RES 2010-0641 - SDL for concert at Louis Bar & Grill June 26 2010 )5/17/2010 21:00 402-551-5993 LOUIS BAR PAGE 01
APPLICATION FOR SPECIAL
DESIGNATED LICENSE
•
RETAIL LICENSE HOLDERS •
N1 BRASKA LTQIJOR CONTROL COMMIS5K N •
301 CENTENNIAL MALL SOYA!
PO EOX 95046
LTNCOT.N.N1368509,5046
.PHONE:(402)471-7-571
PAX:(402)471-2814
Website:www.L0o.ue.iOv/
.. . .... .. ..
BEFORE StBMt't"IOld AIP•p4c.:4T.1 lw.TO TII 'QI•lOR<G't� L 1 SON'' ..::,
, Include approval from the City,Village or County Clerk where the event is to be bald
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)
Co•eQ.Ntil4TIL.AL •..0*611014.0
1. Type of alcohol to be served and/or consumed •
f Beer IS Wine IS Distilled Spirits
2. LiqUor license number and class i.e.C-55441 79829
3. Licensee name(last,first,middle),Corporate name,Limited Liability Company(LLC)
Wu's Bar&Grill LLC
NAME:
•
ADDRESS:9104 Davenport ST .
CITY Omaha ZIP 68114
4. • Location where event will be held;name,address,city,county,zip code
Louis
ADDRESS: Bar&Grin
TY Ract'at HWY 88104
CI ZIP
COUNTYDouplas
•
•
REY 6/09 Page 1
05/17/2010 21:00 402-551-5993 LOUIS BAR PAGE 02
a. Is this location within the eity/village limits? 1,11 YES 11NO •
b. Is this location within the 150'of church,school,hospital or home
aged/Indigent or for veterans their wives? DYBSNO
c. Is this location within 300'of any university or college campus? OYESNO
Must be consecutive days ,
5. •;Pate(Slatid,l'iniC(4.4Cenittioitititi,tfiefi:Xlii4jatiiiiiititifie4ayssii,,iiitalifiAiiiitiort).' -
Date 06126r2010 Dree pate Date Date Date
flours Fiont3P0 Hours Proni Hoots From Roars From Hours From Hours From
Tof 2AM To To To To To
a,. Alternate date
b. Alternate location: •
(Alternate date or location must be approved by local)
6. Iodic.*type of activity be carried on during event . concert/live musk
Cl Dancer)itteepbort0 Fund Raiserri Beer Garden riSamplingtrastmgrifi Other
—
7. Description of area to be licensed
CI Insidebuilding,dimensions of mato be covered IN rizr
Name of building (not square feet or acres)
la Outdoor area dimensions of area to be covered Di' 120 FrXr 80
x
• (not square feet or acres)
If outdoor area,bow will premises be enclosed .
Lig fence,type of finical snow Recce'cbain link cattle panels0 other
ti tent Chain kik fence&Orange PlastiO Fericklg
Doter explain 11(Y\s ; \ 1 1411 t(.1 ( ,j-
*If both inside and outdoor area to be licensed include simple sketch
8, How many attendees do you expect at event?300
9. If over 150,indicate the steps that will be taken to prevem underage persons from obtaining alcohol
beverages.
10. Will premises to be coveted by license comply with all Nebraska"imitation laws?
YES CI NO
a. A=there separate toilets for both men and women? YESO NO
11, Where will,you be purchasing your alcohon wholesaler retailer°both
12. Will there be any games of chance operating dining the event? DYES NO
If so,describe activity
NOTE:Only games of chance approved by the Department of Revenue,Charitable Owning Division are pamitted. All other
forms of gambling are ptchibited by Suite Lair There are no exceptions for Non Profit Organizations or any events raising fonds
for a duititY• This is Maly upplirotirio for a Sposisl Detrigosted License uuder it Liquor CotUrol Act and is not a gambling
permit application.
REV 4/og Page 2
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7. Description of area to be licensed
CI Insidebuilding,dimensions of mato be covered IN rizr
Name of building (not square feet or acres)
la Outdoor area dimensions of area to be covered Di' 120 FrXr 80
x
• (not square feet or acres)
If outdoor area,bow will premises be enclosed .
Lig fence,type of finical snow Recce'cbain link cattle panels0 other
ti tent Chain kik fence&Orange PlastiO Fericklg
Doter explain 11(Y\s ; \ 1 1411 t(.1 ( ,j-
*If both inside and outdoor area to be licensed include simple sketch
8, How many attendees do you expect at event?300
9. If over 150,indicate the steps that will be taken to prevem underage persons from obtaining alcohol
beverages.
10. Will premises to be coveted by license comply with all Nebraska"imitation laws?
YES CI NO
a. A=there separate toilets for both men and women? YESO NO
11, Where will,you be purchasing your alcohon wholesaler retailer°both
12. Will there be any games of chance operating dining the event? DYES NO
If so,describe activity
NOTE:Only games of chance approved by the Department of Revenue,Charitable Owning Division are pamitted. All other
forms of gambling are ptchibited by Suite Lair There are no exceptions for Non Profit Organizations or any events raising fonds
for a duititY• This is Maly upplirotirio for a Sposisl Detrigosted License uuder it Liquor CotUrol Act and is not a gambling
permit application.
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135/17/2010 21:00 402-$51-5993 LOUIS BAR PAGE 03
13. Any other information or requests for extanptions:1
14. Name and telephone numbericell 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 andior 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 Mthat 490-5418 551-5993
PhOtte7 Before During
Print name of Event Supervisor
Signs of Event Supervisor
Consent of Authorized Itepreseatativeapplicant
15. I declare that l sin the authorized representative of the above named license applicant and that the
statements made on this application ate true to the best of my lmowledge and belief. I also consent to an
investigation of my background mehiding all records of every kind including Police reeords. 1 agree to
waive any rights or causes of action against the Nebraska Liquor Control Commission,the Nebraska Stale
Patrol or any other individual releasing said inforraation to the Liquor Control.Commission or the Nebraska
• State Patrol. l father 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 persona
directly responsible to the holder of this Special Designated License.
sign.
apAuthorized Representativei plicant Title.
Don Greenberg
Print Name
This individual M1151 be listed oti the application as an officer,or stocltholder unless a letter has been filed
appointing an individual as the catering manager allowing them to sign all SDL applications.
The taw riquizeas*an ao special de/Agnated license provided for by this section shell be Uell by the Commission without the
approval of the local governing body. For the purposes of du:ruction,the local governing body shall be the city or vfllairc within
wbieh the verticals/ P4aec fot-which the special designated lierasse is roqucstod looitteit or if soeh place is net lehlge the
corporate lit:rale O4 city ovillege,t1we/heti level gowaujes body 4011 bc.4.1,0 IPouslity within Nvhich the piece for which the epochal
designated license isrequested located.
guy 6/09 Page 3
eptions for Non Profit Organizations or any events raising fonds
for a duititY• This is Maly upplirotirio for a Sposisl Detrigosted License uuder it Liquor CotUrol Act and is not a gambling
permit application.
REV 4/og Page 2
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