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RES 2018-1072 - Sheraton Omaha appoints Kenneth R Gantz manager 7OF�ti�e.sr,T£ E-MAILED TO NLCC I I STATE OF NEBRASKA s<. • - �1,a Pete Ricketts y,M;o'-' �� �.'g NEBRASKA LIQUOR CONTROL COMMISSION a 5. .t.:«. .Ar> Governor k°� � " i ��� Hobert B.Rupe ' Executive Director °rt •Ise e'+` 301 Centennial Mall South,5`,Floor P.O.Box 95046 Lincoln,Nebraska 68509-5046 Phone(402)471-2571 Fax(402)471-2814 or(402)471-2374 OCTTRS USER 800 833-7352(TTY) O 18'18 fii'11O:44 web address http://www.lcc.nebraska.gov/ City Clerk Omaha NE-RC CID October 17, 2018 To: CITY CLERK OF OMAHA Email: CARMAN.JOHNSON@CITYOFOMAHA.ORG Manager Name: KENNETH GANTZ • Licensee Name: SUMMIT HOTELS LLC Licensee Trade Name (DBA): SHERATON OMAHA License Number: C - 122332 Date Due: , Dec 6,08t t 1, dal V e I have attached a copy of a new corporate manager application that was submitted to the Nebraska Liquor Control .Commission. Please complete_ the following information below to indicate your recommendation. Send back to Kim Frederick at kim.frederick annebraska.gov or fax to (402) 471- 2814. If you have questions concerning this matter, please contact our office at (402) 471-2573. APPROVED NO LOCAL RECOMMENDATION DENIED COMME TS: (YOU MAY ATTACH MINUTES AND/OR ADDITIONAL NOTES) . 3_ 1 es 1V120 �e lti► t� � Y Clerk Signature: kirk �t Date: )J)2i/1 0 KMF • Janice M.Wiebusch Robert Batt Bruce Bailey Commissioner Chairman Commissioner An Equal Oppornmily Employer MANAGER APPLICATION mono RECEIVED INSERT-FORM 30 NEBRASKA LIQUOR CONTROL COMMISSION i i N 1 c 2 013 301 CENIENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NB 61509-5046 NEBRASKA LIQUOR PHONE:(402)471 2571 PAX(402)4712i14 CONTROL COMMIS-NON N Website www.leamebras&a.gov fVIUST BE: ✓ Citizen of the United States. Include copy of US_birth certifioatetnetymlizatiotl paper or currant US D I Nebraska resident. Include copy ofvoter reftdatratton card or print out document tkom Secretary or §tate website I Fingerprinted. See form 147 for Rather Information,read form carefully to avoid delays in processing,this form MUST be included with your application ✓ 21 years of age or older Name of Corporation/LLC: lsvwvn t+ F+o g L-LC. I:�s'•fCi4kiy1..., on :�,T;; FAW4i11; :,k>. .;,,' .. •",:: :," 1r Liquor License Number: 122 33 2 Class Typo C a re.wippuuflon taw wm1 Premise Trade Name/DBA: L St,Qom' v, 0 v„„,•t,..M Premise Street Address: Co S 5 1J 10(0 k.C'•- City: Q Ana.(eNN. County: lnr DU%5 Zip Code: (9`b 15 y Premise Phone Number. 14°Z 416 0 2$50 Premise Email address: ICgc - t 0 $t'o^A.,"ow.o•. . t.,9 vr1 The Individual whose name Is fisted as a corporate officer or managing member as reported on insert form 3a or 3b or listed with the Commission. To see authorized offlears or members scarab your license Information <<: IIK SIGN. . t °+ '4'QUI RED B1;CORPORATE pRFIC.PR I MANAGING MEMBER (Faxed signatures are acceptable) I Form 103 i RevJan1016 i Pogo 3 06 . 1 • . • MANAGER APPLICATION office use INSERT-FORM 3c NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 IN,. FAX:(402)471-2814 Website:www.lcc.nebraska.gov MUST BE: ✓ Citizen of the United States. Include copy of US bird f\ • CQ passport V ✓ Nebraska resident. Include copy of voter registration State website \, I Fingerprinted. See form 147 for further information,rl processing,this form MUST be included with your app ✓ 21 years of age or older Cop�tion/LLC inform _ ,. ,� Name of Corporation/LLC: cj�w►M.�- V42) lLC. �,x s �� �^��rr rA��-� ... �a ��.r„�,-'� �. ��'�......_....r=� .:�'�.».-_._. :.F(e c , ,�v_� �c.ii .t�f,.,��C�'r� Liquor License Number: 1223 3 2. Class Type C. (if new application leave blank) Premise Trade Name/DBA: S teraA-o Ow ii,o‘ Premise Street Address: (a55 N 1615 Ave City: (j onaiAel, County: 0r," l�.g Zip Code: (ora i 4 Premise Phone Number: '1 o 2. Yet b 0 Premise Email address: 149�,4-Z Q g�v�.'�vr��,w�o.�►. L>a+�n The individual whose name is listed as a corporate officer or managing member as reported on insert form 3a or 3b or listed with the Commission. To see authorized officers or members search your license information her . SIGNAT REQ D BY CORPORATE OFFICER/MA.NAGING.mEMBER (Faxed signatures are acceptable) Form 103 Rev Jan 2018 Page 2 of 6 MANAGER APPLICATION Office Use INSERT-FORM 3c RECEIVED NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH J U N 19 2013 PO BOX 95046 LINCOLN,NE 68509-5046 • PHONE:(402)471-2571 NEBRASKA LIQUOR FAX:(402)471-2814 CONTROL COMMISSION Website:www.lcc.nebraska.gov FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR APPLICATION TO BE PROCESSED MANAGER MUST: • • Complete all sections of the application. Be sure it is signed by a member or corporate officer, corporate officer or member must be an individual on file with the Liquor Control Commission • Fingerprints are required. See form 147 for further information,read form carefully to avoid delays in processing,this form MUST be included'with your application. • Provide a copy of one of the following: US birth certificate,naturalization papers or current US passport(even if you have provided this before) • Be a registered voter in the State of Nebraska,include a copy of voter card or print document from Secretary of State website with application Spouse who will not participate in the business,spouse must: • Complete the Spousal Affidavit of Non Participation Insert(must be notarized). The non- participating spouse completes the top half; the manager completes the bottom half. Be sure to complete both halves of this form. • Need not answer question#1 of the application • Spouse who will participate in the business,the spouse must: • Sign the application • Fingerprints are required. See form 147 for further information, read form carefully to avoid delays in processing,this form MUST be included with your application. • Provide a copy of one of the following:birth certificate,naturalization papers or current US passport (even if you have provided this before) • Be a registered voter in the state of Nebraska, include a copy of voter card with application • Spousal Affidavit of Non Participation Insert not required [ARC()DE Form 103 • Rev Ian 2018 Page I of 6 Managei's;r Inforatli mast be completed,below x PLEASE PftINTCLEARLY , 'z { Last Name: GAS}z First Name: 14e—vwv% MI: Q. Home Address: 112.21 Fra....\t y' Plato, 4 ttQ 23 City: 0 rya ko. • County: f i3• Zip Code: (o t S'l Home Phone Number: H 01 (e 515 1106 Driver's License Number&State: Social Security Number: _ _ _ _ Date Of Birth: Place Of Birth: Ods , IuE Email address: k c r,#z ca% e w►c� /. � � r' 1 R et spotts�� nf�xm .yeilif ,'tp©usaI Bff iit.' �*10m tted) =k`h. ❑YES KNO Spouses Last Name: First Name: MI: Social Security Number: Driver's License Number&State: Date Of Birth: Place Of Birth: `APPLICANT&S'13Ir.SERMU.ST LIST 40X* §Ytft R tit PAST TEN(10)r AI�S'� 7 x h APPLICA � � �, � SPOUSE , { Y CITY& STATE YEAR YEAR CITY&STATE YEAR YEAR FROM TO FROM TO Form 103 Rev Jan 2018 Page 3 of 6 r d ? .1T,1 Jaya, M7\77r r � � giy , .: 1V1fAlYAGER yL 'lO EMPLOYER 4 f 1 YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE 7 FROM TO NUMBER • t°t% Zo► Two e.. tk.Aknvt qO z 59$ 41542 zo►, 2.0 —rAtiv x4A GAP C,L\O J'aSe►n Gv.440-"Fc4.0x yoz Ztto 1.41 1. READ CAREFULLY. ANSWER COMPLETELY AND ACCURATELY. Must be completed by both applicant and spouse, unless spouse has filed an affidavit of non- participation. Has anyone who is a party to this application,or their spouse, EVER been convicted of or plead guilty to any charge. Charge means any charge alleging a felony,misdemeanor,violation of a federal or state law;a violation of a local law, ordinance or resolution. List the nature of the charge, where the charge occurred and the year and month of the conviction or plea,includetraffic violations. Also list any charges pending at the time of this application. If more than one party, please list charges by each individual's name. Commission must be notified of any arrests and/or convictions that may occur after the date of signing this application. ❑ YES g NO If yes,please explain below or attach a separate page. Date of Where Description Name of Applicant Conviction Convicted of Disposition (mm/yyyy) (City&State) Charge 2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or any other state? 1YES ONO IF YES,list the name of the premise(s): 44tvkc .o. P(c -a 332t 2 12'^` 9k (2)tevvolv.,, LiF Co'b►L'4 3. Do you, as a manager, qualify under Nebraska Liquor Control Act($53-131.01) and do you intend to supervise, in person,the management of the business? YES ONO Form 103 Rev Jan 2018 Page 4 of 6 4. List the alcohol related training and/or experience(when and where)of the person making application. *NLCC Training Certificate Issued:i;p S Name.on Certificate: 3/1(ot to Applicant Name ( ayYyy) Name of program(attach copy of course completion certificate) hYt 03/zo,2c+Aq T.?S GAw,(r • *For list of NLCC Certified Training Programs see training Experience: Applicant Name/Job Title Date of Name&Location of Business: Employment: t _ oVA -es/ks � • l(e>^ G��+z 6er Ma _r �;bve�. G(+i 1�v. (,c.�4t Ibem K6 03/I10 -03/,-� Abvtens Cagier �v, kg/met -o3/lb 9sc. 14, pu,2x„ O on(,b,o. Vol GA 5. Have you enclosed form 147 regarding fingerprints? YES ONO Form 103 Rev Jan 2018 Page 5 of 6 SSN: X)0(XX-I000( :. Issued: 3/16/2016 Expires: 3/2/2019 M 4207539 D.O.B.: xxnanW0( KENNETH R GANTZ •:2200 River Rd Council Bluffs, IA 51501-7070 For service visit us Online at www.gettips.com Terre Gasman,38327 M .. r c ,y. • • HEALTH 4 1400 Key BIv4•y Suite 700 • • Arlington.VA 22209 , . • 703-524-1210 • www.gettips.com 7lits card was i syed fix:nrcce lion of the riPS fecor • '•F!Pat', .,Y•t z r t2 4 y_N The above individual(s), being first duly sworn upon oath, deposes and states that the undersigned is'the applicant and/or spouse of applicant who makes the above and foregoing application that said application has been read and that the contents thereof and all statements contained therein are true: If any false statement is made in any part of this application, the applicant(s).shall be deemed guilty of perjury and subject to penalties provided by law. (Sec$53-131.01)Nebraska Liquor Control Act. The undersigned applicant hereby consents to an investigation of his/her background including all records of every kind and description including police records, tax records (State and Federal), and bank or lending institution records, and said applicant and spouse waive any rights or_causes of action that said applicant or spouse may have against the Nebraska Liquor Control Commission and any other individual disclosing or releasing said information to the Nebraska Liquor Control Commission. If spouse has NO interest directly or indirectly, a spousal affidavit of non-participation may be attached. The undersigned understand and acknowledge that any license issued,based on the information submitted in this application, is subject to cancellation if the information contained.herein is incomplete, inaccurate, or fraudulent. Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history records of the FBI. You have the opportunity to complete or challenge the accuracy of the information contained in FBI identification record. The procedures for obtaining a change, correction, or updating an FBI identificat' n r cord are set forth in Title 28, CFR, 16.34. ignature of Manager Applicant Signature of Spouse ACKNOWLEDGEMENT State of Nebraska w County of t +� L The foregoing instrument was acknowledged before me this _ `� by /Il9Ne date NAME OF PERSON BEING ACIINOWLEDGED Affix Seal ; No 1c gnature DANIEL N FITZPATRICI STATE OF NEBRASKA GENERAL NOTARY NMY COMM15SiflN EXPIRFS FEBRUARY-13,2020 In compliance with the ADA,this application is available in other formats for persons with disabilities. A ten day advance period is required in writing to produce the alternate format. Form 103 Rev Jan 2018 Page 6 of 6 1.1 *AV ArdesiltiyAreg7,i PRIVACY ACT STATEMENT/ # SUBMISSION OF FINGERPRINTS/ i RECEIVED PAYMENT OF FEES TO NSP-CID JUN 1 9 2018. NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH NEBRASKA LIQUOR PO BOX 95046 C ' ISION LINCOLN,NE 68509-5046 PHONE: (402)471-2571 FAX: (402)471-2814 Website: www.lcc.nebraska.gov THIS FORM IS REQUIRED TO BE SIGNED BY EACH PERSON BEING FINGERPRINTED: DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS: • FAILURE TO FILE FINGERPRINT CARDS AND PAY THE REQUIRED FEE TO THE NEBRASKA STATE PATROL WILL DELAY THE ISSUANCE OF YOUR LIQUOR LICENSE • Fee payment of$45.25 per person MUST be made DIRECTLY to the Nebraska State Patrol; It is recommended to make payment through the NSP PayPort online system at www.ne.gov/go/rise Or a check made payable to NSP can be mailed directly to the following address: ***Please indicate on your payment who the payment is for(the name of the person being fingerprinted)and the payment is for a Liquor License*** The Nebraska State Patrol—CID Division 3800 NW 12th Street • Lincoln,NE 68521 • Fingerprints taken at NSP LIVESCAN locations will be forwarded to NSP—CID Applicant(s)will not have cards to include with license application. • Fingerprints taken at local law enforcement offices may be released to the applicants; Fingerprint cards should be submitted with the application. Applicant Notification and Record Challenge: Your fingerprints will be used to check the criminal history records of the FBI. You have the opportunity to complete or challenge the accuracy of the information contained in FBI identification record. The procedures for obtaining a change, correction, or updating a FBI identification record are set forth in Title 28, CFR, 16.34. Trade Name: Su•vol t+ k Li Io u s►►.e 55 A s S 1^e�, 0 0 i "A Name of Person Bring Fingerprinted: ILehr.c . Date of Birth: . _ „ Last 4 SSN: _ Date fingerprints were taken: Location where fingerprints were taken: tJ exo Y7.43 c SVt-. c J Y-4 Tr? H w was payment made to NSP? NSP PAYPORT 0 CASH El CHECK SENT TO NSP CK# My fingerprints are already on file with the commission—fingerprints completed for a previous application less than 2 years ago? YES 0 SIGN REQUIRED OF PERSON BEING FINGERPRINTED FORM 147 REV MAY 2018 6/1/2018 Point-m-uene rayments NEBRASKA.GOV PURCHASE RECEIPT Nebraska State Patrol-Criminal Identification Division 3800 NW 12th Street,Suite A Uncoin NE 68521 ` (402)479-4037 miranda.erick@nebraska.gov OTC Local Ref ID: 25939114 THANK YOU FOR USING THE NEBRASKA STATE PATROL PAYPORT SERVICE Status: APPROVED Customer Name: Jatin Batra Type: Visa Credit Card Number: **** **** **** i, Total Amount Charged USD$46.38 Items Location Quantity TPE Order Total ID Amount Liquor Ucense 1 29957906 $45.25 Applicant Name: Kenneth Gantz Date of Birth: -_ _ Last four digits Soc. Security Number: Total remitted to the Nebraska State Patrol - Criminal $45.25 Identification Division https//atc.cdc.nicusa.com/PublicReceipt.aspx?src=csh 1/t Cityof Omaha, Wth'ras&a HA , .� ra� 1819 Farnam—Suite LC 1 � �'' 'k :i��iti`� tat t, Omaha, Nebraska 681 83-01 1 2 1�'^ Elizabeth Butler (402) 444-5550 ,j6,,�` � City Clerk FAX (402) 444-5263 o•P �' TEDFE11 November 6, 2018 Summit Hotels, LLC Application to appoint Kenneth R. Gantz Dba"Sheraton Omaha". manager of your present Class "C"Liquor 655 North 108th Avenue License location Omaha,NE 68154 Dear Liquor License Applicant: • This letter is notification that a hearing before the Omaha City Council on your application to appoint a manager to the liquor license has been set for November 20, 2018 . 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 or his/her representative 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, Elizabeth Butler City Clerk EB:clj Cityo OmahaWebras&a o4) mpow4-, Net, 1819 Farnam —Suite LC 1 Omaha, Nebraska 681 83-01 1 2 ngr r* l '^ O r�. .c:gaza<'±r; :'fi ,�, Elizabeth Butler (402) 444-5550 City Clerk FAX (402) 444-5263 u 9TE13 FEB1‘3A November 6, 2018 Kenneth R. Gantz Application to be appointed manager of the present 11227 Franklin Plaza#1623 Class"C"Liquor License location for Summitt Omaha,NE 68154 Hotels, LLC, dba"Sheraton Omaha", 655 North 108th Avenue Dear Liquor License Manager Applicant: This letter is notification that a hearing before the Omaha City Council on your application to be appointed manager of the liquor license has been set for November 20, 2018 . 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 or his/her representative 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, Elizabeth Butler City Clerk EB:clj