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RES 2008-0560 - SDL for Santa Lucia Festival at Lews & Clark Landing May 29-June 2 2008 * Prin .Fol`rit APPLICATION FOR SPECIAL DESIGNATED LICENSE NON PROFIT APPLICANTS 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 0 Include approval from the City,Village or County Clerk where the event is to be held Q Include signed statement from the local law enforcement(see question#8) ❑ 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) ID 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) Letter from IRS declaring your organization exempt from payment of federal income taxes, or copy of federal tax return, as filed with the IRS, as well as affidavit signed by an officer of the organization declaring that the copy of the tax return is true and correct copy as filed with the IRS COMPLETE ALL QUESTIONS 1. ,,TT�pe�ype of alcohol to be served and/or consumed Ild'Beer 1 "Wine In Distilled Spirits 2. Status of applicant(check one) ,,, El Municipal Cl Political El Fine Arts❑Fraternal!'Religious ❑Charitable❑Public Service 3. Licensee name (last, first,middle),Corporate name,Limited Liability Company(LLC) NAME: S r..l 71A- 1"'U A FE-S 7-7 1.�L C�1�1✓t9, - I-1 Si G ADDRESS: 0 dh ✓�!-�/4-)") ( �i°e COUNTY b u GAS • 4. Location where event will be held; name, address, city,county,zip code S C i,/k2 t& LA ' ' - ADDRESS: ..SicA✓F-1LFR-s•-ri-Z\2V J s— COUNTY p,LA. 0 iv\Jet-bl�k rJ E ( F-/O a. Is this location within the city/village limits? EKES ONO b. Is this location within the 150' of church, school,hospital or home / aged/indigent or for veterans their wives? ❑ YES,L�,N 0 c. Is this location within 300' of any university or college campus? ❑ YES ENO 5. Date(s)and Time(s)of event(no more then six(6)consecutive days on one application) Dateja.po .p.,r Date38y"Ylgy4D0 DateJ 4. .,c. - Date/_J Nk Date al", Date�� Hours From Hours From Hours From Hours From Hours From`gyp Hours From J PM To),!cOel ✓�0 To t Z' 1�0)e°442 Pi''‘/.2.r mo,J To )2 PM Pi'^ To _P_, To pM a. Alternate date:I ! er-Aj 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 ❑Dance DReception ❑Fund Raiser Q-ier Garden ❑Sampling/Tasting ❑Other 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) 1170utdoor area dimensions of area to be covered INFEET cO / x 5-(9 r>! (not square feet or acres) If outdoor area,how will premises be enclosed © fence, type of fence tcnt Lother,explain Z-P-1S<1z �A6 � kk)j G W y I CiN *If both inside and outdoor area to be licensed include simple sketch / l rv) ('AN O - 8. Attach a signed statement from local police chief or county sheriff,whichever is applicable,that local law enforcement has been informed in advance of this event,and if they are aware of any reason the event should not occur. , QN 9. Indicate the steps that will be taken to prevent underage persons from obtaining alcohol beverages. c u1/4,5 (Li• s 8 DS . 10. AN/1 emises to be covered by license comply with all Nebraska sanitation laws? t1B'YES ❑ NO a. Are there separate toilets for both men and women? c 4 S❑NO r • 1 ' To:Nebraska Liquior Commission From: Santa Lucia Festival Committee 84 Dear Sirs, This will be the rfryear of our Italian Festival.The site for this years festival will be at Lewis&Clark Landing on Omahas riverfront. We are requesting the Liquior Commission to waive 013.03 due to the natural barriers of a 6 to 10 foot brick wall on one side,and 5 foot wire fence on the river side.The city of Omaha owns this property and will not allow any penetration of the ground for fencing.The extra costs of materials and labor would create a finincial hardship to our organization and would not be practical because of the permanent barriers already in place.Security will be provided by .Id's will be checked and wrist bands will be used. Thank you for your consideration. 5U-C.A4AZ ry -o 1/1 <:"..---- --�•-tc•N•� s '(1.7.f :i '''0 I.' 1‘.... 0 0 ir,N o J� /c�f „LPN .';i .' ..........0 Zii :�r/ / • / x ,,.. /N m 0 I ''''...0 It( \ ...,... . hJ mi `cam ,, R '• 4 \ / /‘ . m� N' VJO /P Z. i N t. 1 2 S • ._ _ _ _ D r -:..‘.. t O r • Ig. it. 1If ( z 5i _ . ) 11. Will there be any games of chance operating during the event? 0 YES 0 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. b11Nr I 0 E 1 ' )�, b21 Phone: Before 15 3 -Lo 00 During �a h 0-? 1i16/1 J Print name of Event Supervisor ��4 c 11(2,,A(4 Signature of Event Supervi§6r Consent of Authorized Representative/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. sign n , here .Szk- � // Authorized Represent'fitie/A'pplicant Title a e • je't s J h . Th /pr -e - 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. Application for Special Designated License Under Nebraska Liquor Control Act Affidavit of Non-Profit Status I HEREBY DECLARE THAT THE CORPORATION MAKING APPLICATION FOR A SPECIAL DESIGNATED LICENSE UNDER THE NEBRASKA LIQUOR CONTROL ACT IS EITHER A MUNICIPAL CORPORATION, A FINE ARTS MUSEUM INCORPORATED AS A NONPROFIT CORPORATION, A RELIGIOUS NONPROFIT CORPORATION WHICH HAS BEEN EXEMPTED FROM THE PAYMENT OF FEDERAL INCOME TAXES, A POLITICAL ORGANIZATION WHICH HAS BEEN EXEMPTED FROM THE PAYMENT OF FEDERAL INCOME TAXES,OR ANY OTHER NONPROFIT CORPORATION, THE PURPOSE OF WHICH IS FRATERNAL, CHARITABLE, OR PUBLIC SERVICE AND WHICH HAS BEEN EXEMPTED FROM THE PAYMENT OF FEDERAL INCOME TAXES AS PER§53-124.11(1). AS SIGNATORY I CONSENT TO THE RELEASE OF ANY DOCUMENTS SUPPORTING THIS DECLARATION AND ANY DOCUMENTS SUPPORTING THIS DECLARATION WILL BE PROVIDED TO THE NEBRASKA LIQUOR CONTROL COMMISSION, THE NEBRASKA STATE PATROL OR ANY AGENT OF THE LIQUOR CONTROL COMMISSION IMMEDIATELY UPON DEMAND. I ALSO CONSENT TO THE INVESTIGATION OF THIS CORPORATE ENTITY TO DETERMINE IT'S NONPROFIT STATUS. I AGREE TO WAIVE ANY RIGHTS OR CAUSES OF ACTION AGAINST THE NEBRASKA LIQUOR CONTROL COMMISSION, THE NEBRASKA STATE PATROL OR ANY PARTY RELEASING INFORMATION TO THE AFOREMENTIONED PARTIES. �% '• ia� (7i✓L-(.,tz.tQ.A /vz;Q �2rr ir.t/1'LQ NAME OF CORPORATION L1 7- U Cp 1 S 7 9 • FEDERAL ID NUMBER SIGNATURE OF TITLE QF CORPORA E OFFICERS THE ABOVE INDIVIDUAL STATES THAT THE STATEMENT ABOVE IS TRUE AND CORRECT: IF ANY FALSE STATEMENT IS MADE ON THIS APPLICATION, THE APPLICANT SHALL BE DEEMED GUILTY OF PERJURY AND SUBJECT TO PENALTIES PROVIDED BY LAW. (SEC. §53- 131.01)NEBRASKA LIQUOR CONTROL ACT SUBSCRIBED IN MY PRESENCE AND SWORN TO BEFORE ME THIS // DAY OF • se SI / ,-sx-- ✓ NOTARY PUBLIC GNATURE&SEAL GENERAL NOTARY-State of Nebraska I'll SHIRLEY ANN BROWN My Comm.Exp.Aug.1,2009 e't s J h . Th /pr -e - 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. 04/04/2008 15:36 8669351987 PAGE 02/03 DAVIDSON-BABCOCK 11128 John Galt Blvd.,Suite 102 Omaha,Nebraska 68137 • Phone: (402)935-0171 Fax: (402)935.1987 www.davidson-battcodc.conl BINDER TO: SW Insurance,inc.-Gfilem Policy Number. CLS1455574 8707 W Center Rd Omaha, NE 68124 Name of Risk: Santa Lucia Festival Committee 725 Pierce Street Omaha NE 68106 This Binder is effective on 5/26/2008 12:01 AM Standard Time and shall remain in effect for 60 days,unless superceded by the policy or certificate or canceled by the Company. This binder may reflect reduced coverage and/or limits from your original request or the expiring policy. Your customer must be notified. INSURANCE COMPANY(S): Scottsdale insurance Company A+(XV)7-6-99 COVERAGES/LIMITS: SPECIAL EVENT LIABILITY:$2M/$1M/$1M/$100,000/$5,000 Event dates:May 26th-June 3rd. DEDUCTIBLES: RATES: ATTENDANCE:3,000 PER DAY • TERMS AND CONDITIONS: EXCLUSIONS: Total Pollution;Asbestos;Lead;Nuclear;Employment Related Practices;Mold; Punitive;War&Terrorism, Designated Profession Services-"Any and all professional .exposures",Total liquor liability,Assault&Battery. ATTACHEMENTS:Limitation of Coverage to designated premises or project. OTHER: Premium is 100%fully earned. Carnival ride operator must carry at least equal verified with a certificate. Will need certificate ASAP. Advance Premium $2,250.00 Policy Fee $100.00 Tax $70.50 Totals $2,420.50 The premium shown herein is a minimum&depose premium.In the event that coverage is in effect for the full term the emium effect e Is not in for t the s Nil term,the earned premium will be computed In accordance with earned&no return premium will be allowed et the time of audit t the terra&condition the event that gof the policy but In no event win it be tests than the minimum earned premium of 25%plus fees. This Company binds the kind(s)of insurance stipulated herein. This insurance is subject to the terms,conditions and limitations of the policy(s)in current use by the Company. The binder may be canceled by the insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective—subject to minimum earned premium. The binder 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. Date of issuance:April 4.2008 Signed: „HA, City of Omaha, fl\lebras&a ` Nit„ -�l gitola 1819 Farnam—Suite LC 1 2 r , , Ft Omaha, Nebraska 68183-0112 0 , ' _: 4 Buster Brown (402) 444-5550 �A ti' City Clerk FAX (402) 444-5263 oR'�ED ��BRv�►1A April 11, 2008 Santa Lucia Festival Committee Application for Special Designated 725 Pierce Street Licenses on May 29-31, 2008 and June Omaha, NE 68108 1-2, 2008 at Lewis & Clark Landing, 375 Riverfront Drive (Santa Lucia Festival) Music till 12:00 midnight Dear Liquor License Applicant: This letter is notification that a hearing before the Omaha City Council on your application for a Special Designated liquor license has been set for April 22, 2008. 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 to the Nebraska Liquor Control Commission. Sincerely yours, uster rown • City Clerk BJB:clj • certificate. Will need certificate ASAP. Advance Premium $2,250.00 Policy Fee $100.00 Tax $70.50 Totals $2,420.50 The premium shown herein is a minimum&depose premium.In the event that coverage is in effect for the full term the emium effect e Is not in for t the s Nil term,the earned premium will be computed In accordance with earned&no return premium will be allowed et the time of audit t the terra&condition the event that gof the policy but In no event win it be tests than the minimum earned premium of 25%plus fees. This Company binds the kind(s)of insurance stipulated herein. This insurance is subject to the terms,conditions and limitations of the policy(s)in current use by the Company. The binder may be canceled by the insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective—subject to minimum earned premium. The binder 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. Date of issuance:April 4.2008 Signed: • > - \ b d 7 CD q a a �. \ ? 9 / ƒ. � v ° C r ) § _ 7' @ c) / J . - ° E / Ro ? §. ® 2 8c ? \ k6 \ ° ƒ § o m\ _ o 0 2 7 § 2 ) 0 § 7 A' n .4 n 0 4 §' v) 5' § n ¢ k § \ ° § - c = w # m / / c. § / s 7 CD § § C p " G E / 2 2 7 2 U 2 . ' = u' t • 0 0 0 < .2. §` ' • k 9 § § ¥ P P § IN f (A . . 5i _ . )