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RES 2007-0883 - SDL for luau party at Kozee Lounge August 4 2007 LICENSEE NEl3R§RA LIQUOR CONTROL COMMISSION P.O,Box 95464 Lincoln NE 68509-5046 • ALL ISSUED LICENSES ARE MAILED TO LOCAL CLERKS WHERE THE EVENT IS HELD ❑ All Applications must be received in the Commission Office 10 working days (excluding weekends and holidays) prior to the date of the event El Complete and return THE ORIGINAL WITH A DUPLICATE to the Nebraska Liquor Control Commission Cl A license fee of$40 (payable to Nebraska Liquor Control Commission)for each day (no fees if caterer) ❑ APPROVAL FROM CITY,VILLAGE OR COUNTY CLERK must be included with this application Cl A Signed Statement from Local Police Chief or County Sheriff Type of Beverage(s) to be served or consumed: Beer Wine Vsl. Distilled Spirits (pqc._,Y l 2. License number and class Ps Retailer ❑ Caterer (i.e. I/K-12345) 3. Name and Address of Applicant(as listed on liquor license) (City, County,Zip Code) zS ( til o ( C lJMcam'�Q kiC- i I L 1 4. Address or location of premises to be covered by license, (street, city, county, zip code)P3 /6) • 60 r,5i (• Vi') ( 5. Address of where alcohol is to be stored if other than at location listed in question#4 above • 6. Name, address, phone number/cell phone number of owner or lessee of premises for which the license is requested " z5`7:.,� z; Koff Gvy1 $13 �.; C 51 °" �of 7. DATE(S) OF EVENT (If Sunday, attach Sunday sales ordinance) no more then six (6) consecutive days per application a) if alternate date is requested please list below: (must be approved at local level prior to event) ALTERNATE DATE: • b) If alternate location is requested please list below: (must be approved at local level prior to event) ALTERNATE LOCATION: 8. Time(s) of event (example 8am to lam, this is considered one day) FROM: V u TO: J L/1.\A_ ; c Of,, 1 \ (1-2 ti;� 1 -.01(,) 4 iv) 9. Describe type of activity to be carried on during the time period for which the license is requested e- U Pat 10. Provide an estimated numbAL,6f attendees at this event J . If the number of attendees is over 150 attach a separate page indicating the steps that will be taken to prevent underage persons access to alcoholic beverages. 11. Attach a signed statement from your 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 ®N � ses (western most bay commonly referred to as 9656 Mockingbird), provided, however, that the Lessee will have the right to relinquish this western most 1,300 square feet only if the Lessee does so by providing written notice to the Lessor to that effect, no earlier than September 1, 2008 and no later than October 1, 2008. If the Lessee does not elect to relinquish the 1,300 square feet(western most bay)between the dates hereinbefore mentioned, (September 1, 2008 through October 1, 2008) the Lessee's right to relinquish shall expire and the Lessee shall continue to have rental payment obligations on the entire 3,900 square feet leased herein. If the Lessee exercises its right to relinquish the western most 1,300 square feet(only the western most 1,300 square feet can be relinquished)the Lessee shall continue to pay rent on that portion of the Premises that has been relinquished through the month of January, 2009, as the surrender of the western most 1,300 square feet shall not become effective until February 1, 2009. If the Lessee elects to relinquish the western most 1,300 square feet, the Lessee shall no longer be obligated to pay rent for such space shall expire 3 claims,costs, and liabilities, including reasonable attorneys fees and costs,arising out of or in connection with the cleanup,removal, or restoration associated-with the indemnifying- party's use of hazardous materials. ATTEST: City of Omaha, Revenue anager r � Dimensions of area to be covered by license: x 0 . Please draw in the space provided below, the area Where liquors will be sold and consumed. LENGTH WIDTH (In feet) ' t If outdoor area, how will premises be separated from areas open to the general public? Fence, type of fence -)" np Tent ❑ Other (if other, please explain) • • 13. Is the premises to be covered by the license located within the city/village limits? YES ❑ NO 14. Is the premises to be covered by the license within 150 feet of any church, school, hospital, or home for the aged or indigent persons or for veterans, their wives or children'? ❑ YES sIR NO 15, Is the premises.to be covered by the license within 300feet of any university or college campus ❑ YES , NO 16. Explain how alcoholic liquors will be purchased by the licensee.If purchased from a retail licensee,please give the name and license number. Check here if for consumption only 153t (no purchases or sales, i.e. byo) • 17. Will the premises to be covered by the license comply with all Nebraska sanitation laws'? RYES ONO 18. Are there separate toilets.for both men and women? ,'YES ❑NO A 19. Other information or requests for exemptions, must be requested and approved prior to event: 20. Will there be any games of chance operating during the event? EYES 'NO if so, describe activity NOTICE: 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. 21. Name and telephone number/cell phone number of immediate supervisor, who will actually be present at the location of the event when it occurs, that can be contacted by law enforcement before and during the event, and who is responsible for ensuring that any applicable laws, ordinances, rules and regulations are adhered to. Supervisor must sign on page 2. cty ( CLa-0 a 15-sy• � .7,2- � persons access to alcoholic beverages. 11. Attach a signed statement from your 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 ®N � ses (western most bay commonly referred to as 9656 Mockingbird), provided, however, that the Lessee will have the right to relinquish this western most 1,300 square feet only if the Lessee does so by providing written notice to the Lessor to that effect, no earlier than September 1, 2008 and no later than October 1, 2008. If the Lessee does not elect to relinquish the 1,300 square feet(western most bay)between the dates hereinbefore mentioned, (September 1, 2008 through October 1, 2008) the Lessee's right to relinquish shall expire and the Lessee shall continue to have rental payment obligations on the entire 3,900 square feet leased herein. If the Lessee exercises its right to relinquish the western most 1,300 square feet(only the western most 1,300 square feet can be relinquished)the Lessee shall continue to pay rent on that portion of the Premises that has been relinquished through the month of January, 2009, as the surrender of the western most 1,300 square feet shall not become effective until February 1, 2009. If the Lessee elects to relinquish the western most 1,300 square feet, the Lessee shall no longer be obligated to pay rent for such space shall expire 3 claims,costs, and liabilities, including reasonable attorneys fees and costs,arising out of or in connection with the cleanup,removal, or restoration associated-with the indemnifying- party's use of hazardous materials. ATTEST: City of Omaha, Revenue anager 22.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 v here Ai .: ©cefiveir -/6—Q 7 Authorized Representative/Ap yQ:.nt Title Date ,/rRALD t Print Name sign here . �.�(. s' !�"Vt4 {/ 0.-r�7 �sor tle Date 1.1) M 01 Print Na4e 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. In Compliance with ADA, this form is available in other formats for persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. • • Rev 7/04 35-4121rt Name and telephone number/cell phone number of immediate supervisor, who will actually be present at the location of the event when it occurs, that can be contacted by law enforcement before and during the event, and who is responsible for ensuring that any applicable laws, ordinances, rules and regulations are adhered to. Supervisor must sign on page 2. cty ( CLa-0 a 15-sy• � .7,2- � persons access to alcoholic beverages. 11. Attach a signed statement from your 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 ®N � ses (western most bay commonly referred to as 9656 Mockingbird), provided, however, that the Lessee will have the right to relinquish this western most 1,300 square feet only if the Lessee does so by providing written notice to the Lessor to that effect, no earlier than September 1, 2008 and no later than October 1, 2008. If the Lessee does not elect to relinquish the 1,300 square feet(western most bay)between the dates hereinbefore mentioned, (September 1, 2008 through October 1, 2008) the Lessee's right to relinquish shall expire and the Lessee shall continue to have rental payment obligations on the entire 3,900 square feet leased herein. If the Lessee exercises its right to relinquish the western most 1,300 square feet(only the western most 1,300 square feet can be relinquished)the Lessee shall continue to pay rent on that portion of the Premises that has been relinquished through the month of January, 2009, as the surrender of the western most 1,300 square feet shall not become effective until February 1, 2009. If the Lessee elects to relinquish the western most 1,300 square feet, the Lessee shall no longer be obligated to pay rent for such space shall expire 3 claims,costs, and liabilities, including reasonable attorneys fees and costs,arising out of or in connection with the cleanup,removal, or restoration associated-with the indemnifying- party's use of hazardous materials. ATTEST: City of Omaha, Revenue anager O OM A H. CityofOmaha, fftlebras&a. ' 1819 Farnam—Suite LC 1 a' t d Omaha, Nebraska 68183-0112 0 �nWr �� _:•, ro Buster Brown (402) 444-5550 ti' City Clerk FAX (402) 444-5263 oR'TtD FEBR�1,'4- July 11, 2007 Burgess Lounge, Inc. Application for Special Designated Dba "Kozee Lounge" License for August 4, 2007 5813 North 60th Street (Music to end at 1:00 a.m.) Omaha, NE 68104 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 17, 2007. 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. Sincer ly yours, Buster Brown City Clerk BJB:clj y 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. In Compliance with ADA, this form is available in other formats for persons with disabilities. A ten day advance period is requested in writing to produce the alternate format. • • Rev 7/04 35-4121rt Name and telephone number/cell phone number of immediate supervisor, who will actually be present at the location of the event when it occurs, that can be contacted by law enforcement before and during the event, and who is responsible for ensuring that any applicable laws, ordinances, rules and regulations are adhered to. Supervisor must sign on page 2. cty ( CLa-0 a 15-sy• � .7,2- � persons access to alcoholic beverages. 11. Attach a signed statement from your 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 ®N � ses (western most bay commonly referred to as 9656 Mockingbird), provided, however, that the Lessee will have the right to relinquish this western most 1,300 square feet only if the Lessee does so by providing written notice to the Lessor to that effect, no earlier than September 1, 2008 and no later than October 1, 2008. If the Lessee does not elect to relinquish the 1,300 square feet(western most bay)between the dates hereinbefore mentioned, (September 1, 2008 through October 1, 2008) the Lessee's right to relinquish shall expire and the Lessee shall continue to have rental payment obligations on the entire 3,900 square feet leased herein. If the Lessee exercises its right to relinquish the western most 1,300 square feet(only the western most 1,300 square feet can be relinquished)the Lessee shall continue to pay rent on that portion of the Premises that has been relinquished through the month of January, 2009, as the surrender of the western most 1,300 square feet shall not become effective until February 1, 2009. If the Lessee elects to relinquish the western most 1,300 square feet, the Lessee shall no longer be obligated to pay rent for such space shall expire 3 claims,costs, and liabilities, including reasonable attorneys fees and costs,arising out of or in connection with the cleanup,removal, or restoration associated-with the indemnifying- party's use of hazardous materials. ATTEST: City of Omaha, Revenue anager q n �. rrl • r° �d o oS a oo ----1 R)o o C.3%'S\\ fib • OCD CD v v,, — c� cam, A' p--h r. o o'er u). o o ,4 o g Fr CO 0 • • C- h AREA APPROX 59'X 34' KNOWN AS BAY 9658 * LICENSED PREMISES 1 STY L SHAPED BLDG APPROX . 64'X 59' *(2007 -OLD 48' X 60') OFFICERS: OWNER -MARY KAY ENGDAHL, 3822 NORTH 85TH AVE, 68134 (H) 884-5119©680-9668