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RES 2022-0710 - SDL for Septemberfest - Salute to Labor at CHI Center September 2-5 2022 NEBRASKA LIQUOR CONTROL COMMISSION PHONE:(402)471-2571 Website: www.lcc.nebraska.eov Special Designated License Local Recommendation(Form 200) Applications must be entered on the portal after local approval-no exceptions Late applications are non-refundable and will be rejected Septemberfest - Salute to Labor Retail Liquor License Name or*Non-Profit Organization(*Must include Form#201 as Page 2) 6910 Pacific St Ste 450, Omaha, NE 68106 Retail Liquor License Address or Non-Profit Business Address 47-0437880 Retail License Number or Non-Profit Federal ID# Consecutive Dates only Sept. 2 Sept. 3 Sept. 4 Sept. 5 Event Date(s): Event Start Time(s): 5p.m. noon noon 10 a.m. Event End Time(s): midight midnight midnight midnight Alternate Date: n/a Alternate Location Building&Address: Event Building Name: CHI Center Event Street Address/City: 455 N. 10th Street, Lot D Indoor area to be licensed in length&width: X 510 880 Outdoor area to be licensed in length&width: X (Diagram Form#109 must be attached) Type of Event: Festival Estimate#of attendees: 4,000 Type of alcohol to be served: Beer X Wine Distilled Spirits (If not marked,you will not be able to serve this type of alcohol) • Event Contact Name: Linda Morin Event Contact Phone Number:402-981-7115 Event Contact Email: Iinda@laboroma a.org *Signature Authorized Representative: Z,OttOtinted Name Terry L. Moore I declare that I am the authorized representativef abov nafned lice se applicant and that the statements made on this application are true to the best of my knowledge and belief.I also consent to an inve igation of m background including all records of every kind including police records.I agree to waive any rights or causes of action against the Nebra a Liquor Co trol Commission,the Nebraska State Patrol or any other individual releasing said information to the Liquor Control Commission or th Nebraska Sta a Patrol.I further declare that the license applied for will not be used by any other person,group,organization or corporation for p it or not for profit and that the event will be supervised by persons directly responsible to the holder of this Special Designated License. 'Re ACS} -e0r Ou.3400 r MUASiC to *Retail licensee-Must be signed by a member listed on permanent license A a} M�dy,�Q�}, *Non-Profit Organization-Must be signed by a Corporate Officer �►�ri J Local Governing Body completes below: The local governing body for the City/Village of Omaha OR County of approves the issuance of a Special Designated License as requested above.(Only one should be written above) Local Governing Body Authorized Signature Date 1- Q2o2..z- O1 i�proval contingent,t9gn applicant obtaining necessaryce— permits. WI k( a' ct t a- APPLICATION FOR SPECIAL DESIGNATED LICENSE Non-Profit Applicants ONLY 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.nebraska.gov/ Email Applications: michelle.porter@nebraska.gov This page is required to be completed by Non-Profit applicants only. 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. \Q-1 \0 � -e��_S� \\, y NAME OF CORPORATION 7�—` -\ - 1 �C�ei FEDERAL ID NUMBER )JNATURE OF LE OF CORPORATE OFFICERS THE ABOVE INDIVIDUAL STATES THAT THE STATEMENT OVE 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 / V DAY OF 94,6v_ NOTARY PUBLIC SIGNATURE&SEAL General Notary•State of Nebraska a • PATRICIA A.KOSON eistoComm.Ex .Au .23 2022. FORM 201 REV NOV 2016 OUTDOOR AREA DIAGRAM HOW AREA WILL BE PATROLLED •Rre.A 1 S SV Y r O(-)l )'0 i�_q- (1 _ot L\n A.n-' `\A, G., 0'..4 c\`ram S-- r:Ae pc��J0\ CS,r.c'\ Sect:�,-1.--\. • IF APPLICABLE,OUTDOOR AREA MUST BE CONNECTED TO INDOOR AREA IF INDOOR AREA IS TO LICENSED • MEASUREMENT OF OUTER WALLS OF AREA TO BE LICENSED MUST INCLUDED LENGTH& WIDTH IN FEET • DOUBLE FENCING IS REQUIRED FOR ALL NON-PROFIT ORGANIZATIONS UNLESS FORM I/140 IS FILED WITH THIS FORM AND IS APPROVED BY THE COMMISSION ' • RETAILER LIQUOR LICENSE HOLDERS ARE NOT REQUIRED TO DOUBLE FENCE,ALTHOUGH MEASURES NEED TO BE TAKEN TO SECURE THE AREA DIAGRAM OF PROPOSED AREA: 510' . L,�,c> - ''' . O . .`~�",,84. K ODIE KANGOoa1 �.10 ' 4 y r ` ..y- , 1 i 7 dig 'IS' e --L---Akii- - -. -.. e.--"--, ,,o, ,..,. , V 1 --------- . . _ t-c:FO: - . IA 880'I u �i .1'11;'1 _ =� Wi.,,,,..---. - . t, _,.. g `� � , ., • i o [\''�ma�x 7�Z. 4 5rr-cp < `k i V � - 4 . .. :BAC,Q. © \ ?I,- r E',Vr/ ..r.yea l . i r`o s .' s r/ -c�_c�z 3,��.,Ztiti�Lx,—,.1. t = �.-_,�2,z. C....,:,,,., ��..a..i ILo c..‹,.m ",.k,nor- -t e r ic. North Form 109 Rev Nov 2016 CITY OF OMAHA, Nebraska NO. R6536 THIS CERTIFICATE IS NOT TRANSFERABLE • • • NAME LOCATION SEPTEMBERFEST SALUTE TO LABOR CHI CENTER 6910 PACIFIC STREET SUITE 450 455 NORTH 10TH STREET LOT D OMAHA, NE 68106 OMAHA, NE 68102 • INSPECTOR# 1 SPECIAL DESIGNATED LIQUOR LICENSE-PUBLICATION FEE 0 0 0.00 0.00 2 SPECIAL DESIGNATED LIQUOR LICENSE-ORD 19 62 0 s 0 0.00 0.00 3 SPECIAL DESIGNATED LIQUOR LICENSE-OCCUPATION TAX 1 4 25.00 100.00 • TOTAL 100.00 EFFECTIVE DATE 2-Sep-22 EXPIRATION DATE 6-Sep-22 • PLACE IN A CONSPICUOUS PLACE . DIVISION .1).012flan BY a O- . City of Omaha Cashier := VAR Vi . 1819 Farnam St. + ' G, Omaha, NE 68183 6�$?d4� CHI CENTER • 455 NORTH 10TH STREET LOT D • OMAHA, NE 68102 4rF r i Autumn Drickey(CCIk)<autumn.drickey®cityofomaha.org> Septemberfest - Salute to Labor SDL - City Council Appearance Autumn Drickey(CCIk)<autumn.drickey@cityofomaha.org> Tue, Jul 19, 2022 at 11:24 AM To: Linda Morin <linda@laboromaha.org> Cc: "Carman Johnson (CCIk)"<Carman.Johnson@cityofomaha.org> Bcc: "Elizabeth Butler(CCIk)"<elizabeth.butler@cityofomaha.org>, "Kimberly Hoesing (CCIk)" <Kimberly.Hoesing@cityofomaha.org> We did receive receipt of payment for your SDL. We have scheduled you to appear before the City Council for approval of music after 11 p.m. on Tuesday, July 26th at 2 p.m. Your presence is required. You are able to appear either in person or via Zoom: https://cityclerk.cityofomaha.org/ Autumn Drickey Office Supervisor City of Omaha City Clerk's Office 1819 Farnam St Ste LC1 Omaha,NE 68183 Office: (402)111-5553 Fax: (402)1I11-5263 www.cityofomaha.org