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RES 2015-1597 - Appoint Michael J Staton manager of Omaha Marriott Hotel E-MAILED TO NLCC sx `sr42,l :$1:0"1/4 «:+ `" STATE Gpete overnor MANAGER RE 4WENDATtt►I I s s + Hoot Po*. ramD Naver»bert},2015 �: 301 Cennia4 $o ,5t#i P.O Box 95046 Uncolnt"aka 685090 TO: Omaha City Clerk EMAIL: carman ohnsonCr cit afom a, "Phme 4°2)471 611 -402 474,2814°err(40 �47 -2374 MISUSER WO0317352 frrY) web address:bttp://wwwicc.oe.00vi MANAGER: Stators;Michael J LICENSEE: HNC TRS LC Portfolio LLC,dba Omaha Marriott Hotel LICENSE#: Class CK—065810 c � ,.. DUE DATE: January 5,2016 r,z Ism " Attached Is a copy of a new manager application submitted to Nebraska Liquor Controbacommissickii ri? Please complete the following to submit your recommendation, Send back to Shanno '"Nyhoff at%) r-- , Shannon.nvhoffC nebraska.gov or fax to(402)471-2814,with questions call(402)471-2572. Ivo APPROVED CCID#1597 DECEMBER 22, 2015 NO LOCAL RECOMMENDATION DENIED • COMMENTS: (may attach minutes and/or additional notes) CLERKS SIGNATURE: 7.447L— DATE: 49.,//3// Janice M.Wlebusch Robert Batt Wes*Bogey Commissioner Chairman Convns&fsfiorrer_ An Equal Opportunity Employer 4 nr-f � MANAGER APPLICATION Office Use INSERT-FORM 3c CEIV NEBRASKA LIQUOR CONTROL COMMISSION NOV 0 3 2015 301 CENTENNIAL MALL SOUTH PO BOX 95046 Ez RAS LIQUOR LINCOLN,NE 68509-5046 PHONE(402)471-2571 CON iPOL COM ISSION FAX:(402)471-2814 Website:www.lcc.nebraska.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 REV JUNE 2015 Pagel of 6 MANAGER APPLICATION Office Use INSERT-FORM 3c C al NEBRASKA LIQUOR CONTROL COMMISSION NOV 0 3 a015 301 CENTENNIAL MALL SOUTH PO BOX 95046 LTNCOLN,NE 68509-5046 RAS A� LIQUOR PHONE:(402)471-2571 CONTROL COMMISSION FAX:(402)471-2814 Website:wwwJcc.nebraska.gov MUST BE: ✓ Citizen of the United States. Include copy of US birth certificate,naturalization paper or current US nassport ✓ Nebraska resident. Include copy of voter registration in the State of Nebraska ✓ Fingerprinted. See Form 147 for further information,this form MUST be included with your application. ✓ 21 years of age or older -) • Name of Corporation/LLC:HHC TRS LC Portfolio LLC 065810 Liquor License Number: Class Type C K {if new application leave blank) Premise Trade Name/DBA:Omaha Marriott Hotel Premise Street Address: 10220 Regency Circle City:Omaha County:Douglas Zip Code:68114 Premise Phone Number:402-399-9000 Email addres : isasalts@remingtonhotels.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. Click on this link to see authorized individuals. http;//www.lcc.ne.govflicense search/tiesearch.cgi SIGNATURED OFFICER/ MANAGING ME I a� ' Deric Eubanks, President (Faxed signatures are acceptable) 1500025222 Form 103 REV JUNE 2015 Page 2 of 6 LastName:Staton First Name:Michael MI:''I' Home Address(include PO Box if applicable):9473 Spencer Street Omaha Douglas 68134 City: County: Zip Code: Home Phone Number:4©2-312-3572 Business Phone Number:402-399-9000 Social Security Number. Drivers License Number&State: NE ° Date Of Birth: Place Of Birth:Omaha, NE Email address:mike.staton@marriott.com IN YES I—I NO 't r ems,a ' ' w "-'S`i it yaps F q Spouses Last Name:Staton First Name: Danielle MI:M. Social Security Number: Drivers License Number& State: /NE Date Of Birth: Place Of Birth:Omaha, NE 'i= '' ' — t.,^h ei' a . ° ' �`*. _., g "af ' zr .^..�a. n. ..._ .`tea ��+ �* ,r � �': .. � � •� '-�„ .�. ii , . ' ,. .,o-� mil ' . YEAR YEAR YEAR YEAR CITY& STATE FROM TO CITY & STATE FROM TO Omaha, NE 2006 current Omaha, NE 2006 current Omaha, NE 1995 2006 Omaha, NE 1995 2006 IVED 2 15 EBRASKA LIQUOR Farm 103 CONTROL CO LS Page 332of6�s YEAR NAME OF EMPLOYER NAME OF SUPERVISOR FROM TO NUMBERTELEPHONE 1999 current Omaha Marriott Mike Rice 402-399-9000 1998 1999 Spanna Terry 402-493-7606 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 occurni,, month of the conviction or plea. Also list any charges pending at the time of this application. oifTrty, please list charges by each individual's name. NOV 0 3 2015 E YES E NO rsleBRASKA LIQUOR If yes,please explain below or attach a separate page. CONTROL COMMISSION 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? OYES •NO IF YES, list the name of the premise(s): 3. Do you, as a manager, qualify under Nebraska Liquor Control Act ( 53131.01) and do you intend to supervise, in person, the management of the business? [DYES ONO Form 103 REV JUNE 2015 Page 4 of 6 4. List the alcohol related training and/or experience(when and where)of the person making application. None *NLCC Training Certificate Issued: ns-v Name on Certificate: KV 6%0%,AlkTSfvev-""-\ Date Applicant Name (nim/YYYY) Name of program(attach copy of course completion certificate) cit,4v 10 KB*S-1-- AA setvie I iga.cic. -xs *For list of NLCC Certified Training Programs see wwwiceme.govitraininginfo.hunt Experience: Applicant Name/Job Title Date ofName&Location of Business: Employment: Michael Staton/F&B Director 05/99-Present Omaha Marriott 10220 Regency Circle,Omaha, NE 5. Have you enclosed Form 147 regarding fingerprints? *YES ENO RECE1V Nov 0 3 2.015 NEB SKik LIQUOR CONTROL COMtAISSION Form 103 REV JUNE 2015 Page 5 of 6 ' • • . •- .,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 §53-13 1.01)Nebraska Liquor Control Act. The undersigned applicant hereby consents to an investigation of his/her background including all records of It kind and description including including police records, tax records4 (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. a i.411111111111r15: . o e • vi.9 4:. ...I -41111MK-n Signa e of Spouse "• E MED NOV 0 3 2(15 ACKNOWLEDGEMENT NEBRASKA LIQUOR State of Nebraska NTROL OtkAMISSION County of Douglas The foregoing instrument was acknowledged before me this r--,24e' Cczy\vsra.§- ,&<.",,t-S by Michael Staton and Danielle Staton date name of person acknowledged Affix Seal Notary Public signature egateGENEROLNEWARY-State arttetada DIANE L.STEVENSON *Cowan).Wavy 211.2012 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 JUNE 201S Page 6 of 6 SPOUSAL AFFIDAVIT OF off- tir_ice se RECEIVED riff2jaiZti.,;141# NON PARTICIPATION INSERT NEBRASKA LIQUOR CONTROL COMMISSION NOV 0 3 2015 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN,NE 68509-5046 NEBRASKA LIOLIOR PHONE:(402)471-2571 FAX (402)471-2814 0 CONTROL 00%11101.W N Website: VONWACC.ne goy :-(C4it: Ctg" t • I V... ,-ri,94;...:14.,:gliillt4i4,44`1 *Vg.§*-1Vie774:15,It41:4000.:' •i`rttr':'7'4 074 Psts7, Danielle M. Staton Signature of spouse asking for waiver Printed name of spouse asking for waiver (Spouse of individual listed below) Nebraska State of County of i\DEA,( 10$5 The foregoing instrument was acknowledged before me this f, r9 Cak-- vat'131 by t 1, J. - Tart 0."‘ date name of person acknowledged Affix Seal ...du..St*ofNebtasks Not Public signature DIANE L STEVENSON 1 Com Exp.February 28,2019 ;. 7: are responsible for compi that the above individual has violated( 3- 25(l3))the , s - e d . - ' Michael J. Staton g ure of i nvolvØ' ith application Printed name of applying individual ( ouse of indSiduallisted above) State of issk.elfitAsv,46, County of bot,A13L05•- The foregoing instrument was acknowledged before me this 01445- -.204* by rni druke.i1/4 . V"\ date name of person acknowledged X , a210;dte4e.":—.4.&01111 Affix Seal ENBIALlid1111-Sib diadrade No ar ry Public signature DIANE L.STEVENSON 0099„bp,999,91129,2019 In compliance with the ADA,this spousal affidavit of non participation is available in other formats for persons with disabilities A ten day advance period is requested to writing to produce the alternate format FORM 354178 Revisal 1/2008 rf , REST Online Training Credentials ..-'��f � � .. _ 't1�7^�✓t��`I� ��t -11" MICHAEL JAMES STATON l �t has earned a Certificate of Achievement -for those who serve or sell alcohol in Nebraska `Jl #RB-0051947 Expires:-10-27-2018 Amount Paid:$ • Responsible Beverage Service Training E R A S K j1 4 !Ufl L.\`�I{ �{.-.fir ,1 i{.- 1C Sf •� �f !: it- L ¶/2 CEIV NEORASKA LIQUOR ION CONTROL COtAKAIS RBST Online Training Credentials General credential Number Earned Expires Michael James Staff REST GENERAL RB-0051947 10-27-2015 10-27-2018 10220 regency circle Omaha NE 68114 111 ECEIV V0 3 2015 KA.LIQUOR NE$RhS CON MM 2,z ao • Sr- 5 r � i vx u O z f. R ! iV Icr NOV 0 2015 NEBRAS LIQUOR CONTROL COMMISSION SUBMISSSION OF FINGERPRINTS/ !RECEIVED PAYMENT OF FEES TO NSP-CID NEBRASKA LIQUOR CONTROL COMMISSION NOV 0 3 Z015 301 CENTENNIAL MALL SOUTH PO BOX 95046 NEB- SKA LIQUOR LINCOLN,NE 68509-5046 CONTROL COMP441061q1N1 PHONE: (402)471-2571 Office Use Only FAX: (402)471-2814 Website: wwW lcc.nebraska.gov Class: License#: Applicant Name: HHC TRS LC Portfolio LLC (Corporation, LLC,Partnership or Individual) Trade Name: Omaha Marriott Hotel (Doing Business As) (402) 399 - 9000 lisasalts©remingtonhotels.com Phone Number Contact E-mail Address DIRECTIONS FOR SUBMITTING FINGERPRINTS AND FEE PAYMENTS: • See New Application Requirement Guide for listing of Fingerprint Requirements, found on our website under"Licensing"tab in "Brochures". • 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. • Fee payment of$28.75 per person must be made directly to the NSP; You may submit the payment through the NSP PayPort online system at www.ne.gov/go/nsp 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 • 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. • 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). • Fingerprints are not required for spouses that have no involvement with business - Spousal Affidavit of Non Participation(Form 116)is required in lieu of fingerprints. Please complete information on the following pages for EACH person fingerprinted. FORM 147 REV OCT 2015 PAGE 1 — — Point-of-Sale Payments Page 1 of 111 1p A ow , !\:I-LBR ASK A.1,1(.:7A' YOUR RECEIPT Nebraska State Patrol-Criminal Identification Division 3800 NW 12th Street, Suite A Lincoln NE 68521j[ (402)479-4971 Transaction Id: 7765278 NEtaRAS U THANK YOU FOR USING THE NEBRASKA STATE PATROL PAYPORT SERVICE Customer Name: Michael J. Staton CONTROL COMM' - ION Credit Card Number: **** **** **** 3294 nebraska total amount charged $29.47 Total Items Location Quantity Order ID Amount Liquor License 1 17663098 $28.75 Applicant Name: Michael 3.Staton Date of Birth: 12-15-1971 Last four digits Soc. Security Number: 7384 Total remitted to the Nebraska State Patrol - Criminal Identification Division $28.75 https://otc.cde.nicusa.com/PublieReceipt.aspx?src=esh 10/27/2015 �OMAHA, N City oCity of Omaha, Nebraska � 1819 Farnam — Suite LC 1 •�='r` a '1 Omaha, Nebraska 681 83-01 1 2 c� v.�lr� l - ,�, Buster Brown (402) 444-5550 4 4 ,y. City Clerk FAX (402) 444-5263 0 444 � TFD FEPO' December 7, 2015 HHC TRS LC Portfolio, LLC Application to appoint Michael J. Staton Dba"Omaha Marriott Hotel" manager of your present Class "C" and 10220 Regency Circle Catering Liquor License location Omaha,NE 68114 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 December 22, 2015 . 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, 4-,1-e‘17410'49.6"24e ) Buster Brown City Clerk BJB:clj CityofOmaha [ebrasAz o�oMAHA N�8 ere4141819 Farnam — Suite LC 1 z c! ¢r' Omaha, Nebraska 68183-0112 ,r4‘41/4 , Buster Brown (402) 444-5550 City Clerk FAX (402) 444-5263 O� 46 ,41'ED FEa03 December 7, 2015 Michael J. Staton Application to be appointed manager of the 9473 Spencer Street present Class "C" and Catering Liquor License Omaha, NE 68134 for HHC TRS LC Portfolio, LLC, dba"Omaha Marriott Hotel", 10220 Regency Circle 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 December 22, 2015 . 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, Zek-je, Buster Brown City Clerk BJB:clj No. 7397 HHC TRS LC Portfolio, LLC, dba "Omaha Marriott Hotel, 10220 Regency Circle, requests permission to appoint Michael J. Staton manager of their present Class "C" and Catering Liquor License location. 12-22-15;cj RECEIVED Presented to Council: December 22, 2015 - Approved 7-0 Buster Brown City Clerk 1