RES 2008-0775 - SDL for festival at Lews & Clark Landing August 22-23 2008 APPLICATION FOR SPECIAL .
r 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/
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BEF i :00:40 fi I�4.00LIC00/ 3 + u O O OMME40 1 `._ 011 1
Include approval from the City, Village or County Clerk where the event is to be held
Include signed statement from the local law enforcement (see question #r,)
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)
CONIPI PrO t* Qgt TON. rtk ba ,F 5 4 nd' j y , 3 / '}
1. Type of alcohol to be served and/or consumed
El Beer .' Wine XDistilled Spirits
2. Liquor license number and class (i.e. C-55441) 01 a�7
3. Licensee name (last, first, middle), Corporate name, Limited Liability Company(LLC)
NAME:CV 6 �L r' C 1-+C
ADDRESS: MY —2/ f-ot COUNTY b. ,a 1
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 A,ter,AZ
here / /11E"1324 5/ZS-kg
Authorized Representative/Applicant Title Date
Print Name
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.
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4. Location where event will be held; name, address, city, county, zip code
Lgwl5 r ci 1r't (-a"; 1 5/ f o
ADDRESS: ) i(.- : ,:Pr)ffc 1/ COUNTY ))6,01./lk 5
a. Is this location within the city/village limits? f''ES D NO
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 a NO
_
5: • Date(s) and Tiine(s) of eventf(no more;then`s (6) onsecutive day5on one applicatton) s.
Date fv.,7 e70,0% Date ktqf 0/3•-og Date�;, aqe, Date Date Date
Hours From Hours From Hours From Hours From Hours From Hours From
i To 'Jfot !/lt.., To item ►. To )Ppvn To To To
a. Alternate date:
b. Alternate location:
(alternate date or location must be approved by local and law enforcement)
6. Indicate type of activity to be carried on during event
D Dance 0 Reception 0 Fund Raiser ❑ Beer Garden D Sampling/Tasting OtherFe,s4,)01(
7. Description of area to be licensed
❑ Inside building, dimensions of area to be covered INFEET x
Name of building (not square feet or acres)
Outdoor area dimensions of area to be covered INFEET 11r x
(not square feet or acres)
If outdoor area, how will premises be enclosed
t fence, type of fence
❑ tent
0 other, explain
*If both inside and outdoor area to be licensed include simple sketch •
8. Attach:a signed statement from local police chief or county;; he sriff, Whichever is applic able, that local
law enforcement h •as been informed in advance of this event, and'if they. are aware of any reason the
event should not occur
9. 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 ❑ NO
a. Are there separate toilets for both men and women? 'YES 0 NO
al 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.
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side and outdoor area to be licensed include simple sketch •
8. Attach:a signed statement from local police chief or county;; he sriff, Whichever is applic able, that local
law enforcement h •as been informed in advance of this event, and'if they. are aware of any reason the
event should not occur
9. 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 ❑ NO
a. Are there separate toilets for both men and women? 'YES 0 NO
al 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.
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11. Will there be any games of chance operating during the event? 0 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.
12. Any other information or requests for exemptions:
13. 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.
•
CA. (" eAt , li.o5 Phone: Before 31 3 -G During 3-'6 f c
Print name of Event Supervisor
(7)
r>> went Supervisor
Consent of Authorized izcpi.e _`_n{,y 'Applicant
•
14. 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.
saga
here J�; V1-.0 . �� O
Authorized Representative/Applicant Title • Date
CO4 irAnc¢. ? Ji ko5
Print Name •
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.
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PPROVED BY: 06/02/08
Bu ter Brown, City Clerk, City of Omaha Date
MIDNIGHT
Sincerely yours
Buster Brown
City Clerk
BJB:clj
Enclosure