RES 2010-0622 - SDL for beer garden at Pauli's June 23-28 2010 a. Is this location within the city/village limits? 0 YES ONO
li. Is this location within the 150' of church, school, hospital or home
aged/indigent or for veterans their wives? 0 YES ONO
c. Is this location within 300' of any university or college campus? D YES[x]NO
Must be consecutive days
5. Date(s)and Time(s)of event(no more then six(6)consecutive da s on one application)
Date 6/23/2010 Date 6/24/2010 Date 6/25/2010 Date 6/26/2010 Date6/27/2010 Date 6/28/2010
Hours From 11AM Hours From11AM Hours From 11AM Hours From 11AM Hours From Noon Hours From 11AM
To 1 AM To 1AM To 1AM To 1AM To 1AM To 1AM
a. Alternate date: 7- Z-/0
b. Alternate location:
(Alternate date or location must be approved by local)
6. Indicate type of activity to be carried on during event
D DanceD ReceptionD Fund Raiser Beer Garden 0 Sampling/TastingD Other
7. Description of area to be licensed
D Inside building, dimensions of area to be covered IN FEET x
Name of building (not square feet or acres)
180 100
0 Outdoor area dimensions of area to be covered IN FEET x
(not square feet or acres)
If outdoor area, how will premises be enclosed
0 fence,type of fence0 snow fenceE chain link[J cattle panels0 other
0 tent
D other, explain 1M\A S , L w;// ¢. '044///, i_
sat(al
*If both inside and outdoor area to be licensed Zc1pleth ' '
500-2000
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?
D YES ONO
a. Are there separate toilets for both men and women? 0 YES❑ NO
11. Where will you be purchasing your alcohol0 wholesalerD retailerD both
12. Will there be any games of chance operating during the event? 0 YESD NO
If so, describe activity Big Red Keno
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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Form 3c Page 2
Print Form
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
1 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
1. Type of alcohol to be served and/or consumed
0 Beer p Wine D 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:
4014-16-18 Leavenworth Street
ADDRESS:
•
Omaha ZIP 68105
CITY
4. Location where event will be held;name, address, city, county,zip code
4014-16-18 Leavenworth Street
ADDRESS:
CITY Omaha ZIP 68105
Douglas County
COUNTY
REV 6/09 •
Page 1
'
500-2000
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?
D YES ONO
a. Are there separate toilets for both men and women? 0 YES❑ NO
11. Where will you be purchasing your alcohol0 wholesalerD retailerD both
12. Will there be any games of chance operating during the event? 0 YESD NO
If so, describe activity Big Red Keno
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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Form 3c Page 2
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CITY
4. Location where event will be held;name, address, city, county,zip code
4014-16-18 Leavenworth Street
ADDRESS:
CITY Omaha ZIP 68105
Douglas County
COUNTY
REV 6/09 •
Page 1
'
500-2000
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?
D YES ONO
a. Are there separate toilets for both men and women? 0 YES❑ NO
11. Where will you be purchasing your alcohol0 wholesalerD retailerD both
12. Will there be any games of chance operating during the event? 0 YESD NO
If so, describe activity Big Red Keno
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
"fig.
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CITY&STATE YEAR CITY&STATE YEAR
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Form 3c 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 POLICY FOR THE PAST, YEARS.
WE WILL ALSO HAVE 4/TO/O 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.
.
T
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 402-212-4999 402-212-4999
Phone: Before During
Print name of Event Supervisor
Signature of Event S rvisor
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 Owner/President 5/7/2010
here
Authorize epresentat. /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
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
"fig.
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CITY&STATE YEAR CITY&STATE YEAR
_
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FROM TO
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Form 3c Page 2
CityofOmaha, fAlebraskg k ;14
Agrettirl
1819 Farnam ®Suite LC 1 nr r , ,
Omaha, Nebraska 68183-0112 0 : "';_=, �'
Buster Brown (402) 444-5550 .o
City Clerk FAX (402) 444-5263 o�'rED FEBRv1..1-
May 11, 2010
Pauli's, Inc. Application for a Special Designated
Dba "Pauli's" License during the CWS for
4014-18 Leavenworth Street June 17-30, 2010 with music on
Omaha, NE 68105 Fridays & Saturdays till 12:00 midnight
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 25,
2010 .
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
t will be supervised by persons
directly responsible to the holder of this Special Designated License.
sign Owner/President 5/7/2010
here
Authorize epresentat. /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
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
"fig.
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CITY&STATE YEAR CITY&STATE YEAR
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FROM TO
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Form 3c Page 2
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