Loading...
RES 2016-1071 - Appoint Jason M Smith manager of Hilton Garden Inn E-MAILED TO NLCC 7,-,2/7'6 \ 1 ! _ _ S iSPT. 1,v STATE OF NEBRASKA .*A4pq Pete Ricketts 2@lt J01 I NEBRASKA LIQUOR CONTROL COMMISSION Governor Hobert B.Rupe '4 4, Executive Df rector lh‘l/ecri 0'6." 301 Centennial Mall South.5th Floor MANAGER RECOMMENDATION PO Box 95046 Lincoln,Nebraska 68509-5046 Phone(402)471-2571 DATE: June 30,2016 Fax(402)471-2814 or(402)471 2374 TRS USER 800 833-7352(ITY) TO: Omaha City Clerk E-MAIL: carman.johnson@cit finfnahaArg Y°.- wev-zroareass http// vIcc ne.gov/ MANAGER: Jason M.Smith LICENSEE: Apple Ten Hospitality Management Inc. dba Hilton Garden Inn 1005 Dodge Street LICENSE#: 1-96280 DUE DATE: August 15, 2016 Attached is a copy of a new manager application submitted to Nebraska Liquor Control Commission. Please complete the following to submit your recommendation. Send back to Tracy Burmeister at tracy.burmeisterPnebraska.goY or fax to(402)471-2814,with questions call (402)471-2572. XAPPROVED NO LOCAL RECOMMENDATION DENIED COMMENTS: (N Ez_in 10 4- I (may attach minutes and/or additional notes) CLERKS SIGNATURE: DATE: 111111111111111111111111 1600012465 Janice M.Wiebusch Robert Batt Bruce Bailey Commissioner eha Commorzer An1.qcia,("pport ,tEtt'Emplover MANAGER APPLICATION Office Use INSERT-FORM 3c vo CEIVE NEBRASKA LIQUOR CONTROL COMMISSION 301 CEN I ENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 PHONE:(402)471-2571 ktm. rkt.„,„.". FAX:(402)471-2814 COMM S ' CONTR°Website: www.lcc.nebraska.gov FORM MUST BE COMPLETELY FILLED OUT IN ORDER FOR A":3Pf:Ikt4CL414T:IIOLINQ TO BE PROCESSED MANAGER MUST: ,,,,e( 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 elays in processing,this form MUST be included with your application. oreat 614,11-c, avoid Provide a copy of one of the following: US birth certificate, naturalization papers or current US passport(even if you have provided this before) , VBe 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 ,4 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 befbre) • 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 Form 103 REV MAR 2016 Page 1 of 6 • MANAGER APPLICATION 0111,c use INSERT-FORM 3c C MED NEBRASKA LIQUOR CONTROL COMMISSION 3 0 2.016 301 CENTENNIAL MALL SOUTH JUN PO BOX 95046 LINCOLN.NE 68509-5046 NEBRASKA LIQUOR PHONE:(402)471-2571 CONTROL COMMISSION FAX:(402)471-2814 Website: www lee.nebraska.g0s MUST BE: 1 Citizen of the United States, Include copy of US birth certificate. naturalization paper or current 1;S passport I Nebraska resident. Include copy of voter registration card or print out document from Secretor\ ot State website 1 Fingerprinted. See form 147 for further information, read form careful]) to avoid delays in processing,this form MUST be included with your application .1 21 years of age or older Apple Ten Hospitality Management, Inc. Name of Corporation/LLC: •• Liquor License Number: 96280 Class Type (if ne$1,.applmitiorl leme blank Premise Trade Narne/DBA: Hilton Garden Inn Premise Street Address: 1005 Dodge Street Omaha Douglas City: County: Zip Code:68102 Premise Phone Number: 402-341 -4400 Premise Email address: iason.smith©whitelodging.com 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 tir license information het David Buckley Vice President SIGNATURE EQIJIREI) BY CORPORATE OFFICER MANAGING MEMBER ;Faxed signatures are accer;able) ithm 'y 2 Last Name:Smith First Name:Jason - Home Address: 3310 S. 186th St. City:Omaha County: Douglas Zip Code:68130 RECEIVE Home Phone Number:847-778-8955 / NE Driver's License Number& State: JUN $0 A Social Security Number: NEBRASKA LIQUOR York Ccfdi'il§RS46°MMI • Date Of Birth Place Of Birth: jason.smith@whitelodging.com Email address: YES E]NO 1.7oNi '4;11. Spouses Last Name: First Name: MI: Social Security Number: • Driver's License Number& State: Date Of Birth: Place Of Birth: - , = YEAR YEAR CITY & STATE YEAR CITY & STATE YEAR 4 FROM TO FROM TO Omaha, NE 2015 present Wilmington, NC 2008 2011 Glenview, IL 2013 2015 Cary, NC 2006 2008 Chicago, IL 2013 2013 Northbrook, IL 2011 2012 Form 103 REV MAR 2016 Page 3 of 6 .:.,.mNAGEfes */-4„ IKOWqkg: YEAR NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE FROM TO NUMBER 8/2011 present White Lodging Services Hunter Carmichael 219-472-2900 11/2O0918/2011 The Generation Companies Rick Stroud 919-361-9000 I. 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. include traffic 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 dale of signing this application. YES NO az if yes, please explain below or attach a separate page. Date of I Where Description Name of Applicant I Conviction i Convicted of Disposition (min,> y) 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? [DYES 1NO IF YES, list the name of the premise(s): Hampton Inn & Suites Omaha 3. Do you. as a manager, qualify under Nebraska Liquor Control Act C3-1 3 1.01 ) and do you intend to supervise, in person. the management of the business'? . , 11111YES LINO 1 orn• 103 \R 2016 Parc 4 k,16 *VWBurmeister, Tracy C From: Jason Smith <jason.smith@whitelodging.com> Sent: Thursday,June 30, 2016 11:12 AM To: Burmeister, Tracy Subject: Re: Manager Application Hi Tracy, Thank you for being so helpful.Sorry for the inconvenience.The answer is(still)no. Thanks again! Jason M.Smith Dual General Manager Hampton Inn &Suites/Homewood Suites Omaha Downtown jason.smithc whitelodging.com On Jun 30, 2016, at 9:55 AM, Burmeister,Tracy<tracy.burmeister@nebraska.gov>wrote: Jason, I cannot process this manager application without question (1)one being answered. I have included this page for your convenience. You can print,answer and scan back to me, fax or plain old fashioned mail. I will not be able to begin processing until I have this information. I realize that this application was filled out less than a year ago and the answer was no but I just need you to tell me yes or no. You can even just email me back with a no or yes and I will process immediately. Thank-you for your prompt attention to this matter. Tracy Burmeister Licensing Division • 402-471-2571 <Scan-20 1 60630-091013-001.pd f} This email has been scanned for email related threats and delivered safely by Mirnecast. For more information please visit htto.//www.mimecast.com 4. List the alcohol related training and/or c perience(when and where) of the person making application. *NLCC Training Certificate Issued: _ Name on Certificate: Jason Smith Date Applicant Name 71Name of program (attach copy of course completion certificate) nunlvv‘v) Jason Smith ' 08/2015 eTIPS On Premise 2.0 ECEIVED JUN 3 0 2016 NEBRASKA LIQUO7 *For list of NEC('Certified Training Programs see 6 NTROL COMMISSlON Experience: Date of Applicant Name/Job Title Name & Location of Business: Employment: Hotel Management 2011-present White Lodging Services - company HQ in Indiana —I! 5. Have you enclosed rorin 47 regarding tingerprints? FYES VINO •• (\13-(/kri)6(4t. Ve--) 103 RrA MAR 2016 Pago of 0.,)lP i 4 tiR1'Rk 11 ,.. ..j' .'A'iWft`A 'Y*a 0VS,,"30*tj ',.I.1"'S T.V4'tt(:C i, ;a. .�,'i' .t 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. 9Z-v9-177 .4/. Signature of Manager Applicant Signature of S 013 laps 4 ACKNOWLEDGEMENT State of Nebraska{ � C C A County of ��UU { to The foregoing instrument was acknowledged before me this (11V k Jurd ZOI _ by J � ��' 1 SVO: i41 date NAME OF'PERSON BEING ACKNOWLEDGED AAA �{ 1 <u 1riticto- Affix Seal GENERAL NOTARY State of Nebraska ota Public signature ?" rY g KELLIE L CEDER My comm.Exp.Aptit 9,2019 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 MAR 2016 Page 6 of Apple Companies E D JUN ' 0.2016 NEBRAsKA LIQUOR June 24, 2016 CONTROL CMAMISSION — Nebraska Liquor Control Commission 301 Centennial Mall South P.O. Box 95046 Lincoln, NE 68509-5046 Re: Manager Change Application License#96280—Hilton Garden Inn Omaha Dear Sir or Madam: Enclosed is a completed Manager Application for the above hotel, along with supporting documentation. Please note that the new manager, Jason Smith, has previously submitted fingerprints to the Commission, in connection with the application for permit#104602 for the Homewood Suites Omaha, If is it necessary that he be fingerprinted again, please let me know. Thanks. Please contact me at 804-727-6414 with any questions. Very truly yours, &719/ Amy D. Kramer Senior Paralegal Enclosures cc: Jason Smith Apple REIT Companies 814 East Main Street • Richmond, Virginia 23219 • 804-344-8121 • 804-344-8129 Fax . ..., Certification Manager for TIPS Page 1 of 1 Print Main florin Do not click Back-Space to leave this window . ,..... 4. .0, ' ; a .4 ., .°-,4 , 4 1 , '4,- 4. , ,,,,f r, ',,,34g, ,, v :•,,,,,..f., ' 16.4,, to ' N r. ' , t, , t, , t ti) .. ,..„..., ..., r at 0 0111 et 1,t ,. ,„ .„, .., ... )6., This Certificate of Completion of ...- OW* . . nCtftNiso* eTIPS On Premise 2,0 For ct)ursewfok et)trft:)1eted 4)61 August 6,2015 , >gs provided by Health C4::intmtittications., Inc. 0%... .., , ...', - is hereby granted to: „.....-- , Jason smith >0: Certiftestion'to be sent to: >114 *imp ton inn&Suites,Omaha 1732 CAtmlna St we'll, Omaha NE',(411)14402 US A ,... l'SVP'- ''': :''''', 4 ..'' *, , , ' , ' J. ' : .A. .4., 'tr.'. ",:.P -',A-,11,,,v,°e,q ,,,,,,./cA• -4 '''''',„;::-.;,,.....,:.,,,,,4!„.„.:. ,',,,,, ,:.', ,., . A-.-,,i,,....:,„:,: •, „Nil.. fliiil'INIA:At:='„ '...,,..;. , ': !,' It . A A „.-, 11111011111 rt.A crtnrttiZt l'• IT)."OfIRC)JKSX4M-Ivr&TED... 8/6/2015 Cityof OmaFui, Nebraska OMAHA, 1819 Farnam — Suite LC 1 z9jitj Omaha, Nebraska 68183-0112 : '��� 4i' Buster Brown (402) 444-5550 ' �ti, City Clerk FAX (402) 444-5263 0� 944'0 FEBR3/.'4 July 12, 2016 Apple Ten Hospitality Management, Inc. Application to appoint Jason M. Smith Dba"Hilton Garden Inn" manager of your present Class "I" Liquor 1005 Dodge Street License location Omaha,NE 68102 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 July 26, 2016 . 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, dA0414 Buster Brown City Clerk BJB:clj City of Omalui, 9Vjbras a oMAHA, tp, �i a� fir¢ � 4� 1819 Farnam —Suite LC 1 z 'rifl�t. '?'-`rM Omaha, Nebraska 68183-0112 n WS*jtawzrirt Buster Brown (402) 444-5550 0� = ' ' ``� City Clerk FAX (402) 444-5263 op ' '9a ry 4 FEBO'- July 6, 2016 Jason M. Smith Application to be appointed manager of the 3310 South 186th Street present Class "I" License location for Apple Omaha, NE 68130 Ten Hospitality Management, Inc., dba"Hilton Garden Inn", 1005 Dodge Street 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 July 26, 2016 . 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, dehoo Buster Brown City Clerk BJB:clj • l✓ C:LjAt,S' No. /97/ Apple Ten Hospitality Management, Inc., dba "Hilton Garden Inn", 1005 Dodge Street, requests permission to appoint Jason M. Smith manager of their present Class I Liquor License location. 07-26-16;cj � RECEIVED Presented to Council: July 26, 2016 - A\Ww: Buster Brown City Clerk