RES 2016-0665 - Appoint William L McAlpin manager of Saints Pub + Patio Midtown Crossing imam.
E-MAILED TO NLCC :5-11 7/4,
,•r* '+ - * ''''%
STATE OF NEBRASKA
,,,'' "-. ,,----.. ..-.7•*4;
:4(11-1,-:,,,c i r' Pete Ricketts NEBRASKA LIQUOR CONTROL COMMISSION
"ir, ' 4,..: Governor Hobert B.Rope
41,,44 SI, 0 y
Executive Director
301 Centennial Mall Soutr& oor
. ,
MANAGER RECOMMENDATION P.O 95046
Lincoln.Nebraska 68509;5046
Phone(402)42,1-2571
DATE: March 31,2016 Fax(402)471-2814 or(402)471-2374
MS USER 800 833.7352(TM
web address http/Amu'lcc ne.govi .......i
TO: Omaha City Clerk E-MAIL: carman.iohnsonPcitvofomaha.org
MANAGER: McAlpin, William L .
-
r_•.,i
LICENSEE: Riley Drive Entertainment - 'clba Saints Pub& Patio Midtown Crossing
..- -..Located at 120 South 31st Street,Suite 5103 -
. .._
--r,,, ___
LICENSE#: IK-100687 --
,
DUE DATE: May 16th,2016
"4-:-
, r , f-r7
Attached is a copy of a new manager application submitted to Nebraska Liquor Control Comrsion..--7—
Please complete the following to submit your recommendation. Send back to Shannon Nyhoff at
Shannon.nvhoffPnebraska.gov or fax to(402)471-2814,with questions call (402)471-2572.
(( APPROVED
NO LOCAL RECOMMENDATION
DENIED
COMMENTS: (?Tj) )til 5 111A),.. /7 7 0
i
(may attach minutes and/or additional notes)
CLERKS SIGNATURE:
DATE: 57/r/aXi
Janice M.Wiebusch Robert Be I
'
1111111 -' 111 ley
1 e 7
Commissioner Chairman 1600000682
An Equal Opportunav Employer
MANAGER APPLICATION Of Use
INSERT-FORM 3c t`
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH - , ?0'
PO BOX 95046 b
LINCOLN,NE 68509-5046 4sLIQUOR
PRONE:(402)471-2571
FAX:(402)471-2814
Website: n.lce.ne.gov
Manager must:
• Complete all sections of the application. Be sure it is signed by a corporate officer,corporate officer
must be an individual on file with the Liquor Control Commission
• Fingerprints are required. See Form 147 for further information,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 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,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
Form 103
RFV JAN 2015
Page 1 or6
MANAGER APPLICATION OMNI* a
INSERT-FORM 3cIV k
NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH f r>
PO BOX 95046
LINCOLN,NE 68509-5046 NEBRASKA p" OR
PHONE.(402)471.2571
FAX:(402)471-2814 CONTPC11, CONAi 'S .
Webaite:www.lcc:.ne,gov
MUST BE:
✓ Citizen of the United States. Include copy of US birth certificate.naturalization paner or
current US passport
✓ Nebraska resident. jgcpdr 500v of voter repjstration in the State of Nebraska
✓ Fingerprinted. Sec Form 147 for further information,this form MUST be included with your
application.
✓ 21 years of age or older
Name of Corporation/LLC: ,\` D l V( gait "( I f r r- X 1
Liquor License Number: 1 tJ 0 (-MS—1 Class T K
Type_ (if new Rave blank)
Premise Trade Name/DEA:, 6I 11 P .1 i- Pali
Premise Street Address: 12-l.! � v
City. OrnalV County: u&1 C 3 Zip Code: 131
Premise Phone Number: q ~l '. 7
Email address: s a nde S 0 f 6? 1 coon
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, Click on this link to see authorized individuals.
httpa/www.jvc.ne.tovf' $p11e sea obilicaenrch.cmi
r _
SIGNATURE REQUIRED`BY CORPORATE4F 'T J MANAGING.ME ER
(Faxed signatures are acceptable)
FOUR 103
REV JAN 2013
Page 2 orb
444
Last Name: f111(..-A ip First Name: L. rh. MI: L
Home Address(include PO Box if applicable): tor)3 t.Je., S .
City: 0,4 1,4 County: Zip Code: 6gigt
Home Phone Number: qi3 - 74) - 2.8.03 Business Phone Number: 4.-/ 5;•ti, e z q7
Social Security Number: - Drivers License Number& State: 4/1
Date Of Birth: Place Of Birth: Re.t.1
Email address: /0-1c 4 9-,.1e,dr,'ve Cd-rt.
EYES ENO
Spouses Last Name: pt.'n First Name: Tcty 0
Social Security Number: Drivers License Number&State: _ _ /11
Date Of Birth: Z. Place Of Birth:
+.17
dM
YEAR YEAR. YEAR YEAR CITY&STATE CITY & STATE
FROM TO FROM TO
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11 ei 0 /4 4
2,ccr rsoi‘j
PI,ce 4 t 9\004 .200 ‘Al\ \
Form 103
REV JAN 2015
Page 3 of 6
'
YEAR OM TO
NAME OF EMPLOYER NAME OF SUPERVISOR TELEPHONE
FR NUMBER
20 ILI - # 4S P, 4 P4'4 SC014* AiderS0,1 84- 879 - 706.7
zoo 2_014 333- /03/
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 au charge alleging a felony,misdemeanor,violation of a federal or state law;actittliettDRAM41.4aw,
ordinance or resolution. List the nature of the charge, where the charge occurred and the 'afttl-rfientlr igf the
conviction or plea. Also list any charges pending at the time of this application. If more than one party, please list
charges by each individual's name.
MAR 3 I 2016
Err YES Ei NO NEBRAiiic LIQUOR
CONTROL COMMISSION
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
{Lea 6'4 4(
/111(..Alpii," /2.1.2003 /4 e
slutd A/at-4)014's
11.d, 941-004 AA". Preniass Pnia
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2. Have you or your spouse ever been approved or made application for a liquor license in Nebraska or
any other state?
RYES
IF YES, list the name of the premise(s):
3. Do you. as a manager, qualify under Nebraska Liquor Control Act(§53-I31.01) and do you intend to
supervise, in person,the management of the business?
1E(ES ONO
Form 103
REV JAN 2015
Page 4 of 6
4. List the alcohol related training and/or experience(when and where)of the person making application.
lis
*NLCC Training Certificate Issued: Name on Certificate: kA1,I a-rtn L.0-0 Cl 0 n
(Y1C.,POW\
Date
Applicant Name Name of program(attach copy of course completion certificate)
(mm/YYYY)
U\s) \ a (\kW p tt, t KtbST
N akP4Kik rl
OKTROL COMMiSS1°N
*For list of NLCC Certified Training Programs see www.lcc.ne.gov/traininainli).htnil
Experience:
Applicant Name/Job Title Date ofName&Location of Business:
Employment:
5. Have you enclosed Form 147 regarding fingerprints?
KYES FINO
Form 103
REV JAN 2015
Page 5 of 6
REc ivEs
MAR 8 I 2016
NeGRASKA LIQUOR
CONTROL COMMISSION
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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 §53-13L01)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.
41-SC"C .c o(Asa I
Signature Manager Applicant gnature of Spouse
ACKNOWLEDGEMENT
State of Ne(raska
County of Da( ,(i k as The foregoing instrument was acknowledged before me this
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Mc.k1 1:
date name of person eknowledged
Affix Seal ,r GENERAL NOTARY-State of Nebraska
No Public signature NK OLE R.CONNER
s...S,.'"Ve kem Corn, Exp.Sept.18,2017
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 2015
Page 6 of 6
form
Office Use
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SPOUSAL AFFIDAVIT OF
NON PARTICIPATION INSERT tior
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NEBRASKA LIQUOR CONTROL COMMISSION
301 CENTENNIAL MALL SOUTH '1
PI)BOX 95046
LINCOLN.NE 68509-5046
PI IONE•(402)471-2571
FAX (402)471-2814
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date
Affix Seal ass&NOTARY•St&of f"let"3/2
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. acknowledge di . 0 sotti.„,,,, ,:--
compliance withco
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S ignature of individual involved with application Printed name of applying individual
(Spouse of individual listed above)
State of h. t\9 r a.5 V-0\
County ofA I
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The foregoing instrumentua was acknowledged beefore mei
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Affix Seal
name of person acNkarnopAwyled.
o ry b ic si ure GENERAL
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FORM 35-4178
ith the ADA,this spoulsna
l affidavitto of non
ij Xn ten dav advance period is requestedathrteicalipaterntioanteisfavailable in other formats for persons with disabilities
Revised 1/2008
writingproduce')
•
SUBMISSSION OF FINGERPRINTS
PAYMENT OF FEES TO NSP-CID
NEBRASKA LIQUOR CONTROL COMMISSION 4 261'
301 CENTENNIAL MALL SOUTH
PO BOX 95046 PA$Kit,
LINCOLN,NE 68509-5046 CONTROL cOMMis .
PHONE: (402)471-2571 Office Use Only
FAX: (402)471-2814
\k-
Class: License#:'st .lcc..nebraska.gov
Applicant Nam._ \ rif \ W:NtA X \ /
LL
(Corporation.LLC,Pa nership or Individual)
I rade Name: UI VCt
Ck VA (--; La/2 PCkti (3 a \
(Doing Business As)
I CA C<C(-X t1/4 \C(SA(SC-1 V 1 LS Ci
Phone Number Contact E-mail Address
(CT\A
DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS:
• See Application Requirement Guide for listing of Fingerprint Requirements, found on our website under
"Licensing"tab in"Guidelines/Brochures". FAILURE TO FILE FINGERPRINT CARDS AND PAY
THE REQUIRED PROCESSING FEE TO THE NEBRASKA STATE PATROL WILL DELAY
THE ISSUANCE OF YOUR LIQUOR LICENSE.
• This completed form MUST be included with your Liquor License Application and/or Manager
Application or changes to: Corporate Officers or Stockholders, LLC Members, Partners or Addition of
Spouse where new fingerprint cards are required(see New Application Requirement Guide).
• DO NOT send fee payments to the NLCC—fees MUST be paid directly to NSP;
Include a list of names covered by your payment to insure proper application of payment.
• Fee payment of S28.75 per person must be made directly to the NSP;
It is recommended to make payment through the NSP PayPort online system at www igoinsp
Or checks made payable to NSP should be mailed directly to the following address:
The Nebraska State Patrol—CID Division
3800 NW 12th Street
Lincoln,NE 68521
• Fingerprints are not required for spouses that have no involvement with business- Spousal Affidavit of
Non Participation(Form 11 6) is required in lieu of fingerprints.
• Fingerprints taken at NSP 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 will be released to the applicants;
Fingerprint cards should be submitted with the application.
Please complete information on the following pages for EACH person fingerprinted.
FORM 147
REV MAR 2016
PAGE 1
I. Name: V\J \ CM\ 1\441\-LM t
(Please print legibly)
Date of Birth: _ Last 4 SSN:
ry f
How was payment made to NSP? ONSP PAYPORT Or ' 4,.....91ECK SENT TO NSP Ck# 3 p• s)
2. Name:
(Please print legibly)
Date of Birth: Last 4 SSN:
How was payment made to NSP? CINSP PAYPORT Or OCHECK SENT TO NSP Ck#
3. Name:
(Please print legibly)
Date of Birth: Last 4 SSN:
How was payment made to NSP? 0 NSP PAYPORT Or OCHECK SEN TL
S 2
4. Name:
(Please print legibly) NEBF*ASKA Lia,i0
Date of Birth: Last 4 SSN: COrii IVA t,ssc
4,
'4,titD1.„„NS
How was payment made to NSP? ONSP PAYPORT Or OCHECK 10 ?Ck#
5. Name:
(Please print legibly)
Date of Birth: Last 4 SSN:
How was payment made to NSP? ONSP PAYPORT Or 0 CHECK SENT TO NSP Ck#
6. Name:
(Please print legibly)
Date of Birth: Last 4 SSN:
How was payment made to NSP? ONSP PAYPORT Or OCHECK SENT TO NSP Ck#
I hereby certify that fees of$28.75 per person have been submitted directly to the Nebraska State Patrol—CID office.
The undersigned certifies on behalf of the Corporation,LLC,Partnership or Licensee that it is understood that a
misrepresentation of fact is cause for rejection of this application or suspension,cancellation or revocation of any license
issued.
Name(Print): A r\P
!\(... I ?( Title: I ps I 41/44(.4.41
ak t/Y
Date: 7 2
FORM 147
REV MAR 2015
PAGE 2
i of Omaha Nebraska oMAHA N
1819 Farnam — Suite LC 1 � « t
Omaha, Nebraska 681 83-01 1 2 cIV. �. '1 '�1
Buster Brown (402) 444-5550 o �L _ `` `"' CCI
City Clerk FAX (402) 444-5263 4 g�
dT4D FEBRU'
May 3, 2016
Riley Drive Entertainment XI, LLC Application to appoint William L. McAlpin
Dba"Saints Pub—Patio Midtown Crossing" manager of your present Class "I" and
120 South 31St Avenue, Suite 5103 Catering Liquor License location
Omaha, NE 68131
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 May 17, 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.
Sincer y yours,
Buster Brown
City Clerk
BJB:clj
City of OmaFuz, Nebraska
pMAHA, N
6
1819 Farnam — Suite LC 1 z
Omaha, Nebraska 681 83-01 1 2 ��lilei,14•‘40=0r'i
i1 j
�! 4N�. coBuster Brown 4 ,
(402) 444-5550 �4 . __�` r
•
City Clerk FAX (402) 444-5263 o �"'= ��
FD FEBOt.'
May 3, 2016
William L. McAlpin Applications to be appointed manager
11003 Weber Street (SEE ATTACHED)
Omaha, NE 68142
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 May 17, 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,
Buster Brown
City Clerk
BJB:clj
CLASS "I" AND CATERING LIQUOR LICENSE
RILEY DRIVE ENTERTAINMENT XI, LLC 120 SOUTH 31ST AVENUE, SUITE 5103
DBA SAINTS PUB + PATIO MIDTOWN CROSSING
CLASS "I" LIQUOR LICENSE
RILEY DRIVE ENTERTAINMENT XVII, LLC 4915 NORTH 120TH STREET, SUITE 1
DBA SAINTS PUB ROANOKE
zr,
No.
Riley Drive Entertainment XI, LLC, dba
"Saints Pub + Patio Midtown Crossing", 120
South 31 St Avenue, Suite 5103, requests
permission to appoint William L. McAlpin
manager of their present Class "I" and Catering
Liquor License location.
05-17-16;cj
RECEIVED
Presented to Council:
Ma 17, 2016/_; proved
Buster Brown
City Clerk