by a policy. Data of Issuance:April 28,2011 Sighed: 0 C Daniels . •4•61b, •.5rirei,,t.°4.,....f At,•'i '''''4•7: ...AP:.„ ., t,... • . . Spouses Last Name; First Name: MI: 10 I A Social Security Number:, • Drivers License Number& State: — . r•a:n:..4... .riac,..;Of.i.. .i.w.,.. . . Date Or Birth: pr•-..1.61=T......C. 911... .." CCLIM.1......' ..,... : 7...4•7 ./ '' t , ?'',T fk'llAWil4,i1.1X:': , ,,. . .,,,,,, ..4:.s. . r, 7 .: i.4,01,?..T•gg.,Ip.,....ul ..,..w.4*,..• • .,...k,x4:-,4.:It• .- --Trs. •,..-..i1.-,r0A7•71:t.,- 44-,32_,11..., ,,. ,-;,.. .,,A.,,. ,.. ....v..,4_,..i._,.‘;:•.„....,-.s.:. fyitr,d,,,... ,--,.,, ", ,..0.,,.., 7.4,,, - •• ' ' t"`,.4.1-..i., -P'-'1•• ...,,a,k1,,•,,,,- "d,,,fiteTWA,Mik-A,,,,.." "Z r:.;..', ,t.r..d$.... .1., ,,,,..7,..?4,... ,,, ,.. ,..,,,,z.,,,,.. ... .,..„.,,,,, .',..,,,,c,,,j.,,,,,I, t, ,44..., ,, „...4 .,. .e., . __.,,t.4...,.:„..,nrl_,a,„ ,..,„„.,v,. .444,, ,•••4:‘,.....7-,,..A•5,:,:;:j,;,4,,,,,tta=1:.....z.,. ;"....A.,0.,•,.•:f.....-,.... . 0,. ,. - ) ,i,„,,,,,,,c'V,.o.,,;•za ill.•„_.,4§3.,.‘i.,..:71..., :. "4., .,4..1.....7,..'.71........r.,...1,..1.yr.60.......k.f.i.: 1. ' .r.,74:T.,,../....*.3.X•ft. e. - :4. •4..t4.1c,.q,.............4 i,.... .4.,,i iet,r. ,...,,,,,,, ,4,,,,riltlerf 1",, •'::..,,,r,6.'epy.L.,..4 .4,p4c,.. . ,4 , ,;,--4...,,,A,:Sg4.,6*,,,,, ..ets ',.;,.4e.,,,,tt, .". 1,1,C._,Atr.i... ....,5"641 ,,thatt a,...... ,..'". •' ..... C'S'4,4,e''l)trn Ir'.;c--,Nit 4 E,..4\-17,1'1:N. t3.'5";',44"5•Moe,,,11-.:.•:4-• . ''' •::`244-',.LAt-*Zt''''I'''''' ' *-- • . . • r env & STATE . I YEAR YEAR CITY &STATE YEAR YEAR F FROM TO FROM TO ge .3/4IN As-- 4 tR -goi 0 Piwoh+ Lk ocl ow 1 1-_ Li4c..3k lc 200 o".17 i 002s- Ai mslievc.,Plazk Org462,_ . • ,33 5- c Ar 2 0E8 2 tl,ut Om 0 am D ...6t1 kj4k.oi Ce1noteab-in LinGivh, %a,tAown.51. 0 ThellIA, AAT ..._ r2— goo3 , Lilth it._ aon a.610, 1;04 0 vdit• 5+. Li.D9C•01 r2 l&C 1 1171/ /1/41. LIticAv vv Form 103 R,,,inai 1 Page 3 of 5 l ..i S .1 'I t \) tjh V �� ., . ; h i flt aAli \-! 0PA r y CDF d � o � E• N -, � �! '� 1 " J �• _ `�S C vpi ' ONO N • N '-' 0 v' c ..• 000 000 (D O • : ,c-r e nH CQG+O 64' 'O' O c-, v, 0 k \ O O' 0. n N O o� O w ° n `eD g '� I..) IQO• Pt', A> v � E• cp � rr U. 05/05/2011 Buster Brown, City Clerk, City of Omaha Date 4-8099 * E-MAIL-RKAVANAUGH@LARSONMANAGEMENT.COM u; v h 13. Any other information or requests for exemptions: �}�1UC 1 - A, ( ✓7 IVY f�G`�1st -it ���• (j oC VLF 0Sj 14. Name and telephone number/cell phone number of immediate supervisor. This person will be at t DL 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. JA III 5�\ -Tbar hii Ckr) Phone: Before 4b2� 'y - 57113 During 4b 2 -G 7 q3 Print name of Event Supervisor fs:i;d000 Signature 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. � '� hereg cloy)-6k 1 '15{G'r'{'t Au orized Representative/Applicant Title Date 2,1K lic-f -'1049004-' 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 is not a gambling permit application. REV 6/09 Page 2 d by the Company by notice to the insured in accordance with the policy conditions., This binder is canceled when replaced by a policy. Data of Issuance:April 28,2011 Sighed: 0 C Daniels . •4•61b, •.5rirei,,t.°4.,....f At,•'i '''''4•7: ...AP:.„ ., t,... • . . Spouses Last Name; First Name: MI: 10 I A Social Security Number:, • Drivers License Number& State: — . r•a:n:..4... .riac,..;Of.i.. .i.w.,.. . . Date Or Birth: pr•-..1.61=T......C. 911... .." CCLIM.1......' ..,... : 7...4•7 ./ '' t , ?'',T fk'llAWil4,i1.1X:': , ,,. . .,,,,,, ..4:.s. . r, 7 .: i.4,01,?..T•gg.,Ip.,....ul ..,..w.4*,..• • .,...k,x4:-,4.:It• .- --Trs. •,..-..i1.-,r0A7•71:t.,- 44-,32_,11..., ,,. ,-;,.. .,,A.,,. ,.. ....v..,4_,..i._,.‘;:•.„....,-.s.:. fyitr,d,,,... ,--,.,, ", ,..0.,,.., 7.4,,, - •• ' ' t"`,.4.1-..i., -P'-'1•• ...,,a,k1,,•,,,,- "d,,,fiteTWA,Mik-A,,,,.." "Z r:.;..', ,t.r..d$.... .1., ,,,,..7,..?4,... ,,, ,.. ,..,,,,z.,,,,.. ... .,..„.,,,,, .',..,,,,c,,,j.,,,,,I, t, ,44..., ,, „...4 .,. .e., . __.,,t.4...,.:„..,nrl_,a,„ ,..,„„.,v,. .444,, ,•••4:‘,.....7-,,..A•5,:,:;:j,;,4,,,,,tta=1:.....z.,. ;"....A.,0.,•,.•:f.....-,.... . 0,. ,. - ) ,i,„,,,,,,,c'V,.o.,,;•za ill.•„_.,4§3.,.‘i.,..:71..., :. "4., .,4..1.....7,..'.71........r.,...1,..1.yr.60.......k.f.i.: 1. ' .r.,74:T.,,../....*.3.X•ft. e. - :4. •4..t4.1c,.q,.............4 i,.... .4.,,i iet,r. ,...,,,,,,, ,4,,,,riltlerf 1",, •'::..,,,r,6.'epy.L.,..4 .4,p4c,.. . ,4 , ,;,--4...,,,A,:Sg4.,6*,,,,, ..ets ',.;,.4e.,,,,tt, .". 1,1,C._,Atr.i... ....,5"641 ,,thatt a,...... ,..'". •' ..... C'S'4,4,e''l)trn Ir'.;c--,Nit 4 E,..4\-17,1'1:N. t3.'5";',44"5•Moe,,,11-.:.•:4-• . ''' •::`244-',.LAt-*Zt''''I'''''' ' *-- • . . • r env & STATE . I YEAR YEAR CITY &STATE YEAR YEAR F FROM TO FROM TO ge .3/4IN As-- 4 tR -goi 0 Piwoh+ Lk ocl ow 1 1-_ Li4c..3k lc 200 o".17 i 002s- Ai mslievc.,Plazk Org462,_ . • ,33 5- c Ar 2 0E8 2 tl,ut Om 0 am D ...6t1 kj4k.oi Ce1noteab-in LinGivh, %a,tAown.51. 0 ThellIA, AAT ..._ r2— goo3 , Lilth it._ aon a.610, 1;04 0 vdit• 5+. Li.D9C•01 r2 l&C 1 1171/ /1/41. LIticAv vv Form 103 R,,,inai 1 Page 3 of 5 wry() N .0 t ofOmaha, Webraskg �� 1 p' '4+,,„ C. A.., ;� 1819 Farnam—Suite LC 1 ® �4r � � gir Omaha, Nebraska 68183-0112 0 ,�� . " _,, Buster Brown (402) 444-5550 � City Clerk FAX (402) 444-5263 o'�aTEo rEB��t•• May 3, 2011 Todorovich Management Company Applications for a Special Designated Dba "Starsky's " License for June 17-20 & 24-29, 2011 4020 South 13th Street requesting music until 1:00 a.m. Omaha, NE 68107 Dear Liquor License Applicant: This letter is notification that a hearing before the Omaha City Council on your application(s) for a Special Designated liquor license has been set for May 17, 2011 . The City Council Meeting begins at 2:00 P.M. in the Legislative Chamber, (LC-4), Omaha/Douglas Civic Center, 1819 Farnam Street, Omaha, Nebraska. City Council Liquor Rule No. 6 states, "Each applicant for any type of license shall be personally present in the Council Chambers, in order that the Council may make inquiries, on the date of public hearing of the application for said license". Failure to be present at this Council Meeting is grounds to recommend denial of your application(s) to the Nebraska Liquor Control Commission. Sincerely yours, Buster Brown City Clerk BJB:clj ganization 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. � '� hereg cloy)-6k 1 '15{G'r'{'t Au orized Representative/Applicant Title Date 2,1K lic-f -'1049004-' 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 is not a gambling permit application. REV 6/09 Page 2 d by the Company by notice to the insured in accordance with the policy conditions., This binder is canceled when replaced by a policy. Data of Issuance:April 28,2011 Sighed: 0 C Daniels . •4•61b, •.5rirei,,t.°4.,....f At,•'i '''''4•7: ...AP:.„ ., t,... • . . Spouses Last Name; First Name: MI: 10 I A Social Security Number:, • Drivers License Number& State: — . r•a:n:..4... .riac,..;Of.i.. .i.w.,.. . . Date Or Birth: pr•-..1.61=T......C. 911... .." 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' .r.,74:T.,,../....*.3.X•ft. e. - :4. •4..t4.1c,.q,.............4 i,.... .4.,,i iet,r. ,...,,,,,,, ,4,,,,riltlerf 1",, •'::..,,,r,6.'epy.L.,..4 .4,p4c,.. . ,4 , ,;,--4...,,,A,:Sg4.,6*,,,,, ..ets ',.;,.4e.,,,,tt, .". 1,1,C._,Atr.i... ....,5"641 ,,thatt a,...... ,..'". •' ..... C'S'4,4,e''l)trn Ir'.;c--,Nit 4 E,..4\-17,1'1:N. t3.'5";',44"5•Moe,,,11-.:.•:4-• . ''' •::`244-',.LAt-*Zt''''I'''''' ' *-- • . . • r env & STATE . I YEAR YEAR CITY &STATE YEAR YEAR F FROM TO FROM TO ge .3/4IN As-- 4 tR -goi 0 Piwoh+ Lk ocl ow 1 1-_ Li4c..3k lc 200 o".17 i 002s- Ai mslievc.,Plazk Org462,_ . • ,33 5- c Ar 2 0E8 2 tl,ut Om 0 am D ...6t1 kj4k.oi Ce1noteab-in LinGivh, %a,tAown.51. 0 ThellIA, AAT ..._ r2— goo3 , Lilth it._ aon a.610, 1;04 0 vdit• 5+. Li.D9C•01 r2 l&C 1 1171/ /1/41. LIticAv vv Form 103 R,,,inai 1 Page 3 of 5 :•PK7 2 oCAc k � \ _ 0 /. \ 0 2 ' \ 6 » Cl) / / § k § r` ^ §• 7 § lc, 0 k 4 • - 0 v \ E ; § Q ,c) tcz' • i),,-- c.::•:....\4, G1‹.- 9 C � -� . ' /. 2. \ ? q kT zb \ C ° . ¢ §. § , k G G.� . . U « § 2 / 2 *(- : • k @ q �. U U / O 8 , p • . � . , City Clerk, City of Omaha Date 4-8099 * E-MAIL-RKAVANAUGH@LARSONMANAGEMENT.COM