RES 2010-0833 - SDL for fundraiser at Rookies Bar & Grill August 7 2010 •
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Print Form I
f
APPLICATION FOR SPECIAL •
DESIGNATED LICENSE
I1ETAIL 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
Ej Include approval from the City, Village or County Clerk where the event is to be held
ID A license fee $40 (payable to Nebraska Liquor Control Commission) for each day/event to be
licensed (i.e. if you have two separate areas at one event they both need to be licensed) (unless
licensed as a K Caterer no fees required)
0 Application MUST be received at the Liquor Control Commission Office no later than 10 working
days prior to event (excluding weekends, Federal and. State observed holidays)
COMPLETE ALL QUESTIONS
• 1. Type of alcohol to be served and/or consumed
•
I Beer IN Wine t$J Distilled Spirits
2. Liquor license number and class (i.e. C-55441) 84861
3. Licensee name (last, first, middle), Corporate name, Limited Liability Company (LLC)
Coconuts, Inc.
NAME:
11746 Mayberry Plaza
ADDRESS:
CITY Omaha, NE ZIP 68154
4. . Location where event will be held; name, address, city, county, zip code
•
1702 North 120th Street O L /)4, C,c/ /
ADDRESS: CJU L�C�S / •
Omaha, NE • ZIP 68154
CITY
Douglas
COUNTY
REV 6/09 Page 1
a. Is this location within the city/village limits? la YES NNO
b. Is this location within the 150' of church, school, hospital or home
aged/indigent or for veterans their wives? ® YES MNO
c. Is this location within 300' of any university or college campus? DYES 13NO
Must be consecutive days
5. Date(s)and Time(s) of event(no more then six(6) consecutive da s on one application)
Date Aug 7, 2010 Date Date Date Date Date
Hours From4:00 Hours From Hours From Hours From Hours From Hours From
T012:00 To To To To To
a. Alternate date: /Z 4 j/ be.i // d9 ,'��/gyp
b. Alternate location:
(Alternate date or location must be approved by local)
6. Indicate type of activity to be carried on during event
l� Dance* Reception 12 Fund Raiser.• Beer Garden 0 Sampling/Tasting I 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)
13 Outdoor area dimensions of area to be covered IN FEET 80 x100
(not square feet or acres)
If outdoor area, how will premises be enclosed roped off area
* fence, type of fence' snow fenceD' chain linkQ cattle panels`,other
Al tent
® other, explain
*If both inside and outdoor area to be licensed include simple sketch
400
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?
• YES I NO
a. Are there separate toilets for both men and women? 0 YES Kt NO
11. Where will you be purchasing your alcohol a wholesaler I retailerD both
12. Will there be any games of chance operating during the event? II YES if 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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9. Steps that will be taken to prevent underage persons from obtaining alcohol beverages.
All alcoholic beverages will be sold by employees of Rookies. Identifications of age will be checked at
point of entry and wristbands will be used for persons that meet the age requirement for consuming
alcoholic beverages. Also security will be double checking throughout the night to ensure age. Clear
plastic glasses will be purchased to ensure security persons are able to see what type of liquid is in
glasses.
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.
Shawn Jones/Marjorie Jones 402-315-0653/315-8679 Same
Phone: Before During
Print name of Event SupeJAL/AAA
rvisor
e
,i �
Signature of ent Supervisor C tul � J
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 I
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.
sign6/7/ /,/ !II / President 7/2/2010
here !WAIF' ��
Authorize Representative/App icant Title Date
Noel Stoddard
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
Page 2
' zty gy imafia, Webriska A ik.,..: „,.,.,- ._,,,,s,„,
(.) .Da/A ' `,7
I /al&-4%tisiall
1819 Farnam — Suite LC 1 �`' r
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Omaha, Nebraska 68183-0112 0�� as �'TM °�
Buster Brown (402) 444-5550
City Clerk FAX (402) 444-5263 0,?�1-, vv,�
tp FEti
July 6, 2010
Coconuts, Inc. Application for a Special Designated
Dba "Rookies Bar & Grill" License for a fundraiser on August 7,
1702 North 120th Street 2010 requesting music till 12:00
Omaha, NE 68104 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 July 13,
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.
Sinc-,.,-ly yours,-0: - , 4:01,S:-.2 e, '
156°
Buster Brown
City Clerk
BJB:clj
here !WAIF' ��
Authorize Representative/App icant Title Date
Noel Stoddard
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
Page 2
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