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11.16.16 BLA Packet
BEVERAGE LICENSING AUTHORITY NOVEMBER 1612016 PUBLIC NOTICE CITY OF BOULDER BEVERAGE LICENSING AUTHORITY H E A R I N G WEDNESDAY, NOVEMBER 16,2016,3:00 P.M. CITY COUNCIL CHAMBERS MUNICIPAL BUILDING —2ND FLOOR 1777 BROADWAY, BOULDER, COLORADO AGENDA 1. Member roll call; Approval of Beverage Licensing Authority (BLA) minutes from October 19, 2016 hearing; and hearing agenda issues from licensing clerk. 2. Matters from the Boulder Police Department. 3. Matters from the Responsible Hospitality Group. 4. Show cause hearing concerning an August 19, 2016 violation and whether the Hotel - Restaurant type liquor license held by CRO Development III, LP d/b/a Cantina Laredo, 1680 29th Street, Boulder, CO 80301, should be suspended or revoked. 5. Public hearing and consideration of a September 27, 2016 application from Johnny's Cigars, Inc d/b/a Johnny's Cigars, 1801 13th Street, Unit 110, Boulder, CO 80302; John Welsh, President and Registered Manager; with a business mailing address of 751 Eldorado Blvd, Unit 1821, Broomfield, CO 80021, for a renewal of a Tavern type liquor license. 6. Public hearing and consideration of an October 7, 2016 application from Zythos Restaurant Group LLC d/b/a Zythos, 1320 College Avenue, Boulder, CO 80302; Konstantinos Korres, Owner and Registered Manager; with a business mailing address of 3175 E. Yarrow Circle, Superior, CO, 80027, for a renewal of a Hotel -Restaurant type liquor license. 7. Public hearing and consideration of an October 11, 2016 application from The Bouldering Garden, LLC d/b/a Spot Bouldering Gym, The Spot Cafe, 3240 Prairie Avenue, Boulder, CO 80301; Daniel Howley, Member and Manager, Patricia Howley, Co - Member, James Howley, Co -Member, and Ashley Woods, Member; with a premise business mailing address, for a renewal of a Beer and Wine type liquor license. 8. Public hearing and consideration of an August 24, 2016 application from City Club d/b/a Highland City Club, 885 Arapahoe Avenue, Boulder, CO 80302; Sina Simantob, Non - Profit's Director, Member and Location Manager; with a premise business mailing address, for a new Club type liquor license. 9. Public hearing and consideration of a September 14, 2016 application from Lucky's Market of South Boulder, CO, LLC d/b/a Lucky's Market, 695 S Broadway, Boulder, CO 80305; Lucky's Market of South Boulder, CO LLC [LMSB] as LLC Applicant with Lucky's Market Expansion LP [LME] as 11t underlying sole owner, Lucky's Market Expansion GP, LLC [LMEG] as 2nd underlying sole owner, Lucky's Market Parent Company LLC [LMPC] as 3rd underlying sole owner, and with The Kroger Co [Kroger] and Lucky's Founders Holding LLC [LFH] as 5` underlying co-owners, and with Jason Sharon and PG Holdings LLC [PGH] as co-owners of LFH; Jason Sharon as Managing Member of LMSB, LMEG, LFH, and CEO of LMPC, Andy Pillari, CFO of LMPC, Steve Black as President of LMPC, Russell Dispense and Monica Garnes and J. Michael Schlotman as appointed representatives of publicly traded company Kroger, Patrick Gilliland as majority owner and managing member of PGH, and with Tim Overlie as Regional Manager of LMSB; with a business mailing address of 6328 Monarch Park Place, Suite 100, Niwot, CO 80503, for a new 3.2% Beer On/Off Premise type liquor license. 10. Public hearing and consideration of a September 15, 2016 application from Coma LLC d/b/a Coma Mexican Grill, 4800 Baseline Road, Unit E-105, Boulder, CO 80303; Juan Ibarra, Owner and Registered Manager; with a premise business mailing address, for a new Hotel -Restaurant type liquor license. 11. Matters from the Assistant City Attorney 12. Matters from the Licensing Clerk a. Neighborhood boundary setting for applications for December 14, 2016 BLA hearing i. BeBold LLC d/b/a Vinca — New Beer and Wine type liquor license at 1141 Pearl Street, Boulder, CO 80302 b. Breweries, Wineries, and Distilleries requests for local licensing authority input on Application for Colorado Liquor Sales Room i. Discussion about a new Colorado Liquor Sales Room application from Gunbarrel Brewing Company d/b/a Gunbarrel Brewing Company, 7088 Winchester Circle, Unit 200, Boulder, CO 80301; with a business mailing address of 6525 Gunpark Drive 370, # 140, Boulder, CO 80301 c. Informational items i. The Riverside Group Ltd d/b/a Riverside, 1724 Broadway Street, Boulder, CO 80302 - Monthly status renewal report to BLA ii. 13th Street The Hill, LLC d/b/a Taco Junky, 1149 13th Street, Boulder, CO 80302 - Monthly status renewal report to BLA iii. November Special Events and Temporary Modifications iv. November Liquor License renewal mailing lists v. Email from Mishawn Cook to BLA Authority regarding an Invitation to Responsible Retailing Forum (RRF) and International Town & Gown Association (ITGA) and the Alcohol Responsibility Program Community Meeting 13. Matters from the Chair and Members of the Authority Adjournment For information, call (303) 441-3010. Any petitions or remonstrances pertaining to the above may be filed at the City of Boulder Finance Department, Sales Tax and Licensing Division, Municipal Building, 1777 Broadway, Boulder, Colorado. It is the City of Boulder's practice to provide more notice than is required by law whenever possible. However, this practice shall not be used to invalidate any action taken with the minimum notice required by state law. Final on Wednesday, November 2, 2016 Mishawn J. Cook, Licensing Administrator, CMC Published on Sunday, November 6, 2016, in the Daily Camera newspaper STATE OF COLORADO) COUNTY OF BOULDER) CITY OF BOULDER ) SS: CERTIFICATE OF PUBLIC NOTICE I, Mishawn J. Cook, Tax and License Administrator, City of Boulder, Colorado, do hereby certify that I caused the attached City of Boulder Public Meetings notice and the attached Legal Public Notice to be published in the Daily Camera on Sunday, November 6, 2016 in compliance with the laws of the State of Colorado and the ordinances of the City of Boulder, Colorado. 2016 City of Boulder PUBLIC MEETINGS 'COMPLETE AGENDAS 1 '' visit wwvw-boluld.ercolo _.do. ov-ca QR g—._I_._dar or call 3034413388 *INDICATES THAI' A COWIIETE AGENDA IS IN TODAY'S MLIC NOTICES IIS THE (3LASS=D SECTION. MONDAY, NOVEMBER 7 5:30-9 PM Downtown,lianagement Commission Meeting Council Chambers. 1777 Broadway Update on Mobility as Service Pilot Ruth Weiss, 303-413-7318, htlps:i/bo l�lgrsoloradr�:gov/baar _ omm ssiQp _n_�-do�ntpry��anage_rnent-commi�ian-m_ �etine WEDNESDAY, NOVEMBER 9 4-6 mi Design Advisory Board Meeting 1777 West Conference Room, 1777 Broadway Cindy Spence. 303-441-4464, ��rl�ec��boulder_C9lorado. cav h •' d r 4� v. mri�i i 6 PM Special City Council Meeting - Executive Session Council Chambers, 1777 Broadway An executive session regarding municipalization. 6-9 PM Open Space Board of Trustees Meeting (televised) Council Chambers. 1777 BroadR ay 1. Matters from Staff.. Flood Recovery, BVCP ?. Matters from the Board: Feedback for January City Council Retreat, Chautauqua Access Management Plan update Yiiammq orgor call 303-441-3440 THURSDAY, NOVEMBER 10 5 PM *Board of Zoning Adjustments Meeting Main Library Flatirons Conference Room, 1001 Arapahoe Ave. Cindy Spence, 303-4444464, %encec@bouldercolorado gov hh0s i derr,�1 rad . v 4mmi si ns . za 5:30 PM Special City Council Meeting Council Chambers, 1777 Broadway Public Hearings: 2A - 3261 3rd Street 2B - Eastpointe Apartment Homes 2C - Ord 8154 - Short Term Rentals 6 PM Municipalization Financial Forecast First Presbyterian Churdi, Oerter Room, 182015th Street Public Presentation on the Municipalization Financial Forecast MONDAY, NOVEMBER 14 4-7 PM Public Participation Working Group Alfalfa's Community Room, 1651 Broadway Meeting information: htros?.Qk l rad , r u lic- ar[i i ati n-�'arking�rouP. C3omments to Pu iicE=i Va i=W—grkin r hoWr Ira v WEDNESDAY, NOVEMBER 16 3 PM *Beverage Licensing Authority Hearing Council Chambers, 1777 Broadway For Full Agenda - See Public Notices in Classified Section Mishawn Cook, 303-442-3010, Qo a 1 rg! l do.eov. Any petitions or remonstrances pertaining to the above may be filled at: Licensing Division, 17" Broadway, 1st floor. Hearing agenda: nnw,bouiderco_14rado.c iqugrr 6:30-8:30 PM BVCP Future Choices Forums Meeting - Southern/Eastern Boulder New Vista High School, 700 20th St. Comprehensive plan, with opportunities for facilitated small group discussions on key issues. Holly Opansky, 303-441-1882, ins h@ i rc 1 !�w-1 B d PI n.n THURSDAY, NOVEMBER 17 6 PM *Planning Board Meeting West Senior Csenter, Creekside Room, 909 Arapahoe Ave. Cindy Spence, 303-44+1-4464, n e 1. Vv, h stt�1 151erco7 iQm plan ingboard 6-8 PM Library Commission & Landmarks Board Joint Board Meeting Boulder Public .Library, Canyon Meeting Room, 1001 Arapahoe Ave. Discussion of historic resource survey of the north wing of the Boulder Public Library. Historic Preservation Staff - 303-441-1881 or Library Staff - 303-441-3106 se-. N� Page PUBLIC NOTICE CITY OF BOULDER BEVERAGE LICENSING AUTHORITY H E A R I N G WEDNESDAY, NOVEMBER 16,2016,31:00 P.M. CITY COUNCIL CHAMBERS MUNICIPAL BUILDING - 2ND FLOOR 1777 BROADWAY, BOULDER, COLORADO AGENDA 1. Member roll call; Approval of Beverage Licensing Authority (BLA) minutes from October 19, 2016 hearing; and hearing agenda issues from licensing clerk. 2. Matters from the Boulder Police Department. 3. Matters from the Responsible Hospitality Group. 4. Show cause hearing concerning.an August 19, 2016 violation and whether the Hotel -Restaurant type liquor license held by CRO De- velopment III, LP d/b/a Cantina Laredo, 1680 29th Street, Boulder, CO 80301, should be suspended or revoked. 6. Public hearing and consideration of a September 27, 2016 appli- cation from Johnny's Cigars, Inc d/b/a Johnny's Cigars, 1801 13th Street, Unit 110, Boulder, CO 80302; John Welsh, President andReg- rsPtered Manager, with a business mailing address of 751 Eldorado Ivd, Unit 1821, Broomfield, cO 80021, for a renewal of a Tavern type liquor license. 'Public hearing and consideration of an October 7, 2016 applica- ion from Zythos Restaurant Group LLC d/b/a Zythos, 1320 College venue, Boulder, CO 803021 Konstantinos Korres, Owner and Regis- ered Manager, with a business mailing address of 3175 E. Yarrow ircle, Superior, CO, 80027, for a renewal of a Hotel -Restaurant type iquor license. 7. Public hearing and consideration of an October 11, 2016 applica- tion from The Bouldering Garden, L4C d/b/a Spot Bouklering (iym, The Spot Cafe, 3240 Prairie Avenue, Boulder, CO 80301; Daniel Howley, Member and Manager Patricia Howley Co -Member, James Howley, Co -Member and Ashley Woods, Member, with a premise business mailing address, for a renewal of a Beer and Wine type liq- uor license. R. Public hearing and consideration of an August 24, 2016 applica- tion from City Club d/b/a Highland City Club, 885 Arapahoe Avenue, Boulder, CO 80302; Sina Simantob, on -Profit's Director, Member and Location Manager, with a premise business mailing address, for a new Club type liquor license. 9. Public hearing and consideration of a September 14, 2016 appli- cation from Lucky's Market of South Boulder, CO, LLC d/b/a Lucky's Market, 695 S Broadway, Boulder, CO 80305; Lucky's Market of South Boulder, CO LLC [LMSB] as LLC Applicant with Lucky's Mar- ket Expansion LP [LME] as 1st underlying_sole owner, Lucky's Mar- y -s MarKeL i-aremL L;om any LLL; tLMNGJ as 3ra unaerlying sole owner, and with The Kroger Co ):Kroger] and Lucky's Founders Holding LLC [LFH] as 5th under)ying co-owners, and with Jason Sharon and PG Holdings LLC [PGH] as co-owners of LFH; Jason Sharon as Managing Member of LMSB, LMEG, LFH, and CEO of LMPC Andy Pillars, CFO of LMPC, Steve Black as President of LMPC, Russell Dispense and Monica Garnes and J. Michael Schlotman as appointed representatives of publicly traded company Kroger, Pat- rick Gilliland as majority owner and managing member of PGH, and with Tim Overlie as Regional Manager of LMSB; with a business mailing address of 6328 Monarch Park Place, Suite 100, Niwot, CO 150503, for a new 3.2Qu Beer on/Off Premise type liquor license. 10. Public hearing and consideration of a September 15, 2016 appli- cation from Coma LLC d/b/a Coma Mexican Grill, 4800 Baseline oad Unit E-105, Boulder, CO 80303; Juan Ibarra, Owner and Regis- eedManager, with a premise business mailing address, for a new 'Hotel -Restaurant type liquor license. , 11. Matters from the Assistant City Attorney 12. Matters from the Licensing Clerk a. Nei hborhood boundary setting for.applications.. for December 14 zEIG—S" W51d - i. BeBold LLC d/b/a Vinca - New Beer and Wine type liquor license at 1141 Pearl Street, Boulder, CO 80302 lo-. Breweries, Wineries and Distilleries requests for local licensing aufhorlfyinput on AppFica�on for Colorado Liquor Safes F£oom i. Discussion about a new Colorado Liq uor Sales Room application from Gunbarrel Brewing Company d%/a Gunbarrel Brewing Company 7088 Winchester Circle Unit 200, Boyider, CO 80301; with a business mailing address R 6525 IGunpark Drive 370, # 140, Boulder, CO 80301 i. The Riverside Group Ltd d/b/a Riv- erside, 1724 Broadway Street, Boulder, CO 80302 - Mont$ly status renewal report to BLA ii. 13th Street The Hill, LLC d/b/a Ta- co Junky, 1149 13th Street, Boulder, CO 80302 - Monthly status re- newal report to BLA porary Mddifications iii. November Special Events and Tem - mailing lists iv. November Liquor License renewal v. Email from Mishawn Cook to BLA Authority regarding an Invitation to Responsible Retailing Forum (RRF) and International Town & Gown Association (ITGA) and the Alcohol Responsibility Program Community Meeting 13. Matters from the Chair and Members of the Authority Ad' urnm nt For information, call (303) 441-3010. Any petitions or remonstrances 1 pertaining to the above may be filed at the City of Boulder Finance Department, Sales Tax and Licensing Division, Municipal Building, 1777 Broadway, Boulder, Colorado. It is the Cthan City of Boulder's practice to provide more notice an Is re- I quiredd yyto Invalidatehenever possible. However, this ,practice shall not' be re- quired by state law. any action taken with the minimum notice EllillikilP Final on wednesday. November 2_ 2016 Mishawn J. Cook, Licensing Administrator, CMC Published Daily Camera November 6, 2016 -1221876 � • /yam C') lL e e i� API "� o�'Oj nmeeoso�'e f7� c. Informational items k IN WITNESS WHEREOF, I have hereunto set my hand and the official seal of the City of Boulder, Colorado this Tuesday, November 8, 2016. Secretary to Beverage Licensing Authority Agenda Item 1 CITY OF BOULDER BEVERAGE LICENSING AUTHORITY ***MINUTES*** WEDNESDAY, OCTOBER 19,2016,3:00 P.M. CITY COUNCIL CHAMBERS MUNICIPAL BUILDING — 2ND FLOOR 1777 BROADWAY, BOULDER, COLORADO NAME OF BOARD/COMMISSION DATE OF MEETING: NAME & PHONE OF PERSON PREPARING SUMMARY: Beverage Licensing Authority (BLA) October 19, 2016 ,3 RAFT Mishawn Cook, License Administrator (303-441-3010) Beata Mazurkiewicz, Licensing Specialist (303-441-3091) NAMES OF MEMBERS, STAFF, AND INVITED GUESTS PRESENT: Board Members: David Timken, Lisa Spalding, and Matthew Califano Staff Present: Carey Markel, Assistant City Attorney, Mishawn Cook, License Administrator, and Beata Mazurkiewicz, Licensing Specialist QUASI-JUDICIAL MEETING OUTLINE OF AGENDA 1. Administrative Board Matters i) Member Roll Call Roll call was taken. A quorum of three BLA members attended with both Chair Steve Wallace and Member Alyssa Lundgren absent. Beata Mazurkiewicz reminded the Authority that all motions must be unanimous by the three attending BLA members for the action to be effective. Approval of BLA minutes from September 21, 2016 Member Spalding moved, Califano seconded, to approve the September 21, 2016 minutes without amendment. Motion approved 3:0. iii) Hearing agenda issues from licensing clerk Mishawn Cook noted that City Licensing would ask that the Authority forgo setting neighborhood boundaries for the City Club's new Club type liquor license because BLA 10.19.16 DRAFT Minutes Page 1 of 8 neighborhood reasonable requirements were confirmed not to be applicable to Club licenses. No other changes to the agenda or order of the items was noted for the Authority. 2. Matters from the Boulder Police Department (BPD). Officer Daniel Bergh appeared on behalf of the BPD. Officer Bergh provided copies of a DUI reduction poster modeled on a similar campaign from Scotland to the Authority which was marked as agenda item 2, exhibit 1. Vice Chair Timken and Member Spalding congratulated the Police Department on the poster which they thought was a very good. 3. Matters from the Responsible Hospitality Group (RHG). Ms. Mazurkiewicz advised the Authority that city licensing had received an email from Michael Absalom with the RHG that he would be unable to attend the hearing. It was also noted that the RHG meeting attendance sheet and meeting notes would be included as agenda item 3, exhibit 1. Member Spalding asked that city licensing remind RHG members that tailgating with alcohol outside of a liquor license premises is not allowed. 4. Continued show cause hearing concerning an April 22, 2016 violation and whether the Hotel -Restaurant type liquor license held by Pearl Dive LLC d/b/a Wild Standard, 1043 Pearl Street, Boulder, CO 80302, should be suspended or revoked. Howard Bittman, Esq. appeared as the licensee's attorney. Adrian Chavez, Natalie Spring, Micah Nushawg, and Bradford Heap of the Wild Standard restaurant were all sworn in and each provided testimony about mitigating factors for this violation hearing. No ex -parte communications or conflicts of interest were disclosed by the Authority members. Hearing procedure reading was waived by the licensee's attorney. Lucas Markley, BPD prosecutor, offered a stipulation to the facts in this matter. Member Spalding moved, Califano seconded, to accept the stipulation. Motion approved 3:0. A written statement and employee signed acknowledgements of the restaurant's alcohol policies were marked as agenda item 4, exhibit 1. The Authority noted the substantial written mitigation information provided. Member Spalding did request a copy of Dillan Rages TIPS card. The Licensee requested to pay a fine in lieu, however, the BLA declined the request. Member Califano moved, Spalding seconded, to set the penalty for this violation at 3 suspension days with 11 days held in abeyance. Motion approved 3:0. Member Spalding then moved, Califano seconded, to set the 3 suspension days to be served from Monday October 24 to Wednesday October 26, 2016. Motion approved 3:0. S. Show cause hearing concerning a May 14, 2016 violation and whether the Hotel -Restaurant type liquor license held by Huckleberry Foods, Inc d/b/a Boulder Dushanbe Teahouse, 1770 13th Street, Boulder, CO 80302, should be suspended or revoked. BLA 10.19.16 DRAFT Minutes Page 2 of 8 Matthew Kefer and Lenny Martinelli from the Boulder Dushanbe Teahouse were both sworn in and each testified concerning mitigating factors for this violation hearing. It was confirmed that they were not represented by an attorney, at which time Vice Chair Timken read the hearing procedures. No ex -parte communications or conflicts of interest were disclosed by the Authority members. Lucas Markley, BPD prosecutor, offered a stipulation to the facts in this matter. Member Spalding moved, Califano seconded, to accept the stipulation. Motion approved 3:0. The Authority noted that corkage was reference in the provided alcohol policy and Mr. Martinelli confirm that customer's bringing in their own alcohol was not allowed. Member Spalding noted the need for previous training dates. The Authority noted some mitigating evidence and testimony. Member Spalding moved, Timken seconded, to set the penalty for this violation as 4 suspension days served with 10 days held in abeyance. Motion approved 3:0. Member Spalding then moved, Califano seconded, to set the 4 suspension days to be served from Monday October 24 to Thursday October 27, 2016. Motion approved 3:0. 6. Show cause hearing concerning a July 22, 2016 violation and whether the Hotel -Restaurant type liquor license held by Sancho's Boulder Arrow, LLC d/b/a Sancho's Boulder Arrow & Fast Eddie's,1325 Broadway, Unit 201, Boulder, CO 80302, should be suspended or revoked. Jay Bianchi with the Sancho's restaurant was sworn in and provided testimony in this matter. It was confirmed that he was not represented by an attorney, at which time Vice Chair Timken read the hearing procedures. No ex -parte communications or conflicts of interest were disclosed by the Authority members. Lucas Markley, BPD prosecutor, offered a stipulation to the facts in this matter. Member Spalding moved, Califano seconded, to accept the stipulation. Motion approved 3:0. The Authority that, while an email of explanation was submitted, no mitigating factor information was provided by Mr. Bianchi. As well, the Authority noted that Mr. Bianchi had held this transfer license for less than a one-year period. Additionally, the Authority noted that this location had a substantial past with alcohol violations which Mr. Bianchi was apprised of and agreed to accept the transfer license as is at this location. BLA 10.19.16 DRAFT Minutes Page 3 of 8 Member Spalding moved, Califano seconded, to set the penalty for this violation as 9 suspension days served with 20 days held in abeyance. Motion approved 3:0. Member Spalding then moved, Califano seconded, to set the 9 suspension days to be served from Monday October 24 to Tuesday November 1, 2016. Motion approved 3:0. 7. Public hearing and consideration of whether there is good cause for non -renewal of an August 16, 2016 application from A -M Holdings, LLC d/b/a Alfalfa's Market, 1651 Broadway Street, Boulder, CO 80302; Barnet Feinblum, Manager, Mark Retzloff, Manager, Hugo van Seenus, Manager, and Anne Townsend, Registered Manager; with a business mailing address of 1645 Broadway Street, Boulder, CO 80302, for renewal of a Retail Liquor Store type liquor license. Kevin O'Boyle, store controller, and Anne Townsend, retail liquor store manager, were both sworn in and they confirmed posting for the required 10 day period. It was confirmed that he was not represented by an attorney, at which time Vice Chair Timken read the hearing procedures. Ms. Mazurkiewicz stated to the Authority that this renewal hearing was only convened due to late filing. No ex -parte communications or conflicts of interest were disclosed by the Authority members. No third parties requested to provide public comment or to be made parties in interest in this matter. Mr. O'Boyle stated that he was the new controller and had updated several procedures so that future license renewals would be filed timely. Updated training information was provided and it was marked as agenda item 7, exhibit 1. Member Spalding then moved, Califano seconded, to approved this license renewal application. Motion approved 3:0. 8. Public hearing and consideration of a July 29, 2016 application from Summit Hotel TRS 131, LLC d/b/a Boulder Marriott, 2660 Canyon Boulevard, Boulder, CO 80302; Summit Hotel TRS, Inc., 100% Managing Member, with Daniel Hansen, President, Christopher Eng, Secretary, and Jack Paul, Registered Manager; with a business mailing address of 12600 Hill Country Boulevard, Suite R-100, Austin, TX 78738, for a transfer of a Hotel -Restaurant type liquor license. Adam Stapen, Esq. appeared as the applicant's attorney. TJ Devoe, hotel manager, was sworn in and confirmed posting for the required 10 day period. Hearing procedure reading was waived by the applicant's attorney. No ex -parte communications or conflicts of interest were disclosed by the Authority members. No third parties requested to provide public comment or to be made parties in interest in this matter. BLA 10.19.16 DRAFT Minutes Page 4 of 8 Ms. Mazurkiewicz noted for the record that the hearing agenda should reflect that Jack Paul has been removed as registered manager and that the manager now is Theodore (TJ) Devoe. Ms. Mazurkiewicz also noted for the record that a certificate of training would be included as agenda item 8, exhibit 1. The applicant also provided signs which stated that removal of alcohol from the licensed premise was illegal and this was marked as agenda item 8, exhibit 2. The Authority discussed with the applicant that at least sandwiches and light snacks must be available after the kitchen has closed when alcohol is served or sold in accordance with law. Member Califano moved, Spalding seconded, to approve this transfer license application. Motion approved 3:0. 9. Public hearing and consideration of an August 15, 2016 application from Element Bistro, LLC d/b/a Element Bistro, 6315 Lookout Road, Boulder, CO 80301; Patrick Tornqvist, CEO and Owner, Tiffinie Gaibler, Owner, Partner and HR, and Eric Lee, Owner, Managing Partner and Registered Manager; with a business mailing address of 949 Glen Arbor Circle, Longmont, CO, 80504, for a Permanent Modification of a Hotel -Restaurant type liquor license. Ryan Gaibler (advised to be Tiffinie Gaibler husband) and Eric Lee, Managing Member and Registered Manager of the applicant restaurant, were both sworn in and confirmed the required 10 day posting. Because the applicant was not represented by an attorney, hearing procedures were read by Vice Chair Timken. No ex -parte communications or conflicts of interest were disclosed by the Authority members. No third parties requested to provide public comment or to be made parties in interest in this matter. Mr. Lee explained to the Authority that the purpose of the submitted modification was to add their banquet room to their liquor licensed premise. Member Spalding moved, Califano seconded, to approve this permanent modification application. Motion approved 3:0. 10. Matters from the Assistant City Attorney No matters were discussed. 11. Matters from the Licensing Clerk a. Neighborhood boundary setting for applications for November 16, 2016 BLA hearing BLA 10.19.16 DRAFT Minutes Page 5 of 8 L City Club d/b/a Highland City Club — New Club Liquor type liquor license at 885 Arapahoe Avenue, Boulder, CO 80302 Ms. Mazurkiewicz stated that, as stated earlier in the hearing, that petitioning boundaries should not be set for this application. ii. Lucky's Market of South Boulder, CO, LLC d/b/a Lucky's Market — New 3.2% On/Off Premise type liquor license at 695 S Broadway, Boulder, CO 80305 Mishawn Cook noted for the Authority that there were some members of the audience who would like to address them on this matter. Ann and Chris Coppinger, co-owners of Pettylohn's Liquor and Wine, then addressed the Authority to ensure that their business location would be in the designated neighborhood. Ms. Coppinger also stated her concern with the changes included in SB 16-197 concerning their store. The Authority reviewed both the suggested boundaries from Oedipus Inc and the city licensing suggested boundaries. Ms. Cook offered to contact Ms. Coppinger after the hearing with additional hearing process information. The following neighborhood boundaries were discussed: Dartmouth Avenue to Broadway to 27th to Hwy 36 on the North, City Limits on the South, Hwy 36 to Moorhead Circle Extended on the East, and City Limits on the West. Member Califano moved, Spalding seconded, to set the neighborhood boundaries for this application as described above. Motion approved 3:0. iii. Coma LLC d/b/a Coma Mexican Grill — New Hotel -Restaurant type liquor license at 4800 Baseline Road, Unit E-105, Boulder, CO 80303 The following neighborhood boundaries were discussed: Arapahoe Avenue on the North, South Boulder Road on the South, 55th Street on the East, and 30th Street Extended to Hwy 36 on the West. Member Califano moved, Spalding seconded, to set the neighborhood boundaries for this application as described above. Motion approved 3:0. b. Breweries, Wineries, and Distilleries requests for local licensing authority input on Application for Colorado Liquor Sales Room i. Email from Mishawn Cook to Kettle and Spoke Brewery, Salone Dede, and Paul Sink regarding Kettle and Spoke Brewery new salesroom floor plan BLA 10.19.16 DRAFT Minutes Page 6 of 8 The Authority asked if City Zoning would be reviewing this application. Mishawn Cook replied that as part of the building permit process, which this brewery would also need to follow, the zoning would be reviewed. c. Informational items L The Riverside Group Ltd d/b/a Riverside, 1724 Broadway Street, Boulder, CO 80302 - Monthly status report to BLA Ms. Mazurkiewicz noted for the Authority that sales tax would approved this license renewal if submitted at this time. ii. 13th Street The Hill, LLC d/b/a Taco Junky, 1149 13th Street, Boulder, CO 80302 - Monthly status report to BLA Ms. Mazurkiewicz noted for the Authority that sales tax would approved this license renewal if submitted at this time. iii. October Special Events and Temporary Modifications This summary list was advised to be in the hearing packet. iv. October Liquor License renewal mailing lists This summary list was advised to be in the hearing packet. v. Email from Mishawn Cook to BLA Authority regarding City of Boulder response to Jon Balliet email Ms. Cook discussed with the Authority the drafting of the city response letter, and changes (if any) to the documents sent with show cause hearing notices. Ms. Cook also advised that she had attended the last RHG meeting by invitation to provide an update to the membership. Carey Markel also suggested that shortly after the next BLA retreat that either she or Ms. Cook should attend an RHG meeting to provide a yearly briefing. vi. Email from Mishawn Cook to BLA Authority regarding City Clerk's Office request to review BLA application and board requirements and expectations This item was discussed. It was expressed that it would have been helpful to have all BLA members in attendance for any board requirements document drafting, but perhaps this could be done through a rulemaking session then provided to the City Clerk's Office for their 2018 BLA board recruitment. A quorum of the members did discuss that they would like a BLA 10.19.16 DRAFT Minutes Page 7 of 8 question added to the BLA board prospective applicants have any involvement with the liquor industry. 12. Matters from the Chair and Members of the Authority application which asks whether connection, ownership, or family Vice Chair David Timken advised on how the DUI state statute is being construed by Colorado Judges in the instance of four DUI offenses, sometimes resulting in probation only sentences, given that such a pattern of convictions has previously been amended so that the fourth conviction is a felony. Vice Chair Timken also advised that he likely will be absent from the November 16 hearing due to a work conflict. Ms. Cook also reminded the Authority members that the December, 2016 BLA hearing would occur one week earlier this year on Wednesday December 14, 2016 in an alternate location. ADJOURNMENT Member Spalding moved, Califano seconded, to adjourn the meeting. Motion approved 3:0, thus the hearing was adjourned at 6:13 p.m. TIME AND LOCATION OF FUTURE MEETINGS, COMMITTEES OR SPECIAL HEARINGS: 3rd Wednesday of every Month at 313M in City Council Chambers for 2016. Attested: Approved: Mishawn J. Cook, License Administrator Chair of Beverage Licensing Authority BLA 10.19.16 DRAFT Minutes Page 8 of 8 Agenda Item 2 L v L C Q) Q) L L N N O O E to c m m c O � N rn r0 Q) Q) m 0 Y 4, f0 by tip c v p 0 E U -0 42 L c a > O 0 'a c C -0 O O 1 7 m _ O a 0 j t `- O v` Q) E O 0. L O Q1 O j LA m y o 3 r 0 v o `n O u 4--;N C Q) O f0 U Z +O Q) Ln C 3 _ M M = 4 W Y E Q) v c=mCL. 4 _0 � Q) Q) l�/1 w Q) L V1 z m° u 3 o Q ¢ 2 v 3 EA c as -o 'u L v L C Q) Q) L L N N O O E to c m m .-i ,1 O � N rn r0 Q) Q) m 0 O H Q) U O41 Q) L mO a u > O 0 c ` O O 1 7 m _ p O z 0 j H a.' L! � N a L Q) Q) L L N N Q, v MA a Y w E to a- m m .-i ,1 a` � � N rn c O O L 4J co E N m c z 3 r0 Q) Q) m 0 a, -a coo c F= Ln H v LO Police Reports Last Drink Location Month of October These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Report No Date Time Age Nature of Call Location Total: 0100 1 160013181 10/02/2016 08:36 19 DUI 576 HARVARD LN 0100 hours 1 160014141 10/21/2016 05:41 21 INCIDENT 943 BROADWAY #1 0200Hrs 10/22/2016 1 160014192 10/22/2016 02:41 20 WARRANT 9TH ST/GRANDVIEW AV 1 hour prior to contact 1 160014190 10/22/2016 02:15 22 DUI 9TH ST/EUCLID AV 10/06/2016 1 160013405 10/06/2016 15:36 40 WARRANT BROADWAY/CANYON BV 10/22/2016 1 160014241 10/23/2016 01:17 30 DUI ARAPAHOE AV/BROADWAY 10/30/2016 2100HRS 1 160014676 10/30/2016 22:30 48 DV 4242 26TH ST 10/7/2016 1 160013484 10/07/2016 23:34 49 WARRANT 3325 28TH ST 1800 Broadway - at work 1 160013490 10/08/2016 11:31 24 VIOL OF RESTRAINING ORDER 1800 BROADWAY #125 1800 Broadway at Work 1 160013490 10/08/2016 01:00 24 VIOL OF RESTRAINING ORDER 1800 BROADWAY #125 2 beers 1 160014138 10/21/2016 02:27 26 DUI 15TH ST/WALNUT ST 2 BEERS AND 1 SHOT 1 160013494 10/08/2016 02:39 21 DUI - INCIDENT 17TH ST/BROADWAY 2460 Baseline Rd 1 160014203 10/22/2016 10:36 58 WARRANT 2460 BASELINE RD 2690 28th 1 160014329 10/25/2016 07:33 31 WARRANT 2690 28TH ST #E 2920 Baseline Rd 1 160014210 10/22/2016 13:45 41 WARRANT 2920 BASELINE RD 3 beers 1 160013831 10/14/2016 23:14 18 ALCOHOL OFFENSE 1027 14TH ST 3 beers within last 3 hours 1 160013894 10/15/2016 21:02 33 DUI FOLSOM ST/PEARL ST 5 -Nov -2016 Page 1 of 6 These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Report No DateTime ASC e Nature of Call Location Total: - 45 minutes prior to contact 10/30/2016 05:48 19 WARRANT 1 160013782 10/14/2016 02:12 22 DUI BROADWAY/PLEASANT ST 1065 UNIVERSITY AV at a party 10/13/2016 00:21 24 WARRANT 1 160014566 10/28/2016 23:46 20 DV 955 17TH ST #4 1326 PEARL ST At home 10/07/2016 11:09 57 WARRANT 1 160013779 10/13/2016 23:16 19 WARRANT 843 17TH ST 1777 6TH ST Broomfield / House party 10/27/2016 12:53 33 PROBATION VIOLATION 1 160013539 10/08/2016 20:48 64 DUI 2920 BASELINE RD BROADWAY/UNIVERSITY AV DRINKS 10/29/2016 12:00 28 PUBLIC PEACE OFFENSE 1 160014194 10/22/2016 03:21 24 DV 204 29TH ST 1124 LINCOLN PL Evening prior 2000 hours 10/05/2016 17:14 33 DRUGS POSSESSION 1 160014450 10/20/2016 09:55 19 ALCOHOL OFFENSE 17TH ST/BASELINE RD 2440 ARAPAHOE AV Home between 1900 to 2100 10/07/2016 16:08 27 1 160014325 10/25/2016 00:38 51 DUI BROADWAY/NORTH ST in her hotel room 1 160013945 10/16/2016 19:41 36 VIOL OF RESTRAINING ORDER 555 30TH ST Just prior to contact 5 160014738 10/31/2016 23:48 19 GOVT OPERATIONS OFFENSE 1101 13TH ST 160014136 10/21/2016 01:56 22 DUI BROADWAY/GRANDVIEW AV 160013163 10/01/2016 22:39 26 DV 430 S 42ND ST 160014558 10/28/2016 22:38 19 DRUGS POSSESSION 1301 BROADWAY 160014193 10/22/2016 03:06 33 DUI 3100 34TH ST n 13 160014644 10/30/2016 05:48 19 WARRANT 10TH ST/PEARL ST 160014512 10/28/2016 02:42 22 DV 1065 UNIVERSITY AV 160013740 10/13/2016 00:21 24 WARRANT 1300 PEARL ST 160013180 10/02/2016 06:29 52 WARRANT 1326 PEARL ST 160013451 10/07/2016 11:09 57 WARRANT 1120 PINE ST 160013392 10/06/2016 11:03 41 WARRANT 1777 6TH ST 160014468 10/27/2016 12:53 33 PROBATION VIOLATION 1777 6TH ST 160014568 10/28/2016 23:23 17 DRUGS POSSESSION BROADWAY/UNIVERSITY AV 160014601 10/29/2016 12:00 28 PUBLIC PEACE OFFENSE S BROADWAY/TABLE MESA DR 160013363 10/05/2016 18:19 56 WARRANT 1124 LINCOLN PL 160013357 10/05/2016 17:14 33 DRUGS POSSESSION 2440 ARAPAHOE AV 160013357 10/05/2016 17:14 38 DRUGS POSSESSION 2440 ARAPAHOE AV 160013466 10/07/2016 16:08 27 WARRANT 1575 30TH ST 5 -Nov -2016 Page 2 of 6 These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Report No Date Time Acme Nature of Call Location Total: n/a 25 160014600 10/29/2016 10:32 51 DV 625 WALDEN CIR #104 160013495 10/08/2016 03:26 22 DV 626 MARINE ST#6 160013553 10/09/2016 01:46 23 DV 1017 TANTRA PARK CR 160014089 10/19/2016 20:59 25 DV 704 MOHAWK DR #17 160014166 10/21/2016 15:33 29 WARRANT 1650 30TH ST 160013386 10/06/2016 09:31 23 DUI 4865 STERLING DR 160014186 10/22/2016 00:54 54 WARRANT 2800 E AURORA AV 160014509 10/28/2016 02:30 20 DV 1513 20TH ST #2 160014390 10/26/2016 07:51 36 WARRANT 5640-436 ARAPAHOE AV 160013785 10/14/2016 06:00 43 WARRANT 2995 EAGLE WY #16 160013784 10/14/2016 03:26 25 GOVT OPERATIONS OFFENSE 1325 BROADWAY 160013877 10/15/2016 17:00 22 PUBLIC PEACE OFFENSE 3271 30TH ST 160014152 10/21/2016 11:45 42 WARRANT 1805 33RD ST 160013323 10/05/2016 08:07 46 DV 2076 OAK AV 160013732 10/12/2016 19:48 29 WARRANT 1770 21 ST ST 160013835 10/14/2016 23:38 48 DV 3575 28TH ST #203 160014625 10/29/2016 22:21 32 ASSAULT 1480 CANYON BV 160014178 10/21/2016 22:16 18 DUI COLORADO AV/FOLSOM ST 160014374 10/25/2016 22:36 23 WARRANT 1050 ARAPAHOE AV 160013287 10/04/2016 13:49 17 GOVT OPERATIONS OFFENSE 1625 16TH ST 160014612 10/29/2016 15:17 67 WARRANT 1160 OAKDALE PL 160013374 10/06/2016 00:54 17 DUI 4TH ST/DELLWOOD AV 160014077 10/19/2016 15:01 53 WARRANT 28TH ST/GLENWOOD DR 160014355 10/25/2016 15:58 29 GOVT OPERATIONS OFFENSE 15TH ST/CANYON BV 160013486 10/26/2016 22:19 29 SUPPLEMENTAL 29TH ST/BASELINE RD na 5 160014541 10/28/2016 15:16 36 THEFT MISDEMEANOR - PETTY 1650 30TH ST 160014093 10/20/2016 00:02 28 WARRANT 2105 GOSS CR 160013255 10/03/2016 18:30 13 ASSAULT FOLSOM ST/VALMONT RD 160014429 10/26/2016 21:09 20 DRUGS POSSESSION 3348 28TH ST 160014132 10/20/2016 22:35 44 MISCELLANEOUS OFFENSE 28TH ST/ARAPAHOE AV Near Boulder High School property 1 160013826 10/14/2016 20:50 15 ALCOHOL OFFENSE 1604 ARAPAHOE AV none 9 160014408 10/26/2016 14:35 38 WARRANT 1301 BROADWAY 160013849 10/15/2016 07:17 45 WARRANT 2312 14TH ST 160014278 10/24/2016 08:25 33 WARRANT 1805 33RD ST 160014540 10/28/2016 14:30 28 WARRANT 902 PEARL ST 160011321 10/08/2016 13:40 31 FRAUD FELONY 1333 IRIS AV 160013658 10/11/2016 11:00 51 WARRANT 1101 ARAPAHOE AV 160014616 10/29/2016 15:38 30 DRUGS POSSESSION 1811 FOLSOM ST 160014287 10/24/2016 10:38 37 WARRANT 2860 WILDERNESS PL 160014610 10/29/2016 15:38 41 WARRANT 1811 FOLSOM ST 5 -Nov -2016 Page 3 of 6 These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Report No Date Time Age Nature of Call Location Total: none known 1 160013478 10/07/2016 18:18 55 WARRANT 1650 30TH ST NOT ENOUGH 1 160013496 10/08/2016 05:11 19 DUI 27TH WY/BASELINE RD On scene 1 160014621 10/29/2016 21:55 38 WARRANT 15TH ST/ARAPAHOE AV park 2 160014545 10/28/2016 16:25 56 WARRANT 1575 30TH ST 160014398 10/26/2016 16:34 34 WARRANT 4747 ARAPAHOE AV Public park 1 160013596 10/09/2016 18:31 33 DV 3473 28TH ST #14 School 1 160013659 10/11/2016 11:47 14 ALCOHOL OFFENSE 700 20TH ST stated 25 min prior to contact 1 160013486 10/07/2016 23:48 29 DUI 29TH ST/BASELINE RD stated at 2300 1 160013375 10/06/2016 01:14 26 DUI BROADWAY/CANYON BV Streets 1 160013415 10/06/2016 20:04 39 ASSAULT 1447 PEARL ST Sun Down Saloon 1 160014243 10/23/2016 01:33 24 DUI BROADWAY/CANYON BV The Walrus Saloon 1 160014438 10/27/2016 01:58 22 DV 2740 MOORHEAD AV #102 TWO BEERS 1 160013176 10/02/2016 01:28 27 DUI BROADWAY/SPRUCE ST UNK 4 160013223 10/03/2016 10:16 21 WARRANT 1101 ARAPAHOE AV 160013379 10/27/2016 11:17 41 CRIMINAL MISCHIEF NON -GF 5600 ARAPAHOE AV #100 160014191 10/22/2016 02:17 22 DV 765 ARAPAHOE AV #102 160013260 10/03/2016 21:00 42 WARRANT 2590 WALNUT ST 5 -Nov -2016 Page 4 of 6 These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Report No Date Time Age Nature of Call unknown 160013194 160014188 160014584 160014599 160013376 160014281 160013889 160013524 160013250 160014497 160014502 160013629 160013829 160013352 160014645 160014737 160013770 160013648 160006086 160013548 160013701 160013557 160014094 160014225 160014400 160013301 160013213 160014144 160014570 160014578 160014572 160014599 160013367 160013739 160013286 160014245 160014572 160014629 160014095 160014510 10/02/2016 15:30 54 10/22/2016 01:59 45 10/29/2016 03:18 20 10/29/2016 11:48 42 10/06/2016 02:20 52 10/25/2016 10:24 21 10/15/2016 19:43 51 10/08/2016 13:46 36 10/03/2016 18:00 36 10/27/2016 22:02 30 10/28/2016 00:45 52 10/10/2016 17:58 30 10/14/2016 22:24 23 10/05/2016 16:12 65 10/30/2016 06:00 37 10/31/2016 22:44 18 10/13/2016 18:46 30 10/11/2016 06:05 40 10/06/2016 16:23 50 10/09/2016 00:09 22 10/12/2016 08:40 35 10/09/2016 03:20 22 10/20/2016 01:04 31 10/22/2016 19:30 54 10/26/2016 11:48 62 10/04/2016 18:20 58 10/03/2016 05:29 29 10/21/2016 07:25 45 10/29/2016 00:30 19 10/29/2016 02:36 19 10/29/2016 00:59 18 10/29/2016 11:48 35 10/05/2016 20:14 58 10/12/2016 23:24 43 10/04/2016 13:27 65 10/23/2016 02:53 20 10/29/2016 00:59 18 10/29/2016 23:46 36 10/20/2016 01:04 35 10/28/2016 02:17 18 GOVT OPERATIONS OFFENSE WARRANT DUI PUBLIC PEACE OFFENSE WARRANT WARRANT WARRANT WARRANT GOVT OPERATIONS OFFENSE DUI WARRANT GOVT OPERATIONS OFFENSE MISCELLANEOUS OFFENSE WARRANT WARRANT ASSAULT DRUGS POSSESSION BURGLARY COMMERCIAL WARRANT CRIMINAL MISCHIEF NON -GF WARRANT DUI WARRANT WARRANT WARRANT WARRANT CRIMINAL MISCHIEF NON -GF ASSAULT ASSAULT DUI PUBLIC PEACE OFFENSE PUBLIC PEACE OFFENSE DUI DUI WARRANT DUI PUBLIC PEACE OFFENSE WARRANT WARRANT DUI Location 30TH ST/ARAPAHOE AV 3325 28TH ST 33RD ST/ARAPAHOE AV 1580 CANYON BV 2850 MAPLETON AV 3195 PEARL PY #303 1701 33RD ST 1740 30TH ST 3180 AIRPORT RD TABLE MESA DR/US HWY 36 WB BROADWAY/CANYON BV 3180 AIRPORT RD 1135 13TH ST 4685 BASELINE RD 13TH ST/PEARL ST 1135 11TH ST 4777 BROADWAY 4775 WALNUT ST #102 555 30TH ST 1720 WALNUT ST 1905 28TH ST BASELINE RD/BROADWAY 3065 W STERLING CR 3600 TABLE MESA DR 5340 GUNBARREL CENTER CT BROADWAY/ROSEWOOD AV 3180 AIRPORT RD 1820 15TH ST 1111 COLLEGE AV 11TH ST/PENNSYLVANIA AV 903 16TH ST 1580 CANYON BV 3990 BROADWAY BROADWAY/VIOLET AV FOLSOM ST/MAPLETON AV 27TH WY/BASELINE RD 903 16TH ST 35TH ST/E AURORA AV 3065 W STERLING CR 20TH ST/BROADWAY Total: 40 Unkown 1 160013234 10/03/2016 13:16 25 WARRANT 1001 ARAPAH0E AV World of Beer 1 160013377 10/06/2016 02:12 22 VIOL OF RESTRAINING ORDER 9TH ST/UNIVERSITY AV 5 -Nov -2016 Page 5 of 6 These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Report No Date Time Age Nature of Call Location Total: 142 5 -Nov -2016 Page 6 of 6 Citations Last Drink Location Month of October These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Citation No Date TimeAge Violation 1 Citation Location Total: 1005 12TH ST #302 1 G000153312 10/15/2016 0053 20 5-7-4 1005 12TH ST #302 1080 11TH ST 1 G000157630 10/14/2016 0045 20 5-7-4 1080 11TH ST 1100 13TH ST 1 G000153309 10/14/2016 2030 25 5-7-2 1100 13TH ST 1111 BROADWAY 1 G000155529 10/15/2016 2215 30 5-7-2 1111 BROADWAY 11TH/COLLEGE 2 G000155485 10/08/2016 2356 20 5-7-4 11TH ST/COLLEGE AV G000155486 10/08/2016 2356 21 5-7-2 11TH ST/COLLEGE AV 11TH/EUCLID 1 G000155480 10/01/2016 2350 19 5-7-4 11TH ST/EUCLID AV 12TH/COLLEGE 1 G000155484 10/07/2016 2350 19 5-7-4 12TH ST/COLLEGE AV 13/CANYON 1 G000157876 10/19/2016 0940 42 5-7-2 13TH ST/CANYON BV 18TH/CASCADE 1 G000155604 10/01/2016 0008 19 5-7-4 18TH ST/CASCADE AV 1911 11TH ST 1 G000155530 10/26/2016 0015 30 5-4-3 1911 11TH ST 2580 BASELINE 1 G000146681 10/19/2016 1930 56 5-7-2 2580 BASELINE RD 5660 SIOUX DR 1 G000146764 10/19/2016 1840 35 5-7-2 5660 SIOUX DR 800 18TH ST 2 G000155429 10/14/2016 2345 19 5-7-4 800 18TH ST G000155430 10/14/2016 2350 20 5-7-4 800 18TH ST 84317TH 2 G000153305 10/13/2016 2330 20 5-3-11 843 17TH ST G000153306 10/13/2016 2330 19 5-3-11 843 17TH ST 911 17TH ST 1 G000155433 10/15/2016 1715 19 5-7-4 911 17TH ST 962 PLEASANT 1 G000157239 10/22/2016 1922 19 5-7-4 962 PLEASANT ST 5 -Nov -2016 Page 1 of 2 These Statistics are self reported by the offender, and are thus not reliable nor should any conclusion or decision be made solely on this report Citation No Date Time Acme Violation 1 Citation Location Total: 972 PLEASANT 4 G000155434 10/15/2016 1719 19 5-7-4 972 PLEASANT ST G000157404 10/15/2016 1718 20 5-3-11 972 PLEASANT ST G000157405 10/15/2016 1718 21 5-3-11 972 PLEASANT ST G000157403 10/15/2016 1718 21 5-3-11 972 PLEASANT ST 9TH/UNIVERSITY 1 G000153310 10/14/2016 2300 19 5-4-13 9TH ST/UNIVERSITY AV NOT DOCUMENTED ON THE CITATION 1 G000152806 10/20/2016 1210 40 5-7-2 1300-BLK PEARL ST ON THE HILL 1 G000155428 10/07/2016 1758 18 5-7-4 14TH ST/COLLEGE AV UNK 1 E01614439A 10/27/2016 0113 21 18-6-800.3 695 WALDEN CIR UNKNOWN 14 G000154426 10/28/2016 0154 19 5-7-4 1430 PEARL ST G000155491 10/20/2016 1415 42 5-7-2 13TH ST/ARAPAHOE AV G000143110 10/21/2016 0115 20 5-7-4 12TH ST/COLLEGE AV G000155694 10/22/2016 0250 20 5-5-10 9TH ST/GRANDVIEWAV CR00123971 10/16/2016 2037 36 18-18-403.5 555 30TH ST G000155435 10/16/2016 0015 20 5-7-2 700 19TH ST G000155693 10/16/2016 0130 18 5-7-4 1107 13TH ST G000155017 10/16/2016 0219 18 5-7-4 1200 EAST RIDGE AV G000149075 10/01/2016 0106 20 5-7-4 12TH ST/EUCLID AV G000155014 10/14/2016 0004 25 5-3-1 11TH ST/WALNUT ST G000152835 10/15/2016 1150 47 5-7-2 3375 28TH ST G000155431 10/14/2016 2350 20 5-7-4 800 18TH ST G000153311 10/14/2016 2330 18 5-7-4 1700 AURORA AV G000155163 10/14/2016 2314 18 5-7-4 1000 14TH ST 41 5 -Nov -2016 Page 2 of 2 r•b'QlIua DCIII 3 Cook, Mishawn Tot�e_ // oy, From: RHG Boulder <mike@mountainsunpub.com> Sent: Monday, October 17, 2016 12:42 PM` To: Cook, Mishawn Subject: RHG Update & ID Refresher Course RHG Boulder - Update RHG Boulder's loth meeting of 2016 is Wednesday 11/2/2016! www.rhgboulder.com RHG Boulder will be hosting our last meeting of the year on Wednesday 11/02/2016. We will be doing our year end wrap up and will be hosting some guest speakers. More details to follow. RHG Boulder also wanted to let our membership know about tomorrow's ID Refresher Course being hosted by Jonathan Balliet with TIPS Colorado. Refresher Course on I.D. Protocol & Sting Operations When: Tuesday, October 18th 2:30 - 4:00 PM Where: The Sink 116513th St., Boulder Cost: $15 per person $10 per person RHG member employees open to the public *** this is a NON -Certifying refresher class focusing on the specifics/importance of proper I.D procedures and how the Compliance ("Sting") Operations work. Please send any of your staff if you think they would benefit. To Register: Call, Text, or Email your Name & Employer to: 303-210-1351 JB@TIPSCOLORADO.COM We look forward to seeing you all there! Please forward Mike's email address along to anyone in the community that would like to be involved with RHG Boulder. Wednesday, 11/02/2o16 2:30 pm TAJ Restaurant 263o Baseline Rd Boulder, CO 80305 (303) 494-5216 Please contact Mike with any questions about the meeting or RHG Boulder in general. Thank you! STAY CONNECTED: [Your Company Name], 54 Active Members, Boulder, CO 80302 SafeUnsubscribeTM cookm(&bouldercolorado gov 2 Forward this email I Update Profile I About our service provider Sent by mike@mountainsunpub.com in collaboration with Constan t Con tac t'. 4 O` Try it free today Cook, Mishawn From: RHG Boulder <mike@mountainsunpub.com> Sent: Friday, October 28, 2016 3:12 PM To: Cook, Mishawn Subject: RRForum Opportunity RHG Boulder - Update RHG Boulder's loth meeting of 2oi6 is Wednesday 11/2/2016! www.rhgboulder.com RHG Boulder will be hosting our last meeting of the year on Wednesday 11/02/2016. We will be doing our year end wrap up and will be hosting some guest speakers. More details to follow. RHG Boulder also wanted to let our membership know about an opportunity to get involved with the RRForum: We'd like to know your thoughts ... on serving alcohol in a college community Boulder is one of six national sites participating in a new Alcohol Responsibility Program ("ARP") developed for the International Town & Gown Association by the Responsible Retailing Forum ("RRForum"). Our goal for the ARP is to promote safe and responsible alcohol sales, service, and consumption. For the ARP to succeed, we need to learn more about the concerns of individuals who work in licensed establishments and how the ARP can be of assistance. That's why we need your help. We are inviting you to participate in a 1 -hour meeting with RRForum staff to discuss these important issues. The meeting will be held at the Boulder Chamber of Commerce, 2440 Pearl Street, Boulder on Monday, November 7th, from 12:00 to 1:00 p.m. At the meeting, RRForum staff will ask you and others in the Boulder hospitality industry about the challenges of serving alcohol in a college community and trying to achieve full compliance with state and local alcohol sales laws. All responses will be strictly confidential. You would be free to refuse to answer any question or to leave at any time. Only RRForum staff will be present. As a 'thank you," each participant will receive a $50 gift certificate. Please R.S.V.P. by contacting Maureen DeJong at dejong@rrforum.org rrforum.org or 508-661-9706. We look forward to seeing you all there! Please forward Mike's email address along to anyone in the community that would like to be involved with RHG Boulder. Wednesday, 11/02/2016 2:30 pm TAJ Restaurant 263o Baseline Rd Boulder, CO 80305 (303) 494-5216 Please contact Mike with any questions about the meeting or RHG Boulder in general. Thank you! STAY CONNECTED: [Your Company Name], 54 Active Members, Boulder, CO 80302 SafeUnsubscribeTM cookm bouldercolorado gov Forward this email I Update Profile I About our service provider Sent by mike Ccbmountainsunpub.com in collaboration with AF Constant Contact %11: Try it free today Cook, Mishawn From: RHG Boulder <mike@mountainsunpub.com> Sent: Saturday, October 29, 2016 4:11 AM To: Cook, Mishawn Subject: RHG Meeting - Wednesday, November 2nd, 2016 - 2:30 pm - Taj Restaurant RHG Boulder - Monthly Meeting - Reminder RHG Boulder's loth & final meeting of 2016 is Wednesday 11/2/2oi6! www.rhgboulder.com RHG Boulder will host our final meeting of 2016 next Wednesday at 2:30 pm at the Taj Restaurant. We will be discussing a new responsible alcohol program and warp up our year. We will also be discussing potential officers for 2017 and sites for meetings. We look forward to seeing you all there! Here is some info on the new responsible alcohol program and an opportunity to get involved: The Responsible Retailing Forum and the International Town & Gown Association have joined forces in a unique strategic alliance to develop an Alcohol Responsibility Program for ITGA communities that addresses the unique challenges of alcohol use and abuse in college and university communities. Boulder has been selected as one of six ITGA member communities to participate in the development of the Alcohol Responsibility Program. As an important leader in the community, we would like to invite you to join us to discuss the new initiative and to share your thoughts on how we may adapt this program to be most effective in the community. Your insight and expertise in this area are valued. We believe that by working together with all stakeholders, we will build a stronger and more successful program. Monday, November 7, 2016 9:00-10:3oam Boulder Chamber of Commerce Building, 2440 Pearl Street, Boulder, CO 80302 Please RSVP to: Jennifer Korbelik, University Liaison, City of Boulder korbelikj@bouldercolorado.gov or (303) 441-4142 Please feel free to contact Jennifer with any questions as well. Thank you for your support. We look forward to seeing you on November 7th. Please forward Mike's email address along to anyone in the community that would like to be involved with RHG Boulder. Wednesday, 11/2/2016 2:30 pm TAJ Restaurant 263o Baseline Rd Boulder, CO 80305 (303) 494-5216 Please contact Mike with any questions about the meeting or RHG Boulder in general. Thank you! STAY CONNECTED: E3©®0 [Your Company Name], 54 Active Members, Boulder, CO 80302 SafeUnsubscribeT" cookmC&bouldercolorado.gov Forward this email I Update Profile I About our service provider Sent by mike@mountainsunpub.com in collaboration with Constant Contact. y' Try it free today Agenda Item 4 BEVERAGE LICENSING AUTHORITY, CITY OF BOULDER, COLORADO STIPULATION OF FACTS IN RE: HOTEL -RESTAURANT TYPE LIQUOR LICENSE # 28-59548-0000 OF CRO DEVELOPMENT III, LP D/B/A CANTINA LAREDO 1680 29th ST BOULDER, COLORADO 80301 The above Licensee, by and through its attorney Adam Stapen, and the City of Boulder, by and through its Assistant City Attorney, Lucas Markley, hereby stipulate and agree as follows: 1. That the Beverage Licensing Authority of the City of Boulder, Colorado, hereinafter referred to as "the Authority," found probable cause that the above Licensee had violated certain laws, and therefore issued and caused to be served upon said Licensee a Notice of Hearing and Order to Show Cause. 2. That a hearing concerning the violation is scheduled to be held on November 16, 2016, in the Municipal Building at 1777 Broadway, Boulder, Colorado, at which time said Licensee will be ordered to show cause why License # 28-59548-0000 should not be suspended or revoked, as provided by law. 3. That this stipulation shall not be effective unless and until it is approved by a majority vote of the attending members of the Authority on the scheduled hearing date. 4. That Licensee sold an alcoholic beverage to a person who was under 21 years of age. The sale occurred essentially as described in the affidavit attached to the Notice of Hearing and Order to Show Cause. 5. That the sale to a minor was investigated or detected using a person under 21 years of age to purchase alcoholic beverages, during a compliance check conducted by Officer Dan Bergh of the Boulder Police Department. 6. That the sale of the alcoholic beverages was a violation of sections 12-47-901(1)(a.5) and 12-47-90](5)(a)(1), C.R.S. 7. That Licensee acknowledges the violation by its admission and elects not to contest the underlying facts. Licensee waives its right to a public hearing to contest the facts of the violation charged. Page 1 of 2 8. That both parties, Licensee and City of Boulder, expressly reserve the right under 1 C.C.R. 203-2, Reg. 47-600, to present evidence in explanation and mitigation or in aggravation of the violation. 9. That Licensee understands that, if a suspension is imposed as a sanction, Licensee is required to display a poster giving notice of the suspension for the duration of all suspension days. Licensee understands that failure to serve a suspension, post a notice during a suspension, or abide by any additional local condition ordered by the Authority will comprise a separate violation of the terms of License # 28-59548-0000. 10. That Licensee has read and understood the terms in this stipulation. Licensee understands the right to due process in this matter. Licensee understands that it is waiving the right to appeal the decision of the Authority in this matter to a court. Licensee is not under the influence of alcohol or any intoxicant. Licensee enters into this stipulation knowingly, intelligently, and voluntarily. DATED this day of Al�&0*4ep--, Signatures: Licensee / Altornef Ifor Licensee L ar ey / At City Attorney h Date t\ Date -7 �- Page 2 of 2 BEVERAGE LICENSING AUTHORITY, CITY OF BOULDER, COLORADO ENTRY OF APPEARANCE, REQUEST FOR CONTINUANCE AND REQUEST FOR DISCOVERY IN THE MATTER OF: CRO Development III, LP D/B/A Cantina Laredo 1680 29th Street Boulder, Colorado 80301 License Type: Hotel and Restaurant Class License COMES NOW the law firm of DILL DILL CARR STONBRAKER & HUTCI-IINGS, P.C., by and through Adam P. Stapen, Esq., and respectfully enters its appearance on behalf of CRO Development III, LP d/b/a Cantina Laredo ("Respondent"). 1. Respondent respectfully requests a continuance of the hearing date currently scheduled for October 19, 2016, as Respondent's manager will be out of town on that date. The Respondent has conferred with the City Prosecuting Attorney, and the City Prosecuting Attorney does not object to the requested continuance. 2. Respondent also respectfully requests all police reports, videos, investigative reports, and any other documentation of any kind or character, whether in tangible or electronic form or otherwise, relating to this pending Order to Show Cause. Specifically, a copy of the video and the identification that was presented at the time the violation is alleged to have occurred are hereby requested. i, Respectfully submitted this .4-'/ day of September, 2016. DILL DILL CARR STONBRAKER & HUTCHINGS, LC --,-- Adam P. Stapen, #27506 455 Sherman Street, �St 00 Denver, CO 80203 Telephone: (303) 777-3737 Fax: (303) 777-3823 E -Mail: astapen@dillanddill.com Attorney for Respondent CERTIFICATE OF DELIVERY day of September, 2016, a true and correct copy of the I hereby certify that on this ,� in Ent U of Appearance, Rc uest for Continuance and Request for Discovery was foregoing ry PP � 9 � 9 � delivered via e-mail as follows: Mishawn Cook Staff Liaison cookm cr,bouldercolorado.gov Carey Markel, Esq. Assistant City Attorney markelc(@bouldercolorado.gov 'g�- City of Boulder Finance September 29, 2016 Adam P. Stapen, Esq. Dill Dill Carr Stonbraker & Hutchings, PC"' 455 Sherman Street, Ste: 300 Denver CO 80203 Sent Via US Mail and Email to astapen@dillanddill.com Re: Show Cause Notice dated September 13, 2016 for Hotel -Restaurant liquor license at 1680 29" Street, Boulder, CO 80301 and Show Cause Hearing Continued to November 16, 2016 Dear Adam: The purpose of this letter is to provide written confirmation that your request for a continuance of the Beverage Licensing Authority (BLA) show cause hearing for your client, Cantina Laredo, has been granted. As such, you will then be scheduled and are hereby ordered to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado on Wednesday November 16, 2016 at 3:00 PM for a continued show cause hearing to determine if there is good cause to suspend or revoke your liquor license. All other information in my hearing notice letter dated September 13, 2016, remains unchanged and still applicable. Mitigating evidence submission, if any, will be required by Monday November 7. If you have questions, or require additional information, please contact me at the below listed numbers. Sincerely yours, Mishawn J. Cook Licensing Administrator Certified Municipal Clerk Phone: 303-441-3010; Fax: 303-441-1919 Email: cookm@bouldercolorado.gov Website: www.bouldercolorado.gov/licensing City of Boulder- Finance Dept 1777 Broadway Boulder, CO 80306 licensing@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) BEVERAGE LICENSING AUTHORITY, CITY OF BOULDER, COLORADO IN THE MATTER OF THE HOTEL -RESTAURANT TYPE LIQUOR LICENSE OF CRO DEVELOPMENT III, LP d/b/a CANTINA LAREDO, 1680 29TH STREET, BOULDER, COLORADO NOTICE OF HEARING AND ORDER TO SHOW CAUSE To: Manager YOU ARE HEREBY ORDERED to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado, at 3 p.m. on Wednesday, October 19, 2016, to show cause why your above referenced Hotel -Restaurant Type License should not be suspended or revoked, for the following violations: 1. On August 19, 2016, at approximately 5:18 p.m., the licensee sold, or permitted the sale of malt, vinous, or spirituous liquor to an individual, who was then under 21 years of age, in violation of Section 12-47-901(1)(a.5)(1), C.R.S., as more fully set forth on Exhibit A, attached hereto and incorporated herein by this reference. You should be prepared at the above stated time and place to cross-examine any witnesses who appear against you and to present such evidence as you desire in defense, explanation, and mitigation. The City's penalty schedule is enclosed. If you are found responsible for the violation, you will have an opportunity to provide mitigating evidence during the sentencing portion of the hearing. For a suspension less than the table value found in the penalty schedule, please focus your efforts on providing evidence of mitigating factors identified on the second page of the penalty schedule. This notice is issued pursuant to Section 12-47-601, C.R.S. and Section 10-2-2 of the City of Boulder Licensing Authority Rules of Procedure. Please be advised, that in the event that the Authority determines that the facts alleged in this notice are sufficient to impose a suspension of your license, the Authority will select the specific days to be served for any imposed suspension. Please be further advised that any imposed suspension period falls within a 30 -day time period from the date of the hearing; 2) the suspension days are consecutive business days; and 3) that the suspension days are days that your business would ordinarily and otherwise be open. Once a suspension period is set and approved by the Authority, it will generally not be modified unless as directed by written order by the licensing clerk or Authority. SECRETARY OF THE AUTHORITY CERTIFICATE OF MAILING I hereby certify that on the Dih day of , 20U, a true and correct copy of the above and foregoing Notice of Hearing and Order to 8how Cause was duly mailed by placing same in the U.S. Mail, certification no. -701a a'i J 0 ocgo �bj I I cil q3 , return receipt requested, postage prepaid, addressed to the following: CRO Development III, LP d/b/a Cantina Laredo 12200 N. Stemmons Freeway, Suite 100 Dallas, TX 75234-5877 Via U.S. Mail postage pre-paid.- Manager repaid.•Manager CRO Development III, LP d/b/a Cantina Laredo 1680 291' Street Boulder, CO 80301 7 ® Complete items 1, 2, and 3. Also complete item'4 if Restricted Delivery is desired. s Print your name and address on the reverse so that we can return the card to you. * Attach this card to the back of the mailplece, or on the front if space permits. T1. Article Addressed to: - - — -� A. Sign Vd'.b�y � D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below- 0 No CRO Development III, LP �d/b/a Cantina Laredo 12200 N. Stemmons Freeway, Suite 100 Dallas, TX 75234-5877 3. se vice Type 61' Certified Mail 0 Express Mail 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number -- (rransfer from service labeo 7 012 2920 00003112 9797 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 Postal Service,, 3TIFIFn mmr— R1=r-mr- No. • ErCoverage N ]�° (j (j (� (� (� ru !t • @ U •U A L LTJ E rLJ ri ri Postage $ Certified Fee L 1 1 O Return Receipt Fee 14 Postmark Q (Endorsement Required) Here Restricted Delivery Fee (Endorsement Required) l� rU D^ Total r`tant Tc CRO Development III, LP R'r-q d/b/a Cantina Laredo N orPO1 12200 N. Stemmons Freeway, Suite 100 ciry,'si Dallas, TX 75234-5877 CITY OF BOULDER COPIES Original: Deputy City Clerk Request for Show Cause Hearing Copy 1: BPD Legal Advisor Copy 2: Originating Officer Co 3: City Attorney's Office Pursuant to § 12-47-901 (Colorado Revised Statutes), Regulation 47-600 (1 Colorado Code of Regulations 203-2), and Rule 17 (Rules of Procedure), I respectfully request a hearing be held before the City of Boulder Beverages Licensing Authority to show cause why the below license should not be suspended or revoked for the violation(s) of Laws, Regulations, and/or Ordinances specified in the attached Affidavit. Licensee's Name Trade Name Location CRO Development III, LP Cantina Laredo 1680 291" Street, Boulder CO City Attorney Lucas Markley No. 80301 Mailing Address License Type License License License a 012, 0/ � City Attorney Lucas Markley No. Issued Expires 12200 N. Stemmons Freeway, Suite 100 Dallas, TX 75234-5877 Hotel -Restaurant 28-59545-0000 08/19/16 09/27/16 Violation Date Case No. Officer 1. UNLAWFUL ACTS: on Aug. 19, 2016 licensee did unlawfully a 012, 0/ � City Attorney Lucas Markley Signature permit the sale, serving, giving, or procuring, of any alcohol Deputy Chy Clerk j Signature" Date beverage to a person who is under twenty-one years of age, 12- 08/19/16 9�z 47-90 1(1)(a.5)(I) UNDER THE COLORADO REVISED 16-10839 D. Bergh STATUTE, AS AMENDED. Hearing Date Hearing Time Previous Violations I Days in Abey. /0//e///6 a 012, 0/ � Originating Officer Sianature Date Daniel Bergh a 012, 0/ � City Attorney Lucas Markley Signature Date Deputy Chy Clerk j Signature" Date Mishawn Cook 9�z NOTES CRO Development III,LP d/b/a/ Cantina Laredo AFFIDAVIT FOR SHOW CAUSE HEARING Your Affiant, Officer Daniel Bergh (hereinafter referred to as, "I") is a duly commissioned Police Officer for the City of Boulder Police Department. I am currently assigned to the Special Enforcement Unit, a division of the Community Services Section of the Boulder Police Department, and investigate crimes occurring within the City/County of Boulder, State of Colorado. I have over 17 years of experience in the investigation of criminal and liquor law violations. I do swear and affirm the following to be true: On August 19, 2016, Officer B. Rech and I were on duty for the enforcement of Colorado and Boulder liquor laws and regulations. We conducted underage compliance checks at various licensed establishments in the City of Boulder. Underage Operative #I was a volunteer for this operation. Operative #1's date of birth is 01/24/1997. She had a Colorado driver license with the upright/vertical format showing he was under 21 years of age on that date. A photocopy of the Operative #1's Colorado Driver License was made and a digital photograph of her as she appeared that evening was taken. Before the operation began, I verified the following about the underage operative: • She did not have fraudulent or false identification on their persons. • She had no pending criminal or traffic offenses. • She had no prior convictions for alcohol related offenses. Through me the Boulder Police Department supplied the operative with "buy money." The operative was not allowed to use her own money for any purchases of alcoholic beverages. The operative was not allowed to consume any alcoholic beverages during the operation. From records provided by the Deputy City Clerk, CRO Development III, LP, doing business as Cantina Laredo, holds a Hotel -Restaurant type liquor license, number 28- 59545-0000. At approximately 1718 hours Officer Rech and I transported the operative to Cantina Laredo, 1680 29th Street, where she made her way inside in an attempt to purchase alcohol. Operative #I was seated at a table on the west side of the restaurant. The waiter, later identified as Bahy Ghoneim, approached Operative #1 and told her about the specials. Operative #1 then requested a, "Casa Rita" which I later learned was a house margarita offered at a discounted price during happy hours. Ghoneim asked Operative #1 for an ID. Ghoneim looked at the ID, "closely" (per operative #1) before returning it to Operative # 1. Ghoneim returned with the alcoholic drink and served it to Operative # 1. Operative #1 then alerted me that she had been served alcohol. Page 1 CRO Development I II, LP d/b/a/ Cantina Laredo Officer Rech and I entered and found Operative #1 seated at the table with a drink in front of her. Operative 42 then pointed out the server to me and then left the restaurant and returned to our vehicle. Officer Rech collected sample of the cocktail which was later placed into Property and Evidence. I contacted Ghoneim, identified myself and asked him if he had served the drink to Operative #1. He said that he had done so. I told him that the operative was underage. I asked Ghoneim if he had checked our operative's ID. He said that he had and after I pointed out that the ID was vertical, Ghoneim admitted that he had made a mistake. I issued Ghoneim a summons and advised the manager of what had occurred. Ghoneim was apologetic during the remainder of my contact with him and, in the presence of the manager, said that it was, "...my fault." I made a CD -R copy of the audio recording of the event and later placed it into Property and Evidence at the Boulder Police Department. At approximately 6:45 minutes into the recording the interaction between Ghoneim and Operative #1 can be heard although Ghoneim's voice is faint. Based upon the above information, I believe there is probable cause to show that on Friday, August 19, 2016 at approximately 1718 hours, the owner/licensee, CRO Development III, LP, doing business as Cantina Laredo at 1680 29t11 Street, City/County of Boulder, State of Colorado violated the following: 1. UNLAWFUL ACTS: on August 19, 2016 licensee did unlawfully permit the sale, serving, giving, or procuring, of any alcohol beverage to a person who is under twenty-one years of age, 12-47-901 (1)(a.5)(I) UNDER THE COLORADO REVISED STATUTE, AS AMENDED. I respectfully request a hearing before the CITY OF BOULDER BEVERAGES LICENSING AUTHORITY to show cause if said license should not be suspended or revokqO for the above vi lation. C Affiant — Daniel ergh / Date AotaoPblic /Date KADY ECKSTROM NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20024024201 MY COMMISSION EXPIRl16 JIJI Y 2Q, 2018 Page 2 Your 1 DATE: UNDERAGE OPERATIVE'S SUMMARY OF FAILED COMPLIANCE CHECK DAY OF WEEK: 'Fr',rj G V TIME: jrj . Ze-j in m v BUSINESS NAME: (_an,: % rNa- L a !'o_j U LOCATION: 1656 2-A .F.k 4: C'Pe1- Approximate number of people in business: Business checking I.D.'s at the front door? ❑ Yes JgNo Did you have an I.D.? if Yes ❑ No If so, what age was shown on the I.D.? __ 19 Did an employee ask for your I.D.? P Yes ❑ No Did an employee look at your I.D.? 14 Yes ❑ No Where did you sit? A 4- G +Qbl P— Were other operatives with you? ❑ Yes P No Who ordered the alcohol? Did an employee accept payment for alcohol? ❑ Yes 0 No Type and brand of alcohol ordered: The words used to request alcohol: LGn 1 C', *1 le— s1 4 -t, C50 description of employee who served alcohol: l6aw e-rj q lctbu L 2t. 1 u�C� a1�SSa�—�ac-k ec' Go10 C' healC Gck-er- C 6t-0(— 5k'IV }- +!A 1on 12 Your notes about the purchase and the conversation with the employee. This is intended to help you remember the conversation later, if needed. Write down anything that will help you recall what happened. Use the back of this page if needed. 5ck4 A o cx, n a L- -i-hy I. a b l a, eC— cam o ve c i -c l d C►�e_ �h� hov52 S oeGtals ars haop46r, - AgcA1S. ernk-es-3 C'or' +V IMcg Q V%3 -C& An - ijer rnCk'S, �,e_ ae P0103cf.d oc,k kVe- l,aO-et— ko oFF�cec-. 9/12/2016 License Database Page 1 of 1 Liquor Violations License #: 28-59548-0000 Year: 2011 Trade Name: CANTINA LAREDO Applicant: CRO Development III; LP Location: 1680 29th St Address: 12200 N Stemmons Freeway, Suite 100 License Type: Hotel -Restaurant Liquor DallasTX 75234-5877 Hearing Date: 4/18/2012 Violations Found: Sanctions Imposed I ❑ None Other sanctionsrnformation: ❑ Renewal Denied Effective Date: 2 suspension days to be served from May 13 to 14, F_ Revoked Total Days: 14 2012 Suspended Days Served: 2 Days held in abeyance: 12 Fine in lieu of active suspension: $0.00 License #: 15-65291-0000 Year: Trade Name: CANTINA LAREDO Location: 1680 29th St License Type: Hotel -Restaurant Liquor Hearing Date: 1/21/2009 Violations Found: Sale to a Minor Applicant: CRO Development GP, LLC Address: 12200 N Stemmons Freeway, Suite 100 Dallas JTX 1 175234-5877 Sanctions Imposed ❑ None ❑ Other sanctionsrnformation: ❑ Renewal Denied Effective Date: 2 days to be served from Feb. 1-2, 2009 F' Revoked Total Days: 14 Suspended Days Served: 2 Days held in abeyance: 12 Fine in lieu of active suspension: $0.00 Location = 1680 29th St or Applicant = CRO Development III, LP or Number = 28-59548-0000 City of Boulder Yr Finance Department T= Tax and License Division Sales and Use Tax - Community Information • Special Event Liquor Liquor License • Miscellaneous License • Marijuana Business License Dear Licensee: February 17, 2015 Enclosed you will find a "Notice of Show Cause," which is issued by the Boulder Liquor Authority (BLA). Your Show Cause Order alleges a violation of the Colorado Liquor Code under your alcohol beverage license. Your appearance date is noted in the Show Cause Order and a representative of the licensee is required to appear. At the Show Cause Hearing, the licensee will need to "show cause" as to why the liquor license should not be suspended or revoked. You may have an attorney represent you at the Hearing, but one is not required. You or your attorney must contact the prosecutor at least one week prior to the hearing. If you fail to contact him, you may be subject to the maximum suspension/revocation penalty. You will also need to provide proof of training within 3 months of hire for all of your employees that are involved in the sale or service of alcohol. Please use the attached form to summarize attendance by your personnel at a state -certified Responsible Vendor alcohol service training. The Boulder Beverage Licensing Authority has determined that class attendance will be deemed valid for the current term indicated on the card or the certificate. In addition, please provide copies of Completion Certificates or Class Cards from state -certified Responsible Vendor alcohol service trainings for all employees involved in the sale or service of alcohol (such evidence of complete employee state approved training must be considered by the Authority as to mitigation for violations from compliance checks). Please return fully completed training chart and above certificates or cards to City Licensing, delivering same to 1777 Broadway, I" Floor, Tax and License Division, no later than nine days prior to the hearing (this will fall on a Monday). Please also submit any other Mitigating Fact evidence no later than nine days prior to your hearing. Failure to turn in these documents or to turn in thes documents by the deadline may be viewed by the Authority as an "aggravating" factor and could potentially increase any suspension days imposed. The city prosecutors are in the City Attorney's Office Prosecutor for the Boulder Police Department, their telephone number is 303-441-3020, and the mailing address is City Attorney's Office, P.O. Box 791, Boulder, CO 80306, Attention: PD Prosecutor for BLA hearings. Please be advised that it is your responsibility as a liquor licensee to know the state and local liquor codes and regulations. The prosecutors will discuss the issues involved in your pending Show Cause Hearing, but they cannot provide you with legal advice as to the defense of your case. A copy of Boulder Liquor Authority "Penalty Schedule" for liquor code violations is attached. If you are found to have committed a violation, this schedule will be used as a guideline, at the discretion of the BLA, to impose your penalty. In certain situations, C.R.S. 12-47-601 permits you to petition the BLA for permission to pay a monetary fine or "fine in lieu" of having your license suspended for all or part of the suspension period. If you decide to petition the BLA to pay a fine in lieu, you must bring to the hearing your books and records for the period of the last 90 days of your overall sales totaled and your alcohol sales totaled for that period. The fine amount shall be not less than $200 or more than $5,000. The BLA may, in its sole discretion, grant the petition to pay a fine, instead of a closure. The BLA will consider these requests on a case-by-case basis but do not have to grant them. Per state law and local rules, you will be required to display a poster for the duration of all suspension days. Failure to serve your suspension, post during your suspension, or abide by any additional local conditions directed by the BLA will result in an additional notice of show cause for violation. Cnv of Boulder 1777 Broadway P 0 Box 791 Boulder, CO 80306 licensing ttbouldercolorado.sov (303) 441-4192 (303) 441-1919 (FAX) Trade Name: Location Address: PROOF OF TRAINING: The Beverage Licensing Authority has determined that it is a local condition of a liquor license that everyone involved in service/sale of alcohol is required to take a State approved Responsible Vendor Alcohol Service training within three months of premise opening or three months of hire date and that such training is valid and current at the time training certification is provided. Please fill out the following form, list any and all employee training below, and attach all Certificates of Training and Class Certification cards, or other evidence of training completion for each listed employee. Employee's NameI Training Title I Hire Date I Previous I Latest Training Date Training Date Rev. 2/17/15 CITY OF BOULDER'S BEVERAGE LICENSING AUTHORITY MITIGATING AND AGGRAVATING FACTORS FOR VIOLATIONS AND PENALTY SCHEDULE GUIDELINES Effective January 1, 2003 and last updated on August 20, 2015 The Beverage Licensing Authority MAY, in their discretion, consider the following mitigating and aggravating factor evidence in imposing penalties. WRITTEN MITIGATING FACTOR EVIDENCE NEEDS TO BE SUBMITTED TO CITY LICENSING OFFICE AT LEAST 9 DAYS PRIOR TO ANY SHOW CAUSE HEARING. Mitigating Factors Aggravating Factors Training Programs- initial and on-going. Responsible Vendor Training and supplemental. Must be current. Failure to submit Mitigating Factor evidence at least nice days before hearing to City Licensing Written Policies Prior Offenses in the past five (5) Years Supervision Procedures Violations occurring outside of compliance checks (aka "Stings") Self -check programs Lack of effective operational/training programs Use of birth -date input cash registers Multiple Police Contacts Community Involvement Failure to cooperate with liquor enforcement representatives Responsible advertising practices Irresponsible advertising policies Active Responsible Hospitality Group membership (8 out of 11 yearly meetings) Failure to Accept Responsibility for Violation Other Pertinent Facts Other Pertinent Facts These suspension penalties are guidelines only and are not binding on the Authority. The Authority reserves the right to impose any penalty authorized by law. Fines in lieu of suspension days served are generally not granted by Authority All Other Liquor Store All Other Liquor Store Licenses Tavern License Licenses Tavern Code Violation Days Served Days Served Abeyance Days License Abeyance Days Sale/Service to a Minor 1 count 5 3 9 6 2 counts 10 6 20 12 3+ counts 15 9 30 18 Second Offense within 1 year 10 6 20 12 Conduct of Establishment 1 count 8 6 6 3 2 counts 13 9 17 9 3+ counts 18 12 27 15 Second Offense within 1 year 20 11 20 12 Sale/Service to Intoxicated Person First Offense 1 count 5 3 9 6 2 counts 10 6 20 12 3+ counts 15 9 30 18 Second Offense within 1 year 10 6 20 12 Sale/Service after Legal Hours First Offense 3 2 7 4 Second Offense 10 6 20 12 Removal of alcohol from licensed premises 1 count 3 3 7 7 2 counts 5 5 5 5 Underage Employee selling or serving First Offense 1 count 2 1 5 3 2 counts 4 3 10 6 3+ counts 10 6 20 12 Permitting Disturbances First Offense 10 6 20 12 Second Offense 20 12 30 18 Purchases of liquor from someone other than wholesaler 1 count 3 3 7 7 2 counts 5 5 5 5 Failure to maintain adequate books and records First Offense 5 3 9 6 Second Offense 10 6 20 12 Failure to report manager, corporate, financial or trade name changes First Offense 0 0 5 3 Second Offense 3 2 7 4 Failure to Meet Food Requirements 9 (w/30 to First Offense 5 N/A correct) N/A Second Offense 10 N/A 20 (w/ 30 to N/A [Includes correct) Tavernsl [Includes Taverns] Permitting Illegal Gambling First Offense 3 2 7 4 Second Offense 15 9 30 18 Third Offense 20 12 30 18 Video Poker Gambling First Offense 15 9 30 18 Second Offense 20 12 30 18 Violations on Follow Up Inspections For each Offense 1 1 2 1 Altered Alcohol 1 count 5 3 9 6 Shake a Day 1 count 5 3 9 6 2 counts 10 6 20 12 In determining whether or not a second or subsequent violation occurred within a one-year period for abeyance days, the Authority will use the date of conviction for the first violation (usually the date of the show cause hearing) to the actual date of the second violation. For example, if a licensee was "convicted" of their first violation at a March 1, 2001 hearing and had ten days held in abeyance for one year and then they were cited on February 1, 2002, that would be considered a second violation within a year. The licensee would automatically have to serve the ten days held in abeyance from the first violation, plus their new suspension days determined by the Authority. If however, the licensee were cited on March 9, 2002, then it would not be considered a second violation within a year. Please Note: if a recording of the compliance check interaction inside of your liquor license premise was produced, it is made available so that the licensee may hear it on our liquor licensing website at: www.bouldercolorado.gov/licensing and select "Liquor Licensing", "BLA Hearing Agenda & Packets -Search", and then select the applicable Year and Month for your BLA Hearing date. Having access to the audio recording associated with your show cause hearing is an important part of your review of the allegations against you, so please do not hesitate to call so that City Licensing may assist you in accessing the recording. Please call us at 303-441-4192 and select "Liquor Licensing" immediately if you cannot find the recording or if you have any issue with your ability listening to it. E3 Cantina LAREDO. gonrmer mexican .food CANTINA LAREDO Mitigating Facts Document List Factor 1 Responsible Alcohol Training Program Records Factor 2 Written Policies of Alcohol Related Issues Factor 3 Self -Check Programs Factor 4 Community Involvement & Donation Records Factor 5 Responsible Advertising Practices n /Zcv 111y/6 Factor 6 Active Responsible Hospitality Group Membership Factor 7 Pertinent Facts Factor 1 Responsible Alcohol Training Program Records Staff Tips Alcohol Certification Binder (TIPS) Points of Section: • No one hired unless TIPS certified • Must shove proof of certification card • Active employees are notified 3 months prior to expiration date • Training Session on proper ID checking on October 2, 2016 by Jonathan Baliiet Factor 2 Written Policies of Alcohol Related Issues Serving Alcohol Responsibly (SAR) Points of Section: • ( In-house (CRO) Alcohol Training Flip Chart i Orientation •; Written policies and test • SAR (Serving Alcohol Responsibly) is reviewed by Gm •' Employee Is tested and must pass before he serves first guest •I All facts on on-going training (pertinent facts) will be j discussed during presentation Factor 3 Self -Check Programs (Bars Program) Points of Section: • Use of bars program instituted in February 5, 2009 • Two visits per month • Only four red cards since 2009 • Have 100% pass rate last two years • Reward employee during the pre -shift meeting when they earn a green card • Terminate employee who receives a red card Factor 4 Community Involvement & Donation Records Points of Section: • Total donations for 2012 - $ 41,627 • Total donations for 2013 - $ 59375 • Total donations for 2014 - $1,524 • Total donations for 2015 - $ 3,045 • Total donations for 2016 - $1,645 • Request and Thank You Letters • Receipts of donations Factor 5 Responsible Advertising Practices Points of Section: • Quarterly alcoholic beverage promotions • Tequila Dinner promos • Promote in-store, social media • Uber offer on most promotions Factor 6 Active RHG Member & Attendance Points of Section: • Active member of RHO • Active status has been current since 2009 • Attended 9 of the 11 meetings in 2016 o RHO cancelled July o June meeting missed due to new SM • All dues are current Factor 7 Pertinent Facts Points of Section: • We have shift meeting before every shift to go over serving alcohol responsibly • Change "legal age date" signage (posted in the service alley and bar) in front of all staff during shift meeting • Server utilize the buddy system to remind each other to ID, especially when they hear a questionable guest order an alcoholic beverage • ID each guest that appear to be under 40 years old • Do not serve alcoholic beverages to anyone who presents a CO vertical ID • Out of State vertical IDs go directly to a manager for verification • Manager Is Involved when ID or guest age is in question • We have a digital and infra -red ID scanner In place • We have a current ID checking guide • Only 1 drink per person at a time and all lDs must be present on each person placing the order s Cantina LAREDO. gonrme( mexican food Pertinent Facts Factor 7 Pertinent Facts Points of Section: • We have shift meeting before every shift to go over serving alcohol responsibly • Change "legal age date" signage (posted In the service alley and bar) in front of all staff during shift meeting • Server utilize the buddy system to remind each other to ID, especially when they hear a questionable guest order an alcoholic beverage • ID each guest that appear to be under 40 years old • Do not serve alcoholic beverages to anyone who presents a CO vertical ID • Out of State vertical IDs go directly to a manager for verification • Manager is Involved when ID or guest age is in question • We have a digital and infra -red ID scanner in place • We have a current ID checking guide • Only 1 drink per person at a time and all Ws must be present on each person placing the order Cantina LAREDO. gourmet tnesican food Responsible Hospitality Group Membership 2016 RHG Membership Invoice Date: Business Information Name Address City, State, Zip Phone Type of Business: Contact Information CANTINA LAREDO 1680 29T" Street Boulder, CO 80301 303-444-2260 Restaurant Name Andrew Richardson Position General Manager Email Boulder@cantinalaredo.com Phone 303-444-2260 PLEASE REMIT PAYMENT TO: RESPONSIBLE HOSPITALITY GROUP (RHG) ANNUAL DUES RECEIPT 2016 RHG Annual Membership: $100 Date: March 2, 2016 Business Name: CANTINA LAREDO-BOULDER #193 Type of Payment: PERSONAL CHECK #1313 from Scott D. Smith Due Date: April 6th, 2016 c Cantina LAREDO. gourmet me.ciean food c Bar Promotions IN U Pow, ,, _ _• • Jain us for an exclusive TEQUILA DINNER FEATURING SUERTE TEQUILA #** .............. a........000 ..................00........ FRIDAY, MARCH 4, 2016 Cocktail Service Begins at 7:00pm Four -Course Dinner Served at 7:30pm .•....................................................... appetizer Sope de Brisket soup Sundried Tomato Chipotle Soup entree Pork Tenderloin with Chile de Arbol Sauce OR Redfish with Langostino Corn Sauce dessert Key Lime Pie r-- , I $49.99 PER PERSON CALL FOR RESERNIONS: 303.441 #CLTequib0inner ® E._ s T l �e7v► of GET A FREE UBER RIDE AND $10 OFF YOUR TEQUILA DINNER! ].Download the Uber app and enter the code CANUBER to get your first ride free* 2.Ride Uber to Cantina Laredo 3.Show your Uber receipt on your phone to — claim your discounted dinner -_i. „_ eln-aa.a..j- MOS ITO SUMMER chill out with an � Orange or Superfrult Mojito 1 ORANGE NIOJITO BACARDI O. mint. Monin Ac avc Nectar, lime. oranc:e and Sprite. SUPERFRUIT MOJITO BACARDI Dracion Berry. mint, M(--)nin A(. avc Nectar, blackberries. blueberries and Sprite s• ,V+ FREE 7� a l T�LOLL tti .. _ ,iole,NA -� + :enc.{ al r:ccnc: aJJiti+nal Lloumm5 and upc at -.s All SKINNY BEBIDAS STRAWBERRY SENSATION 105 CALORIES I v, I 1cl) illil-it PASSION MOJITO 115 CALORIES LATIN LOVER 142 CALORIES \.,()ll 01,11"t"L: \*,ill;ll:l Vodk-1 p1c —sm—,— Fii-*,'--i,,- I p!kFl.?0iN ivolig Cantina LAREDO v,turmri m I.' F1 'aali El,joy a special happv lzovir `astinr NvA colnplirncntarg Voll G.), ktall yarnplC6. LATIN LOVER 'drlt Ura ny::'Jnnlllr; :rl;kc, Eerrionode, �Vti;�riln /+;,-gr:t' I e ler; 'lu r �.rt7 ; mple Sec -nd Pin&apple Juice, I42.�t STRAWBERRY SEDUCTION Slfowb2Nies �r I.i tfe; Bonin Ayu-v''e Neclr;r, S` quf hc'E' Sec, 1 "32. ckjlcjr-e:: happy hour with VODK FlIday P11111,11 -y 13' 4 p.m. - 6 p.n-i. • SKINNY CITRUS CRUSH and Sulgai lie2e liip1G Sec. 1-iesh l.L?ETiEc, and limL.if�i �; �r; `�:a71; i 10 colorier' JAUsco TEA :mon %lodko, Giro Silver Tequik-, nin Surcrr i•ree, Ti i❑ e Scat -and _.._- rrC°tn lc�mor suirlf�; 1 38J calories r�� CELEBRATE CINCO! --� lJP SWEET H EA-F'F\'J-I-'JA CUOI DO\/\/N! CfNC'0 MAS Ll .44 t cliq rmY71 ITOS CAZADORES, CABO Dc RA Our house -made margarita starts with fresh -squeezed lime juice and Cointreau Orange Liqueur. Served with a sidecar of Hornitos Plata Tequila and a Coronita... Three's a crowd pleoser! ;rp I L Oil YOU R SUMMER -%`0,tTF_ TAMA RIND HEAT Mount Gay Eclipse Rum with tamarind puree, fresh mint, pineapple, lime and I FELICTDADES OUR IDEA OF THE PERFECT GIFT IN A GLASS SNOWFALL SANGRIA Solerno Blood Orange Liqueur, red wine, orange juice and fresh fruit - an instant holiday favorite! POMEGRANATE ROSEMARY MARGARITA Avion Silver Tequila, Cointreau Orange Liqueur, pomegranate puree and margarita mix. LA 1 '-�- fir• , �, -;'-! 101 TROPICAL FIZZ Savor a refreshing medley of Cointreau, Malibu Rum and agave sour topped with soda. Calories: 127 SKINNY RASPBERRY RITA Homitos Plata, fresh lime juice, agave nectar and raspberry create a sweet and tart combination. Calories: 120 BLOOD ORANGE SUNSET Experience a citrus explosion with Milagro Silver Tequila, blood orange and fresh lime juice, topped wit6prite. Calories: 139 �I 0 HORNITOS FIESTA DE MAYO DOS EQUIS LAGER CINCA tAAS 'RFA PITCHER TAtAARIND 'RITA Wr11 ERNIELO Y 'RITA � ,� i l ,1071 •i. S _ �� SORBET RITAS FRESH, FROZEN, FANTASTIC! MaNGa TAMARIND CITRUS FREEZE Herradura Reposado Tequila with Cointreau Orange Liqueur and Perfect Puree Tamarind shaken and served over Lemon and Mango Sorbets. CARMELIZED PINEAPPLE Herradura Reposado Tequila and Cointreau Orange Liqueur with Perfect Puree Carmelized Pineapple, orange juice and cayenne, served over Lemon Sorbet. SUPERFRUIT CHILLER Mount Gay Eclipse Rum and Cointreau Orange SANGRIA SUMMER Welcome to a new summer tradition. White Honey Pineapple Spice' Sangria Y Sangria Blood Orange Sangria VV cantina LAREDO, _!jfy=•rr. r=t.•Z." u n Try t6cE c n4cw cocktails bore for dic 7c:a-zon I GINGER, SPICE ........................ I ............................. I ........ EVERYTHING NICE 'RA'-\'- ;I' GER MITA ���_ 'i�l, tai•-,�1--�f SKINNY MARGARITAS WITH FLAVOR YOU'LL FLIP FOR! Caliente Flaca Flip 135 CALORIES` Hornitos Plata Tequila and Monin O'Free Triple Sec with fresh lime juice, orange and jalaperio, topped with club soda and a jalapek flip of Domaine de Canton Ginger Liqueur, Citrus Burst Flaca Flip 130 CALORIES° • Hornitos Plata Tequila, Manin f r O'Free Triple Sec, fresh lime _ juice and orange, topped ' with club soda and a lemon r •+ " flip of SKYY Citrus Vodka b t.l Peach Berry Flaca lip 140 CALORIES' Hornitos Plata Tequila and fresh 1 y lime juice with Monin O'Free f Peach and Triple Sec, topped with club soda and c strcwberry f ' __._DeKuyper-Strcwberry-Pucker __; MEQ E�__I ■I c' POP OILER FOR I cit. =..1 CINCO i , DE MAY r- �t T� POP-A-RITA CINCO MAS RITA 1}us 'Ritz, alas a PUp U` Bcacl7 {lavt)r! Olir fat -U I']tc 1i�A:-- 1 _ 1 •.1 �.liw ��'abu kcpczsadt) Tequila ith '�'Tas fur �.in_u! C(llntrcall Oran<uruslt <c: Liqueur. Tlime juice Girt) and Hurn' and mrawkerry tuts topped .x•ith a Bloc Bcll Oran,'u Liqucul C.UCl,nut Fruit Pop. Silver T�.luila. CABO E . CULL ._WAI10 D O B E L,. PATRON HOKNIT05 T E 0. 1 L A itD to) - . . . . BLOOD ORANGE MANGO RASPBERRY BERRY `RITA CITRUS 'RITA CHIPOTLE'RITA ' . E Mount Gay Eclipse Rum ?J„xmi "ay EcliF;st iium Rum and �clernc Blood ��'� •� ��f :.arc: :oinir ou O: a�x�c •.grang e Liqueur vr'h our Liqueur ,.vith our house til — nwracri!a mix cnc freshkk fresh mint, serves: over bcail, served aver lemon i r� and mango sorbet. . r1. f ; *R i (,�.,1703:„ MOUNT GAY- �• or r I " e4L BLOOD ORANGE MANGO RASPBERRY BERRY `RITA CITRUS 'RITA CHIPOTLE'RITA Mount Goy Eclipse Mount Gay Eclipse Rum ?J„xmi "ay EcliF;st iium Rum and �clernc Blood cr.d Coi.ntre.cu Orange :.arc: :oinir ou O: a�x�c •.grang e Liqueur vr'h our Liqueur ,.vith our house house margar,ta rTlix a. -Id nwracri!a mix cnc freshkk fresh mint, serves: over bcail, served aver lemon raspberry sorbet. and mango sorbet. (,�.,1703:„ MOUNT GAY- � tllfi THE MEXICAN SPARKLE R"O' a Toast the 3'acisoly . . . . . . . . . . 4 . . . . . Ko p Our top shelf Herradura' Reposado Margarita gets topped with a split of Korbel California Champagne. The,perfect way to toast the season! ADD A SWIRL OF DEEP EDDY e .ij CRANBERRY VODKA FOR $2!. • vnr 'JIIA�! A delicious blend of 1800 Reposado - �Tequila and Salerno Blood'Qrange.. Liqueur with flavors of 'pass iori.fr�it- and pomegranate purge: 'N. r 1 48 00 INCO CEL-BRACION I. BEBIDAS FROM ACROSS THE BORDER THE RFP,,--� rl j'. r.' clot cf: tjpg-clde; (.-;-;.,oe A (-cmc Wchci, He. rodurc, C-cl."ll Noble Ham:l, RE!F05',1d0 TPCjcJlC!,VVllh A Frcsh -ime J;U:ce olid �- r)t il.i rer; u ro -, rj e h( i n 0 OLT FAVORITE M E X I C /-', N B E FIR Dos Eauis Lacer & Arni-ir or Tecate beer, available in arch or 4, f -- -f ?;—Vw jW?mQ5i-.. --- �W_ UI=TZ' jv'- Li ■ 00 q)7*(& SAVOR THE FLAVORS OF SUMMER! Ili}.rJ ISO 47 block & P )1,,je m [SOWN THE HATC Pep-up with our Fall Margaritas i' s I Strawberry -Hatch Margarita V S.mwhprrp and popper-mrvs d Mr.rgonfa Ivnng A 5.1 : Tpaalla, ft,- h I me i-ce @- ago = -arar and oranga f e =A Strawberry -Hatch Margarita V S.mwhprrp and popper-mrvs d Mr.rgonfa Ivnng A 5.1 : Tpaalla, ft,- h I me i-ce @- ago = -arar and oranga f e e J � i 1 CLASSIC MULE ABSOLUT Vodka & fresh lime juice, topped I _-.Nor MEZCAL MULE Los Amantes Joven Mezcal with prickly pear syrup, muddled jalapeno & lime juice, topped with ginger beer. T MEXI-MULE I Espolon Blanco Tequila with fresh grapefruit juice, agave nectar & lime juice, topped with ginger beer. ®-ESPOLOH-ABSOLUT. TEQUILA - i lk Coron❑ p a I o III a . Ah Ginger PC lorTio 1�1 Ruby Pnlr%r,nl" !j r E R F E. ill Ti -. Ir j YA • i �.W . -' µ `' CINCO 'RITA PFk,iy 'HE VERDE INFUSION L° "`" 'RITA `''` N U MULES & �• Smoke �� 81 Pire � f�` Mule r� a I wmwiSmoked ' �� ,fir • � Y � �. Peach'' .` Mountain Mule *00,1 oilOki �9 � ti. a (Ila TSE I T A ............. ..................... $Tr . .. ..... ........ . ...... ... . . .... u Do MAK ING SPIRITS Keposocio rwo SMiSPCt�N5; T G Lr,,,-!rl N I ( ).N IN MLLIKKI; nki" TEULIILA 0 .0 Hai ri itos Black Barrel 'R;lt(,i iIdv Ir o ` . . . � . � . . .. . . . . ,1_'^�'_'','' 7 �~ ��� U | \ E ...~'.,...-.........,, ,.� .^°".^,~..'...^.^.'...... � �.��....'. � `..,~....'.,,.�.^^ ^� . .^....""..`.`.'..'.�.� ...^ .'� . . . / ' M �K� M | ���� ���.L� bt�MNNENTER-THErNtIST R!LIL 01,141-1i WT VALID ON ubefT Cantina LAREDO. gourmet mexican food B.A.R.S. Membership The Bars Program Reports THE BARS PROGRAM Back to Report Selections Welcome Robbie Wright from Cantina Laredo Page 1 of 1 Phone:1-877-540-5501 Email: custom erservice@barsprogram.con Home Testimonials How it Works Training Blog Contact Us am Visit Videos Basic Vlsit Vedfv Visit 2 in 1 Visit Restaurant Viso Download Download 1 Cantina Laredo 1 01/11/10f1019j 9:00PM Cantina Laredo - Detailed Report for All Visits 01/01/16 -10/25/16 Total Visits: 11 Total Green Canis: 11 Total Red Cards: 0 % Green Cards: 100% % Red Cards: 0% Row Store Name Store No. Visit Date VisitTlme Result Employee Manageron Duty 1 Cantina Laredo 1 01/11/10f1019j 9:00PM G DANIELLE ANDREW -DINING 2 Cantina Laredo 1 02/11/16 LIUM 7.07PM G DUSTIN RICARDO-DINING-BAR 3 Cantina Laredo 1 03/15118 in ] 6:45PM G TONY SCOTT -DINING 4 Cantina Laredo 1 04/11/16 BjIW 4:25PM G AMANDA ANDREW -DINING 5 Cantina Laredo 1 05/12116 linfol 8:35PM G MEREDITH BRAD -DINING 6 Cantina Laredo 1 06117/16 Raid 7:15PM G ALI DESSE-DINING 7 Cantina Laredo 1 06178116 in B:08PM G TONY DESSIE-DINING a Confine Laredo 1 07/011116M ] T45PM G GIOVANNI SCOTT -DINING 9 Cantina Laredo 1 08/05/16 f�j 7:45PM G ROGELIO SCOTT -DINING 10 Canfina Laredo 1 09105/16 flijbI T22PMFG PAUL SCOTT -DINING 11 Cantina Laredo 1 10/20/18 n&j 7:39PM TEAGAN SCOTT -DINING Back to Report Selections -. - --~— — Contact Blog r - - -- Phone: 1-877-540-5500 Email: customerserviceMbarsoroaram com The BARS® Program 07999-2016. BACK TO TOI http://www.barsprogramreports.com/newrep/index.cfm?c... 10/25/2016 The Bars Program - Alcohol and Tobacco Compliance C... Page 1 of 2 Phone: 1-877-540-5501 Email: custom erservice@barsprogram.con THE BARSJOIN REPORTS ,,T PROGRAM Home Testimonials How it Works Training Blog Contact Us How It Works 2 MONTHLY VISITS BY CHECKERS LH EG KEIR 1_"MKEK PRESENTS RED PRESENTS GREEN CARD CARD BARS CHECKER ASKS FOR EMPLOYEE NAME LEAVES STORE AND REPORTS TO CORPORATE The BARS Program has raised compliance training to an advanced level. We send our Checkers twice a month, aged 21-25, into client stores or restaurant locations to conduct mock purchases of cigarettes and/or beer. The purpose of this is to monitor the store employees, seeing if they ask for the customer's ID prior to quoting a price. If the ID is requested, the employee receives a Green Card. If not, a Red Card is given. BARS Program Procedure If a store has an age -verification device, we monitor if the store employees actually use the device. We partake in regular visits to ensure proper use of the Point -of -Sale (POS) system and age -verification devices. After the visit, an email report is sent to the store's management. Visit results are archived in our password -protected reporting website. View sample reports. Jeff Evans, Front End Manager King Soopers "BARS Program does a great job. We have seen a return in our investment by educating our employees in TIPS. They can property handle the sale of alcohol and tobacco." http://www.barsprogram.com/howitworks.htm 10/25/2016 6 ri O N O O O O Ol Ol Ol ri 1 �> c U) Ln o ct Ln 1 1 i Q t OM d Q u OP ui to cr .Q Q U C ml U m a C a m C — 16 E t 0 F- U Z Z Z i- Z Q z � o wQ Q 0 21 [7 Q Q C7 a V U6 tJ l7 0 0 0 0 0 0 f•- t11 Lo Ln m w Ln 0 N m C7 Sk N M -1 O ch 19' N M t- t0 cc h 00 t- t` t• t- O O O o .^0.. 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Fl v i v C d i C i d d c 0 3 bA C .a � V E a 0 0 0 N ' C C .0 *0 0 0 d O C '0 CL a 0 > a 0 cc 0: O 0 N i - C I=R i H O CL O � O � = v i v C d i C i d d c 0 3 bA C .a � V E a 0 0 0 N ' C C .0 *0 0 0 d O C '0 CL a 0 > a 0 cc 0: SERVING ALCOHOL RESPONSIBLY TEST IM Answer all questions to the best of your ability. 1. List the four acceptable forms of identification: DATE: SCORE: 2. We card any guest if they appear years old or younger. What are the five guidelines concerning the sale of alcohol? Check all that apply. 3. We ID 40 or younger 4. We DO NOT serve alcohol to minors, nor allow minors to pay for alcohol 5. Guests must order food with alcohol 6. Never serve alcohol to a visibly intoxicated guest 7. Every member of the party must be 21 in order for anyone to drink alcohol 8. The Manager will PERSONALLY handle all alcohol related problems 9. We will provide any intoxicated guest with a safe ride home 10. What is a designated driver? 11. List five signs of intoxication: (any five) 12. How will the manager handle alcohol-related problems? Number the correct steps in the proper order. Provide any intoxicated guest a safe ride home Decide if a guest must be refused service Visit the table to assess the situation Inform the staff immediately if a guest must be refused service 13. What is a minor? 14. Is it OK to accept an expired ID? 15. Is it OK to accept a school ID? August, 2015 Confidential and Proprietary r 16. If you think a guest may be intoxicated what must you do? ONLY 3 of the steps below are proper, number the 3 steps in the correct order. Take the order as you normally would Tell the guest they have had enough Order the alcoholic beverages Immediately tell the manager about the situation Do not order any alcoholic beverages until you get the MOD's OK 17. How will we provide any intoxicated guest with a safe ride home? Check all the apply: Seek a sober member of the party to drive (a designated driver) Call a cab "on us" if there is no sober member of the party If a guest refuses our offer of a safe ride home, and leaves, the manager will call the police We must be sure the guest gets home safely, even if we must force them to stay against their will 18. Once the Manager has decided to stop service to a guest, that decision is final. And, everyone is: A. Told loudly B. Informed once guest has left C. Informed quietly of the decision so that the guest is not accidentally served by another associate 19. What is the only thing that will reduce the effects of alcohol? TRUE OR FALSE? 20. You will be terminated (fired) for serving a minor. 21. You will be immediately terminated (fired) for serving an already visibly intoxicated guest. 22. It is OK to serve non-alcoholic beer to a minor. 23. It is against the law to serve someone who is already visibly intoxicated. 24. The server must track the number of alcoholic drinks each guest has had. 25. It's OK if a minor pays for alcohol, as long as they don't drink it. As a staff member, I understand my responsibility and liabilities when serving alcohol to my guests. And, I fully understand what I am accountable for regarding the service of alcoholic beverages to my guests. I, (name) understand that as an employee of CRO it is my responsibility to check the ID of everyone and anyone who appears to be 40 years of age or under who orders an alcoholic beverage. I am aware of the penalties of serving anyone under the age of 21, and of the penalties for allowing anyone under the age of 21 to pay for an alcoholic beverage. The penalties are as follows: • Arrested and fined up to $4,000.00 • Sentenced to up to one year in jail • Employment with CRO will be terminated immediately Associate Signature Manager Signature Date August, 2015 Confidential and Proprietary E3 Cantina LAREDO. di gourmet nsestcan food STAFF TIPS ALCOHOL CERTIFICATION BINDER 07 City of Boulder lfyoucheckedM y for training an your city renewal, please Jill Finance Department • Licensing Division out thlsJorm&attach cords/certlJ7mteso/ training for employees I 1777 Broadway, Boulder, CO 80302 - 303,441.4192 PROOF OF TRAINING Trade Name: CANTINA LAREDO /STORE #193- BOULDER, CO. Address: 1680 29th STREET BOULDER, COLORADO 80301 The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all Involved in service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, Or other evidence of training completion for each listed employee. Employee's Name State Training Type Hire Date Previous Training Date Latest Training Date Bertha'Betty' Cardoza bar/server-TIPS on premise 02/24/2016 N/A 4/29/2016 Dessie Castillo GM- Tips on Premise 10/13/2015 N/A 9/22/2016 Teagan Claggett server -TIPS on premise 08/18/2016 N/A 2/11/2016 Paul Devine Pride server -TIPS on premise 02/16/2016 N/A 11/21/2014 Amanda Duensin server -TIPS on premise 05/29/2015 N/A 6/11/2015 Josh Dwernychuk server -Tips on premise 08/23/2016 N/A 04/29/2016 Juan Carlos Espinoza bartender -TIPS on premise 08/21/2015 3/12/2013 4/29/2016 Paul Garcia server -Tips on premise 07/22/2016 N/A 12/28/2015 Danielle Harrison bartender -TIPS on premise 06/15/2015 N/A 6/15/2015 Madison Hernandez server -TIPS on premise 08/2022016 N/A 9/22/2016 Meredith Jones server -TIPS on premise 11/12/2014 3/24/2012 2/5/2015 Rogelio Luna server -TIPS on premise 10/22/2010 4/8/2013 06/28/2016 Giovani Ocampo server -TIPS on premise 07/07/2016 N/A lode dans l 0/6!16 Band pweU B retake Riley Romano server -TIPS on premise 08/10/2016 N/A 10/12/2016 Sarah Rubbiolo host -TIPS on premise 10/02/2016 N/A 10/04/2016 Tristan Sawyer server -TIPS on premise 02/25/2016 N/A 3/17/2016 Willow Schram server -TIPS university 05/31/2016 N/A 02/03/2016 Kaitlyn Rushton server -TIPS on premise 08/02/2016 N/A 10/4/2016 Scott Smith Manager -TIPS on premise 04/15/2011 04/2/2012 6/28/2016 Kyle Vaughn bartender -TIPS on premise 10/17/2016 N/A 10/6/2016 Tony Ziadeh server -TIPS on premise 11/20/2014 N/A 2/5/2015 page 1 you checked VES ' City of Boulder Jor trolning on Vourcltyrenewo4 pleaseJlH ii �out this form & attach rnrds/rertlJlcotes of Finance Department - Licensing Division craMinglaremployeesl 1777 Broadway, Boulder, CO 80302 - 303.441.4192 PROOF OF TRAINING Trade Name: CANTINA LAREDO /STORE #,193- BOULDER, CO. Address: 1680 291h STREET BOULDER, COLORADO 80301 The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all Involved In service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the Indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, or other evidence of training completion for each listed employee. Employee's Name State Training Type Hire Date Previous Training Date Latest Training Date Zamira Foster Parker server -tips on premise 09/06/2016 N/A 10/12/2016 Chad De Sellem server -tips on premise 9/2�I2016 N/A 04128/2016 Conlan Bahneman _, ,..::,. server-stips on premise -_013119/2016 N/A laking 1112 due to ttips Joe Castillo server -tips on premise 10/08/2016 N/A In pm mof slgntng up i I r page 2 ' �.1 U CERTIFIF eTIPS On Premise 3.0 issued_ 0812&2016 Expires: OW2612019 ID#: 4340063 Cohan Bahnerrian Sushi Hana $ake Bar & Gdl! 1220 Pennsylvanig-Ave Boulder, CO 80302-7023 USA —+-rm;f%r rnr.m/f;b-v/T7TTAT7 OAP0001 ino Page 1 of 1 10/4/2016 Certification Manager for PBSA Y Y�Print_� Y:_CtoseWindow Page 1 of 1 QN760-lertift, rate of 'VE",ompCetinn Tie s :Cer fficate -of Completion of eT]PS On Premise 3.0 For coursework completed on August 26, 2016 provided by Health Coiruuunications, Inc. is hereby granted to: Corlan Bahneman Certification to be sent to: Sushi Rana Sake Bar & Grill t_.._.ii...c .,,...«e„•..:+., —1-4 nofin„PnrP,-t;f;ratP90nPnAaPnt&POP=Y&RTD=63IOJF901G3 10/4/2016 1220 Pennsvlvania Ave Boulder CO, 80302-7423 USA Aa HEALTH el •11.?•.t.l:v;t:ATi: , ;IMG i fieri ':: Ilia dNawltu¢ s,sx t+wf af1'If'S eitttifi�::iat it iYMeteo 0.111, dmt emu ItnU.Iftklad dte C'Y.Aw. 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N Z p o .1G y A. y, V p O O V.� 'd H CA G • CO �s c a3 0 ^ y T�•w 3 �"� ° a� � tom. � .p:3 y •b .� :n E 7 d O CA CV3 T V p C r •-J- O •inn O � � >> :7 � T ',--is is your Official TPS® Certification Card. (,...ry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, 4r Adam R Chafetz President, HCI IWORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN: )=-)(X-)D= Issued: 9/22/2016 Expo: 9/14/2019 IID#: 4359828 D.OB.: XX/X)UXXXX DESSIE R CASTILLO 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.getfps.com B. Jonathan Balliet, 47289 tips, On Premise SSN: - XX X Issued: 2/11 /2016 Expires: 1/31/2019 4183939 D.O.B.: )oC/xxjxx X TEAGAN M CLAGGETT 2135 Kitt W Hall Boulder, CO 80310-0001 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 _ "n /_£ \_\ E.@52\ 0o �5 - %� /� \ \ � k / o § » P ® m § E ® 7 ƒ O 9 ^�)+®/ P� ■, ��ƒC=> ,m k/ o00 �.Ec52 7\\ƒ2� 7kk §kms A g. cc �22IE #CD - \\ �2 q■2 § ¢ k E 0* �t C)ye § ' \\y�ƒ � 9 $f CD � 2 § \ k, $§ _tee§a �R /A9 8R «KeEe �\/77 \/gym/ PC § # 7 kk§ 2 & o w m w $ gm2 wo a CD @� w/w b'\'t \/o �LL� �k a.�G 2 77 �f 0 3 �m I§ / LL j e' § � •= ! e ea � v CD 'C •O C � A O E T a U o p •�. 7 N a'G+ fA X 11-0 E $ N X Cl C) GC 'y C9 U „-, O Q • • QQ 3 0 aix Z O en W❑ to L U eJ u c G c3 $ �•�•�a � L Q O (0 3� n cd' y i C c3 � O Ca Z Ql N NN 3:COco MD ` •� r L GG .U- C .LO O a N O LL C i O O L > 14 _ o E� u •v: O E- � !� a o H ® 03 c - 4 o C� tvD O Cu C •O O .-G. O O 7 C z j M o E L O 5-13 0 r O n �•� 0 `' � G ^� r o � U � .X cu.0.. � •O U � 6 35 ' 4Ti ci u [ P'.9 oma'. e ^ •> o -c � v u � � ` � d C Rid .., .• � >, �! O U .0 O L � � y C C •./. O 2.a0 E v C q t1 s oo •� UU C O 3 O� vt •� T U •U L)5,nC •O Mml CG] h y C G U C. U G t. V] •j L O 0-9 ® d G C 0.. G. `. V C .O+ u T •G •E ir. •O T O O 7 Cy ,� � •3 Cffi O r U 0 cui •p v E: T -21- to '7. U O to 0 U G OL U T O o a u c u .. =. f-- -., This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. C� �ratulations! y successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-5241200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, Adam R Chafetz President, HCI MPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN:-� Issued: 10/4/2016 Expires: 9/23/2019 ID#: 4367953 D.O.B.: XX/XX/)O= JOSHUA S DWSRNYCHUK 91116th St Boulder, CO 80302-7331 For service visit us online at www.getfps.com B. Jonathan Balliet, 47289 r` 3 ° 9 C v V v � U J •tp � o o m i, 3 ami°•, v X N E C7 N y Cl) OI N 0 :0,Z OD a°ao O C aWim jo� 4N O o v o ca SGS °o y b E p ao N m o E e a a rn N Q 7 >m COm G w n C N N =CD m U �oorJ�o Ova 2ca O ` d A tV„ b -I! 7 V d N O O G A ° :ca, T 7 T A L A b U uV3 as t c � � � 03 O ica [3 p OR-. 0 tl'1 o `t c o o a°i h o a V C3 U x ° o a % e vco w.°' e 3 0 a E T O N V'�y Q) O d y •� a) O C C g d s a ei F U T v EL y ^ C V C� 0 O M a L cp > t c c L 4-° o° c o En G O o T> t d O C V .0 T O o m e� = � C ^y c~3 V r U ® >' C rij :65 C y V T O O= IF 'O CL a t a oz o+ c� o T a eo c? ag " 3 L 0 This is your Official TIPS Certification Card. lit with you as evidence of your stalls and knowledge in the responsible _,nd consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, _Z G in61e Adam F. Chafetz President, HCI E%RORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN: XXX XX-XX)O( Issued: 10/12/2016 Expires: 10/7/2019 ID#: 4375313 D.O.B.: XXVJU)000C ZAMiRA C FOSTER PARKER 1900 Goss St Apt 206 Boulder, CO 80302-6566 For service visit us onfine at www.getfps.com B. Jonathan Balliet, 47289 On Premise SSN: XXX-( 1;2128=1 5. 21I812G+:":' 8 TD#` :.4156116� PAULA GARCIA 1192 Sunset Dr Broomfield, CO 80020-7038 For service visit us online at www.gettips.com C C � i op. c _ 3=__'0 r 0, r 5= , 3 adi v O I E3 x a i N CD n G = 1 4D O c o O O O U d tN/1 L] A MQ 4 y E> 'o g O N u� w Ck O C ti cl 60 Wd t o� C d 0 N !n Cc) J J 7 to W N o OW W [L �t v Or [0 V n� O � C •U07 Pa U •R A p � .v-'. tV � U ►� T f], �_. cdi � j p N y O O O T Q U O U O Y is d U O T pp . 6 cc C r3 c r- 'o O p C O 3 0 A w GD O .0" a4 c = u^ a£i C % ja O r. C .T. U T E —r- F ^ _t u = 08 leml � F. _ �_ T � r �•� :n Q 0. d E"' v Q T F E T c•^ yr &y v c w . a c c o U d .O O 5 ^ ®•U �' � O .2 C Ga v � f' 2 � - S+a > r v� •T C C T z� :1 O y C� y L �C1 r U C� This is your official 'TIPS Certification ion Card e in the le skills Carry it with you as evidence of your sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, a.—G4r Adam R Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS' For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN: XXX XX -fit Issued: 9/22/2016 Eapires: 9/14/2019 IN. 4359829 D.O.B.: XX/XXrXXXX MADISON N HERNANDEZ 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.9etfiPs.t0m B. Jonathan Balliet, 47289 C 3 a V C •� U 'C o G E 0 o>+ v O O Go T 1-18 Cd U ° a vyi w A Z o m >0 H C O C N Co U qwC. bU— (n �o G� e p s v, Z U a Q C •� U O N IP W� �Zr WCl) N� CD LLI Z c 10 �-10, O Cl) to vs bo G m m U >' E ji w Q VV2 G O b C 0 O CO uto CL a� a fl C o ® X03 oG -Nr° �•is C �a •�C, O cn CD G �4-A `ice rr OT h b � O �a „" cc O O C d C G w C C U Z Y .O `O vOi 9 •C ,� O V U u >0 GO O i G t U V G Pmi v rA > C •=O v N C Q L v c O O OD y •C � p •� p 7� ra 3 � � O v 9 ® O d CU H 0„y O Z O k°-• G p V E.. CL O CD # C O .,.,, U U s ME n o �J This is your Official TIPS' Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible (--Je and consumption of alcohol. ::tlgratulations9 By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any infonnation you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, -&` qr�- Adam F. Chafetz President. HCI IMPORTANT* Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. LL k7e On Premise SSN: XXX -XX -)000( Issued: 6/28/2016 Fapires: 6/4/2019 ID#: 4289748 D.O.B.: XXDOUXXXX ROGELIO LUNA 5640 Arapahoe Ave Apt 425 Boulder, CO 80303-1356 For service visit us online at www.getUps.com B. Jonathan Balliet, 47289 This is your Official TIPS Certification Carel. )it with you as evidence of your skills and knowledge in the responsible _ -ind consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, 4"-- Adam F. Chafetz President, HCI IWORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • o On Premise SSN: XXX XXXXa Issued: 1011212016 Expires: 10/7/2019 ID#: 4375314 D.O.B.: XX/XXDO= RiLEY A ROMANO 106413th St Apt 4 Boulder, CO 80302-7280 For service visit us online at www.getfps.com B. Jonathan Balliet, 47289 Zis is your Official ZIPS® Certification Card. 'with you as evidence of your skills and knowledge in the responsible s rd consumption of alcohol: Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-5241200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, �-- Adam R Chafetz President, HCI MPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, cogtact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN: XXX-)()(- )Da [Issued- 10/4/2016 Expires: 9/23/2019 ID#, 4367957 D.O.B.: XXDD X)= SARAH G RUBBIOLO 5462 Pueblo PI Boulder, CO 80303-4115 For service visit us online at www.geftips.com B. Jonathan Balliet, 47289 �l This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible S j consumption of alcohol. t 1 gratulation! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol: We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, 4r Adam R Chafetz President, HCI �L IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. On Premise SSN:• XXX XX -)D= Issued: 10/4/2016 Expires: 9/26/2019 ID#: 4368971 D.O.B.: XX/XXDO= KAITLYN L RUSHTON 4021 Riley Dr Longmont, CO 80503-1127 For service visit us online at www.gettips_com B. Jonathan Baiilet, 47289 �3 & � � 2Ci - ' /k77o — ----- . -u=5 /A (�k a o & $ - / 9§d - C uj Cc ƒ _ 3 § 7A$ a \\§f> 2-� -2 Im ac jL to t\ 2J/ to k� D k m co � IL \\$ ? 3§ CIJ / 8 Q mega(& 0) 2 iR .. o v 3 •- - - F . ]- ® L� -� . \ X : •` �\ 3-� » . �\ / - >%» - u( - .5 O f - - / �\> 2S �»\ \■ _ • - « _ » .S$e ■8E=/\\//}\ ZE §2&\/§Jp'�\ �1 VISO SSN:- University 1!2212019 B Issued: Expires: 2/3/2016 D.o..: �' 4178671 X�fKXI)OC)CX ! WILLOW J SCHRAM 1189 Beall Ave Wooster, OH 44691-2363 For service visit us online at www.9ettips.00m Nathan Fein, 61301 This is your Official TIPS Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Q" '3ratulations? successfully completing the TIPS (Training for Intervention ProcedureS) pro,am, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-5241200. Thank you for your dedication to the responsible sale and consumption of alcohol. Siinncceerely, Gam— e4 �rr;- Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. e On Premise SSN: XXX XX-)OCX)C Issued: 6/28/2016 Expires: 6/8/2019 ID#: 4289754 D.O.B.: XX/)0U)000( SCOTT D SMITH 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 This is your Official TIPS Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible consumption of alcohol. 1 (L, Agratulations? By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerel4re Gw Adam F. Chafetz President, HCI IWORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN: )= -XX- XXKK Issued: 10/6/2016 Epic: 9/22/2019 ID#. 4370583 D.O.B : XX/XXDO= KYLE S VAUGHN 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.getfps.com B. Jonathan Balliet, 47289 0 ca -;n U U 0 °" O 3r. a u.0 Cq u 0 eu C '= L •� u 7 O ? m T Ig O c - O U O 3 = O O T CJ "ii L O o ° w alu c C3 L U U G U A t+G L c E a ° _ .b cv eo zs E E �.co Low eacsr o p�U .y A F E 7 L �j •b O 0>. ER . A yL. co O O 10 C-:, � LqR xx yy s p v X � y N O. 02 '� i W N N N Z M. p r C ica W c co 7S c v � C N m .�.i O C C Q U ° h to N c y m o t Z 04 NN �V Z m m a. a COQ Co U= 0 M ° m z� a ti 3 s Q E yL. O O 10 LqR yy s p v y •U 02 '� Isd L O = O C ica e ,a.., t3 7S c v � lFYn1• .�.i O C C 3 C U td o EW o F. ° c >+ o t Z .� ta u U c o o c= r° 3 �•°'o� ae �c�'° r' o � w ° E C '�'' •CI r A C p 7 4' ouL ou d, CL r N u F a D V C U l6 J-4/,s 6) Om V. 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List the four acceptable forms of identification: DATE: SCORE: 2. We card any guest if they appear years old or younger. What are the five guidelines concerning the sale of alcohol? Check all that apply. 3. We ID 40 or younger 4. We DO NOT serve alcohol to minors, nor allow minors to pay for alcohol 5. Guests must order food with alcohol 6. Never serve alcohol to a visibly intoxicated guest 7. Every member of the party must be 21 in order for anyone to drink alcohol 8. The Manager will PERSONALLY handle all alcohol related problems 9. We will provide any intoxicated guest with a safe ride home 10. What is a designated driver? 11. List five signs of intoxication: (any five) 12. How will the manager handle alcohol-related problems? Number the correct steps in the proper order. Provide any intoxicated guest a safe ride home Decide if a guest must be refused service Visit the table to assess the situation Inform the staff immediately if a guest must be refused service 13. What is a minor? 14. Is it OK to accept an expired ID? 15. Is it OK to accept a school ID? August, 2015 Confidential and Proprietary 16. If you think a guest may be intoxicated what must you do? ONLY 3 of the steps below are proper, number the 3 steps in the correct order. Take the order as you normally would Tell the guest they have had enough Order the alcoholic beverages Immediately tell the manager about the situation Do not order any alcoholic beverages until you get the MOD's OK 17. How will we provide any intoxicated guest with a safe ride home? Check all the apply: Seek a sober member of the party to drive (a designated driver) Call a cab "on us" if there is no sober member of the party If a guest refuses our offer of a safe ride home, and leaves, the manager will call the police We must be sure the guest gets home safely, even if we must force them to stay against their will 18. Once the Manager has decided to stop service to a guest, that decision is final. And, everyone is: A. Told loudly B. Informed once guest has left C. Informed quietly of the decision so that the guest is not accidentally served by another associate 19. What is the only thing that will reduce the effects of alcohol? TRUE OR FALSE? 20. You will be terminated (fired) for serving a minor. 21. You will be immediately terminated (fired) for serving an already visibly intoxicated guest. 22. It is OK to serve non-alcoholic beer to a minor. 23. It is against the law to serve someone who is already visibly intoxicated. 24. The server must track the number of alcoholic drinks each guest has had. 25. It's OK if a minor pays for alcohol, as long as they don't drink it. As a staff member, I understand my responsibility and liabilities when serving alcohol to my guests. And, I fully understand what I am accountable for regarding the service of alcoholic beverages to my guests. 1, (name) understand that as an employee of CRO it is my responsibility to check the ID of everyone and anyone who appears to be 40 years of age or under who orders an alcoholic beverage. I am aware of the penalties of serving anyone under the age of 21, and of the penalties for allowing anyone under the age of 21 to pay for an alcoholic beverage. The penalties are as follows: • Arrested and fined up to $4,000.00 • Sentenced to up to one year in jail • Employment with CRO will be terminated immediately Associate Signature Date August, 2015 Manager Signature Confidential and Proprietary Cantina LAREDO, gourmet mcxican food STAFF TIPS ALCOHOL CERTIFICATION HINDER �� Cit of Boulder Cthisform ucheckech dM y p our city renewal, please j111 Finance Department • LicensingDivision attorempls/certijtcotesoj g for employees! 1777 Broadway, Boulder, CO 80302 - 303.441.4192 PROOF OF TRAINING Trade Name: CANTINA LAREDO /STORE #193- BOULDER, CO. Address: 1680 29th STREET BOULDER, COLORADO 80301 The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all involved in service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, or other evidence of training completion for each listed employee. Employee's Name State Training Type Hire Date Previous Training Date Latest Training Date Bertha'Betty' Cardoza bar/server-TIPS on premise 02/24/2016 N/A 4/29/2016 Dessie Castillo GM- Tips on Premise 10/13/2015 N/A 9/22/2016 Teagan Claggett server -TIPS on premise 08/18/2016 N/A 2/11/2016 Paul Devine Pride server -TIPS on premise 02/16/2016 N/A 11/21/2014 Amanda Duensing server -TIPS on premise 05/29/2015 N/A 6/11/2015 Josh Dwernychuk server -Tips on premise 08/23/2016 N/A 04/29/2016 Juan Carlos Espinoza bartender -TIPS on premise 08/21/2015 3/12/2013 4/29/2016 Paul Garcia server -Tips on premise 07/22/2016 N/A 12/28/2015 Danielle Harrison bartender -TIPS on premise 06/15/2015 N/A 6/15/2015 Madison Hernandez server -TIPS on premis 08/2022016 N/A 9/22/2016 Meredith Jones server -TIPS on premise 11/12/2014 3/24/2012 2/5/2015 Rogelio Luna server -TIPS on premise 10/22/2010 4/8/2013 06/28/2016 Giovani Ocampo server -TIPS on premise 07/07/2016 N/A took class 1016116 card pending retake Riley Romano server -TIPS on premise 08/10/2016 N/A 10/12/2016 Sarah Rubbiolo host -TIPS on premise 10/02/2016 N/A 10/04/2016 Tristan Sawyer server -TIPS on premise 02/25/2016 N/A 3/17/2016 Willow Schram server -TIPS university 05/31/2016 N/A 02/03/2016 Kaitlyn Rushton server -TIPS on premise 08/02/2016 N/A 10/4/2016 Scott Smith Manager -TIPS on premise 04/15/2011 04/2/2012 6/28/2016 Kyle Vaughn bartender -TIPS on premise 10/17/2016 N/A 10/6/2016 Tony Ziadeh server -TIPS on premise 11/20/2014 N/A 2/5/2015 page 1 IJyau checked VES City of Boulder Jortrolningonyourdtyrenewal, please/111 Finance Department • �Licensing Division outthlsform&attochcards/certlJlcateso% � %� trolnfng jor emplayeesl y� 1777 Broadway, Boulder, CO 80302.303.441.4192 1� PROOF OF TRAINING Trade Name: CANTINA LAREDO /STORE #193- BOULDER, CO. Address: 1680 29th STREET BOULDER, COLORADO 80301 The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all involved in service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, or other evidence of training completion for each listed employee. Employee's Name State Training Type Hire Date Previous Training Date Latest Training Date Zamira Foster Parker server -tips on premise 09/06/2016 N/A 10/12/2016 Chad De Sellem server -tips on premise 9/27/2016 N/A 04/28/2016 Conlan Bahneman server-etips on premise 09/19/2016 N/A taking 1112 due to a -tips Joe Castillo server -tips on premise 10/08/2016 N/A In process of signing up page 2 vseTIPS On Premise 3.0CERT IF I E Issued. 0612612016 Expires: 0812612019 ID#- 4340063 Cor)an Sahneman Sushi Hana Sake Bar & Grit; 1220 Pennsylvania,Ave Bou'der, CO 80302-7023 USA I,!&. —//,,.c „o, -fog.,;+., .•^,"/f,1Pc/T7T TATT)0AU0001 ina Page 1 of 1 10/4/2016 C Certification Manager for PBSA Page 1 of 1 . . ......... ..................... .................... _....... Print Close Window This Certificate of Completion of eT1PS On Premise 3.0 For coursework completed on August 26, 2016 provided by Health Conui11,inications, Inc. is hereby granted to: Rip. HEALMCIFTYA�4�N.U,-' »SING 'Cii:�c?mwnenf is rtit ritoS�`?'IP$sriliu::ru Corlan Bahneman Certification to be sent to: Sushi Nana Sake Bar & Grill 1220 Pennsylvania Ave Boulder CO, 80302-7423 USA . ar 012%— liar.: W o td aEOi_Cs•n dolt :enls'4ut1�Dr= i�.•nca:�3.a! li� v w"• L"_ . i i ... c .. « , ..:+.. �,.„� „�f/n„P„rart;f ratP9(lnPn A vPntkP0P=Y&RT1)=63I0JF901 G3 10/4/2016 3 � C r3 tD u U tq C OCE o Q, y,•� C) XX� o m U U � v � 'Ci• O m p• U C p •• -- Q M N •3 C0 C C1 C7 N C 0'o 0 0' W (A N r o c� >�0 0 Mo rn 0 •„ i•• O O[ U.. tL0 W N co N C r- a o. o G w+ U O C ov aj •, .. U N t. d J U N �'n E i =N N c) Q CO co 6 p •� c -z d C-4 a rn W G• C N� NL (gyp O `° o o r•`v O d v m�-o� N c v C C y ' in 7 p 0O' LL m _0 5 0 o ti ti L eW T (S. cn C i+ y O O O T V =- to o o E U -v QF C - yrs! �U„ 7 c) O C •� � G C• C L O U o O •3 N v C a 3 C', C E > O v� ,-C. .y ; 2 a S C p o C C r o U 1 o 00 y C u t 5 C u V u s+ �' C- to y G C C T O i O G _ �1 > o F Cto C y C T O C F r n —Cc)- - ^' =O U 0 Y ' C r T 0 u. y fj} 0 U 3L3 C 7 C a °, c_ rn v o co U r c o c tj cl =� is is your Official 'TIPS Certification Card. (_—ry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations? By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerel4r"- Adam F. Chafetz President. HCI IMPORTANT: Keep a copy of this card for your records. Write do your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certificE card. There is a minimal charge for a replacement card if your original ca becomes lost, damaged or stolen. e On Premise SSN: )XX-XX-XXXX Issued: 9/22/2016 Expires: 9/14/2019 ID#: 4359828 D.O.B : XX/XX/XXXX DESSIE R CASTILLO 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 On Premise SSM xxx xx xxxx Issued- 2/11/2016 Expires: 1/31/2019 4183939 !)-O-B-= xx/XxnCXIX TEAGAN M CLAGGETT 2135 Kitt W Hall Boulder, CO 80310-0001 For service visit us online at www.gettips-com B- Jonathan Balliet, 47289 F \ e / ' 2pD I� _' & 9 72 2E / E ? , 7 § S © § I %� 0 M < #� # , 0 — \/ co k �� / $ ms-- % . \7/?{/=»}/ CD � 2 5 o / � � %r - \�� \ F \ e / ' 2pD I� _' & 9 72 2E / E ? , 7 § S © § I %� 0 M < #� # , 0 — \/ co k �� / $ °9] % . \7z CD � 2 5 o / � � \ 2 E B \ £ § 2 m w w 104 ƒ go ac $&co im w E o S0 §k \e & / L U- /22 g >f aeG 00 2 c° V2 3 + .-n , \f LLm 3F-�= CD U U tQ O 7 O C o p T Uo co s�?� T t- ce) V(( r In V u r` f= X LO M C. z U 1. ciC O z•r. O N •r. .^ U C C, p m O 01 3 0 0 Oc 0 0 n ° ZQ m oeDv o co O v 3 o E-0 O eu O Z UJ t11 Mn m c cs N m t 0 Q ao > c � o o—_ _0 _Cc O cov Qti2 2m U U CD i-� j U u O t U LL m 2 ur��E 0 to n O r U u p tL7 c L O 4� .J b C V _. c Q G o E a -, F u U O R C O C U� G N O^ U T.N J o 3 °- � o �.ta C� C O �! 'U U O r T Cl) T 5to S 'cs UO ^ U G U TC-Uj U cc u O ca a o .0 c 05, U f U l ® .T .fie U O O O ff- ESU v O c; c u .. =— This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. C ;ratulations! ,.,y successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-5241200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, a -4r Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write dow your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certificati card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN: XXX-XX-XXXX Issued: 10/4/2016 Expires: 9/23/2019 ID#: 4367953 D.O.B.: XXDCXDO(XX JOSHUA S DWERNYCHUK 911 16th St Boulder, CO 80302-7331 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 0 3 0 tq :1 U Cp r. c O ° J T O ° T U o X > 3 w v X N E 6zi � V � 0 E X j( �t O. G O y a M rn U c n W N 'X o w° a y r y LU Q p p y U y aa) 3 - Z co Go C N r U C c 0 d 0 v y 0 y CO w N E _ E GoCD N N m O Em N 0 Z > 6,4 0�— ° 0 ,7 E O-5 'O cN coo 0 d' d' r Co 0 N p r c N C. U t0 in '°7 O LL. fD d N •v: >> E" 0O UU.y. rN. I V� ' y U U G Iw TLS+ ^ O O U O T � � •v 0 x bD c o r ? o c �0>GC mo d 3 " Fes^ =� to :3 =� to Lro c r- v j r .U.. y c+1 - c OSE 3 0 ° LIE) _ C � _ •v U ,O o � F •Y OJ U �h\y, U C :3 c p m .n U.• '• U O c- G t on q° G] U ° U U = c rc• 'O•' '� 5 U - = a CJ v C. •- T OJ �s T .UU.. ^D ^ p 0 p r G -' > 7D>''� rJ O E �— ��_ L) >N p 3 y v. This is your Official TIPS' Certification Card. C it with you as evidence of your skills and knowledge in the responsible ad consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, �� L4< Adam R Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write do, your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certifica card. There is a minimal charge for a replacement card if your original car becomes lost, damaged or stolen. e Ve On Premise SSN: XXX -)O(-XXXX Issued: 10/12/2016 Expires: 10(1/2019 ID#: 4375313 D.O.B : XXDOUXX CX Z4MIRA C FOSTER PARKER 1900 Goss St Apt 206 Boulder, CO 80302-6566 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 --On Premise SSN: XXX XX X)= Issued: 12/28/2015- Expires: 12/18/2018- - 4156115 `D.O.B.: XX/X)UXXXX PAULA GARCIA 1192 Sunset Dr Broomfield, CO 80020-7038 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 \ \_ E 8 E Um t 2 %k \ E \ \ ) \ a ° e %\ §[§ (\ cr\\ /\ �2 7 \g e=� �� \\ - _ � a�2 ��— / �/ . f�_eke %\ 2.5�`=a§&/ $ 7 p � X33 eta 7777777\z=, c§§ƒ§ b'7— k\ a � f J \ m \ \ \ \ \ § \ \ \ . - #z§_3�=E�o& <_\ �j@ Um This is your Official TIPS Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. you will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerel4/- Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write do% your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certifical card. There is a minimal charge for a replacement card if your original car becomes lost, damaged or stolen. • Vs On Premise SSN: XXX -XX -)O= Issued: 9/22/2016 Expires: 9/14/2019 ID#: 4359829 D.OJ3: XX/)OUXXXX MADISON N HERNANDEZ 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 r ^� 0 C n Up G C )S• C': ✓ < � aG � O O v m to C at V. o fjz O O 6 O "0 0, G O CD r or. G •p = 6 (D l` O V S E% y .O O C UO _� C^ �. y d^ 00 O p O O -0 :: L' OQ v 7-- p AIn (f'+ cn pry n ;77 O d v O C C a: o O aG C.c ; p l� C O is QD S n 7 t _— O r CD O fD O °. ccs —r- -g 0 O p G (OD C O — V. O d n b O — T CD 0 O- m C n C C aG O p` CD d 7 O C e o v = R v m 93 c c CDv c 7 0w m z W N O O 5;* U (D O C cm `�°Linn�, o n c o ` m C D O m N -4o a o M. d o -•f (O cn U1 y O ^ U ;y to O ci " = CD y Q Q '""• i � �' a t 0 CD CO CD OD O'c�a CD 0333 p m W s= CD . N J{� O? z n o Z m CA Q n C x Q t7 y Q C 07 ±i ( 00 O o " a C,, 3 O c 0, n 7• � U O G 0 a This is your Official TIPS Certification Card. Cant' it with you as evidence of your skills and knowledge in the responsible -le and consumption of alcohol. ,agratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, a, 4:--- Adam F. Chafetz President. HCI IMPORTANT: Keep a copy of this card for your records. Write your certification number because you will need it when contacting TIP: For assistance or additional information, contact Health Communication Inc. by using the information provided on the reverse side of your certifi card. There is a minimal charge for a replacement card if your original c becomes lost, damaged or stolen. 0 9 On Premise SSN: XXX XX-XXXX Issued: 6/28/2016 Expires: 6/4/2019 ID:: 4289748 D.O.B.: XX/XX/XXXX ROGELIO LUNA 5640 Arapahoe Ave Apt 425 Boulder, CO 80303-1356 For service visit us online at www.getfps.com B. Jonathan Balliet, 47289 This is your Official TIPT Certification Card. C it with you as evidence of your skills and knowledge in the responsible aid consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken dour place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, Gr�' Adam F. Chafetz President, HCI IWORTANT: Keep a copy of this card for your records. Write do' your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certifica card. 'There is a minimal charge for a replacement card if your original ca becomes lost, damaged or stolen. e ■ �■ �m On Premise SSN: XXX -X( -X)00( Issued: 10/12/2016 Expires: 10R/2019 UA 4375314 D.O.B.: XXIXXIXXXX RILEY A ROMANO 106413th St Apt 4 Boulder, CO 80302-7280 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 This is your Official TIPS® Certification Card. C t with you as evidence of your skills and knowledge in the responsible s id consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, A�- G Krg�- Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write dow your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certificat card. There is a minimal charge for a replacement card if your original cart becomes lost, damaged or stolen. 99 On Premise SSN: XXX-XX-XXXX Issued: 10/4/2016 Expires: 9/23/2019 ID#: 4367957 D.O.B.: XXrXXD = SARAH G RUBBIOLO 5462 Pueblo PI Boulder, CO 80303-4115 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sa.' d consumption of alcohol. l gratulation! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely,-- Adam F. Chaf✓etz President, HCI IMPORTANT: Keep a copy of this card for your records. Write do%A your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certificate card. There is a minimal charge for a replacement card if your original cart becomes lost, damaged or stolen. e On Premise SSN:- X)O(")O("xX)O( Issued: 10/4/2016 Epi e5: 9/26/2019 ID#: 4368971 D.O.B.: XUXX/x xx KAITLYN L RUSHTON 4021 Riley Dr Longmont, CO 80503-4127 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 � \\\\ �/ / � k A / / 0 ` \ \ cr E i -_\ � $ $mac 2E. =2 j2 / ap 2 - E © o 2 o E T t� )\\\k ƒ S 2 « «m )I 2=2\2/ a&m \ 2 gk m } 2 e 2§ 3\\ k m5a7#3 / r\ f !c) Z) Q 2 § § ` - // - _ g k 2 ) Qj- �\ COD \ 2 E 2 it .- > 'S »3: 2@/&g X22 2\Q2=3{)222 E=4\\ SS v: XXX-XX-XXXX University Issued: 2!3/2016 Expires: 1!22!2019 I D#: 4178671 D.o.t3.:Xxfyj)om WILLOW J SCHRAM 1189 Beall Ave Wooster, OH 44691-2363 For service visit us online at www.gettips.com 1301 Nathan Fein, 6 This is your Official TIPS Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. C ,ratulations! ;uccessfully completing the TIPS (Training for Intervention Procedures) pru..am, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, Adam F. Chafetz President, HCI IMPORTANT: keep a copy of this card for your records. Write doH your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certificati card. There is a minimal charge for a replacement card if your original care becomes lost, damaged or stolen. 0 Ta On Premise SSN: XXX XX-XXXX Issued: 6/28/2016 Expires: 6/8/2019 ID#: 4289754 D.O.B.: XX/XX/XXXX SCOTT D SMITH 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.getfps.com B. Jonathan Balliet, 47289 This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible s• nd consumption of alcohol. C—igratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-5241200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerel4/� Gam - Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write do your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certifica card. There is a minimal charge for a replacement card if your original cai becomes lost, damaged or stolen. s Wa On Premise SSN: XXX-XX-�X Issued: 10/6/2016 Expires: 9/22/2019 IDir: 4370583 D.O.B.: XX/XXM= KYLE S VAUGHN 1680 29th St Boulder, CO 80301-1233 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 o ,o O UCr 'ps L c3 t4 U U CO c '� 'C O u-. U O O O T "? U 0 � c 7 NifA� LO o U 'y c. 75 iGG U to d Uig d 3 = O ea N d O ai XLu p 0 r in r '02 Oc = ct? W 0) 0° es nvo � o `o QUOO U a0i o 0 vOiLO N c o� y 'C14 E co U)N CD M cs ... E E LO v Z00 o o of r.j LO O c� c) ��co d CU 1 � �_ v N � � ar•. LL CO y� O ccz p U ^ T Lt., U O O c u r G p C v 'v: O E+ O 4 c O i o _ > co p U o cu 4 3 C c; c 03 _ C-1 a�a Uj C.y _ .- O O U cn G .ra t0 C CO •= C U tj U O u r U> s r—,-to= T 1 Oj .T 'se r O •- > to O > to A LA Cantina LAREDO gourmet mexican food Cantina Laredo #193 Community Involvement & Donation Records 2012 Cantina LAREDO. eaurtnet mexican food Fundraiser Guidelines Your group is responsible promoting your fundraiser. People coming to the restaurant to support your group need to tell the hostess so they can be counted. Your event will take place between 5 p.m. and the close of business. Your group must bring in at least 100 people to qualify for payment. Initial Your group will receive 10% of the net sales of the restaurant from 5 p.►n. to close the night of your event. Your group cannot solicit Cantina Laredo customers, either in the parking lot, outside the front door or in the dining room, to count toward your quota. Your check will be at the restaurant approximately two weeks after your event. Date of Event Name of Group Signature Printed Name & Title S�CY3 trm �P Y^ Phone Number������� Store Number I CI 3 Sales Between 5 p.m. and close $ • 1 Total Donation . SO Mackintosh Academv Parent Council's Community Dinner Fundraising Event_ Ui�ci[�3i �G�4fteom �o21- Page 1 of 1 CantinaLaredo193-Boulder From: sbroderickkeck@aol.com Sent: Thursday, February 16, 2012 12:40 PM To: CantinaLaredo193-Boulder Subject: Fwd: Aft: Andrew Mackintosh Academy School Comunity Dinner Fundraiser Hi Andrew. To follow is the e-mail that I sent earlier this month. In reference to the first e-mail, I have adjusted the dates that would be of most interest to us to include Thursday March 1 st and Thursday March 8th. Thank you, Sharon Keck 303-530-1093 (h) 303-884-8517 (c) sbroderickkeck@aol.com -----Original Message ----- From: sbroderickkeck <sbroderickkeck@aol.com> To: boulder <boulder@cantinalaredo.com> Sent: Mon, Feb 6, 2012 1:46 pm Subject: Aft: Andrew Mackintosh Academy School Comunity Dinner Fundraiser Andrew, Thank you for your willingness to partner with Mackintosh Academy Parent Council's Community Dinner Fundraising Event. Mackintosh Academy is a new school, opening its doors in Boulder this past September,: As a new school, our Parent Council's fundraising efforts are directed at supporting class The opportunity to conduct a school fundraiser at Cantina Laredo would be greatly apprE We are looking at Community Dinner dates for March 2012. Perhaps Thursday, March Dates that do not work include: March 9th and March 23rd - 3oth (spring break). Our school website is: ww-,v.macldntoshacadenlv.com (Boulder campus) Thank you again for your partnership in this endeavor. Sincerely, Sharon Keck Parent Classroom Representative/Volunteer 303-530-1093 (h) 303-884-8517 (c) sbroderickkecka.aol.com 3/10/2012 O LL cnH LU CY LU Y U W 2 U a Q R U - CD N N O I d O O O d V B a O M r M a M M O v Y = V Y O m v a� -_ U t cva U � R U - CD N N O I O O O N N 6R w O M r M 69. M M R U - CD O I O O O 6R M O O M O O O M M 1 c O N ._ m L Q O O i Q y U) L �0 � d L L L 5053 L (D U) 00 O Cl) LO M O O M M p� 69. r Om O v O N a o L 0 D N m O m v a� -_ U ti c U = C ou c U m w M 4 O ~ t U _ = L m O > w c O N ._ m L Q O O i Q y U) L �0 � d L L L 5053 L (D U) 00 O Cl) CD O N CD Om v O N a o L 0 D N m d Z m t U O a m v a� -_ U a' d O c :3 O E c U = C ou c U m w 4 O ~ t U _ = L m m v j2 3 L c > ta y m O U w> = V w _ to C OL (L p 4) U :3 Q U o U m J U N L O LL = LL L y > in > O a U m - N > ;' c U) > v :3 L Tr V � Q Y U a w LL a� a� U N_ N_ c Q V>I O O O O N N 6R CO O to .5C Y r M aa) U U M M w LL a� a� U m w/Y1 W c Q V>I O � � c 4)Q N O LL U 6R 'C ca to .5C Y p� o aa) U U O Qi is O �.Q/i N ti O m w/Y1 W O Cl) V>I O O c 4)Q N O LL U 6R 1 O m w/Y1 W O Cl) V>I O O c 4)Q N 06 LL U O 1 M p� (D m w/Y1 W U) Cl) V>I ,^ d O c 4)Q N 06 LL U O M M p� � r O O ti M •O O co U w = J w N a- _ _ d O O p U U 44 O E ou d wo a a a m w/Y1 W M Q IL� LL V>I ,^ d j O m L � c 4)Q N U a O LL U U) m •O O U U w = J w _ O _ LO a `' > U ++ N U U N Y O LL = O a, > U) > O Ix U w/Y1 W M Q IL� LL V>I ,^ d j O m L � c 4)Q N U a O LL U Page I of 1 CantinaLaredol93-Boulder From: JoseLuis Magana Sent: Sunday, March 11, 2012 8:52 AM To: CantinaLaredo193-Boulder Subject: Re: School Fundraiser #193 Need check request form filled out and sent to me. On Mar 10, 2012, at 9:27 PM, "CantinaLaredo193-Boulder" <Boulcierca,,cantinalaredo.com> wrote: Sir, On Thursday March 8, we hosted a school fundraiser for Macintosh Academy located here in Boulder, Colorado. The school brought in 102 people generating an extra $1,500 towards Thursday night's sales. We need your assistance in getting them a check cut for this fundraiser/philanthropy. The school representative also said she will be putting Cantina in the school newsletter and are planning to have a teacher's happy hour party here on their next teacher in-service day. We had them fill out the'S.T.O.R.M Fundraiser Guideline form' and have it to fax. Is there anything else we need to do or have the school fill out? The total sales for Thursday between 5p.m and close were $3,985.19. We believe this was a great way to spend $398 towards the community. Thursday's sales were the highest in 2012. Andrew Cantina Laredo 1680 29th Street Boulder, Co 80301 303.444.2260 <Cantina Logo.bmp><facelogo jpg> 3/13/2012 Jim@bodinrealty.com From: Deb <Deborah@bodinrealty.com> Sent: Thursday, April 12, 2012 8:53 AM To: 'Jim Bodin' Subject: Restaurant Gift Certificate We will have a booth at the 29th Street CU Sports Car Club Show on April 22nd and would like to offer a $25 gift certificate to your restaurant as a prize. Please call me or stop by if you would like to donate for the drawing. We would love to support our local merchants and will advertise your restaurant at our booth! Thank you, Jim Bodin Bodin Realty International 303-447-2000 1805 29th Street, #1140 Boulder, CO 80301 www.bodinrealtV.com C R UNIVERSITY CORPORATION FOR ATMOSPHERIC RESEARCH NATIONAL CENTER FOR ATMOSPHERIC RESEARCH I UCAR COMMUNITY PROGRAMS October 4, 2012 Cantina Laredo Andrew Richardson 1680 29th Street Boulder, CO 80301 Dear Andrew: I have received your contribution of 3 complimentary entrees & one top shelf guacamole, to use in our Annual Craft fair as a door prize. I wanted to send a thank you for your contribution and to acknowledge receipt. Sincerely, 4L'Ip� Konnie Carrillo Co -Chair EAC 2012 Craft Market can illo(a,ucar.edu (303) 497-8723 P.O. BOX 3000 1 BOULDER, COLORADO 80307-3000 1 303-497-1000 1 WWW.UCAR.EDU L P G � T R i7 ICTXC r F n W:KAY METROPOLIS OF DENVER Sts. Peter & Paul Greek Orthodox Church 5640 Jay Road, Boulder, CO 80301 — P littp://www.stspeterandpaulboulder.org — philoptoc November 2012 Annual Dance, Dear Friend. This letter is a request for Annual Philoptochos Soci raiser to be held at the B contribution is greatly ap Winter N 1Z :)ntifbution frorl ymrand/or your busi Winter Dinner ance, Raffle & Silent Y Country�,o(b on Saturday, Feb. 2� ated . ill contribute to helping ty 434 lder.org for the -r. ion fund 2013. Your v in need. This event is hosted by thk Philoptochos Society of Sts Pete and Paul Greek Orthodox Church, which is philanthropic non-profit orga zation that provides help to the poor and needy, locally, nationally and wo ide. All of the funds raised at this event will go tow s our philanthro ' efforts and over two thirds of our funds assist those in need wit ommunity. We support a wide range of services, including Head Start and local soup kitchens. Our organization is associated with the Greek Orthodox Archdiocese of North and South America. It was organized in 1894 in New York City and there are active chapters in most Greek Orthodox Churches in America. Please describe your contribution on the Attached "Contribution Sheet" and return it with your donation. Any contribution you can give us will be greatly appreciated and very helpful. All contributors will be gratefully acknowledged at the event. On behalf of the Philoptochos Society of Saints Peter & Paul Greek Orthodox Church, we thank you for your generosity.! If you have any questions or concerns, please feel free to contact Candy Soulakis at (303) 432-7697. Sincerely, The Philoptochos Society Executive Board In English, the Greek word "Philoptochos" means "Friends of the Poor" SAINTS PETER & PAUL GREEK ORTHODOX CHURCH Philoptochos Society 5640 Jay Road Boulder, CO 80301 Contributor: Item Contributed: Description: Restrictions: How Redeemed: Value: Auction/Raffle to be held: Saturday, February 23, 2013 Boulder Country Club Boulder, CO (303) 581-1434 Contributor Sheet Signature of Contributor Mailing Address Telephone Number I December 20, 2012 Catina Laredo 1680 201h Street Boulder, CO 80301 Dear Donor, On behalf of the Board, volunteers and staff, thank you for your generous support of the Longmont Theatre Company through your donation. Please check the donated items and listing name (how your name will appear in our donation acknowledgements). If either is not correct, please contact us with the correct listings. For your records, our Taxpayer Identification number is 84-1092371. The Longmont Theatre Company provided no goods or services in return for this contribution, and all contributions to the Longmont Theatre Company are tax deductible to the extent permitted by law. Your involvement is valuable to our theatre. If you would like more information about our programs and upcoming events, please call us at 303-722-5200. Thank you again for your support. Sincerely, Joseph L. Perrotto LTC Treasurer/Board Member Item Donated Amount Listing Name 2 $8 Certificates (free Guacamole) $16.00 Value Catina Laredo 1 Free Entr6e $14.00 Approx. Value 513 Main 6treet • (303) 772-5200 Mailing Address: P.O. Box 573 • Longmont, CO 805022 Founded in 1957 Famt W -e9 Request for Taxpayer Give Form to the (Rev.December 2011) Identification Number and Certification. requester. I not Department of theTmesury Bend t0 the IRS. Intemal Revenue 6erdoa for Atmospheric Research/National Center for Atmospheric Research Illy name, It dieerant (turn check appropriate box for lederal tax dasalfloatiorr ❑ IndlvldueVeolo proprietor ❑ C Corporation ❑ 8 Corporation ❑ Parinwahlp ❑ TrueVeatate Exempt payee ❑ Umked liability company. Enter the tax cleeelfloation (C.0 corporation, S.S corporation, P"pu►tnerahlp) ❑ )] Othar(aaalnatrucllona)► Non -Profit Walrosa (number, shoot, and apt. or collo no.) -- --- -� - - -- --� 11loquoaWs name and sddraac loPVonalr 850 Table Mesa Drive P.O. BOX 3000 _ _ _ state, and ZIP sada loulder CO 80307.3000 Enter your T N In the appropriate box. The TIN provided must match the name given on the "Name" line I Social cocurlty numeoi j to avoid backup withholding. For Individuals, this Is your social security number ISSN). However, for a resident Winn, Bole proprietor, or disregarded entity, sea the Part I Instructions on page 3. For other ——� entitles, It le your employer Identification number (EIN). If you do not have a number, see Now to get e 77N on page 3. Note, If the account Is In more than one name, see the chart on page 4 for guidelines on whose Employer Identification number number to enter. Cert ffcation 11 1 Under penalties of perjury, I certify that, 1. The number shown on this form Is my correct taxpayer Identification number (or I am walling for a number to be Issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I.am subject to backup withholding as a result of a fallure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and I am a U.S. citizen or other U.S. person (defined below). certification Instructions. You must cross out Item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have fol ad to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest pold, acqu'altlon or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and gonorolly, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions on page 4. ti8nr slpnature of Here 1 U.S. pereon► Date 10, General Instructions Note, If a requester gives you a fano other than Form W-9 to request Your TIN, you must use the requester's form If It Is substantially similar Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who Is required to filo an Information return wlih the IRS must obluln your correct taxpayer Identlflcallon number (TIN) to report, for exrunplo, Income paid to you, real aslato transactions, mortgage Interest you pald, acquisition or abandonment of secured property, cancellation of debt, or conlrlbullons you made to an IRA. Use Form W-9 only If you�are a U.S. person Qncluding a re'sldent ellen), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving I8 correct (or you are waiting for a number to be Issued), 2. Certify that you are not subjeci to backup withholding, or 3. Claim exemption from backup withholding If you are a U.S. exempt payee. If applicable, you aro also certifying that as a U.S, person, your allocabio eharo of any partnership Income from a U.S. trade or business Is not subject to the withholding lax on foreign partners' share of offecllvoly connected Income. Cat, to 1W Farm W-9. Oeftitlon of a U.B. person. For federal tax purposes, you are considered a U.S. person if you are: • An Individual who Is a U.S. citizen or U.S. resident ellen, • A partnership, corporation, company, or association created or organized In the United Slates or under the laws of the United States, • An estate (other then a foreign estate), or • A domestic trust (as defined In Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business In the United States are generally required to pay a wllhholdng tax on any foreign partnere' share of Income from such business. Further, In corlaln cases where a Form W-9 has not been received, a partnership Is roqulrod to prooumu that a partner Is a foreign person, and pay the wllhholding tax. Therefore, If you aro a U.S. person that Is s partnor In a partnership conducting a bade or businoss n the United Slates, provide Form W-9 to the partnership to ostabllch your U.S. status and avold withholding on your shore of partnurship Income. A- rarm W-9 (Rev, 12-2x11) Longmont Humane Society September 28, 2012 Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear Cantina Laredo: On behalf of LHS, thank you for supporting the homeless animals in our community through your donation of the following auction item(s): Cantina Laredo Gift Certificate Your donation was sold at the Longmont Humane Society's fundraising event Homeward Bound Harvest on Thursday, September 13, 2012. Your support was tremendous and truly contributed to the overall success of the event. We are excited to announce that we raised aver $113,000 for the animals. We value your commitment in assisting us to give animals not just the care they deserve, but a second chance at life. Thank you again for y6ur gift and for sharing in our mission of caring, serving and educating to improve the lives of companion animals. There were no goods or services provided in exchange for your donation. Please retain this receil,t with yuui tax records. With Appreciation, (� Liz Smokowski Executive Director Longmont Humane Society L 'Fax ID # 84-0645455 • 'f C6mmunityShares 9595 Nelson Road Longmont, Colorado 80501 • Telephone 303.772.1232 • Fax 303.772.2219 • www.longmonthumane.org �l Longmont Humane Society Greetings: The Longmont Humane Society is excited to announce its fundraising event, Homeward Bound Harvest, which will take place on Thursday, September 13, 2012 at the Boulder County Fairgrounds Exhibit Hall. This event promises an exciting evening for our 400+ guests, complete with entertainment, fine liquor and craft -brew tastings, farm to table style dinner, as -well as silent and live auctions. Our fundraising event supports the homeless animals of the Longmont Humane Society. The Longmont Humane Society provides shelter, medical care, and adoption services to more than 4,000 animals each year. We spend an average of $410 on each: animal we successfully adopt or reunite with their companions. I would like to ask you to please consider donating a $75 gift certificate for our auction. Our silent auction plays an important role in our ability to raise funds and meet the growing demand for our services. Your company's name will be promoted to over 7,000 people at the event and on our website, Facebook, newsletter, annual report, and in our event thank you ad in the Times Call. Thank you very much for your consideration. Should you have questions, please feel free to contact me at 303-772-1232 ext. 286 or heather@longmonthumane.org. We appreciate your support! Sincerely, Heather Ponce Development Associate Longmont Humane Society La THURSDAY, SEPTEMBER 13TH, 2012 0 g. CommunityShares 9595 Nelson Road • Longmont, Colorado 80501 • Telephone 303.772.1232 Fax 303.772.2219 • www.longmonthumane.org %444� . bridgehouse Serving Boulder's Homeless & Working Poor September 26, 2012 Cantina Laredo 1680 29th st. Boulder, Co. 80302 Dear Sir or Madam, 303-442-8300 Post Office Box 626 r Boulder, CO 80306 �O www.boulderbridgehouse.org Fax 1-866-831-9443 A Colorado 501 (c)(3) Corporation (formerly The Carriage House Community Table) Our recent fundraising event, "Bridges Troubled Waters" on September 8th was a huge success. Thank you so much for contributing with your gift of three $15 complementary meals plus a $10 certificate to our auction. We at, Bridge House, believe that homelessness is not the end of the road but the beginning. With our bridge of opportunity, we offer everything from meals to employment services. We give opportunities in order for our clients to leave the streets behind. Our event raised over $70,000 which will be put to work immediately to help the homeless and working poor with our programs like Ready to Work and opening the doors of our new one stop shop Resource Center. Thank you for your part in making this possible. So, on behalf of staff, board of directors, volunteers, and the hundreds of people that we serve, thank you for your contribution. In these difficult times, your support means more than ever. With warm wishes, Isabel McDevitt Executive Director p.s. Please contact us to learn about opportunities for volunteering at Bridge House. You can make a difference in the life of someone who needs a second chance. Please call 303-442- 8300 or send an e-mail to Emily@boulderbridgehouse.org. Bridge House is a 501(c)(3) charitable, non-profit organization. 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There will be two Flights, the Serious and the Not -So -Serious. Play will be a 4 person scramble with a shotgun start. Once the sun sets golfers and non -golfers will party in Hawaiian style with yummy food and dancing. Win an award for most outrageous or most authentic costumes. Play glow in the dark golf games during the party. Silent Auction Includes fine restaurant certificates, wine and liquors, gift baskets, weekend getaways and great gifts for everyone. Bid early and follow the bidding to the last minute. Come and enjoy! Golf & Party $125 per person Foursome price is $425 Party Only $45 per person ? SCHEDULE OF EVENTS Registration 4:30 p.m. Tee Time 5:00 p.m. Party and Dinner 7:00 p.m. Silent Auction Ends 8:30 p.m. W. Rex Van Gorden, AAMS® Financial Advisor 3280 28th Street, Ste 3 Boulder, CO 80301 Bus Ph- 303-440-3482 Rotary Club of Boulder Valley P.O. Box 17485 Boulder, CO 80308 www.bvrc.org To: Date: Thank you for your contribution to the "Summer Sunset Swing" fundraiser to be held August 24, 2012 at Flatirons Golf Course in Boulder, CO. Your generosity enables our club to continue to provide both financial and hands-on assistance to organizations and individuals benefiting youth education. Here are some of our recent activities: Focus on Early Childhood Education: Student scholarships and volunteer labor to aid Boulder Day Nursery, Family Learning Center and the Acorn school. Developing Youth Leadership Scholarships to enable middle school and high school students to attend youth camps focused on developing leadership skills. Making College Affordable Provided financial assistance to 3 college freshman per year to help offset a portion of their expenses. Foreign Student Exchange Supported both in -bound and out -bound high school student exchanges each year. We greatly appreciate your support, Rex Van Gorden President 12-13, Rotary Club of Boulder Valley. Description of Donation(s) 3 lk Quiz nexk n a,rck / I ► SG/ 1 Estimated Retail Value (needed for silent auction items) �k ('s Note: Your donation may be a tax-deductible business expense. The Rotary Club of Boulder Valley is not a 501 (c) 3 organization. ':�BoldeReach BoldeReach is a 501(c)(3) non-profit organization that raises awareness and funds to address the needs of women and children living in desperate circumstances around the world. We leverage our passion and connections in the community to support existing non-profit organizations which are already doing great work in the world. Each year we choose a specific issue for our fundraising and interview related non -profits for projects that match our mission. Once we identify and vet the organization and project(s), we build our educational programs and fund raising project around the issue and chosen recipient. BoldeReach began in 2004 and, to date, has raised over $500,000 for local non -profits who align with our mission. This year we are raising funds for Boulder -based International Midwife Assistance, healthcare professionals providing maternal and infant care to people living in areas lacking even basic healthcare services. This letter is to request your support for our May 12, 2012 Gala, a very elegant event that is attended by 250 prominent members of the Boulder community. We are soliciting restaurant gift certificates for our Gala Auction. Your business will be featured prominently at the Gala, in the Auction Program, on our website and in press/literature related to the Gala. If you would be willing to make this donation, please contact me at any of the coordinates listed below: Thank you for your consideration of this request. BoldeReach Board Member: Cindy Lindsay Phone Number: X03.954.8525 Email Address: cindy.lindsay@boldereach.org.9 BoldeReach is a 501(c)(3) non-profit. Our IRS Determination letter and Colorado Sales Tax Exemption letter are attached. Federal Tax ID # 73-1693536 Local Fundraising cis Global Reach for women and children in great need around the world as 1,5(rxiU 5 F)oa xis ORIGINS Powered by Nature. Promn by Science W _1 1 _ Please help us to promote our cause and we'll help to prom ifte your business! Dear Business Manager, Origins will be conducting a free facial/live stream event on April 18 in honor of Earth Month and our ongoing commitment to the environment. We will be planting a tree for each skincare item sold. In addition to the incentives mentioned below, our customers will be given the option to enter to win prizes donated by retailers. Customers will get: 1. FREE mini -facials and makeup consultations on Wednesday, April 18`h during our live -streamed ORIGINS ROCKS Earth Month concert featuring Gavin DeGraw and Vanessa Carlton! 2. Free DELUXE skincare gift bag + wish bracelet with ANY skincare purchase! 3. Origins will PLANT a tree with ANY skincare purchase! If you have any coupons, offers, gift cards, or prizes you could contribute for our event, we would really appreciate it! Please contact the staff at Origins 291h Street (303)545-0132 if you can help in any way. And, if you'd like to participate in the fun, give us a call to schedule an appointment! Thank you. Sincerely, Sarah Botkins Store Manager Origins 291h Street (303)545-0132 Hi Dear Sponsor: My name is Denise Cardoza and I'm going to be competing in AM (National American Miss) ageant and looking for sponsors like you and/or your company to sponsor me. Competing in this pageant would personally help me build self confidence and also to meet more girls like my self that have the same dreams as I do. I would love to become a model or a designer in the future and I'm hoping this could help me achieve my dreams and goals, but most of all I would love to have fun with my family and other girls. In order to do this I need to find 10 sponsors that can help with a donation to raise the cost for the Pageant fee and other cost that my parents can't afford. My goal is to go to finals and if I do you and/or your company will appear in the NAM 2012 Magazine and your donation is also Tax deductable, Thank you for your time and cooperation. IAVy Sincerely VA ' Denise Cardoza e " DONATION RECEIPT TOTAL: �/4() Thank you for your donation! Congregation Bonai Shalom is a 501(c) 3 tax exempt organization Federal Tax ID: 84-0891557 // State Tax ID: 98-04830 Date: April 18, 2012 Congregation Bona! Shalom DONATION Cantina Laredo 1527 Cherryvale Road FROM David Cardona Boulder, CO 80303 Scott Smith (303) 442-6605 1680 29P St. Fax: (303) 442-7545 Boulder, CO 80301 TOTAL: �/4() Thank you for your donation! Congregation Bonai Shalom is a 501(c) 3 tax exempt organization Federal Tax ID: 84-0891557 // State Tax ID: 98-04830 (dP6 C ON GREG AT I ON BONA[ SHALOM Cantina Laredo David Cardona Scott Smith 1680 29th St. Boulder, CO 80301 Dear Mr. Cardona & Mr. Smith, April 17, 2012 Thank you for your support of Congregation Bonai Shalom's (CBS) Purim Gift Package Fundraiser. Your generous support helped us not only reach, but exceed our fundraising goal of $18,000, with the final number showing a 30% increase over 2011. Our membership was ecstatic with the Purim Gift Packages and the wonderful things in them, thanks to you. A booklet with your logo and business name was included with the delivery of the Purim Gift Packages to A CBS members, JCC Pre -School Teachers, & CU Hillel Students. A copy of the booklet is enclosed. Your business was also included in: • Multiple emails to CBS members; • The CBS bimonthly newsletter; Weekly written and verbal announcements. As Congregation Bonai Shalom is a 501 (c ) 3 not-for-profit organization, your contribution is tax-deductible to the extent allowed by law. Our tax ID numbers are on the attached donation receipt. Please let us know if you need additional documentation' For your donation. We hope you are enjoying the patronage of CBS members now and in the future. We look forward to working with you again next year! Best Re ard�s,,f Rhonda Wildman Purim Package Chair 1527 Cherryvale Road • Boulder, Colorado 80303 tel: 303.442.6605 • fax: 303.442.7545 • www.bonaishalom.org 771 TII"Y1my Global Health- Building healthyfuiures ClO�lt FIEP`��` 22 East 22ntl Street Indianapolis, IN 46202 Tel 317.920.1822 Fax 317.920.1821 Dear Timmy Global Health is taking a humanitarian service trip to Ecuador and we need your help! From May 23rd -May 31st eighteen University of Colorado students with eight medical professional volunteers will participate in serving the people of Ecuador by running medical clinics in communities that would otherwise have no access to healthcare. We hope that the experience will be beneficial not only to the people of Quito, but for the students who are learning the necessary skills and rewards of providing service. Timmy Global Health is a 501(c)3 non-profit organization based out of Indianapolis, Indiana that channels resources to sustainable health projects in developing countries. Timmy Global Health sends a group of volunteers every two -three months to perform medical relief in under -served areas in Ecuador, Guatemala, and the Dominican Republic. Additionally, Timmy Global Health partners with established NGOs and works directly with partner organizations stationed in the visiting communities to support their year-round outreach to the poor. Utilizing the charisma of college students, Timmy Global Health has developed its volunteer base at over 50 universities around the United States. Timmy Global Health strives to keep overhead costs as low as possible. As a chapter, we will fundraise all the medications necessary for the trip in the United States and transport them to Ecuador. In addition to the medical supplies, we fundraise money to donate to our international partner organization in Quito, which ensures that care is provided to those who need it year-round. 93% of all donations go towards subsidizing costs of medical care in Ecuadorian hospitals, funding a mobile medical unit that travels to small farming communities outside of Quito, and to the construction of a new hospital/keeping the local clinic staffed five days a week. HOW YOU CAN HELP Monetary Donations: Checks can be made payable to "Timmy Global Health" in the memo line. (Tax Deductible) Donate Supplies: Children's vitamins, toothbrushes, toothpaste, soap, shampoo, Ziploc plastic bags, over the counter medicines etc. Donate Gift Certificates and Prizes: Timmy Global Health is holding a "Spread the Love" banquet. Please consider donating a gift card/membership for your business to be included in our annual Spread the Love Banquet dinner on Sunday, February 21st from 5-8pm in the University Memorial Center room 235. ---- Willing to donate? ---- Willing to attend? ---- Perhaps next year? How We Can Help • Advertising: If interested, we can provide an advertising opportunity for your company at our event. Please contact us at cutimmv(@Rmail.com if interested. Non -Profit ID# 35-201-2757 Thank you for your encouragement and generosity, John Morella President of Timmy Global Health @ The University of Colorado -Boulder (970)376-5085 john.morella@colorado.edu timmyglobalhealth.org cutimmy.org N COO R S community based art exhibition + juried competition INVITATION TO SPONSOR AND DISPLAY THE ART Bold Doors is a community based art competition and exhibition taking place in Boulder this summer. But this isn't just any art competition – all entries will incorporate at least one old doorl ■ Display a "door" work of art in a window, inside your business or at the entrance ■ Guide maps will be widely distributed and available online– identifying exhibition host sites ■ Sponsors providing funding or in-kind contributions will be featured in advertising, social media activities and guide maps ■ Exhibition begins in mid-June and ends with a "Door Jam" event on August 4`h ■ ...a great opportunity to demonstrate support for sustainability and the artsl Exhibition hosts and competition sponsors are now being sought for a first-ever, highly visible competition and community-based exhibition in Boulder, Colorado featuring works of art created with or on reclaimed doors ... any kind of door made of any kind of material. Sponsorships are sought at several funding levels and can include in-kind contributions or sponsoring a unique award. Sponsor logos or names will be featured in promotional materials and advertising. Artists will compete for over $3,000 in prizes, with jurors including executive directors of arts organizations, gallery owners and art buyers. The works of art may still function as doors or may be transformed into another functional or visual art object. Over 150 entries are expected. A student team competition is also offered, with entries exhibited May 4`h to 6`h,2012 at the Resource Yard in Boulder during a conservation fair. Businesses may also contribute prizes for student teams. Be a part of this first ever competition and exhibition – and support the arts and sustainability! SMART (Sustainable Materials +Art) is a new initiative started by the Center For Resource Conservation to celebrate and promote re -use of hard -to -recycle objects, expand market opportunities for artists working with reclaimed materials, and reflect the value that Boulder places on sustainability in public and private works of art. For more details and application forms: www.conservationcenter.org/bolddoors Questions? Contact us at smart@conservationcenter.ore - CENTER FOR F TAy� ReSource 1 Resource F_I�ifa �� CONSERVATION ad.—iswy sustainable material + art Reprinted courtesy of the Daily Camera 52 c got in W f z c' as c c_ ^ T7=—.Re- nrz= R g R •c, c 5. a^ of M CNg �o..a rw^ °c.wso My £,ea��€ _ c 2 •• c FOR —5 a rd a .c A c � �cY G E° —`o'c .oc `(3ry o n°'�.c£_, Jc oARc 1 mj=7 cc.c^vl n g 1 34 n wn o wn•�7 �3 g.P^g v0�, �,' n.�^�, .G�c=Si margo PS _��av�:� 0l2 o 3 O •C N j C I3' O� � 7. ' G u y 8 O p 'n�5•SmcEn_: oa��c� �n+c.nRo m •. a R �5 �' n w N n E_. .: 0 2. •£ v. R• n �. rc�n ri n c n_ ^ }4. o o in' •`° �_'� r� F o m ��. o•am �E o4,� a o.� ° cHIS pm- Ito V p 8a ss^�� 6•���wa�� � is n C its� �d a �$ s F�5 5'�. p•�� w �o.� �a Ig e`12gn= =cs L'a FV .nom �topic n��+oy��m �� n o wnwo,g _ B •Ori pyo Q �O, o ❑ � ��y' n Oil Ci G O 0 p E rt L C O r� V1 V1 CD on Cn R" CM CD CD r=r^ v� CD c m W. G1 G' m -' s3 W I £ w N• N _& N L� 0 C E CO a QJ q e 3 m - m'o M -•A Kid ;c a .b � p? ,�5 3 n� cFS_. - _n 3 3M � 7 � C d O m w -ni v, n c. F c v 0 w +' c ' t°y, n �' a.• o 'c o d 'O 3 9 n E ca. .@- m i^c k rt ary n ?cw o g ,ui c n O 7 7 C C NC d m o.b B. 'a r. o c s cg n n c 7 0 2S .. � C W 7 O fD 7 Q5� o•A.n fir. o � ac � � y o �•..=nom a � � ° 3 � .� M� m O. •' o: o. 25 i� e. & o o n g rr. c : Z n A y$ 5. ~ c a `� rc N M y N C• Q ri C x c Cs G9 c• �� eqo Bo•?. rc'o=R e'`icArt _.� �_ ,N .+�.0 �n �c `� po q �d.c •$ m � &6' c ^�.�C � c4:° �R c, N .. n M 0 217� c o$� G, D I rt 3 I g w. �°� ,� �O s y Y �� '.�'. `n_ � °- n n 4 Q 7 O Q 7 O• a 1 i - Y Com+• C �, CT •' O ? S N ,i 1.1tti t,. 60 LLC,�dar, co Guest commentary Reprinted courtesy of the Daily Camera J:45 Recycled doors to connect u, Ms Y artists, art lovers, business these individuals gain expo- sure for their creativity. By ex- hibiting these artworks throughout town via our "door- ways" exhibition, we also hope to offer people one more rea- son to visit Boulder, take a walk, enjoy the art, and enjoy a day. In initial planning with local businesses, the response has been positive as well. Some, like Ozo Coffee, have already incorporated recycled materi- als as part its decor, and are looking forward to being in- strdlation sites for Bold Doors 2012. As we know, cultural tourism is critical to the city's economic vitality. Bold Doors 2012 is the type of event that makes a city a destination for people who seek innovative arts initiatives. We've made Bold Doors 2012 accessible to artists at many levels. We've created three competition categories, including Professional, Open and Student. To better coin- cide with the student calendar, student work is due April 28. For the Professional and Open' categories, doors are due by June 9. Local businesses will then display the door art from mid-June through mid-AugusL Understanding our vision for connecting the arts communi- ty, the Boulder Arts Commis- sion has generously com- mitted funds to support this project. We will apply much of this money to artist awards and prizes. Maps will be widely avail- able to enable walking tours along the main arteries of the city, including Pearl Street Mail, Twenty Ninth Street shopping district, University Hill Ideal Market and other satellite locations. Bold Doors 2012 truly is community-based project Led and managed by volunteers, it is supported by all the major avis organizations in Boulder, including BMoCA,'lbe Dairy Center for the Arts, OpenArtc, Boulder County Arts Alliance, EcoArts, Downtown Boulder, Inc., local artists, schools and more. We believe Bold Doors 2012 will offer many benefits: • Putting Boulder on the map as a city with a large - arts exhibition • Creating mutually re- warding business and promo- tional engagements between the local businesses and local artists, grounded by the CRC's values of sustainability • Bringing economic bene- fits vial cultural tourism to the city • Expanding creadvity and appreciation of art [Wade of re- cycled materials • Helping Boulder's art scene reflect the city's overall values of sustainability, arts, business and community in- volvement • Creating earning opportu- nities for local artists • Introducing the public to the artistic potential of sus- tainable art As this first of a land event unfolds, CRC needs cominu- nity support. We ask artists to participate by submitting their creative work. We ask businesses to support the ini- tiative as installation sites, fin- ancial supporters or co -mar- keters for activities that will benefit them as well. For more details and application forms visit www.cutiservatioiicenter.org /bolddoors. Keith Frausto is the Execu- tive Director of the Centerfor ReSource Conservation, and Elzbieta Nolan and Linda Ols- son are co -leader volunteersfor Bold Doors 2012. Gas prices may fuel changes previously outlined to spending cuts as well . emphasis on how he'd future Social Securit Medicare benefits. He pledged repeatedl duce federal deficits, bt dependent analysis hae that his plan, like those Santoru n and Newt Gi would add trillions to t eniment's already debt over 10 years. Any serious plan to the debt heeds some n raising component, an that score, all of these dates fail," said Alice the former Federal l vice chair and federal director who co-chairec bipartisan panel that mended deficit-reductit egies. Apart from Texas R Paid, the GOP pree candidates' plans are similar. All want lowe big spending cut: changes in Social Secu Medicare. Paul alone p plans that, if enacted reduce the national de time. Romney is promoth self as a business -tun specialist uniquely qua Maher € By Scott Collins and Greg Braxton Los Angeles Times LOS ANGELES —V shining an unexpected on the shadowy politic of "super PACs'? It's la comics such as Bill Ma Stephen Colbert. Maher, the host of F "Real Time With Bill N announced on Thursda he was donating $1 mil the pro-Obama group 1 ties USA Action. The n comes after Colbert ha tine past few months m super PACs —politica that operate with very restrictions — with a h raising group of his off Americans for a Better row, Tomorrow. Nuke i quickli By Keith Frausto, Elzbieta No- lan and Linda Olsson rJ Doors are versatile. When open, they admit light, air and receive passage, and when closed, they offer a barrier to noise, rg 28?29 heat or cold, even protection. 3,124; Dec. We use doors frequently in art s1 as metaphors for passages to new ways forward. Unfortu- - 3:00 P.M. nately, doors are also one of 11:00 a.m- the most commonly discarded 11:00 as m. and hand to recycle household items. ,me a0 our Each year, the Center for I. or In Resource Conservation col- lects thousands of discarded doors at the Resource Yard. a to: While we are able to recycle am Ave.., many back into the communi- ty, many do not. When Boul- der area artists and art leaders responded to our invitation to look for new and creative ways to reuse home re -modeling dis- cards dropped off at the yard, er ideas were plentiful. Avision was bom for Boulder to be- come a city known for sustain- able art, visible in homes and businesses as well as in public - spaces - 777 f' As a result, a group of volun- teers, the arts community and CRC conceived Bold Doors 2012, citywide art competition and exhibition this summer. Through Bold Doors 2012, doors once headed for discard piles will be brought to life.by our arts community. The task is simple: we ask artists to create a work of art using a "rescued" door we will be glad to supply via our yard. Artists can transform old doors of any sort — interior or exteri- or house doors, gates, cabinet `y doors —intorepurposedfunc- tional doors, sculptures, hang- ing art, room dividers, func- tional objects, and more. Our local arts community is rich and diverse. By providing this platform, we hope to ]yelp these individuals gain expo- sure for their creativity. By ex- hibiting these artworks throughout town via our "door- ways" exhibition, we also hope to offer people one more rea- son to visit Boulder, take a walk, enjoy the art, and enjoy a day. In initial planning with local businesses, the response has been positive as well. Some, like Ozo Coffee, have already incorporated recycled materi- als as part its decor, and are looking forward to being in- strdlation sites for Bold Doors 2012. As we know, cultural tourism is critical to the city's economic vitality. Bold Doors 2012 is the type of event that makes a city a destination for people who seek innovative arts initiatives. We've made Bold Doors 2012 accessible to artists at many levels. We've created three competition categories, including Professional, Open and Student. To better coin- cide with the student calendar, student work is due April 28. For the Professional and Open' categories, doors are due by June 9. Local businesses will then display the door art from mid-June through mid-AugusL Understanding our vision for connecting the arts communi- ty, the Boulder Arts Commis- sion has generously com- mitted funds to support this project. We will apply much of this money to artist awards and prizes. Maps will be widely avail- able to enable walking tours along the main arteries of the city, including Pearl Street Mail, Twenty Ninth Street shopping district, University Hill Ideal Market and other satellite locations. Bold Doors 2012 truly is community-based project Led and managed by volunteers, it is supported by all the major avis organizations in Boulder, including BMoCA,'lbe Dairy Center for the Arts, OpenArtc, Boulder County Arts Alliance, EcoArts, Downtown Boulder, Inc., local artists, schools and more. We believe Bold Doors 2012 will offer many benefits: • Putting Boulder on the map as a city with a large - arts exhibition • Creating mutually re- warding business and promo- tional engagements between the local businesses and local artists, grounded by the CRC's values of sustainability • Bringing economic bene- fits vial cultural tourism to the city • Expanding creadvity and appreciation of art [Wade of re- cycled materials • Helping Boulder's art scene reflect the city's overall values of sustainability, arts, business and community in- volvement • Creating earning opportu- nities for local artists • Introducing the public to the artistic potential of sus- tainable art As this first of a land event unfolds, CRC needs cominu- nity support. We ask artists to participate by submitting their creative work. We ask businesses to support the ini- tiative as installation sites, fin- ancial supporters or co -mar- keters for activities that will benefit them as well. For more details and application forms visit www.cutiservatioiicenter.org /bolddoors. Keith Frausto is the Execu- tive Director of the Centerfor ReSource Conservation, and Elzbieta Nolan and Linda Ols- son are co -leader volunteersfor Bold Doors 2012. Gas prices may fuel changes previously outlined to spending cuts as well . emphasis on how he'd future Social Securit Medicare benefits. He pledged repeatedl duce federal deficits, bt dependent analysis hae that his plan, like those Santoru n and Newt Gi would add trillions to t eniment's already debt over 10 years. Any serious plan to the debt heeds some n raising component, an that score, all of these dates fail," said Alice the former Federal l vice chair and federal director who co-chairec bipartisan panel that mended deficit-reductit egies. Apart from Texas R Paid, the GOP pree candidates' plans are similar. All want lowe big spending cut: changes in Social Secu Medicare. Paul alone p plans that, if enacted reduce the national de time. Romney is promoth self as a business -tun specialist uniquely qua Maher € By Scott Collins and Greg Braxton Los Angeles Times LOS ANGELES —V shining an unexpected on the shadowy politic of "super PACs'? It's la comics such as Bill Ma Stephen Colbert. Maher, the host of F "Real Time With Bill N announced on Thursda he was donating $1 mil the pro-Obama group 1 ties USA Action. The n comes after Colbert ha tine past few months m super PACs —politica that operate with very restrictions — with a h raising group of his off Americans for a Better row, Tomorrow. Nuke i quickli Fall 2012 Boulder Community School of Integrated Studies & Friends of BCSIS2 a Avenue (:Boulder, CO 8 Tax ID #84-1542618 RE: Request for Donation for Silent Auction Fundraiser Dear Potential Donor: On behalf of the students, families and staff at the Boulder Community School of Integrated Studies (BCSIS) I am requesting a donation of an item, gift certificate, service or cash for our 9`h Annual Winter Festival —Silent Auction and Talent Show taking place on Saturday, December 1, 2012. We hold this primary fundraising and community building event to raise the balance of funds needed to meet our annual budget. This year, our funding goal for this event is $25,000. BCSIS is a public elementary school in the Boulder Valley School District which integrates the arts into a rich academic curriculum. If you would like to learn more about our school, our website is http:/Ischools.bvsd.org/bcsis. All proceeds from our fundraiser will directly improve the quality of education for our children. Last year, the success of our silent auction allowed us to maintain our staff for this school year, despite large district -wide budget cuts which otherwise would have resulted in positions being eliminated. We are also able to contribute to the improvement of out outdoor space, which now includes an outdoor classroom, a mosaic sundial and a garden for our Garden to Table program. This type of success cannot be realized without the generosity of donors like you. Friends of BCSIS is a 501©(3) non-profit, to the donation is tax deductible to the extent allowed by the law. For your records, our Federal Tax ID is #84-1542618. We would also like to show our appreciation by making our school community of 250 families aware of your business. Each donor will be recognized in our auction preview booklet and on our auction website, the link of which will be sent by BCSIS families to their friends and families. If you would like your logo and a link to your website to be included on the auction website, please email the logo in jpg format to. We need to receive all donations by Friday, November 16, 2012. A donation form is attached to collect all the pertinent information about your donation. The more you can describe your product or service, the better. If you have any questions or need additional information about the silent auction, please contact ? ------------- Thank you for your contribution, directly hel ' vid wonderfully rich and supportive learning environment for our childre nd teachers. BCSIS Parent / GREENWOOD WILDLIFE REHABILITATION CENTER PO B0%18987 BOULDER COLORADO 80308 PHONE 307877.9755 Securing a Future for Wildlife in Colorado 0 WILDLIFE REHABILITATION CENTER August 3, 2012 Andrew Richardson, General Manager Cantina Laredo 1680 291h St. Boulder CO 80301 Dear Andrew: Many thanks for your generous donation of gift certificates to Cantina Laredo, valued at $70, for our annual Wild Night for Wildlife auction fundraiser. We very much appreciate your support of this event, which will help us to rehabilitate the orphaned and injured animals in our community. We hope you will join us for Wild Night 2012 to be held Friday, September 28 at the UCAR Event Center in Boulder. Last year, Greenwood cared for more than 2,400 small mammals and birds in need. We are not a government agency and depend solely on contributions from businesses, foundations, and important donors like you to provide our vital services to the animals and the community. Greenwood Wildlife Rehabilitation is a 501(c)(3) organization and your donation is tax deductible. No goods or services were given to you in return for this donation. Thank you again for your support. Sincerely, Linda Tyler Executive Director www.greenwoodwildlife.org Hello! The field of environmental law needs your help! And how better to help the field of environmental law, than supporting those who are learning about and working in environmental law? The Environmental Law Society at the University of Colorado Law School (ELS) serves as a primary outlet for students interested in natural resources and environmental law to become involved and meet others with similar interests immediately upon beginning their first year. ELS is a highly active group, organizing various service outreach activities, fundraising events, and outdoor adventures each semester. ELS members cultivate connection in the local outdoor community by participating in at least one volunteer outreach effort each semester. Our fundraising efforts serve two ends: ELS provides scholarships for law students who wish to do low or unpaid summer internships for non-profit environmental and resource conservation organizations, and ELS also uses fundraising dollars to send several students to environmental law conferences around the country each year. This year, we are putting a 5k fun run, Race Judicata, to help us with our fundraising efforts. The race is on Saturday October 13. Community members and law students from every class level will be joining in the fun and running the race. Our goal is to raise $1,000 by offering an enjoyable event to our guests and having items to offer as race prizes and through a drawing. ELS needs your help to provide prizes for top competitors and for our drawing. All donors will receive a shout out in promotional materials for the race, which is always a well -attended event. Please consider supporting the Environmental Law Society at the University of Colorado, and with your help we can continue to help law students work in the environmental field! Thank you for your time and consideration in supporting our organization Sincerely, Josh Kruger Co -President, Environmental Law Society University of Colorado Law School joshua.kruger@colorado.edu (720) 232-3934 Environmental LawSocletq Colorado Law School I I ��a iBOULDER BOARD OF DIRECTORS Mary A. Casey, II Mike Conroy Chris Dropinski Becca Heaton Don Mock Al Quiller Tim Shea 1 /v 20 July, 2012 David Cardona Cantina Laredo boulder@cantinalaredo.com Dear Mr. Cardona: We are honored to have Cantina Loredo on board as a Gold Sponsor for the 2012 Boulder Nites Classic. This letter serves to identify the commitment Cantina Loredo is making to receive all the benefits of the Gold level sponsorship. Cantina Loredo agrees to: • Cantina Loredo will donate food for 500-900 riders of the Boulder Nites Classic. We look forward to a successful and fun Boulder Nites Classic — Thank you for making it all possible! Sincerely, 19- Colleen King Executive Director PO Box 20935 Boulder Colorado 80308 www.PLAYBoulder.org fO American toHeart Association heart ball 2013 Denver Heart Ball Januan,I26th, 2013 Hutt Regency @ The Convention Center Heart Ball Chair Bill Lindsay, President of Lockton Contpmties Heart Ball Vice Chairs Dick Kelly, CEO of Xcel Energy John Ikard, President & CEO of First Bank Holding Company Charlie Nelson, President of Great West Life Andrew Richardson Cantina Laredo 1680 29th St Boulder, CO 80301 Dear Andrew Richardson, Thank you again for your support of our 2012 Denver Heart Ball. Your contribution was one of our most popular items and you helped us raise over $30,000 in our auction! In preparation for our 2013 Heart Ball, we would be so appreciative of your donation for our 2013 event. The American Heart Association's 2020 goal of improving the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20% is only attainable through our ability to fund essential research grants and to develop community educational programs. The dollars raised at our 2013 Heart Ball will go directly towards this invaluable research and educational initiatives. We appreciate your consideration of donating a tax-deductible item to this important event as we strive towards our vision of raising $1,000,000 at the Denver Heart Ball in the next 2 years. Thank you in advance for your contribution to the Denver Heart Ball and the American Heart Association. We are grateful for your support. Sincerely, Ashley McCurrach Heart Ball Director Tax ID #: 13-5613797 American Heart Associaton VQW- SouthWesl Affiliate 1280 S. Parker Rd Denver, CO 80231-2100 TO 303.369.5433 Fax 303.369.8087 Andrew Richardson Cantina Laredo 1680 29th St Boulder, CO 80301 Dear Andrew Richardson, Thank you again for your support of our 2012 Denver Heart Ball. Your contribution was one of our most popular items and you helped us raise over $30,000 in our auction! In preparation for our 2013 Heart Ball, we would be so appreciative of your donation for our 2013 event. The American Heart Association's 2020 goal of improving the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20% is only attainable through our ability to fund essential research grants and to develop community educational programs. The dollars raised at our 2013 Heart Ball will go directly towards this invaluable research and educational initiatives. We appreciate your consideration of donating a tax-deductible item to this important event as we strive towards our vision of raising $1,000,000 at the Denver Heart Ball in the next 2 years. Thank you in advance for your contribution to the Denver Heart Ball and the American Heart Association. We are grateful for your support. Sincerely, Ashley McCurrach Heart Ball Director Tax ID #: 13-5613797 SCANDINAVIAN 1'f July 2012 C CLI �t i n Ck 1,--0- rej o On behalf of the Estes Park Midsummer Festival, we would like to you for your generous donation to our Silent Auction — '1 �fi Ce-r–� 1 C- ate S We appreciate your support, which allows us � continue promoting and preserving the Scandinavian Tradition and Culture in our area. It has turned into a regular Folk Festival with several thousand visitors over the two-day period. Many non -Scandinavians also show up out of curiosity, attracted by the lively music and colorful costumes. We do have such a great advantage since our fest is held in a downtown park and no admission is being charged. We trust that we can count on your continued support and hope that you will be able to visit us one year and see for yourself how your contribution is being put to work- Lynn ork Sincerely G Lynn Anderson Silent Auction Chairperson Estes Park Midsummer Festival COLORADOROCKY MOUNTAIN MUSIC CENTER FOR FESTIVAL MUSICAL ARTS Office Use Only Item #: Gift Cert. Attached: Category: AUCTION CONTRACT 900 Baseline Rd., Cottage 100 Boulder, CO 80 02 Phone 303.449.1397 Federal Tax ID #84-07357 66 Please type or print clearly (press firmly) and fill out completely. One contract per item, please. (White Copy — Office, Yellow Copy — w/Item, Pink Copy - Donor) Donor(s): Contact Person: rld vt'w r CkCVI . k) Phone: -�353 Donor Address: _ I & 0 y 2-9 911 City, State ZIP: Fax: Complete item description: E-mail: Retail Value: P 1115 Expiration Date (if appl.): This item is a gift certificate:YesNo We need to create gift certificate (it has not been provided by donor): Yes No Special instructions/additional information: CMF & RMCMA Representative:. noj3 Phone: J20 . 29 1, -7 St Date item to be picked up: - Loc tion: CMF & RMCMA Event item will be used at: THANK YOU FOR SUPPORTING THE COLORADO MUSIC FESTIVAL & ROCKY MOUNTAIN CENTER FOR MUSICAL ARTS! December 13, 2012 Dear��y�lfiVLl�l-aYGao The Bradford Elementary PTA would like to thank you for donating to our 11th Anr)ual PTA Auction. Your donation of 2 !a �'`r� valued at $ J helped to make our event a big success. This year we raised over $100,000 for Bradford Elementary. These funds will allow Bradford to retain our Literacy Aides and also help with the general enhancement of our school environment. Remember that your donation may be tax deductible. Our Tax ID number is 98-03264-0000. On behalf of all the students of Bradford Elementary, thank you for your support! Sincerely, Andrea Kempe Bradford Elementary PTA President Bradford Elementary AIT everychild. onevoice. Cantinal-aredol 93 -Boulder From: Cindy Lindsay [cindy.lindsay@boldereach.orgl "-int: Friday, June 22, 2012 1.09 AM CantinaLaredo193-Boulder Subject: BoldeReach Attachments: ThankYou.pdf B®Id+ R"CaCh Andy, I am writing to thank you for your in-kind contribution to the BoldeReach Gala. The event was a huge success and your contribution was a big part of that. Thank you! An acknowledgement letter is attached. Cindy Lindsay Treasurer, BoldeReach P.O. Box 17544 Boulder, CO 80308 w.boldereach.org http://www.facebook.com/boldereach httE.//twitter.com/ /BoldeReach 'Iwo t a ze we gee, we ow44e a kvisrg: evlae we glue, &w evm, mal¢ed a fe e. " Aff z 4jltc 6/22/2012 Pagc 1 of r Bolder June 21, 2012 Andrew Richardson Cantina Laredo 1680 291 Street Boulder, CO 80301 Andy, I am writing to thank you for your incredible contribution to the BoldeReach Gala. Your support allowed us to raise over $100,000 net to support the programs of International Midwife Assistance (IMA)!! THANK YOU for your in-kind contribution of: Gift Certificate valued at $200 100% ofyour contribution goes to support IMA's mission to raise the standard of maternal/infant care in areas experiencing crises in maternal/infant health. IMA places midwives and other healthcare professionals in hospitals, clinics and homes to provide care. IMA trains midwives and other healthcare workers and delivers medical supplies, medications, and teaching aids. IMA supports community-based educational presentations to increase awareness about maternal/infant care. BoldeReach is specifically supporting the Teso Safe Motherhood Project (TSMP) in Scrod, Uganda. TSMP Hors a health clinic/birth center for the most marginalized and vulnerable populations. Thousands of internally displaced persons (IDPs) have moved through squalid "IDP camps' around Soroti and are now struggling to relocate and rebuild their lives after having lost everything in a brutal civil war. Thousands of impoverished people, mostly women and children, have little or no access to basic medical care. Problems include high incidence of malaria during pregnancy, high maternal mortality rate, obstetric fistula or serious injury resulting from prolonged & obstructed labor and lack of access to modern contraceptives. Seventy percent of all Ugandan mothers give birth for the first time by age 19 and only 38 percent of women have a skilled attendant at birth. Through the TSMP clinic, IMA offers general medical care, prenatal checkups, vaccinations, family planning services and a birth center, to help the poorest of the poor. IMA midwives train and assist local practitioners to provide quality prenatal and birth services, as well as general medical care, to increasing numbers of women and children from surrounding poor communities. 'through these services, women receive the assistance they need to help ensure safe, healthy pregnancies. Feasible low-cost health interventions are all that is needed to save countless lives of women and babies in Uganda. Thank you for your support of this important cause and the work of BoldeReach to address issues facing women and children in extreme need around the world. All administrative costs of BoldeReach are board funded. 100% of your donation goes directly to support our mission. For more information, go to www.boldereach.org. Cindy Lindsay Treasurer, BoldeReach cindy.l i ndsay0boldereach.o rg (303) 954-8525 Federal Tax ID # 73-1693536 Local Fundraising o,3 Global Reach for women and children in extreme need around the world T u 0 G7 �J zl KJ + a a + ;a d yam' tl SCJ I a C S d x O - a v C _ - d d U S ca � N 6 _ C � aw- r'� u a v u T d H l7 �J zl KJ + a a + ;a yam' tl SCJ I �J zl KJ a O 0 + a a + ;a yam' a O 0 Office Use Only COLORADOROCKY MOUNTAIN Item#: MUSIC CENTER FOR Gift Cert. Attached: FESTIVAL MUSICAL ARTS Category: AUCTION CONTRACT 900 Baseline Rd., Cottage 100, Boulder, CO 80302 Phone 303.449.1397 - Fax 303.449.0071 Federal Tax ID #84-0735716 Please type or print clearly (press firmly) and fill out completely. One contract per item, please. (White Copy - Office, Yellow Copy w/Item, Pink Copy - Donor) Donor(s): FI " TI k +. Contact Person: t (�( !lr� t. S�rw Phone: -1/ff�l Donor Address: City, State ZIP: l cal Fax: ('- it/f 'Ua '% E-mail:�i Complete item description: i Retail Value: This item is a gift certificate: Yes No Exp'tration:Date (if appl.): .ice Q" -- We need to create gift certificate (it has not been provided by donor): Yes No Special instructions/additional information. CMF & RMCMA Representative:) /)1 f •' -'/( Phone: Date item to be picked up: / +- t I _. Location: CMF & RMCMA Event item will be used at: L.- THANK : THANK YOU FOR SUPPORTING THE COLORADO MUSIC FESTIVAL & ROCKY MOUNTAIN CENTER FOR MUSICAL ARTS! aw.. -- SF�yCine Yf�qh School ll� *,rrn,YyhScF,rof • 600•-L Nounlam 1,irwAte. • Loymora, ('U 80501 • 2'r`me720494 3741 • TaC303 68..' 7382 Dear Skyline Football Sponsor: This letter is to authorize the presenter to solicit donations of money, goods or services on behalf of the Skyline Football Touchdown Club. We are currently seeking donations on behalf of our Golf Tournament (July 20th), Program Book and Auction (August 18th). We are also seeking donations to help provide meals for our players during the summer and the fall. Finally we are asking for donations to sponsor our major program needs and provide scholarships for kids to our team camp this sttmtner in Chadron, Nebraska. Each year we rely upon the generous donations of our community supporters to provide the first-class experience to our players that they deserve. Skyline High School traditionally has been a neglected and underfunded school in the Longmont community and YOU ARE HELPING TO CHANGE THAT!! Any support you can give to our players is very much appreciated and a very worthy cause. All sponsorship goes directly to Skyline Football and helps provide such important items as equipment, uniforms and meals to our players each year. We are a non-profit organization so any support you provide is tax deductible. Our tax exempt ID number is 98-02634. Thank you from all of our players for your generous support of Skyline Football. Please contact Touchdown Club President Charlie Edson at 720-233-2409 if you have any questions or would like to make a donation. Thank you in advance for looking over our specific needs below and the attached Donation Levels form and for deciding today to make a difference in the lives of our young people and improving the future of our community! Your amazing generosity will be greatly rewarded now, and well into the future! With the utmost respect, Kevin Rice Head Football Coach Skyline High School 303-907-2197 2012 Skyline High School Football Sponsorship Needs: Equipment (helmets, shoulder pads, etc.): $5,000 Uniforms (practice and game): $10,000 Team Practice Wear (shorts, shirts, sweatsuits): $6,000 Scholarships to Team Camp: $5,000 Skyline Football Team Banquet: $5,000 Scoreboard for Skyline Field: $10,000 Weight Room Equipment and Renovation: $50,000 New Sports Turf Playing Surface at Skyline High School: $500,000 J10me of the TaCcons IDI i�oG I 15Cr G�� L( 1�aI a _�5G T7 �, 1 r �121 12E gkh School ,SkJ6nel!;gfi.5 ecPr• 6001E Nunnlain lwu,Aie, • Lnnycwnl, Co 8050!• -T.=720494-3747 • 7':-1303 68'-7352 SKYLINE HIGH SCHOOL FALCON FOOTBALL DONATION FORM Name: Business (if applicable): Address: Phone Number: Email: I am making the following dona Financial: $ ( cash check #) Make checks payable to: Skyline High School Football Other (please specify below): Please return this form to Head Coach Kevin Rice: Skyline High School PO Box 254 Longmont, CO 80502 Fax: 303-684-8912 Email: krice73@hotmail.com Website: tiny.cc/shsfootball or tiny.cc/touchdownclub THANK YOU FOR YOUR SUPPORT AILA Colorado Chapter Cantina Laredo 2680 29th Street Boulder, CO 80302 May 25, 2022 Dear Cantina Laredo Staff: RMIAN rocky mountain immigrant advocacy network On behalf of the American Immigration Lawyers Association's (AILA) Immigrant Liberty Awards benefit committee, I write to thank you for donating to the Seventh Annual 2012 AILA Immigrant Liberty Awards Benefit Silent Auction. The event is scheduled to take place on May 32, 2022, in Denver, Colorado. The Rocky Mountain Immigrant Advocacy Network (RMIAN) greatly appreciates your commitment to immigrant rights. Without your support, RMIAN would not be able to serve Colorado's most vulnerable populations, including refugees, asylum seekers, survivors of human trafficking, survivors of serious crimes, and children. The Rocky Mountain Immigrant Advocacy Network is a 502 (c)(3) non-profit organization and as such, your donation is a tax-deductible donation. Please keep this letter for your records as acknowledgement of your donation. Donation: Gift Certificate Donation Value: $40.00 Please let me know if you need anything further at this time by emailing IibertyawardsMrmian.org or calling 303.433.2822• Thank you again for your contribution. Sincerely, av r — AbbieJohnson Staff Attorney Rocky Mountain Immigrant Advocacy Network & member of the AILA Benefit Committee May 31, 2012 Cantina Laredo 1680 29th St Boulder, CO 80301 Thank you for your generous donation of the Entree Vouchers for the silent auction held at our Second Chance Prom on February 11, 2012. Thanks to you and other donors like you, we raised over $4,500 in our third year. This helps in two ways: 1. The PTO will be able to further support the expansion of the technology department at our k-8 charter; and 2. By holding this fundraiser we will reduce the number of fundraisers necessary to support the school. Woodrow Wilson Academy PTO is an organization with 501 c3 status; please retain this document for tax purposes. We are planning to hold this silent auction again next March and again will try to increase the number of donated items and money raised for Woodrow Wilson Academy. We hope that we can count on your support for our next event. Thank you again for your generosity and support! Sincerely Veronica Brunk WWA PTO President Woodrow Wilson Academy 8300 West 94th Avenue Westminster, CO 80021 : 303-431-3694 ReWards Gala 2012 The Center For Resource Conservation 2639 Spruce Street, Boulder, CO 80302 Phone: (303) 999-3820 * Fax: (303) 440-0703 * Email: jshriver@conservationcenter.org IRC 501(c)(3) Organization / Federal Tax 1D No: 84-0808982 10/29/2012 Cantina Laredo 1680 29th St. Boulder, CO 80301 Dear Cantina Laredo: Due to your generosity and the generosity of the many friends of The Center For ReSource Conservation, ReWards Gala 2012 was a resounding success! 215 guests attended the auction bidding on nearly 200 items and helping raise funds to continue our mission to conserve natural resources. Thank you for your contribution. Below is a list of the items you donated. All donations are tax deductible to the extent allowed by law. Please contact a qualified tax professional for more information. As required by the IRS, The Center For ReSource Conservation acknowledges that you have not received any goods or services as a result of your donation. Item Est. Donation Value Dinner at Cantina Laredo 55.00 Total Donation Value $55.00 Again, thank you. We extend our deepest gratitude and hope we can count on your support in the future. Sincerely, Jennifer Shriver Procurement Chair ReWards Gala 2012 3975 2e Street Boulder, Colorado 1304-1603 .03)442-5003 BOULDER ELKS LODGE No. 566 Yd Annual Boulder Elks Lodge #566 Silent Auction &Bar -B -Q Scholarshiu Fund -Kaiser P.O. Box 978 Boulder, Colorado 80306-0978 Fax(303)442-5005 On Friday, June 22, 2012 Boulder Elks Lodge #566 will hold its 3rd Annual Silent Auction Event to raise fiords for their annual scholarships awarded to deserving Boulder area senior students who plan to enroll in college this fall. The Lodge Scholarship Committee solicited applications for the Most Valuable Student Scholarships sponsored by the Elks National Foundation (ENF) earlier this year and sent six of the students applications to the Colorado North district committee who then made their recommendations to the State and then on to the National Foundation committee. One Boulder area student was awarded a 4 -year scholarship of $1,000.00 per year. The Boulder Lodge, in the past, has also awarded scholarships to local students from local Lodge funds. Three years ago these local funds virtually dried up so we held our first fund-raising event. This year we plan to award six students scholarships worth $6,000.00. We raised over $5,000.00 last year and Boulder Lodge would like to continue this project by supporting these six local students. We all know the cost of a college education continues to rise, so our students' needs are even greater this year. Therefore, Boulder Elks Lodge #566, having a history of being very community - minded and funding many youth activities since its founding over 112 years ago, is organizing afiord-raising event Friday, June 22, 2012. There will be free swimming, a silent auction, plus our regular Friday Pool -side B B -Q menu beginning at 5:00 p.m., lasting until 7:30 p.m. (Additional tables will be available in the dining room.) The Silent Auction will open at 6:00p.m.and close at 8:00 p.m. Bidding card numbers will be available @ $5.00 each The Lodge is asking Boulder individuals, businesses and corporations to donate items to be auctioned. Your help in reaching our goal of $6,000.00 will be greatly appreciated. We would like most items donated by 6/15/12. Thank you. Ray Humble, Scholarship/Auction Chairman ��5 Page 1 of 1 CantinaLaredol93-Boulder From: Emily Sellergren [emily.sellergren@bvsd.org] Sent: Tuesday, November 27, 2012 9:08 AM To: Stacey Johnson Cc: (burns@lps.kl2.co.us; mbarajas@smart-girl.org; Robin's Gmail; CantinaLaredol93-Boulder; centennial@cantinalaredo.com; dgrigsby@ourcoloradonews.com; Aimee Heckel Subject: Re: Good News This is great news. Thanks so much for your help and support! Emily Sellergren Casey Middle School 720-561-2760 On Mon, Nov 19, 2012 at 11:48 AM, Stacey Johnson <staceyliohnson( msn.com> wrote: Hi Ladies! I wanted to share the good news. I just heard from Andrew Richardson, manager, Boulder Cantina, and Cantina Laredo corporate has graciously dontated $500 to the Smart Girl Program ... $250 for both Casey Middle School in Boulder and Newton Middle School in Centennial! Maria, as soon as we receive the check we will give you a call and arrange a convenient time to drop off. A special thanks to the Boulder Cantina Staf .f and the Centennial Cantina Staff. Thanks to them, this donation was possible! Thanks everyone! Stacey & Robin Emily Sellergren MA, LPC Prevention/Intervention Specialist Casey Middle School 720-561-2760 11/27/2012 COLORADO ROCKY MOUNTAIN MUSIC CENTER FOR FESTIVAL MUSICAL ARTS Our mission is to inspire and connect community members of all ages by providing access to the best of the world's music through education and performance December 4, 2012 Andrew Richardson Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear Andrew, The Colorado Music Festival & Rocky Mountain Center for Musical Arts gratefully acknowledges your generous inkind contribution of four $30 gift cards to our fall fundraiser, Feast for the Senses, on November 10, 2012. The Boulder/Denver nonprofit landscape is filled with worthy causes, and we greatly appreciate your choice to support the CMF & RMCMA. We suggest that you consult with your tax advisor regarding the deductibility of your costs associated with this donation. In recognition of your donation, we were pleased to list you in the Feast for the Senses event program. You will also be acknowledged in CMF's 2013 concert program guide, which will be published next summer, and on the donor wall at the RMCMA. Your listing will read: Cantina Laredo Again, many thanks for your generosity and support of Feast for the Senses. We look forward to working with you again in 2013! Sincerely, jIi?elopment ohen Director The Colorado Music Festival & Rocky Mountain Center for Musical Arts is a registered not-for-profit organization under 501(c)(3) of the Internal Revenue Code. All contributions are fully tax-deductible, as no goods or services are offered in exchange. This letter serves as your receipt. CMF 900 Baseline Road Cottage 100 Boulder, CO 80302 303.449.1397 1 RMCMA 200 E. Baseline Road Lafayette, CO 80026 303.665.0599 www.COmusic.org May 9, 2012 To Whom It May Concern This letter is to inform you that Ed Correia is a participant in the 2012 Avon Walk for Breast Cancer — Rocky Mountains. Ed will spend the weekend of June 23rd and 24h working to help eradicate breast cancer as a Crew member. Throughout the weekend Ed will work diligently to support the Walkers by participating as a Motorcycle Safety Crew team member. Crew members are considered participants, just as the walkers are. This means they pay a $65 registration fee and commit to spending the entire weekend with us. The Avon Walk Rocky Mountains is one of nine events in a series of weekend fundraising walks taking place from April to October to help raise awareness and funds for access to care and finding a cure for breast cancer. All women are at risk for breast cancer. This year, the American Cancer Society (ACS) reports that over 211,000 women in the U.S. will be diagnosed with breast cancer and over 40,000 deaths will be attributed to the disease. Breast cancer also occurs in men, and this year over 460 men in the U.S. will die from breast cancer. Because there is no known cure for breast cancer, awareness, education and early detection are our best defenses against the disease. According to the ACS, there is a 97% survival rate when breast cancer is caught early, before it spreads to other parts of the body. Funds donated to the Avon Walk for Breast Cancer are managed and disbursed by the Avon Foundation, an accredited 501(c)(3) public charity with funds awarded for breast cancer awareness and education; screening and diagnosis; treatment; support services; and scientific research. Beneficiaries range from leading cancer centers to community- based non-profit breast health programs in the vicinities of each Avon Walk event and nationwide. The focus is on reaching the medically underserved population, including minorities, the poor, elderly, under- and uninsured, with a mission to fund access to care and finding a cure for breast cancer. To date, the Avon Crusade has returned more than $580,000,000 net to breast cancer research and care organizations worldwide. The Avon Walk for Breast Cancer is a 501 (c) (3) public charity. Our federal tax ID number is 13-6123447. Ed's Participant ID number is 258122.. If you have any questions about the Avon Walk, or Ed's participation as a Crew member with us, please do not hesitate to be in touch. I can be reached by phone at 303-753- 2363, or by email at majan rockyrnouritains avonwalk.orcl. Thank you for helping us in the fight against breast cancer! Sincerely, Meo-an Megan Newhouse Crew & Volunteer Coordinator The Avon Walk for Breast Cancer — Rocky Mountains It bridge Serving Boulder's H, Dear Business Leader, My name is George Epp, I am a retired Sheriff, long-time volunteer and chairman of the board for Bridge House. Our organization is a resource for the homeless and working poor in Boulder County. On September 8th, 2012, Bridge House is having our 6`h annual event at the Avalon Ballroom. The theme is "Bridge Over Troubled Waters' and all net proceeds will go to programs to help the homeless and working poor to get access to food, medical care, and employment services. Our theme this year directly represents who we are as an organization. For those in need, caught in the cycles of poverty; experiencing illness, unemployment, and often hopelessness, Bridge House is not only a bridge to the next day, meeting basic needs for survival, but a bridge to a brighter future. Bridge House is a welcoming environment, which builds a trusting community of support. It is also the gateway to opportunity. As Bridge House grows and adapts to meet the challenges of homelessness in Boulder, we are bridging more gaps; innovating to create more access to employment, housing, and support services that will help our clients leave the streets behind — forever. We're looking for you to contribute and support our invaluable organization. Please donate goods, services, or a gift certificate towards purchases at your place of business. The donation is tax deductible and your business will be featured in our auction catalog, which will be distributed at the event. We're expecting a great crowd! Last year this event raised nearly three times more than the year before and had double the number of people attending; all in a year of stiff economic challenges. In 2012, we are hoping to raise even more to assist the growing population of people who find themselves on the street without food or shelter. I hope that Bridge House can count on you for a donation this year. Please just complete the contribution form and send it back to us by September 1St or call our Development Director, Emily Messina -Heim, for questions or more information at (303) 522-9037. With thanks for your consideration, 91_� <9 George Epp - Chair of the Board Post Office Box 626, Boulder, CO 80306 • 303-442-8300 Bridge House Silent Auction Donation Form Please fax completed form to (866) 831-9443 OR email to emily@boulderbridgehouse.org USE ONE FORM FOR EACH ITEM DONATED CONTACT INFORMATION (Please print or type) Donor Name: Contact Name (If donor is a corn Address: City:— Phone:— E-mail:_ ity:_Phone:E-mail: Web site: DONATED ITEM (Please print or type) Ogee use only: Item number: State. _ Zip Code:. Fax Name of Item Donated: L4 ?i -)c— ( Uv— (;:iu;� , cer(z�S Cost or Value: (_n ($25 or higher) "Complete Description of Item: 'If your item contains multiple services or products please detail in description. SERVICE OR GIFT CERTIFICATE INFORMATION REQUIREMENTS If you are donating a gift certificate for a service, please include the following information in the certificate or letter • Name of product or service • Description of what is included and what is excluded • Name of person to contact for further information • Name, address and full contact information for you or your company • Instructions on how to redeem item • Include any additional information such as a photo or description brochure as appropriate • Date of expiration SHIPPING OPTIONS: (Check one) ❑ I, or a representative of my company, will bring the above listed item(s) to the offices of Bridge House at 1120-1/2 Pine Street (behind the First Congregational Church) in Boulder ❑ Our company will ship the above item(s) to the Bridge House office at Bridge House/Silent Auction, PO Box 626, Boulder, CO 80306 to arrive by August 1, 201 1 `. Bridge House is a non-profit 501c3 organization. All donations are tax deductable . EIN 84-1440292 K3 {� I IOMES 3, Providing residential treatment, counseling and safe shelter to at -risk youth since 1966 March, 2012 Dear Friend, Attention Homes has an exciting opportunity for you to support the runaway, homeless and at -risk youth in our community while promoting your business! We are seeking donations for the live and silent auction portion of our 5th Annual Kaleidoscope event being held on Saturday. September 22, 2012 at the Avalon Ballroom. The evening will include live music, food and beverages, a live and silent auction, silent appeal, and most importantly, the recognition of community members receiving the Attention Homes Youth Initiative Award and the Judge Horace "Bud" and Judy Holmes Community Award for their outstanding dedication to runaway, homeless and at -risk youth in our community. We expect approximately 250 guests to join us at Kaleidoscope to help raise $100,000 for the programs and services provided to our resident youth. Our Kaleidoscope guests are high-income business owners and professionals. As an auction donor, your business will benefit from listings in the event program, on Attention Homes' website, in our annual report and mentions on Facebook and Twitter. LY Event: 5th Annual Kaleidoscope Who benefits: Runaway, homeless and at -risk teens living at Attention Homes Where: Avalon Ballroom, 6185 Arapahoe Avenue, Boulder, CO What: Fabulous dinner, exciting live and silent auction, live music and a special appeal for the runaway, homeless and at -risk youth living at Attention Homes Date: Saturday, September 22, 2012 Time: 6:00 pm Number of guests expected: 250 Fundraising goal: $100,000 Please complete the attached Auction Donation Form and mail it with your tax-deductible donation to Attention Homes or call to make arrangements to drop-off/pick-up your donation. For further information about our services or the event, feel free to contact me at (303) 447-1206 ext. 29 or via email at blogan@adentionhomes.org. Warm regards, Brenda L. Logan Development Associate SSr '1 r3oG r l TSG -- Attention Homes 1 3080 Broadway, Suite C I Boulder, CO 1 80304 1 P: 303.447.1206 1 F: 303.447.0623 1 www.attenbonhomes.org ARROW MONTESSORI SCHOOL Cantina Laredo 1680 28th Street Boulder, CO 80302 Cantina Laredo, Thank you so much for your generous donation of Cantina Laredo Gift Certificates, valued at $50.00. Your support of Jarrow Montessori School helped make our fundraiser on May 5, 2012 a huge success! With the money raised we will be able to provide more families with much needed scholarships to attend Jarrow. Jarrow Montessori is a 501c(3) and your donation may be tax-deductible, please check with your tax advisor regarding deductibility. For tax purposes, our tax identification number is 84-0531208. Thank you again! Warm Regards, Z5-- G)vin Green Director of Development Jarrow Montessori School. 3900 Orange Court, Boulder, CO 80304.303.443.0511. www.jarrow.org I .r HOMES J LL 3 Providing residential treatment, counseling and safe shelter to at -risk youth since 1966 Kaleidoscope Committee May 30, 2012 Liz Bowes -Spiegel Michelle few Cantina Laredo Andrew Richardson Patty Flueck 1680 29th St. Boulder, CO 80303 Jann Kloor Mandy McMichen Dear Andrew, Dee Oliver On behalf of the Kaleidoscope Committee, thank you for your generous donation of a gift card for three Nancy Shaw complimentary entrees and one table -side guacamole that you valued at $55, for the silent auction at our 5th Annual Kaleidoscope taking place at the Avalon Ballroom on Saturday, September 22, 2012. Your Helen Shotton donation will contribute to a wonderful silent auction and an exciting evening that will raise $100,000 for the programs of Attention Homes. ChristiAnn Wilows Since 1966, Attention Homes has cared for over 6,000 youth who have benefited from safe shelter, Barbara Runge supervision by positive adult role models, healthy meals, case management, access to accredited education, recreational activities and community service projects, assistance with medical and mental Zsofia Alfonso health care and more. Staff Members We expect approximately 250 guests to join us at Kaleidoscope to help raise $100,000 for the programs and services provided to our resident youth. Our Kaleidoscope guests are high-income business owners Allison Disbrow and professionals. As an auction donor, your business will benefit from listings in the event program, on Brenda Lagan Attention Homes' website and in our annual report. On behalf of the youth living at Attention Homes programs, thank you forjoining us in helping them become healthy members of our community. if you have questions, comments, or ideas on the event or if you would like to purchase tickets for Kaleidoscope, please contact me at (303) 447-1206 ext. 29 or via email at blogan@attentionhomes.org. Auction Donation: Item: a gift card for three complimentary entrees and one table -side guacamole Value: $55 Attention Homes is a 501(c)(3) nonprofit organization (Tax ID #84-0571145). No goods or services were exchanged for this donation. Please see your tax professional for further information about using the donation as a tax deduction. This letter maybe used as your receipt. Attenuon Homes 13080 Broadway, Suite C I Boulder, CO 180304 1303.447.1206 1 www.attenfionhomes.org _PA Ava1e Colorado 564 442.3042 (pt 3.442-0946 (h) n 6cl.erg 4D Emergency Family Assistance Association Meeting our community's basic needs since 1918 Board of Directors December 31, 2012 Aaay Sanders Aesdent Cantina Laredo s<1 BB99°k1 Jkt Attn: Andrew Presrs ide Jon6ordm 1680 29th St President fka Boulder, CO 80302 Ken Von Wald basurer "FeBkomp Dear Andrew: Secretary i Ann� M (copeley {h'at"ry tun for paurin-kind contribution of $100 gift -certificate to the 2012 DanOa�y Celebration benefit for Emergency Family Assistance Association, held on November 9, TomDeR 2012. We are sincerely grateful for your kindness and your support of this event, which Poul6rou raised about $295,000 net, for the programs and services that EFAA provides to low- Lyrut K 0 °g income families, seniors, and people with disabilities living in Boulder and Broomfield JannOldkm counties. Jorge No JeSheehan sko Spruill This year we expect more than 4,500 different households --over 10,000 people --will come Lev,Vissfher to one of EFAA's offices in Boulder, Longmont, Lafayette and Broomfield for help with very basic needs. With the increasing number of people coming to EFAA for help, a very EFAA Guild Co-chairs successful event like this is simply GREAT! Ro6si Luff Cynthia Sion EFAA prides itself on the exceptional stewardship we have demonstrated for more than Christine Velds 90 years. Our volunteers and donors help us to operate more efficiently, making it xecutive Director possible for 86% of every donated dollar to go directly to services. Terry Be*rnui Thank you again for your support and assistance. Have a joy filled new year! Programs Basic Needs Sincerely, Boulder 1575 Yarmouth Avenue 303.442.3042 e Lafayette ✓ 308 East Simpson, 1103 'ferry enjami 303.951.7685 Executive Director Broomfield 26 Gorden Centel, 11 303.4606810 P.S. Please save this acknowledgement and note that the IRS does not allow us to place a Shelter value on your in-kind donation(s). Our Tax ID is 84-0454115. Boulder 929 Marine 303.9517679 Longmont 819 Atwood, 11 303.9517687 Lafayette 201 North Corr, 12 303.9517683 _ Louisville r DIGIT GLLA OBE 1606 Godield r ,wil' wuee way 4 0igitolGlohe 2012 Celehrohon Gala Tide Sponsor Boulder Valley School District Excellence and Equity March 19, 2012 Dear Boulder County Business Owner, High Peaks Elementary School A Core Knowledge School 3995 East Aurora Ave Boulder, CO 80303 720-561-6500 Lora de la Cruz Principal I am writing to request a donation of an item for a Silent Auction being held at High Peaks Elementary School on May 4, 2012. High Peaks is a public school within the Boulder Valley School District with 300 students. We are not a neighborhood school, and therefore, draw our students from all over Boulder County. The Silent Auction has previously been a very successful and well -attended event. All proceeds from the Silent Auction will be used to purchase Smart Boards for our classrooms. Smart Boards are digital, interactive white boards that provide multidimensional lesson plans. They utilize state-of-the-art technology and are a highly engaging and effective teaching tool. We will advertise your contribution in our school's weekly newsletter and in flyers distributed within the school community. We will be happy to display any information promoting your business next to your item at the event. In addition, we will highlight your business logo and a link to your business web site on our Silent Auction Facebook page. If you are able to contribute, please contact the Silent Auction Committee volunteer listed below. Thank you for supporting one of your local schools. Your generous gift will help ensure that Boulder Valley public schools stay strong and viable! Lauren Park 303-506-4485 Iparkco@yahoo.com High Peaks is a 501(c)(3) non-profit organization; our federal tax ID number is 84-1331642 and our State of Colorado tax exemption number is 98-02383. tfinn May 5, 2012 - - 99' 1 caring about people Re: Caring About People Golf Fundraiser - Donation Request CAP Committee: within the local community through service projects and longer Golf Committee Dear Potential Donor, Mark Scott look for unique needs within the community where Intrado President, Event Sponsor We are seeking your support as a prize donor for the Caring Beth Ozanich About People (CAP) Goff Fundraiser. Executive Director and Chair This event will be held on May 19th, 2012 at Mariana Butte Ellen Hartman Golf Course. Vice President We thank you in advance for your support. Tom LaClair The Caring About People Golf Fundraiser, organized by Tom Zander volunteers from the Longmont Community and Intrado, Inc., is Treasurer one of many fundraiser's held throughout the year. The proceeds Stacy Hughes from this event are used to supplement the capital and programs Beth Kimzey for CAP which is a 501(c)(3) entity (Tax ID#27-3033053); your Secretary prize donation is tax deductible to the extent allowed by law. Caring About People (CAP) Committee conducts good works within the local community through service projects and longer Golf Committee term benevolent programs. The committee works together to Volunteers: look for unique needs within the community where Intrado employees can provide helping hands to help support projects Dario Montelongo Jr. that benefit youth, seniors, military, and to help with other special Volunteer Organizer needs that may arise. Michael Patterson Volunteer Organizer We thank you in advance for your support. Tom LaClair Volunteer Organizer Sincerely, Stacy Hughes Volunteer Organizer Jeff Alexander Michael Patterson Volunteer Organizer Golf Committee Organizer Mailing Address CAP, Inc. ATTN: Michael Patterson 1601 Dry Creek Drive Ste 250 Longmont, CO 80504 720-864-6988 d COLORADO Reinventing Politics for a New Generation To Whom It Ma} Concern: New Era Colorado is a local non-profit, non-partisan organization that seeks to engage young voters in democracy. This year in Colorado we registered more than 20,000 young people and now it is our focus to make sure they vote. Our get -out -the -vote program consists of a series of volunteer driven phone bank nights in Boulder and Denver where we call local residents to ensure that they have all the information they need to vote. In addition to phone banks we host one of the largest group canvassing events in the country on Halloween. Trick or Vote, as we like to call it, is the best way to talk to people about voting, on the best day! 200 plus volunteers go door to door in Denver and talk to voters about the importance of casting their vote. Trick or Vote has shown to increase the likelihood that someone votes by upwards of 7% compared to traditional canvassing efforts at roughly 3%. The popularity of this event has turned it into a national movement in the U.S. and in 2012 more than 30 cities will be running Trick or Votes. See trickorvote.org for more information. The key to the success of this event is the participation of local business like yours. New Era Colorado is committed to creating new leaders in the Denver/Boulder area and getting them involved in the democratic process is our main aim. Trick or Vote specifically is a great night for folks to do some good in the community and then enjoy a celebration on the spookiest of holidays. A donation to one of our phone bank nights, which generally includes 10-15 volunteers, or to Trick or Vote would be greatly appreciated. We could use anything from a donation of pizza, to appetizers, or bottled beer, to canvass bags for our volunteers at these events. The Ogden Theater has donated their event space for the evening of TOV and Boulder vendors such as Namaste Solar have donated aluminum water bottles to give away to volunteers as a thank you. New Era Colorado Foundation is a 501(c)3 nonprofit organization. All contributions are tax-deductible! Our tax -id number is 26-1389272. Thanks again for your time, Carrie Jackson Program Director New Era Colorado carrie@neweracolorado.org 720.346.4607 CANCER LEAGUE OF COLORADO Tax -Exempt Letter for Donors This letter is available to all donors who, for income tax purposes, need a copy of the letter that gives Cancer League of Colorado tax-exempt status. INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY TAX EXEMPT LETTER District Director Person to Contact: Cancer League of Colorado, Inc. Customer Service Division 8453 E. Fox Hill PI. Telephone Number Englewood, CO 80112-1857 (800) 829-1040 Refer Reply to: EP/EO:MC:4940 DAL Date: December 23, 1996 EIN 84-0989426 1100 Commerce St., Dallas, TX 75242 `(�Trrd•�5 Our records show that Cancer League of Colorado Inc. is exempt from Federal Income Tax under section 501(c)(3) of the Internal Revenue Code. This exemption was granted May 1986 and remains in full force and ettect. Contributions to your organization are deductible in the manner and to the extent provided by section 170 of the Code. We have classified you organization as one that is not a private foundation within the meaning of section 509(a) of the Internal Revenue Code. Your organization is described in section 509 (a)(2). If gross receipts for your organization reach $25,000 or more, in any one year, the organization will be required to file form 990, Return of Organization Exempt From Income Tax. This letter may be used to verify your tax-exempt status. Ifwe may be of further assistance, please contact the person whose name and telephone are shown above. Tax Exempt #98-08560 Sincerely Yours, W. Mann Chief, Employee Plans and U O o�� o o=av c .�a o � � E N a. Com= cu o E 3 L = (p =meg M o H a CL 0 L M O N cCD m Iwe E 0% ami E ��00 C',o �- � 3�$ycno V �� fo f� I- 0-40- a 4° De, (y,� (a, )-c� 7Y�v�i2c�wv.�- 7n�o Fh�Sp�'l� V��t '(y�e elrPyu, I� ?tt- CL pl�,� b I PJA- CalbOLLd AtfpMt � OZ( PACYLOi7l , LU rvah-es -rhe "PK+ ro-P&-c', �m ao Atz-&,�A� - 009LLOLOWE :aI xel elels ZOZ9 L80118 :QI xel Pad 8 L L-9 96po-I wiayaalsaA AeMJON 10 suoS Spaigisk Vzcte w o-aawwnsppsal o-mmm E9ZE-Z59-E0E uosaapuy auuA-I :sauinbul ao=l 9014iwwoO leAllsad jewwnspyN ueiAEuipueos MlEd salsa aCinoAuegjj � J :enlLA -,::P,4-222 :uoilnqijluoo leAllsad aawwnsplW ,[03 94, of uolleuop jo paooei s,aolnquluoo uOIPOd siyj GABS pue diI3 L9 0L Li. J Ll 4 x W w z THE N V-3 2013 C'Cyoratep, Dright I urure for S Winttr rtstival Silent Auction &Talent Show Fall 2013 Boulder Community School of Integrated Studies & Friends of BCSIS 3995 East Aurora Avenue Boulder, CO 80303 Tax ID #84-1542618 RE: Request for Donation for Silent Auction Fundraiser Dear Potential Donor. On behalf of the students, families, and staff at the Boulder Community School of Integrated Studies (BCSIS) I am requesting a donation of an item, gift certificate, service, or cash for our 10th Annual Winter Festival Silent Auction and Talent Show taking place on Sunday, December 8, 2013. Funds from this community event enable us to reach our annual budget requirements. This year our funding goal for this event is $25,000. BCSIS is a public elementary school in the Boulder Valley School District that integrates the arts into a rich academic curriculum. Please visit our website at http://schools.bvsd.org/bcsis to learn more about our exciting community. All proceeds from our fundraiser will directly contribute to the leaming environment. In recent years, the success of our silent auction allowed us to maintain our staff for the.school year despite large district -wide budget cuts that would have resulted in positions being eliminated. We were also able to contribute to the improvement of our outdoor space: an outdoor classroom, a mosaic sundial, and a garden for our expanding Garden to Table program. Other programs such as the Artist -in - Residence and the First Friday artistic performances have been strengthened as well. This type of success cannot be realized without the generosity of donors like you. Friends of BCSIS is a 501(c)3 non-profit meaning that donations are tax deductible to the extent allowed by law. For your records, our Federal Tax ID is #84-1542618. We would also like to show our appreciation by making our school community of 250 families aware of your business. Each donor will be recognized in our auction preview booklet and on our auction website, which will be sent electronically by BCSIS families to their friends and families. If you would like your logo and a link to your website to be included on the auction website, please email the logo in .jpg format to bcsisauction@gmail.com. We need to receive all donations by Friday, November 15, 2013. A donation form is attached to collect all the pertinent information about your donation. Please fully describe your product or service so that we may effectively market your donation. Your contribution directly helps us to provide a wonderfully robust and supportive leaming environment for our children, teachers, and staff. Sincerely, BCSIS Parent Volunteer Q 0 re GG1�b�te A grit Future {or B O S S � int' cr Ftstl /a4 Silent Auction &Talent Show Friends of BCSIS Boulder Community School of Integrated Studies 3995 Aurora Ave., Boulder, CO 80303 www.schools.bvsd.org/bcsis BCSIS Winter Festival Silent Auction Donation Form Donor — Business DonorName- Position: Contact: Address/Street: Contact Info: ity: tate:Zip: Phone: Email: Item Donation Description: Please tell us about your product or service, so we can fully market !t. Description: Including a brochure, photos, or any other visuals can be helpful and will be displayed/given out at e auction. Retail Value: Expiration Date: [if any] Delivery Please pick onq option for making Notes: 3ptions: your donation. [Please include any 0 1 will drop off my donation at BCSIS. o I in donation additional will mail my to BCSIS. information] o Please pick-up my donation Date donation will be available: BCSIS Name: Contact Info: olunteers We appreciate your donation! Thank you for helping our school. All donations are tax deductible—Tax ID #: 84-1542618 BCSIS Use Only: [BCSIS Parents, please return all forms to Kael Davis in the office.] Item #: Date In: `dotes: (J Sept 11, 2913 IEMPATH IZC. 4845 Pearl East Cir 101:: Boulder CII 80301:: 303.625.4074 On behalf of iEmpathize, a non-profit media group (591c3) serving to eradicate slavery, while impacting the lives of vulnerable and victimized children around the world and creatively engaging the public, I would like to offer an opportunity for COMPANY's sponsorship of IEMPATHIIE'S POKER FUNDRAISER NIGHT at Laudlsio's, at 2EI" and Walnut In Boulder, Oct 11th. All proceeds go to iEmpathize for the further development of their projects and partnerships impacting at -risk kids in Colorado. Explore www.iEmpathize.org. The night will include a SILENT AUCTION. All items donated will enter the auction and serve the fundraiser to raise the total goal of $19,099. Our goal is to engage the public and directly impact the children of Mexico, Russia, Cambodia, and the U.S. Through your sponsorship, not only are you affecting the lives of these amazing kids and making this event passible, but you will also be expanding your community influence by engaging in philanthropic/social issues and inspiring other business leaders to follow suit. Companies that sponsor various iE events include Kroenke Sports and Entertainment. The Altitude Channel, Pepsi Center, Elitch Gardens, Noodles and CO, Silicon Mountain Holdings, Room 214, and more. Will you consider collaborating with [Empathize to Impact kids end Inspire and engage the public by way of sponsoring the event as a table host, up with a door prize, grand prize, or silent auction item? As a sponsor, your company will receive visibility with the inclusion of your COMPANY's name and logo at the silent auction with a public acknowledgement. In addition, we invite you to join us for the event at G:39 pm. In the meantime, if you have any questions about your involvement as a Corporate Sponsor, please feel free to contact us at 303.925.4914 or markPiEmeath ize.erc. We would be thrilled to partner with youto create awareness and lasting change to combat injustices against children. On behalf of iEmpathize, I thank you for your time and consideration. Sincerely, Mark9reode 303-909-1986 TAXI§ Employer Identification Number: 26-3124442 Tax Exemption 98-20407-0000 CantinaLaredol 93 -Boulder From: Sarah Flanagan [sarah@pinkpaisleyevents.coml Sent: Monday, September 09, 2013 2:58 PM To: Becky BaanHofman; Cantinal-aredo 193 -Boulder Subject: Fwd: Delivery Status Notification (Failure) Andrew, We thank you again for your generous donation to the Denver/Boulder Adtech Corporate games presented by Attract Media Group! I am following up to see what exactly Cantina Laredo will be donating food wise to the after party at Federated Media Group on Sept 13th. Chips and salsa for sure. Light apps? Looking forward to hearing from you soon, *Sarah Flanagan Owner/Consultant www.pinkpaisleyevents.com <http://wNvNv.pinkpaisleyevents.com> (303)720-5470 Sarah Flanagan Owner/Consultant www.l)inkpaisleyevents.com (303) 720-5470 9/10/2013 Page 1 of 1 1575 Yarmouth Avenue Boulder, Colorado 803040564o � 303.442.3042 (ph) 303.442.0946 (fax) vnvw.efoa.org Emergency Family Assistance Association Meeting our community's basic needs since 1918 Board of Directors December 16, 2013 Ion Gordon Nanry Andrew Richardson r�r�es�nr Cantina Laredo Ionnoldlwm 1680 29th St ffeskienrEkcr Boulder, CO 80302 Ken Yon WaW Ueasurer Scoff Berggeist Dear Andrew: 5erniory MobethAndora Thank you very much for your in-kind contribution of gift certificates for three entrees �„ Cc and one appetizer at Cantina Laredo, to the 2013 Celebration Gala benefit for Emergency Clan Day Family Assistance Association, which took place on October 19, 2013. We are sincerely FtsY Eykamp grateful for your kindness and support of this event, which raised $383,500 net. These Wrier EemonCban funds help support the programs and services that EFAA provides to low-income families, LYMKaersvrmg seniors, and people with disabilities living in Boulder and Broomfield counties. Kevin tuff Jorge Man Jessica Spruill This year we expect more than 4,500 different households --over 10,000 people --will come to one of EFAA's offices in Boulder, Longmont, Lafayette, Louisville and Broomfield for EFAA Guild Chair help with very basic needs. With the increasing need for immediate and long term Renee Ivael assistance for the victims of the September floods, a successful event was essential. Executive Director EFAA prides itself on the exceptional stewardship we have demonstrated for more than Dr. Stuart C. Lard 90 years. Our volunteers and donors are the foundation of why we are able to operate more efficiently, making it possible for 86% of every donated dollar to go directly to Programs services. Basic Needs Boulder Thi you again for your support and assistance. 1575 Yarmouth Avenue 303.442.3042 Lafayette In the spirit of service, 400 East Simpson, 1203 303.951.7685 Broomfield 26 Garden Center, 11 303.4606810 Dr. Stuart C. Lord Shelter Executive Director Boulder 929 Marine Sheet P.S. Please save this acknowledgement for your records. The IRS does not allow us to 303.951.7679 place a value on your in-kind donation(s). Our Tax ID is 84-0454115. Longmont 819 Wood, 11 303.951.7687 Lafaye0e 201 North Carr, 12 303.951.1683 Louisville 1606 Garfield Ave .f�fil�rlr 'A 303.951.7661 t / BOULDER NYY\ raalhilb UNled Wry BRANDS 11ix.,+e 611uwn �en_xe+ Boulder Brands 2013 Celebration Gala Title Sponsor 1 (EMPATHIZE. 1200 Pearl St. Suite 65:: Boulder CO 80302:: 303.625.4074 Sept 23, 2013 On behalf of iEmpathize, a non-profit media group (501c3) serving to eradicate slavery, while impacting the lives of vulnerable and victimized children around the world and creatively engaging the public, 1 would like to offer an opportunity for your company's sponsorship of 1EMPATHIZE'S POKER FUNDRAISER NIGHT, Oct 11th at Laudisio's, at 29th and Walnut in Boulder. All proceeds go to iEmpathize for the further development of their projects and partnerships impacting at -risk kids in Colorado. Explore www.iempathize.org. silent auction We are in need of donated items of $100 value or more for our SILENT AUCTION. All items donated will enter the auction and serve the fundraiser to raise the total goal of $10,000. As a sponsor, your company will receive visibility with the inclusion of your COMPANY's name and logo at the silent auction with a public acknowledgement. table sponsor We are also looking for TABLE SPONSORS. Each sponsor will have their company logo on a 24"x 24" laminate where cards and chips will slide across throughout the night along with a public acknowledgement. X table sponsor is a $230.00 tax deductible gift. raffle prize Finally we need raffle prizes of $50 value or more. Your donation will receive a public acknowledgement. Through your sponsorship, not only are you affecting the lives of at -risk kids in Colorado and making this event possible, but you will also be expanding your community influence by engaging in philanthropic/social issues and inspiring other business leaders to follow suit. Companies that sponsor various iE events include Kroenke Sports and Entertainment, The Altitude Channel, Pepsi Center, Elitch Gardens, Noodles and CO, Silicon Mountain Holdings, Room 214, and more. Will you consider collaborating with iEmpathize to impact kids and inspire and engage the public by way of sponsoring the event as a table host, or with a door prize, grand prize, or silent auction item? In the meantime, if you have any questions about your involvement as a Corporate Sponsor, please feel free to contact us at 303.625.4074 or mark®iEmpathize.org. We would be thrilled to partner with you to create awareness and lasting change to combat injustices against children. On behalf of iEmpathize, I thank you for your time and consideration. Sincerely, Mark Brende 303-809-1986 TAX ID Tax Exemption 98-20407-0000 Dq /) -.,.k I D p , S C) U 3- 1 06 9- a3-13 ° qt 56 -C 0�c'V UCAR UNIVERSITY CORPORATION FOR ATMOSPHERIC RESEARCH NATIONAL CENTER FOR ATMOSPHERI ESEARCH I UCAR COMMUNITY PROGRAMS Dear Contributor, We represent The Employee Activities Committee (EAC) at University Corporation for Atmospheric Research (UCAR), a non-profit organization, in Boulder, Colorado. We have scheduled a company and community -wide Craft Market for Friday, November 8, 2013 and are requesting a donation of a gift certificate or gift of your choosing to be used 1n Prize Drawings during this event. Enclosed please find our invitation flier that is posted throughout the community. We can offer the following advertising for your contribution: 1. List your name and contribution in "UCAR Staff Announcements" between now and November 8th in our online newspaper that is emailed to all employees daily. 2. Announce your contribution on the PA system at the Craft Market. 3. Show your name and contribution on a slide presentation running continuously during the four hour Craft Market. Please consider our request and let us know your decision. We are happy to pick up the donation if you like - just call, email, or feel free to mail it to the address below. Also enclosed is our tax exempt information should it be needed. We look forward to hearing from you. Thank you and have a great day! Sincerely, 0. /� 2t�6 Nicole koury 1 303.497.8850 I U%e 5 p nkoury@ucar.edu ll Co -Chair EAC 2013 Craft Market Konnie Carrillo 303.497.8723 carrillo@ucar.edu Co -Chair EAC 2013 Craft Market Please mail donations to: UCAR Attn: Nicole Koury Human Resources Address below I D- 11-13 ON P 0 BOX 3000 1 BOULDER COLORADO 80301-3000 1 303-431-1000 1 WWW UCAR EDU :arm W'9 Request for Taxpayer Give Form to the Rev. oaasmb.r 2011)Identification Jspsunei Number and Certification. requester. Do not send to the las. of tir,Troawry ntenal Rsysrrw ssMu . A domestic trust (as defined In Regulations section 301.7701-7). Use Form W-9 only If you are a U.S. person Qncluding a rs' ldent a0an), to provide your correct TIN to the person requesting It (the Special rules for partnerships. Partnershlpe that conduct a trade or business In the United States aro generally required to pay a withholding Name 0 shown on your Income tax return) tax on any foreign paitners' share of Income front such business. University Corporation for Atmospheric ResearchlNatlonal Center for Atmospheric Research N auelnau namardleraperded enery nems. H aresram bcm above partnership Is required to presume thata partner Is a foreign person, UCARfNCAR fie 3. Claim exemption from backup withholding I1 you are a U.S. exempt partner in a partnership conducting a trade or business In the United States, provide Form W-9 to the partnership to eatablleh your U.S. payee. If applicable, you are also certifying that as a U.S, person, your allocable share of any partnership Income from a U.S. trade or business Check appropdate box for federal tax daoslflcaucro Is not subject to the withholding tax on foreign partners' share of ❑ Indhlduat/aole proprietor ❑ C Corporation ❑ 8 Ccrporation ❑ Partnership ❑ TrosVeatale Cat. No. 10231X Farm W -Q (Rev. 12-20111 ❑� raempt payee ❑ United liability company. Enter the tax closafiloeean (C -C carpu anon, s,s corporation, P -partnership)► 9 ❑✓ oweaslesWauanal. Non -Profit Address (nwnbar, draat, and apt a sola n0-1 Requoatees name and address [aptionet ' 1850 Table Mesa Drive P.O. BOX 3000 tilde, ane s Boulder C080307-3000 Uel account nlmrbar(8) has (options!) Taxpayer Iden cation Number Filler your TIN In the appropriate box. The TIN provided must match the name given on the 'Name lino 0oalal seoudry camber to avoid backup withholding. For Individuals, this to your social security number (SSN). However, lot e resident often, sole proprietor, or disregarded entity, ace the Pert I Instructions an page 3. For other- Identification number IEINI. If you do not have a number, see Now to get a ..,tfti, . It I, aeon smnlnver Idm TIN on page 3. Note. If the account is In more than one name, tie° the chert on page 4 for guidelines on whose number to ender. Under penalties of perjury, I certify that* 1. The number shown on this form Is my correct taxpayer Identification number (or 1 am wafting for a number to be Issued to me), and 2. 1 am not subject to backup wllhhotdhng because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service QRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification Instructions. You must cross out Item 2 above If you have been notified by the IRS that you aro currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transections. Item 2 does not apply. For mortgage Inter" paid, acquisition or abendonmont of secured property. cancellation of debt, contributions to an Individual retirement arrangement (IRA), and goneraliy, payments otherthan Interest and dvldands, you are not required to sign the certification, but you must provide your coned TIN. See the Instructions on page 4. Here I uA.peneono- -// General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form ods ► Note. If a requester gives you a fomt other than Form W-9 to request your TIN, you must use the requester's form R It Is substantially similar to We Form W-9. Definition of a U.B. person. For federal tax purposes, you are considered a U.S. person if you enc h I US IU U3 Idt II A person who to required to file an Information return with the IRS must obtain your correct taxpayer Identlllcation number (TIN) to report, for • M IndMduaI w ass . . c zen or .. res on non, • A par"rehlp, corporation, company, or association created or example, Income paid to you, real estate transections, mortgage Interest organized In the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation , An estate (other than a foreign estate), or of debt, or contributions you made to an IRA . A domestic trust (as defined In Regulations section 301.7701-7). Use Form W-9 only If you are a U.S. person Qncluding a rs' ldent a0an), to provide your correct TIN to the person requesting It (the Special rules for partnerships. Partnershlpe that conduct a trade or business In the United States aro generally required to pay a withholding requester) and, when applicable, to: tax on any foreign paitners' share of Income front such business. 1. Certify that the TIN you are giving Is correct (or you are wafting for a Further, In certain cases where a Form W-9 has not been received, a number to be Issued), partnership Is required to presume thata partner Is a foreign person, 2. Ce" that you are not subject to backup withholding, or and pay the withholding tax. Therefore, N you are a U.S. person that Is e 3. Claim exemption from backup withholding I1 you are a U.S. exempt partner in a partnership conducting a trade or business In the United States, provide Form W-9 to the partnership to eatablleh your U.S. payee. If applicable, you are also certifying that as a U.S, person, your allocable share of any partnership Income from a U.S. trade or business status and avoid withholding on your share of partnership Income. Is not subject to the withholding tax on foreign partners' share of effectively connected Income. Cat. No. 10231X Farm W -Q (Rev. 12-20111 Boulder Valley School District Excellence and Equity June 10, 2013 David Cardona Kitchen Manager Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear David, High Peaks Elementary School A Core Knowledge School 3995 East Aurora Ave Boulder, CO 80303 720-561-6500 Lora de la Cruz Principal Thank you so much for your donation of two complimentary entrees and a top shelf guacamole, valued at $40.00, to the 2013 High Peaks Elementary School silent auction. The event was a tremendous success! Due to the generosity and support of local businesses like yours, High Peaks met its fundraising goals and will be able to purchase new non-fiction texts for its literacy library. Please accept our most heartfelt appreciation on behalf of the entire High Peaks community. Please retain this letter for your tax files. High Peaks is a non- profit public school within the Boulder Valley School District. Our State of Colorado tax exemption certification number is 98-02383. No goods or services were provided in exchange for your gift. Thank you again for supporting your local public schools. Sincerely, Lauren Park 2013 Silent Auction Committee High Peaks Elementary School AILA Colorado Chapter Cantina Laredo 1680 29th St Boulder, CO 80301 June 18, 2013 Dear Cantina Laredo, �RMIAN rocky mountain immigrant advocacy network On behalf of the Colorado Chapter ofthe American Immigration Lawyers Association's (AILA) Liberty Awards Benefit Committee, I write to thank you for donating to the 2013 Immigrant Liberty Awards' Silent Auction. Your contribution provided instrumental support in making the 8`h Annual Immigrant Liberty Awards an incredibly successful and inspiring event. Through your support and the participation of more than 300 lawyers, law students, and community leaders, this year's event raised nearly s30,000 to benefit the Rocky Mountain Immigrant Advocacy Network! These funds will ensure that more men, women, and children have access to lawyers in immigration proceedings. Without your support, RMIAN would not be able to serve Colorado's most vulnerable populations, including refugees, asylum seekers, survivors of human trafficking, survivors of serious crimes, and children. The 2o13 AILA Immigrant Liberty Awards Benefit, held on May 16th atthe Greek Orthodox Cathedral in Denver, honored the outstanding achievements and contributions of Alex Alvarado (Asociacion de Jovenes Unidos en Accion), Marketa Zubkova (Hispanic Affairs Project- Inmigrantes Unidos de Gunnison), and Mike Johnston (Colorado State Senator). Colorado AILA also recognized Kimberly Baker Medina with the Fifth Annual Pro Bono Service Award. Thank you for donating Two Entrees & Guacamole to the Silent Auction. The Rocky Mountain Immigrant Advocacy Network is a 501(c)(3) non-profit organization and as such, your donation is a tax-deductible donation. RMIAN's EIN number is 84-1565542• Please keep this letter for your records as acknowledgement of your donation. Please let me know if you need anything further at this time by emailing Iibertyawards(a)rmian.org or calling 303.433.2812 ext. 107. Thank you again for your contribution. 7L, C 1A,:�� Pilar Chapa Programs Assistant Rocky Mountain Immigrant Advocacy Network 3489 W-72 nd Ave Ste 211, Westminster, CO 80030 University of Colorado Boulder Department of Mathematics Campus Box 395, 2300 Colorado Avenue Boulder, CO 80309-0395 PHONE: (303) 492-7664 FAX: (303) 492-7707 Donation Receipt July 29, 2013 We acknowledge, with thanks, the receipt of Guest Cards, which you have so generously contributed to the University of Colorado Boulder Mathematics 2013 Welcome Back Picnic. Donor: Cantina Laredo Donation: Guest Cards valuing $ 5-5_ The donor will receive acknowledgement during the picnic in exchange for the donation both verbally and on a donor list posted. Tax Identification Number: 98-02915 C'F University of Colorado �lJ Boulder Department of Mathematics Campus Box 395, 2300 Colorado Avenue Boulder, CO 80309-0395 PHONE: (303) 492-7664 FAX: (303) 492-7707 July 9, 2013 RE: Donation Request To Whom It May Concern: The Department of Mathematics at the University of Colorado Boulder will be hosting their annual Fall Picnic on August 28, 2013. The picnic is an event for new and returning Departmental Graduate Students, Staff, Retirees, and Faculty to come together and get to know one another during the busiest time of year at CU. We welcome all newcomers, welcome back those who had previously been with the department, and congratulate Graduate Students who have just completed their prelims. This year, the Department of Mathematics has decided to reward those who have worked so hard in the past year by holding a free raffle at the picnic. We would love to provide items from different local businesses, and feel that your business would be a great addition to the raffle. We encourage support of local Boulder businesses, and would love to send our participants to your establishment. We greatly appreciate any donation that you may be able to provide to us for this event. If you are interested in donating, please call me directly at 303-492-3613 or email me at tiffany.dowd@colorado.edu. I will place a follow-up call within a week of this letter's arrival; I look forward to talking to you. Please feel free to contact me with any other questions you may have regarding this matter. Thank you for your consideration regarding this donation. Our departmental tax exempt ID is 98-02915, and you may obtain a copy of our tax exempt certificate by contacting me directly. Sincerely, V Tiffany Dowd Undergraduate Assistant II Department of Mathematics University of Colorado Boulder 303-492-3613 (phone) 303-492-7707 (fax) tiffanv.dowd@colorado.edu IN Rotary Club alley 85 Boulder, CO, 80308 www.bvrc.org Thank you for supporting the "Summer Sunset Swing" fundraiser to be held August 24, 2013 at the Flatirons Golf course located in Boulder, Colorado. You generosity will help us fund and support the following projects/organizations: 1. A water project in Pasmata, Nicaragua. 151 families wilt be provided with freshwater. 2. Mental Health Partners, Attention Homes, Ally Youth Services and the Boulder Institute for Psychotherapy and Research. Our focus this year will be mental health and family services. 3. Coat drive: We provide warm clothes to approximately 2,500 people per year who are in need. 4. RYLA (Rotary Youth Leadership Award and Camp): We sponsor 6 students per summer. S. We will provide dictionaries to approximately 60 students in two local low-income elementary schools. 6. Rotary Youth Exchange: We will sponsor one exchange student (Cadu Curado from Recife, Brazil) and support a local student to study aboard for one year. We greatly appreciate your support. Eric Rutherford President, Rotary Club of Boulder Valley Please provide us with a description of your Donation(s) Estimated Retail value (needed for silent auction items) Note: The Rotary club of Boulder is not a 501(c)3 organization. DLORADOCENTER MUSIC FOR FESTIVAL MUSICAL ARTS Office Usler,only. Item #: Gift Cert. Attached: Category: AUCTION CORNTRACT 200 Baseline Rd., Lafayette, CO 80026 Phone 303.665.0599 F.ede.ral Tax ID #84-0735716 lease type or print clearly (press firmly) and fill out completely. One contract per item, please (White Copy — Office, Yellow Copy w/Item, Pink Copy - Donor) Donor(s): C Vit,: Tiw� L . , z��b Contact Person.- _,P -,p U tc Il 'fi r Phone: Donor Address: City, State ZIP: Fax: E-mail: Complete item description: j' _„fT fvGil� Retail Value: Expiration Date (if appl.): This item is a gift certificate: es No Do we need to create a gift certificate? (not provided by donor): Yes No Special instructions/additional information: CMF & CMA Representative: I I (fill Date item to be picked up: Location: CMF & CMA Event item will be used at: Phone: THANK YOU FOR SUPPORTING THE COLORADO MUSIC FESTIVAL & CENTER FOR MUSICAL ARTS! Colorado Music Festival { & Center for Musical Arts Our mission is to inspire and connect community members of all ages by providing access to the best of the world's music through education and performance. November 21, 2013 Andrew Richardson Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear Andrew, The Colorado Music Festival & Center for Musical Arts gratefully acknowledges your generous inkind contribution of gift certificates valued at $60 to our fall fundraiser, Sizzle Your Senses, on November 2, 2013. The Boulder/Denver nonprofit landscape is filled with worthy causes, and we greatly appreciate your choice to support the CMF & CMA. We suggest that you consult with your tax advisor regarding the deductibility of your costs associated with this donation. In recognition of your donation, we were pleased to list you in the Sizzle Your Senses event program. You will also be acknowledged in CMF's 2014 concert program guide, which will be published next summer, and on the donor wall at the CMA. Your listing will read: Cantina Laredo Again, many thanks for your generosity and support of Sizzle Your Senses. We look forward to working with you again in 2014! Sincerely, Ato�W� Margaret DeMichelis Development Director The Colorado Music Festival & Center for Musical Arts is a registered not-for-profit organization under 501(c)(3) of the Internal Revenue Code. All contributions are fully tax-deductible, as no goods or services are offered in exchange. This letter serves as your receipt. CMF & CMA 200 E. Baseline Road Lafayette, CO 80026 303.665.0599 www.COmusic.org ReachOut Crest View Silent Auction 2013 Crest View Crest View Elementary School • 1897 Sumac Ave, Boulder, CO 80304 Phone: (303) 443-6363 ROCU IRC 501(c)(3) Organization / Federal Tax ID No: 84-1512387 Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear Cantina Laredo: 04/17/2013 Due to your generosity and the generosity of the many friends of Crest View Elementary School our Spring Fling was a resounding success! Over 1230 guests attended the auction bidding on 643 items and helping to raise $43,000 to support our teachers, students and school. Thank you for your contribution. Below is a list of the items you donated. All donations are tax deductible to the extent allowed by law. Please contact a qualified tax professional for more information. As required by the IRS, ReachOut Crest View acknowledges that you have not received any goods or services as a result of your donation. Item Est. Donation Value Cantina Laredo Gift Certificate 55.00 Total Donation Value $55.00 Again, thank you. We extend our deepest gratitude and hope we can count on your support in the future. Sincerely, t\� • Yv\ Mollie McCaig Spring Fling and Silent Auction 20 3 Crest View Elementary School Boulder Valley School District Excellence and Equity May 2013 David Cardona Cantina Laredo 1680 29th St Boulder, Co 80301 Dear David, Horizons K-8 School Buda Campus 4545 Sioux Drive Boulder, Colorado 80303 303447-5580 It is with deep gratitude that we thank you for your recent donation to the 2013 Horizons K-8 School Auction. The auction was a huge success for the school. Your contribution supports our ability to maintain small class sizes, and pay for special programs (such as music and art), resources, and scholarships that will enrich the learning experiences of all Horizons students. We truly appreciate your support of Horizons. Below is a list of the items you donated. All donations are tax deductible to the extent allowed by law. Please contact a qualified tax professional for more information. As required by the IRS, Horizons K-8 School acknowledges that you have not received any goods or services as a result of your donation. Horizons K-8 School Federal tax ID # 84-6014683. We would like to thank you for your donation of: Gift Certificate - Stated Value: $50 Thank You, Horizons K-8 School Auction Committee ARROW MONTESSORI SCHOOL May 1, 2013 Cantina Laredo 1680 28th Street Boulder, CO 80302 Thank you so much for your generous donation of Cantina Laredo Gift Cards, valued at $35.00. Your support of Jarrow Montessori School helped make our fundraiser, Jarrow's Big Night, on April 19, 2013 at Rembrandt Yard the most successful in the school's history! With over 175 people in attendance we were able to raise over $90,000 this year, allowing Jarrow to extend our high-quality Montessori education to even more families in need through our financial aid program. We are deeply grateful for your support of our school and it's mission through your donation to our annual event. Jarrow Montessori is a 501c(3) and your donation may be tax-deductible, please check with your tax advisor regarding deductibility. For tax purposes, our tax identification number is 84-0531208. Thank you again! Warm Regards, Gavin Green Director of Advancement Jarrow Montessori School. 3900 Orange Court, Boulder, CO 80304.303.443.0511. www.jarrow.org Email: leena boulderballet.ora Notes: Appetizers Chips and Two Style of Fire Roasted Salsa Guacamole Entrees 75 Beef Tamale cut in half and covered with Chile De Carne on side 1 Full Tray Chicken Quesadillas 1 Full Tray Cheese Quesadillas 1 Full Tray Beef Quesadillas 3 Full Tray Vegan Gluten Free Individual Black Bean Nachos Beverage Napkins Plates Utensils p off at Dairy Center For the Arts at 5:00 pm ;yclable trays and disposable servers provided by CL I number of guests to be provided by 05/17/13 Total Food $0.00 303.444.2260 Estimated Bar $0.00 boulder@ cooduloredo.com Cantina LAREDO Rourmet merleon Jond Subtotal $0.00 DAY AND DATE OF EVENT: Sunday, May 19, 2013 TIME: 5:00 pm Drop Off �7S CONTACT NAME: Lee Stern • '�\ lMJ BUSINESS: Boulder Ballet FORM of PYMT: PHONE: 303.443.0028 x 7 LOCATION: Dairy Center For The Arts NUMBER OF GUESTS: 100 Email: leena boulderballet.ora Notes: Appetizers Chips and Two Style of Fire Roasted Salsa Guacamole Entrees 75 Beef Tamale cut in half and covered with Chile De Carne on side 1 Full Tray Chicken Quesadillas 1 Full Tray Cheese Quesadillas 1 Full Tray Beef Quesadillas 3 Full Tray Vegan Gluten Free Individual Black Bean Nachos Beverage Napkins Plates Utensils p off at Dairy Center For the Arts at 5:00 pm ;yclable trays and disposable servers provided by CL I number of guests to be provided by 05/17/13 Total Food $0.00 Estimated Bar $0.00 Delivery & Set Up $0.00 Subtotal $0.00 Sales Tax 8.36 $0.00 Gratuity 20 % $0.00V, �7S ]1AMOUNTD UE $0.00 • '�\ lMJ U no charge event. Cash value $11.75 per person. APPROVED BY David Cardona TITLE: Manager BOUIDFR BALLET Mother's Day Program Advertisement Boulder Ballet is the premiere ballet company and school in Boulder County. We serve over 15,000 people throughout the Front Range with performances at Macky Auditorium, Boulder Theater, The Dairy Center for the Arts, and various public parks. In addition, our outreach education and performances in public schools brings the art of ballet to over 10,000 members of the community. Our audience patrons are affluent supporters of the arts and their local community. They are highly, educated, enjoy going out, and have larger families than the national average. They are a loyal community and an exceptional audience for your business to target. Eamings and Household Size of Boulder Ballet Patrons Household Size 5 T-- is a » i � 8 a _ _ u A. - p Mode National Average Earrings - S3uk S30k-50K 550.701, S70k-7001, a Sf00h No Answer Boulder Ballet is offering the opportunity to advertise in our 2013 Mother's Day Program. The program is black and white with full color on the cover. The final size is 51/2 inches x 81 /2 inches. Midsummer Night's Dream. This is our special Mother's Day performance at the Boulder Theater. It is an annual tradition for many families in Boulder County, with nearly 1,700 audience members participating. AD DEADLINE: Monday, April 29 Below are the available ad sizes (in inches) and their rates per placement. Please check your selection below. Placement/Size Ad Rates Premium Color Full, inside covers (41 /2 wide x 7 112 high) $200 Premium Color Half, inside covers (41/2 wide x 3 5/8 high) $100 _ B/W Full Page (41/2 wide x 71/2 high) $100 B/W 1/2 Page Vertical (2 1/8 wide x 71/2 high) $75 B/W 1/2 Page Horizontal (41 /2 wide x 3 5/8 high) $75 B/W 1/4 Page Vertical (21/8 wide x 3 5/8 high) $50 B/W 1/4 Page Horizontal (41/2 wide x 1 3/16 high) $50 W May 20, 2013 J Q Cantina LAREDO M Mr. David Cardona W 1680 29`h Street Boulder, CO 80301 LUDear Mr. Cardona I ® On behalf of Boulder Ballet I would like to thank you for being our generous food sponsor for our Volunteer/Donor Reception. With your support our reception was a huge success. Everyone loved Cantina LAREDO's food and was astounded by all of the wonderful choices; there truly was something for everyone to enjoy! For those that were not familiar with your restaurant I had quite a few people inquiring as to where you were located. In addition, your guacamole was a huge hit, I heard many people commenting on how superior you guacamole was compared to 0 other places in town. Thank you again for everything Mr. Cardona, please let me know if you have any questions or would like any other feedback. Boulder Ballet looks forward to working again with you in the future. Sincerely, Ana Claire er Davison Cheri E. Friedman Co -Artistic Director Co -Artistic Director Executive Director Please keep this letter for your income tax records. Please note: It is the responsibility of the donor to determine the value of this donation for your taxes, with the appropriate paper backup. Boulder Ballet is a 501(c)(3) tax-exempt organization. EIN - 20-344730 2590 Walnut Strf Suite Boulder, Colorado 803 U; tel: 303.443.00 fax, 303.441.52 info@boulderballet.r www boulderballet.c •, • gra Annual Tee.Upfor TIKES .To Benefit Mother House DONATION REQUEST June, 2013 On behalf of Mother House and our upcoming fundraiser - TEE UP FOR TIKES Golf Tournament, we are hopeful that you might consider donating a gift card or other item to be used as player award or raffle prize. Our event will be held on Tuesday, July 30, 2013 at Coal Creek Golf Course in Louisville, Colorado. Corporate donations like yours, are a critical part of the success of this annual event - our most important fundraiser - and in supporting the health of so many women and infants. Mother House is Boulder County's only shelter for homeless, pregnant women who are at risk. We are committed to protecting their children, providing a nurturing and loving home, and helping them to build the confidence and skills necessary for a successful future. Our mission was started in 1982 and we have sheltered over 600 women and their babies. Because Mother House is a non-profit (5016 - #74-2251033) organization, your gift is fully tax deductible and you will be thanked and recognized for your gift in event promotional materials and advertising. Mother House receives no government funding and truly relies on corporate giving to continue providing support to this underserved population in our community. If you choose to support our event, I would be happy to stop by at your convenience to pick up the donation. If you have any questions, please give me a call or email. Thank you so much for your consideration and for your previous support of Mother House! Caren Paul Event Coordinator 303.449.8849 caren@gofarfast.com MOTHER HOUSE, INC. a hD C Wo PO Box 19589, Boulder CO 80308 - Bus: 303-1447-9606 - Fax: 303-147-0761 wmv.mother-house.org - info@mother-house.org Fed. ID # 74-2251033 State ID #98-05275 Children's Hospital Colorado Foundation Summer 2013 Dear Sir or Madam: 4� k ch"IQ, Esc o/ora dofoundation.or9 I hope that this letter finds fou well. I am writing to ask your assistance in raising funds for Children's Miracle Network Hospitals through the donation of an auction item for White House Black Market's Annual Auction. I know that you receive many requests just like this one so I sincerely appreciate your consideration and generosity. All funds raised through Children's Miracle Network Hospitals in Colorado. Wyoming and Western Nebraska benefit Children's Hospital Colorado. Your support specifically has allowed us to achieve the following: • Provide red wagons for our young patients rather than wheelchairs to make the hospital experience a little less intimidating. • Perform nearly 15,000 surgeries, including heart, liver and kidney transplants, giving each of these children a new chance at life and a future. • Treat children without being reimbursed far our expenses, specifically $68 million worth of expenses with $5 million coming directly tlu•ough donations. Allowing children to have top-notch care, regardless of their financial situation. • Offer family -centered care that supports parents, family and siblings as they participate in the day-to-day medical. emotional and social needs of Children's Colorado patients. • Treat over 186,000 kids in 2012. Your support is truly appreciated. We pride ourselves in recognizing each of our donors to the best of our ability. Your donation will be recognized in all printed auction materials and NN ill be displayed in a professional manner. Any marketing materials that you Nvould like to include with your contribution are welcome and will be incorporated into the display of your item as space permits. Enclosed please find a form that we ask )-oil include with your donation. Our tax ID number is located oil this form. Upon receiN ing your donation and completed form, we will send you a receipt for your records. Thank you for your consideration. I hope that you consider becoming a partner in the treatment of our children. If you have any questions, please contact me. 5' best, �Ich•en's Miracle Network Hospitals i iscoloradofoundation.org / .schutz Medical Campus • 13123 East 16th Avenue, 8045 • Aurora, CO 80045 • (720) 777-1700 JOZ GREENW(3DD WILDLIM RCHABILITATION C[NTGR P.O. Box 18987 Boulder, Colorado 80308 303.823.8455 Via email: June 10, 2013 Andrew Richardson, G.M. Cantina Laredo 1680 29th St. Boulder, CO 80301 Dear Andrew, www.greenwoodwildlife.org Many thanks for your generous donation of $60 worth of gift cards for our annual Wild Night for Wildlife auction fundraiser. We very much appreciate your support of this event, which will help us to rehabilitate the orphaned and injured animals in our community. We hope you will join us for Wild Night 2013 to be held Friday, September 27 at the LICAR Event Center in Boulder. Last year, Greenwood cared for more than 2,300 small mammals and birds in need. We are not a government agency and depend solely on contributions from businesses, foundations, and important donors like you to provide our vital services to the animals and the community. Greenwood Wildlife Rehabilitation is a 501(c)(3) organization and your donation is tax deductible. No goods or services were given to you in return for this donation. Thank you again for your support. Sincerely, Gel Linda Tyler CRAZY Executive Director rw Greemmod U%ildlife Rehabilitation Center is lar exempt under Intenial Revenue Code Sertioit 501(x)(3) andjour ronidbulion is lax deductible. Nogoodsorsnviresweirgiventoyonb),GII%RCirrreturnfotootrrronttibrrliort. ' gybine WWW Schoof Sk>16'"1rWh V,6MC • Lwig 4 CO 80501 • SAX 720494.3791 Vena. 682 7JS2 Dear Skyline Football Sponsor This letter is to authorize the presenter to solicit donations of money, goods or services on behalf of the Skyline Football Touchdown Club. We are currently seeking donations on behalf of our Program Book and Auction (August 17th). We are also seeking donations to help provide meals for our players during the summer and the fall. Finally we are asking for donations to sponsor our major program needs and provide scholarships for kids to our team camp this summer. Each year we rely upon the generous donations of our community supporters to provide the first-class experience to our players that they deserve. Skyline High School traditionally has been a neglected and underfunded school in the Longmont community and YOU ARE HELPING TO CHANGE THAT!! Any support you can give to our players is very much appreciated and a very worthy cause. All sponsorship goes directly to Skyline Football and helps provide such important items as equipment, uniforms and meals to our players each year. We are a non-profit organization so any support you provide is tax deductible. Our tax exempt ID number is 98-02634. Thank you from all of our players for your generous support of Skyline Football. Please contact Head Coach Kevin Rice at 303-907-2197 or kevinrice73Cgmail.com if you have any questions or would like to make a donation. Thank you in advance for looking over our specific needs below and the attached Donation Levels form and for deciding today to make a difference in the lives of our young people and improving the future of our community! Your amazing generosity will be greatly rewarded now, and well into the future! With the utmost respect, Kevin Rice Head Football Coach Skyline High School 303-907-2197 2013 Skyline High School Football Sponsorship Needs: Equipment (helmets, shoulder pads, etc.): $5,000 Uniforms (practice and game): S5,000 Team Practice Wear (shorts, shirts, sweatsuits): 56,000 Scholarships to Team Camp: 56,000 Skyline Football Team Banquet: 55,000 Scoreboard for Skyline Field: S10,000 Weight Room Equipment and Renovation: $50,000 New Sports Turf Playing Surface at Skyline High School: $500,000 .home of the Tarcons _ Sk ciy ne 9` qh schooc Sl6+fmcifyb,tcl�rC•MOT. .Nouatuinl4rwgti •Longmont, CC) 60501•.9*=720491-3741•Tkt303682-7362 SKYLINE HIGH SCHOOL FALCON FOOTBALL DONATION FORM Name: Business (if applicable): Address: Phone Number: Email: ZXZA I am making the following donation: Financial: $ Sa ( cash check #) Make checks payable to: Skyline High School Football Other (please specify below): Please return this form to Head Coach Kevin Rice: Skyline High School PO Box 254 Longmont, CO 80502 Fax: 303-684-8912 Email: kevinrice73@gmail.com Website: tiny.cc/shsfootball or tiny.cc/touchdownclu., THANK YOU FOR YOUR SUPPORT BOULDER CHAMBER ORCHESTRA March 26, 2013 Andrew Cantina Laredo 1680 29th St Boulder, CO 80301 Dear Andrew, 4735 Walnut St. Ste F Boulder, CO 80301 303 5831278 www.boulderchamberorchestra.org Thank you so much for your generous donation of 3 $15.00 gift certificates and 2 table side guacamoles in support of our recent fundraiser on March 14 at Rembrandt Yard in Boulder. The evening was very successful, and we were able to raise over $30,000 dollars! Your support will allow Boulder Chamber Orchestra to continue and expand the programming, education, and outreach activities we offer our community, and for that we are truly grateful to you. Thank you again for your generosity. Sincerely, Ci Elizabeth Kennedy Managing Director Organizational Information: Chamber Music Society of Boulder • Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 PEAK TO PEAK Friends of/A \/A\ CHARMSCHOOL ._ 800 Merlin Drive, Lafayette, CO 80026 Phone: 303 453 4600 Fax: 303 453 4613 www.peaktopeak.orq March 18, 2013 Dear Commu t Supporter, � vj Th n� k you for your generous donationtoour Annual Auction and Dinner Gala on February 7, 2013. Due to your generous support along with other fellow community members and Peak to Peak families, this year's event was a big success! Your support is greatly appreciated and will benefit our unique college preparatory program. Your gift(s) are especially important this year as we strive to encourage significant financial support for Peak to Peak's operational needs. Friends of Peak to Peak is a 501 (C) (3) organization set up specifically to support Peak to Peak Charter School. Proceeds from this year's auction will go to support critically needed instructional items for our classrooms. We welcome you to get involved again for our 2014 Auction and Dinner taking place on February 13, 2014 at CU -Boulder's Glenn Miller Ballroom. We hope for even larger attendance at this one with our expanded guest list. Your support truly makes a difference to our staff, students and community! Please consider this letter a receipt for your tax-deductible contribution to Friends of Peak to Peak (tax identification #84-1562332). Thank you again for your generosity and commitment to Peak to Peak Charter School. Sincerely, Carolyn Jannsen, M.Ed. Advancement Director Peak to Peak Charter School 800 Merlin Drive Lafayette, CO 80026 303 453 4604 Good Scholarship Enlightens, Good Character Shines Because the IRS is no longer accepting cancelled checks as evidence of contributions made, please retain this letter in your tax records as a receipt for your gift. We acknowledge that no goods or services were offered in exchange for this gift. The Younger Generation Players Musical Theatre Company March 4, 2013 The Younger Generation Players 2701 W. Oxford Avenue #3 Englewood, CO 80110 Cantina Laredo 6851 South Gaylord Street Centennial, CO 80122 Year Cantina Laredo, Thank you very much for your generous donation of the following usable items for the recent YGP's Silent Auction 2012: "Circus Fun"!: You donated the following item(s): $45.00 (3) Entrees at Cantina Laredo The item(s) is/are donor valued at: $45.00 All donations and sponsorships are tax deductible. The Younger Generation Players is a 501(c)(3) non-profit organization, Tax ID: #74-2378884. As a non-profit company, we depend upon support from area families and businesses to enable us to continue to offer the quality instruction and performance experiences that have become synonymous with YGP for 33 years. Thank you for your support of this vital community asset. Sincerely, YGP's Board of Directors Mailing Address: 2701 West Oxford Avenue #3, Englewood, CO 80110 • (303) 789-4444 The Younger Generation Players is a Non -Profit Corporation Page 1 of 1 Cantinal-aredol93-Boulder From: The Womens Wilderness Institute [events@womenswilderness.org] Sent: Monday, April 01, 2013 4:45 PM To: Cantinal-aredol93-Boulder Subject: Thank You! Hi David - I just wanted to thank you for Cantina Laredo's generous food donation for our Gear & Cheer event on March 21st. Your food was the best we had at the event and our attendees loved it .... so much that we ran out early! Your servers were friendly and personable and we truly appreciate your continued support. Thanks to donors such as yourself, we were able to raise close to $25,000 for our Girls Wilderness Program Scholarship fund. Thanks for your support of The Women's Wilderness Institute! Katie Katie Hegg & Jen Clink:: Gear & Cheer Co -Chairs The Women's Wilderness Institute 1501 Lee Hill Drive Unit 16 Boulder, CO 80304 (303) 938-9191 office 1 (303) 938-5071 fax The Women's Wilderness Institute is a nonprofit organization with the mission of strengthening the courage, confidence and leadership qualities of girls and women, through the challenge of wilderness and community based experiences. Learn more at womens►vilderness.ore 4/1/2013 _^ATe April 16, 2013 Edward Ledford Cantina Laredo 6851 S. Gaylord St. Centennial, CO 80122 Dear Edward, Thank you for your donation of the Gift Certificate for two entrees and queso appetizer to our annual Youth Fundraiser held on March 10, 2013. We greatly appreciate your support. With your help, we were able to raise a significant amount of money that will make it possible for middle and high school students to attend life changing camps, retreats, and mission trips. It will also provide crucial training to our adult mentors and scholarships for those most in need. This assistance would not happen without people and businesses like you who care about the youth of our community. We literally couldn't do it without you! Know that we recognize that your contribution is a sacrifice. We had over 40o attendees at this event, and your business was publically recognized and endorsed. It is our hope and full expectation that this promotion will bring benefit to your enterprise. The staff, volunteers, parents and students who participate in Student Ministries here at Cherry Creek Presbyterian Church salute you! Thank you for investing in the lives of our youth through your generous contribution! In Him, Chris Piehl Pastor of Student and Family Ministries loigo E. Belleview Avenue - Englewood, CO Som ph 303-979-9909 - fax 303-779-4180 - www.cherrycreckpres.org Environmental Law Society Colorado Law School Dear Sir or Madam: The field of environmental Iaw needs your help! And how better to help the field of environmental law, than supporting those who are learning about and working in environmental law? The University of Colorado Law School Environmental Law Society (ELS) serves as a primary outlet for students interested in natural resources and environmental law to become involved and meet others with similar interests immediately upon beginning their first year. ELS is a highly active group, organizing various service outreach activities, fundraising events, and outdoor adventures each semester. ELS members cultivate connection in the local outdoor community by participating in at least one volunteer outreach effort each semester. Our fundraising efforts serve two ends: ELS provides scholarships for law students who wish to do low or unpaid summer internships for non-profit environmental and resource conservation organizations, and ELS also uses fundraising dollars to send several students to environmental law conferences around the country each year. This year, we are holding a trivia night on March 8 at 8:00 at the World Famous Dark Horse Saloon to help us with our fundraising efforts. Community members and students from every class level are welcome to join in the fun. ELS needs your help to provide prizes for top trivia champions and for door prizes. All donors will receive a shout -out during the event, which is always well -attended. Please consider supporting Colorado Law's Environmental Law Society, and with your help we can continue to help law students work in the environmental field! Thank you for your time and consideration in supporting our organization. Sincerely, Josh Kruger, ELS Co -President (720) 232-3934 \ I SG BOULDER ELKS LODGE NO. 566 A FRATERNAL ORGANIZATION BENEVOLENT AND PROTECTIVE ORDER OF ELKS OF THE UNITED STATES OF AMERICA, INC. 4th Annual Boulder Elks Lodge #566 Silent Auction & St. Patrick's Day Party P.O. Box 978 Boulder, Colorado 80306-0978 Fax (303) 442-5006 On Friday, March 15, 2013 Boulder Elks Lodge #566 will hold its 4th Annual Silent Auction Event along with a St. Patrick's Day Party to raise funds for their annual scholarships awarded to deserving Boulder area senior students who plan to enroll in college this fall. The Lodge Scholarship Committee solicited applications for the Most Valuable Student Scholarships sponsored by the Elks National Foundation (ENF) earlier this year and sent four of the student's applications to the Colorado North Scholarship Committee who then make their recommendations to the State and then finally to the National Foundation scholarship committee last year. One Boulder area student was awarded a 4 -year scholarship of $1,000.00 per year. The Boulder Lodge, in the past, has also awarded scholarships to local students from our Lodge funds. Three year ago these funds virtually dried up, so we held our first fund-raising event. This year we plan to award six students scholarships totaling $6,000.00. We raised over $5,000.00 last year and Boulder Lodge would like to continue this project by supporting these local students. We all know that the cost of a college education continues to rise, so our students' need are even greater this year. Therefore, Boulder Elks Lodge #566, having a history of being very community -minded and funding many youth activities since its founding 112 years ago, is organizing a fund-raising event Friday, March 15, 2013. The dinner will feature Corned Beef, Cabbage, Green Beer and all the trimmings beginning at 5:30 P.M. The Silent Auction will open at 6 p.m. and close at 8 p.m. This year the Lodge is also offering donors to be sponsors for $100 (Brotherly Love); $200 (Justice); $300 (Charity); $500 or more (Fidelity). We'll also be offering In -Kind Sponsorships. The Lodge is asking Boulder individuals, businesses and corporations to donate items to be auctioned. Your help in reaching our goal of $6,000.00 will be greatly apprecia.. d. We would like most items to be donated by 3/10/13. Thank you, 3, /i Ray Humble, Boulder Elks Lodge #566 Scholarship Chair �� G 9 Ckocclate ouc rS lire.9 Safehouse Progressive Alliance for Nonviolence 835 North Street 1 Boulder. CO 80304 1 303 449.8623 1 events@satehousealliance org About Safehouse Progressive Alliance for Nonviolence (SPAN): SPAN is a human rights organization committed to ending violence against women, youth and children through support, advocacy, education and community organizing. A staff of 32 provides comprehensive, culturally -relevant services for victims of domestic violence and promotes nonviolence and social justice through violence prevention education, specialized community training and technical assistance programs, and anti- violence/anti-oppression coalition building with individuals, agencies, and institutions. SPAN Programs include: 24-hour Crisis/Information Hotline; Emergency Shelter & Resource Center; Outreach Counseling Services for adults, youth and children; Legal Advocacy Program; Transitional Services Program, including access to post -shelter housing; and, School-based and Community Education Program focused on early intervention and violence prevention. Did you know: • One in four women in the United States will experience violence by an intimate partner at some point in her life. Typically, violence within an intimate relationship escalates in frequency and severity over time. One in five youth age 11 to 14 say their friends are victims of dating violence and nearly half who are in relationships know friends who are verbally abused. • The number of women age 50 and above seeking counseling and advocacy services from SPA has more than tripled since 2007 • Children are witnesses to the violence in 30% of domestic cases reported to the police. Domestic violence is present in 40% of the child abuse cases In Boulder County • The economic recession has created even more obstacles for survivors seeking to leave an abusive partner. SPAN has seen at least a 20% increase in requests for shelter each year since 2007. Since opening in 1979, Safehouse Progressive Alliance for Nonviolence has sheltered more than $8,800 women and children, responded to over 174,000 crisis calls, counseled 23,480 individuals and offered more than 10,200 educational presentations on domestic violence and related topics throughout Boulder and Broomfield counties. More About the Fundraiser: Each family in the Bonai Shalom community receives the same wonderful gift box with a letter that mentions who sent it to them. For a nominal contribution participant's have their name included as a sender of the gift box. We will make 250 of these boxes for our community. What goes in the box are special Purim holiday treats sourced locally and coupons to local merchants. The way you may be able to best assist us and create a win-win would be to provide us with Gift Cards. The gift cards are used to incentivize our members to place their Purim gift box orders. In addition we have a silent auction. The silent auction has been a welcome success and provides another way our members can participate if they missed ordering the gift boxes. Arugula, Breadworks, Brasserie Ten Ten, Cantina Laredo, CPK Noodles& Co., Tangerine, Snooze, were some of the sponsors of this category in past years. Other ways to participate: • Coupons: A donation of 250 "free" coupons (e.g., free cup of coffee, free appetizer, free dessert, buy one get one free). Last year Ozo's Coffee, Moe's Bagels, Spooners, Extreme Pita, Daphnes, Glacier Ice Cream, Red Wagon Organic Farm, and more donated coupons for free items to go into each gift box. • Food/ Sample Size donations: Madhava Natural Sweetners, and Sprouts, provided sweetner packets, and sample size granoloa bars. Note: Food items need Kosher labeling. • Underwriting Contributions: Crist Mountain View and others made direct contributions. • If you have another sponsoring idea - let's talk. All donations for this Fundraiser need to be furnished by Friday February 15, 2013 Please Fax (303-442-7S45) or email (office@bonaishalom.org) this form to Congregation Bonai Shalom or contact Rhonda Wildman at 720-999-0678. Our business would like to par ' I ate or rec' ive�nore information: Name of Busi Contact Perso Emai t Mme to Con We would like to provide: (e.g. 250 coupons for Free (item), 25 Buy One Get One Free Coupon, _.(#) of Gift Cards totaling $- 250 Kosher Food Items). _lam ,— Underwriting Donation to Bonai Shalom for S cp Congregation Bonai Shalom is a 501(c)3 organization CO ID no. 98-04830 / Fed ID no. 84-0891557 American Heart Association aeart ball 13 Denver Heart Ball irday, January 260; 2013 iyatt Regency Denver t Colorado Convention Center Heart Ball Chair Bill Lindsay, 'dent of Lockton Companies `-leart Ball Vice Chairs John Ikard, sident & CEO of Firstflank Holding Co. Dick Kelly Charlie Nelson, esident of Great West Life American Heart Associaton SouthWest Affiliate 1280 S. Parker Rd Denver, CO 80231-2100 Tel 303.369.5433 Fax 303.369.8087 Denver Heart Ball Deaz��2L���,i Thank you for your support of the 2013 Denver Heart Ball. Your contribution will help us raise over $60,000 in our auction. The American Heart Association's 2020 goal of improving the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20% is only attainable through our ability to fund essential research grants and to develop community educational programs. The dollars raised at our 2013 Heart Ball will go directly towards this invaluable research and educational initiatives. On behalf of the American Heart Association, we are asking you and/or your company to play an integral role in our silent and live auctions at this year's event on January 26`, 2013. We would be extremely appreciative of your donation as we strive towards our vision of raising $1,000,000 at the Denver Heart Ball in the next 2 years. We appreciate your consideration of donating a tax-deductible item to this important event. We are grateful of your support. Please feel free to mail any donations to the address above or contact Blair Pesses at t-blair.pesses@heart.org with any questions. Sincerely, Ashley McCurrach Heart Ball Director Tax ID #:13-5613797 Dear Sponsor: Congregation Bonai Shalom is the largest Conservative FEW cam: uV Synagogue outside of Denver with over 200 member families. For the past few years we have conducted our major fundraiser that ties in with the .Jewish Holiday of Purim where the customs include giving charitably, and giving gift boxes. Last year we were able to raise over $16,000 with limited overhead costs so that money raised went directly to support our Synagogue and its many activities in the community. Your help is a key to making this a success. This year we expect even greater participation by our community as many experienced the thrill of giving and receiving the wonderful gift boxes that you help make possible—to us this means more money raised and for you more visibility for your business. So What's in it for you? 1. Our community supports buying local. For example: We are part of the growing CSA (Community Supported Agriculture) movement and work together with Red Wagon Farms. You can help us in our commitment to build relationships with and support local businesses. 2. Your participation translates to visibility to our members potentially resulting in more purchases. 3. A Thank You (and Tax Receipt acknowledging your cash and/or in kind donation). We create visibility for your business by: a. Emails promoting this Gift Box that highlight the businesses supporting us in this project b. Listing you on the Sponsor page that goes with each box c. Including the item you provide to place inside each box d. A Sponsor thank you page in our printed Newsletter We would like to have you join us in this Fundraiser. There are ideas for participation and more details about the fundraiser on the next page. est Re rds,`/� iii... Rhonda Wildman Purim Gift Box Co -Chair Congregation Bonai Shalom 720-999-0678 1527 Cherryvale Road • Boulder, Colorado 80303 • tel: 303.442.6605 9 fax: 303.442.7545 • www.bonaishalom.org / rr �� Chocolateklers"kl in Safehouse Progressive Alliance for Nonviolence 835 North St Boulder, CO 80304 303 499-8623 Safehouse Progressive Alliance fir Nonvio�nce (SPAN) is pleased to request your support for the 32" annual Chocolate Lovcrs' Fling. This e nt will help u raise funds to provide safety and support for victims of domestic violence and w • toward justic nd equity in our community. The Chocolate Lovers' Flin s a high -exposure crit as wela o ular. Ione -standing con munity tradition. The Fling will be r brua 9'h, 2013. Tyear's Fling promises to bevery ectal night Nvith incredible chocolate. chocolate, d more Choc late! Guests will also enjoy a 'I me reception, dinner, music and dancing. "fl -ling, will feature ilent and live auction sh vea c wonderful items from area merchants. 3` We hope you will consider contributing to the succ sof the Cho ate Lovers' Fli , N donating an item to be offered in the live auction. Your contribution wi a us to raise aware in the community, continue to provide services to adults and children who have experienced domes i violence, and give event participants the opportunity to purchase an exciting auction item that al benefits our work. Your donation qualifies as a charitable tax deduction at the item's fair market val less the value of any goods and services provided in return for this donation. (Please reference 5020 tax identification number 74-2145368.) Thank you for considering this request. Should you need additional information, please contact Mary Pierce, L -vents Coordinator. 303 499 8623 or email at nmary@safehousealliance.ore. Sincerely, NlaiA, Pierce FN ents Coordinator COLORADO ROCKY MOUNTAIN MUSIC 1. CENTER FOR FESTIVAL ,: MUSICAL ARTS March 14, 2013 Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear Cantina Laredo, Thank you for your generous donation of a Cantina Laredo $55 Gift Certificate to our recent fundraiser, Crescendo — Good Vibrations, which was held on Saturday, March 3 at the Shelby American Collection museum. Thanks to your generous support, our preliminary estimate is a total gross of over $40,000! This is no small feat, especially considering today's challenging economic climate. We are thrilled that with your help we raised significant funds to support the mission of the CMF&RMCMA. In recognition of your donation, we will be pleased to acknowledge you in CMF's 2013 concert program guide, which will be published in June, and on the donor wall at the RMCMA. Your listing will read: Cantina Laredo If you would like to make any changes to this listing, please contact Kim Brody at brodv@comusic.org. We very much appreciate those in our community who recognize the value of live music and music education. Thank you again for your generous support. Sincerely, Loui a Christopher Development Coordinator CMF&RMCMA is a registered not-for-profit organization under 501 c 3 of the Internal Revenue Code, tax ID 84-073571-6 CMF 900 Baseline Road Cottage 100 Boulder, CO 80302 303.449.1397 1 RMCMA 200 E. Baseline Road Lafayette, CO 80026 303.665.0599 www.COmusic.org rE.�Y Rotary Club of Boulder Valley PO Box 17485 Boulder, CO, 80308 www.bvrc.ore Thank you for supporting the "Summer Sunset Swing" fundraiser which was held August 24, 2013 at the Flatirons Golf course located in Boulder, Colorado. You generosity will help us fund and support the following projects/organizations: 1. A water project in Pasmata, Nicaragua. 151 families will be provided with fresh water. 2. Mental Health Partners, Attention Homes, Ally Youth Services and the Boulder Institute for Psychotherapy and Research. Our focus this year will be mental health and family services. 3. Coat drive: We provide warm clothes to approximately 2,500 people per year who are in need. 4. RYLA (Rotary Youth Leadership Award and Camp): We sponsor 6 students per summer. 5. We will provide dictionaries to approximately 60 students in two local low-income elementary schools. 6. Rotary Youth Exchange: We will sponsor one exchange student (Cadu Curado from Recife, Brazil) and support a local student to study aboard for one year. We greatly appreciate your support. Eric Rutherford President, Rotary lub of Boulder Valley January 30, 2013 Mr. David Cardona Cantina Laredo The Streets at SouthGlenn 6851 South Gaylord St., Space 132-836 Centennial, CO 80122 Dear Mr. Cardona: Summit View Elementary School Douglas County School District RE 1 Sheri Coll, Principal Michael Risdon, Assistant Principal On behalf of the Summit View Elementary PTsO, I would like to thank you for your generous donation of a dinner for two at Cantina Laredo to our auction, "An Evening with Summit View," to be held on April 19, 2013. Your business name is already on our website, along with a link to your business website. Your commitment to helping schools in our community is greatly appreciated. Summit View Elementary School's mission is to develop critical thinkers, optimize individual potential and strive for the extraordinary. Our goal this year is to raise $60,000. With the help of community businesses and the commitment of our parents we are confident we will raise this money to offset ongoing district and state level cuts and accomplish our mission. All funds raised on the evening of the event will go to Summit View Elementary to fund educational assistants and specials programs for our students. We appreciate the support of the Summit View Elementary business community and thank you again for your generous donation. SiZeVail ly, `fk WK You :0 5u�poRTiN 4 Ja - 2013 Auction Chair 5uMM1T VtL�IJ JAt�IICJ= DOUGLAS As a chapter of the Douglas County Educational Foundation, COUNTY Summit View Elementary PTsO has 501(c)(3) non-profit status under `•/ EDUCATIONAL Federal Tax ID#84-1165175 FOUNDATION GmmunipS jRL—ifE.WL,- 10200 Piedmont Drive, Highlands Ranch, Colorado 80126 - (303) 387-6800 (Main) - (303) 387-6801 (Fax) I m „ a E o5 �J Z a 3? o m� N o o _ r,, a i Ito / oi m L° u m m E c m me op0o 0 Q c s U m� O O N U m 6 m N O ZL7 0 „ UN> R' t m o� gv > uoE N nD Q o >> E „�'aLc oE•Eo I-0 0 ° c mx@ u Dy -a c c ua ° �� -o a'ul -a a 'o var m-mon`c aa -60 co oocOocm mom DmEococo uo o 00EEnEdI'poua � a � aJ 2 -ow .c`° ]0 o xc7m at „9'd2 v- u oz � c o0 m- O xuapCOuu>7 cUl a u ou-moiE?EugNGwv- p -c=gEmC2o [] 0) a o c L E 2 a >ypt>c0 0 2 io :2 U o C2 -0y o L o o -5 03 ma'Qcmho c -°a°a 0m.tC, 40 a =LEa U UO a 2 mu L2=E o a tuEL Cc: m° > ° Z op „ oCaouC l7 Q.' 0 LL z 0 Q z 0 0 W J QI F Q I U 01 �• m m E om F 7 m o =`o $ E.� 3 a 13 m $ otoO ° a E z r '= „t u u U F- —° m O U a U U 8" m c 5 U a z ' a °gam O j D c N �' W o m o E u ❑ > ri a a om ° U rn m L '� a u o mm o c W Y U c�- t c a E° L a ❑ mm° z $ om ° E o Q a mC m e a`o y p O a m "O c_ c S j a 4 N c u O z 7 N O U m o a ] C a Y 0 7 O j C J T 'a > U a =, > D a v� a J . U. Q.' 0 LL z 0 Q z 0 0 W J QI F Q I U m 'm = E r o ;o CL m mE a a om Y U U o o, u a c4 m o . 4 W y M Y m c X >O 7° m o $� xa •0 3 m o z w m O ❑ ❑ O -Q CL p U m Y Q E E Z9 M MM U 0 O O �O uOo c0 Of UX m c O O C s p OL m o0m Lm °o = u a c E m ° o } o yc o c E aa) o g E 3 m a o N U O L O m a 'O_ U 'Nut N m m U Y M O °= O 0 0 0 c o o a v -° a) •C V C t0 CL .. �C L O° U = o u o o E m f a° m ' o ,o m° E o o_ m 2 a C3- m o a 0 o mo sc o o p p o „ t `o d0 3 m; Oaa > m S° -0 o E aui c > u c u 0 m Boulder galley School District Excellence and Equity March 19, 2013 La 5c lrL D 1 Dear Boulder County Business Owner, High Peaks Elementary School chool 3995 East Aurora Ave Boulder, CO 80303 720-561-6500 Lora de la Cruz Princioal I am writing to request a donation of an item for a Silent Auction being held at High Peaks Elementary School on May —3,;Q3. High Peaks is a public school within the Boulder Valley School District with 300 students. We are not a neighborhood school, and therefore, draw our students from all over Boulder County. The Silent Auction has previously been a very successful and well -attended event. All proceeds from the Silent Auction will be used to purchase non-fiction guided reading texts in order to update our literacy collection to meet new State curriculum standards. We will advertise your contribution in our school's weekly newsletter and in flyers distributed within the school community. We will be happy to display any information promoting your business next to your item at the event. In addition, we will highlight your business logo and a link to your business web site on the High Peaks Facebook page. If you are able to contribute, please contact the Silent Auction Committee volunteer listed below. Thank you for supporting one of your local schools. Your generous gift will help ensure ld r Valley public schools stay strong and viable! Cen Park -506. 485 IPra� co@yahoo.com High Peaks is a 501(c)(3) non-profit organization; our federal tax ID number is 84-1331642 and our State of Colorado tax exemption number is 98-0238 POMES a Providing residential treatment, counseling and safe shelter to at -risk youth since 1966 Cantina Laredo February 15, 2013 Andrew Richardson 1680 29th Street Boulder, CO 80301 Dear Andrew, Thank you for your previous auction item donation of two $25 gift certificates! I invite you to continue your support with a donation to our silent auction for our 6th Allnual Kaleidoscope Mardi Gras Ball taking place on Saturday. September 21. 2013 at the UCAR Event Center. Your ongoing support allows Attention Homes to continue its mission to provide services to runaway, homeless and at - risk youth. Since 1966, Attention Homes has cared for almost 7,000 youth who have benefited from safe shelter, supervision by positive adult role models, healthy meals, case management, access to accredited education, recreational activities and community service projects, assistance with medical and mental health care and more. We expect approximately 300 guests to join us to help raise $120,000 for the programs and services provided to our resident youth. Our guests are high-income business owners and professionals. As an auction donor, your business will benefit from listings in the event program, on Attention Homes' website and in our annual report. Event: 6th Annual Kaleidoscope Mardi Gras Ball Who Benefits: Runaway, homeless and at -risk youth living at Attention Homes Where: UCAR Event Center, 3080 Center Green Drive. Boulder, CO What: Fabulous dinner, exciting live and silent auction. live music and a special appeal for the runaway, homeless and at -risk youth living at Attention Homes Date: Saturday, September 21.2013 Time: 6:00 pm 'Number of guests expected: 300 Event's fundraising goal: $120,000 Thank you for considering this opportunity to support at -risk youth! Please complete the attached Auction Donation Form and mail it with your tax-deductible donation to Attention Homes or call to make arrangements to drop-offpick-upyour donation. For further information about our services or the event, feel free to contact me at (303) 447-1206 ext. 129 or via email at blogan@attentionhomes.org. re ards, i Brenda Logan Po ect Nl j ager Attention Homes 1 1443 Spruce Street I Boulder, CO 1 80302 1 P:303.447.1206 I F:303.447.0623 I www.aftentionhomes.org www.careconnectbc.org Boulder County CareConnect info a careconneabc.org PO Box 3675 BoLdcler, CO',0307-3675 ph: 303- 1 1.3-193:3 September 24, 2013 David Cardona Cantina Laredo 1680 29`h St Boulder, CO 80301 Dear David, At Boulder County CareConnect, we believe that all people deserve to age with dignity. Your in kind donation of lunch for 25 volunteers and staff will help us to support this mission. Boulder County CareConnect provides services to over 2,500 seniors and adults with disabilities annually to ensure their security, comfort and independence. Because of your support, Boulder County CareConnect will be able provide Safety Net Services such as grocery deliver, minor home repairs and transportation to medical appointments. These programs enable seniors and adults with disabilities to reside independently in their homes for as long as possible. For more information on marketing partnerships or company volunteer opportunities with Boulder County CareConnect, please contact me at 303-443-1933 x415. We appreciate all that you do to make this a great community to live and age well! Sincerely, Chrissy Sollenberger Development Director Tax ID Number: 84-0769724 3v � 113(410 � 5D To Whom It May Concern, IMULDE" 7 RPI: 1�•/ A October 25, 2013 On December 7th, 2013 Boulder Rugby Club will be hosting our Annual Banquet and Silent Auction at the Millennium Grand Ballroom. We anticipate approximately 200 guests at this function and the funds raised will go toward the operations of our Club, including the expansion and maintenance of our new rugby field at Tom Watson Park. To make this fundraising event as exciting and beneficial to our club as we hope, we need your help. Please consider supporting our event by donating gift certificates, merchandise or services. In exchange, you will receive some excellent community exposure and advertising. Your company name will be listed on the Sponsor board at the Auction and your donation is tax deductible. We would be happy to provide our Tax ID number upon your request. We will gladly pick up your donation, or it can be mailed to the Club address listed below. Please fill out the attached Donation Form and submit it with your donation so we can ensure to recognize and thank you formally. Thank you for your consideration in supporting the Boulder Rugby Club, from our team to yours, we wish you the best. Sincerely, Paul Rohr President- Boulder Rugby Club 1335 Stoneham St. Superior, CO 80027 (630)363-7647 paulrohr@boulderruaby.com Raffle & Silent Auction Donation Form Donor Name Donor Company Mailing Address:. Email Address: Phone Number: Description of Item or Service: Approximate Retail Value: Boulder High School "Still the first..." 1604 Arapahoe Avenue • Boulder, CO 80302 • 720-561-2200 Dear Local Business Owner, The second annual Boulder High Student Council Auction is scheduled for April 6th/7th. This auction is a charitable event that will provide a large donation to the Make -A -Wish foundation in order to support a child under the care of the non-profit foundation. Your donation will be considerably appreciated. All donations are 100% tax deductible. Boulder High School's tax ID number is 846014683. If you have any questions or concerns, please feel free to email a student representative at marycait.milliff@gmail.com or our teacher advisor at Russell.Selnau@bvsd.org. We would also be delighted to have you attend our benefit! You may RSVP via either of the above email addresses. Thank you for your consideration, Mary Cait Milliff � Boulder High School Benefit Chairman University of Colorado at Boulder Department of Electrical, Computer & Energy Engineering Engineering Center 425 UCB, Room # ECEE 1655 Boulder, Colorado 80309-0425 Cantina Laredo 16802 9th "Street Boulder, CO 80301 08 March 2013 To Whom It May Concern, Adam Sadoff ECEE Graduate Program Advisor (303)735-0490 Fax (303)492-2758 sadoff@colorado.edu This letter is to thank Betty and Ned and to sincerely urge you to recognize and reward each of them for their very professional and courteous assistance, this evening, when 21 of us dined at your restaurant, Cantina Laredo, in Boulder. Once a year, our department hosts our best and brightest applicants to our graduate program, in order to determine whom our faculty will admit and fund as Teaching and Research assistants. This was an important meal and it was the first year we dined at Cantina Laredo. Our guests, our faculty and I all found your food to be very good, and your atmosphere quite comfortable for a party as large as ours. Most importantly, Betty and Neri were each *outstanding*. I have worked, internationally, in customer service and management in food service, health care, computer firms, and academia --and Betty's and Neri's customer service represents your business in all the most positive ways. Each was *very* attentive to all customers at our table. Their timing was perfect for taking and filling requests very quickly and accurately, for filling beverages, accurately figuring a complex bill, making suggestions and providing descriptions of specific dishes and asking how the food was. Betty's and Neri's demeanor was very professional, politely confident, warm, kind and courteous. *Please* give each of them all the perks, praises and raises they so *very* well deserve --including sharing these comments with each of them. In addition to the included gratuity, I gave them a $20 cash tip, from my own pocket (not from our university). They absolutely earned it, and our department will certainly dine, again, at your restaurant, due, in large part, to Betty's and Neri's very fine work. CJI,,,, —A, /WJL Adam Sadoff ECEE Graduate Program Advisor r4L Boulder County Republicans July 15, 2013 To Our Valued Contributor: May we count on you this year to donate goods or services to the 2013 Boulder County Republicans' Lincoln Dinner silent or live auctions to be held on Saturday, September 14th, with featured syndicated Talk Show Host, Hugh Hewitt? We intend to use the funds we raise for the following purposes: To support our candidates for election to offices at all levels of state, county, and local government To fund a Student Scholarship Program to provide high school, college, and university students with educational opportunities empowering them to learn about, as well as to participate in, the American political process To provide for needed administrative support expenses to operate the Boulder County Republicans' office and administrative systems. No paid employees work for the BCR. Volunteers provide their time, talents, and treasure to lead and serve in the organization Please understand that your donation is not tax deductible When you donate your item(s), please complete the required Auction Donor/Donation Information Form, sign the document and print the name of the BCR Representative with whom you have been dealing, and make a copy for your records Give this original form to the person who asked you for your donation. Thank you very much for your time, interest, and consideration. Cordially, 66w" Zfllut`e Boulder County Republicans Lincoln Dinner 2013 Auction Chair 550 Manorwood Lane Louisville, CO 80027 bwhite@bocogop.org (The deadline date for submission is September 1. 2013.) Black Rock Elementary PTO Parent/Teacher Organization 2000 Mountain View Blvd., Erie, Colorado 80516 720-890-3995 To: Date: February 8th, 2013 Subject: Black Rock Elementary PTO Golf Tournament On behalf of the Black Rock Elementary PTO, We invite you to join us as a sponsor/donor for our 5th1h Annual Golf Tournament on June 1, 2013 at the Colorado National Golf Club at Vista Ridge in Erie, CO. The purpose of the event is to raise money for support materials for our school. This includes: books, paper, online subscriptions, Apps, and other very basic essentials. We are expecting 144 golfers to participate, along with their families. We have 699 students currently enrolled at our school. Please take a few minutes to read through our information and carefully consider whether your business can sponsor or donate to our event. Sponsorship is a great opportunity for you to advertise your company to the community! The sponsorship packages offer premium signage and advertising for up to 4 months. The signs are 3 ft X 6 ft, full color, and will be displayed on school property (facing very heavy traffic), which is on Mountain View Blvd. The banner will be moved to the golf course for the tournament. You will also receive a tee -box sign at your sponsored hole. All signs are provided by us. You will receive web advertising on our golf tournament website (www.brepto.golfreg.com), our Facebook page, the PTO Website (www.bre to o.com), and our smartphone App -Black Rock Elementary. You will find detailed sponsorship information attached. If a sponsorship is not for you, we are looking for prize donations/gift cards, or monetary donations to purchase prizes. You will receive recognition for your donations during the tournament and on all of our PTO advertising sites mentioned above. We are a 501(c)(3) corporation and all donations and sponsorships are 100% tax deductible. For your tax purposes, our EIN# is 26-2327934. Please feel free to contact us with any questions you may have. We look forward to working with you and appreciate your consideration! Thank you, a B o Angi Gambon Stacie Bailey I f Black Rock PTO President Black Rock PTO Treasures- 720-985-4809 303-358-0597 angigambonPaol.com superiordental@comcast.net u 'a `q 'o n n w w (O 3a. Iq'�Uy N u: R ` § / O o ° E § ^ / \ / \ \ \ 0 § w r -L _ CD }/ \ � \rL \ )mm g _ ]q0 \ \\/ cm &m$ t:J c /(D\r) {@)(��® ;\ \#1 &§o p ®M rQ o \/\ %e \/ J n o ( \ Pi \/rD rD* �0 C 4 n o ] \ \ � / r k ` n rD q q ( § § _ �/ ƒ \\ Pi {§ q f§ 7 E m ( § } 2 F i n,Cr• ..' 'ee _ .. '',. {�-r= N'� ,� .l :� .f i ics-.Coldrad ! —) -- -7 Prospect Lake ' I Boulder Reservoir Colorado Springs Boulder .r On-site Check -In begins at Ti.00 riunge begins at 1:00 pm February 23, 2013' Aurora Reservoir Aurora Let the fun begin and be a part of all. the chills and thrills of PlungeFest 2013. It's not just an event - it's an experience that has become a winter -time tradition for hundreds of warm-hearted Plungers! And it all benefits Colorado's children and adults with intellectual disabilities, as they enjoy the life -changing benefits of participating with Special Olympics Colorado. Each participant must raise at least $85 ($50 for students or Special Olympics Colorado athletes). Special ®lympics Colorado Register online at www.Specia101ympicsC*.org * University of Colorado Boulder Office of International Education 2249 Willard Loop Drive Center for Community, Suite S355 123 UCB Boulder, Colorado 80309-0123 Study Abroad Programs: (+1) 303-492-7741 Fax: (+1) 303-492-5185 http://www.colorado.edu/OIE Cantina Laredo 1680 29th St. Boulder, CO 80301 (303)444-2260 To whom it may concern: On October 29th, CU Study Abroad Programs is holding our orientation for students going abroad on spring and calendar year 2014 programs. This is an exciting opportunity for students to learn about their travel destinations and to become prepared for their time abroad. We expect a total of roughly 450 students to attend. We are currently seeking prizes, such as gift certificates, for a drawing at the end of the orientation. Any donation you are able to give for this event will be greatly appreciated, and we will mention Cantina Laredo during the orientation. Thus, this is an advertising opportunity for your business to reach a large audience of students at one time. The University of Colorado holds non-profit status, in accordance with 501(c)(3) of the Internal Revenue Code, so the donation is also tax-deductible. Thanks for your consideration and potential support of international education! Sincerely, Hillary Skeffington Study Abroad Programs Peer Adviser hisk%72excl7a,colorado edu 970-481-3790 q 11;" BOULDER JEWISH COMMUNITY CENTER cc 3800 Kalmia Avenue • Boulder, Colorado 80301 303-998-1900 *fax 303-998-1965 •www.boulderjcc.org boulder Board of Directors January 25, 2013 Susan Rona President Cantina Laredo �omerstone Campaign Chair 1680 29th Street Josh Dinar Boulder CO 80301 Vice President Dear Friends: Matt Rich Treasurer Thank you for helping to make Reflections 2013 a marvelous success. Your Paula Pollachek contribution to our auction will help the Boulder JCC raise critical funds to Secretary support operations and preschool scholarships. Thank you for your donation of: FMV* Item Description Erik Bernstein $40 $40 Gift Card to Cantina Laredo Past President Jon Brandon *Fair Market Value* Leah Csapo We expect over 300 attendees this year and will make sure that everyone is aware of the support that the Boulder JCC received from your business. We Adam Edelman very much appreciate your commitment to our community. Harris Faberman The Boulder JCC serves the Boulder County community with wonderful Jennifer Goldman programs, events, and gatherings. This would not be possible without the continued financial support that we raise annually at Reflections. We appreciate Carolyn Grant your commitment and look forward to working with you again in the future. Thank you so much for your support! Ayal Korczak Sincerely, David Levin Adam Sirkus Past President Tom Trager Jonathan Lev Executive Director Butch Weaver The Boulder Jewish Community Center (BJCC) is a Colorado not-for-profit copo•ation exempt from Jason Zickerman federal taxes under Section 501 c3 of the /eternal Revenue Code. Please keep this letter with your tax records. The Boulder./CCs FEIN is 84-1322996. According to the Internal Revenue Sendce (see IRS publication 1771), yourgift is deductible as a Executive Director charitable contribution only to the extent that it exceeds the vahte ofgoods and/orservices you received in Jonathan Lev exchange for j,orrgift. We did NOT provide the donor with any goods and/orsen ices in exchange for items donated. MISSION STATEMENT The Boulder Jewish Community Center's mission is to provide programs and services based in Jewish values and traditions in a place where people of all ages and backgrounds gather to connect, exchange ideas, learn and grow together. .o Mountain View ° 355 Ponca Place 0 o Boulder, Co 803 Every year, Mountain View Preschool holds a highly attended/anticipated fundraising event to help our school thrive by offering "tuition assistance" to families in need and much needed supplies for our classrooms. Our April 19'x' event marks the 30th time that we are holding a successful fundraising event and, as a member of the local business community, we are here to present you with the opportunity to support our school/community. Founded in 1967, Mountain View Preschool is a nonprofit, community preschool. We serve children from Boulder and surrounding communities and try to keep our tuition rates low so that our school represents an opportunity for children from broad socio- economic backgrounds. Sometimes low tuition isn't enough... We are hugely proud of the fact that not one child has ever been turned away from Mountain View due to economic need and all of our children have access to educational toys and supplies. We've succeeded in making this happen because of business owners like you helping to make our annual fundraiser a success! WHAT YOU CAN DO FOR US: • Make a tax-deductible donation of your product or service to be auctioned off at our fundraiser event. (Tax ID Number: 84-0569739) • Make a cash contribution to support our Tuition Assistance Fund. THE BENEFITS of SUPPORTING MOUNTAIN VIEW PRESCHOOL: • The night of the event, your donation will be displayed with your marketing materials (if supplied) and will be viewed by all event attendees. • Your business and generous contribution will be publicized to all Mountain View families through our monthly newsletter. • Your business can anticipate increased support from over 130 Mountain View Preschool families and countless friends. We eagerly support those that support us! Please pledge your support of Mountain View Preschool by contacting us. Valerie McVeigh Preschool Committee Chair 303-499-0818 or valeriemcveigh@yahoo.com ♦ G ^ ` P , T 4 WIc xc F � u NI KA ' ti � A METROPOLIS OF DENVER March 10, 2013 Sts. Peter & Paul Greek Orthodox Church 5640 Jay Road, Boulder, CO 80301 — Phone: (303) 581-1434 http://www.stspeterandpaulboulder.org — philoptochos@stspeterandpaulboulder.org Cantina Laredo 1680 29`t' St Boulder, CO 80301 The Ladies Philoptochos Society of Saints Peter and Paul Greek Orthodox Church, thank you so for your generous contribution to our Winter Dinner/Dance and Silent Auction Fund Raiser. The gift certificate & guacamole, valued at $50, was a popular auction item. Your donation assists us in helping the less fortunate of Boulder County and the greater Denver area. We are grateful for your willingness to help. The event was a great success because of contributors like yourself and your organization. We look forward to working with you in the future. Sincerely, Candy Soulakis, Chairperson, Winter Dinner/Dance and Silent Auction Philoptochos Society of Saints Peter and Paul Greek Orthodox Church NAM V4WV���V��Is1�� L1��1�I ���� ITEMN Emergency Family Assistance Association Event Donation Form Tax IN 84-0454115 1575 Yarmouth Ave' Boulder. CO 80304 phone (303) 447-3042 Please Print Clearly II �I Donor (name as it is to appear on the program), CCLV1 Ina L'✓iC, r 6 Qw Donor Contact: _) /f ((/��y� 5`h_�T b� E-mail:: Address of Donor. City: �1_'xaA 10ter . State: CQ Zip Code: Phone: Detailed Description of Items) Donated: [ n t t'��✓ii/�(T PS \W 3,/tQ S CLL r� Value:_ Can it be exchanged? YES NO Discplay items to be returned: Gift certificate provided by Donor _ Create a gift certificate for Donor Donor signature: Date: O Solicitor/ Guide Member's Name: Phone: Thank you for your charitable donation of the ite (s) list above. This donation becomes the property of EFAA and will be purchased with all proceeds benefiting Emergency Family Assistan Association (A Colnrado Non -Profit Organization). Please retain this receipt as the fair market value of your donation may clai d as a charitable tax deduction. On behalf ajthe entire organization. x•e thank you for lour generonty and support. White Copy - Silent Auction Chair Yellow Copy - EFAA Development Office Pink Copy - Donor Boulder County CareConnect Donor B Cc Agreement Form qao-3�"-y1 Internal Use Only: F] Item received by CareConnect El TY Sent Item Location Date: Event/Program: Donor/Company Name: Mailing Address: City State: TF Zip: Contact: SZ tures Phone #: # Email Address: Web Address: Boulder County CareConnect Boulder County CareConnect Tax Exempt Number: 84-0769724 Retail Value of Donation $ Complete Description (for use on bid sheet/program) Please list all items, any restriction, special instructions, e ? Item name: u "Boulder County CareConnect ww.ca reco n nectbc.o rg 951 Arapah Ave. Ste 10, Boulder, CO 80302 (303) 4 hone (303) 443-1899 fax Delta Delta Delta Sorority Theta Beta Chapter 1025 15`s Street TA IDIBITA Boulder, CO 80302 Dear Prospective Sponsor: I am writing to you as a sister of Delta Delta Delta from the University of Colorado in Boulder. I am excited to announce our second annual Tee Off with Tri Delta Golf Tournament to benefit St. Jude Children's Research Hospital. The tournament will take place on Sunday, October 20 2013 at Fossil Trace Golf Course in Golden, Colorado. We will have a Drive and Putt Contest with fun games at 8:00 am followed by the tournament at 9:00 with many opportunities for prizes. Since Delta Delta Delta partnered with St. Jude Children's Research Hospital in 1999, we have dedicated ourselves to exceeding our past fundraising accomplishments. Our most recent goal is to raise $15 million nationally in five years, of which we have raised $10 million. This money will go towards naming the Specialty Clinic in the Patient Care Center, which will offer important services cardiology, immunology, and more. Every patient will most likely be referred to the Specialty Clinic at some point during his or her care. No other Greek organization has had this level of commitment to a charitable partner and we are proud of the impact we have made. We formally wish to invite your company to be a sponsor for our event. We are expecting around 75 players in our tournament, and this would be a great opportunity to advertise your company. If you agree to sponsor our event, we will send you a letter of acknowledgement so you may file for a tax deduction. We are offering four levels of sponsorship: Platinum ($500+) Name on back banner, check-in banner, banquet chairs, golf carts Gold ($250-500) Name on back banner, check-in banner, banquet chairs Silver ($100-250) Name on back banner, check-in banner Bronze (under $100) Name on back banner If you have any questions, please contact our Ashley Mangus, our philanthropy chairman, at ashlev.mangus n,colorado.edu. We know that our event would not be possible without our sponsors, and thankful for your consideration. Sincerely Delta Delta Delta Too Off With TR IDIM Benelittiug SG Jude Children's Research Hospital Corporate Sponsorship Form Date: %(3 Contact Name: ���;j Company Name: C,6� WP— Lna�--� It 1 g3 Mailing Address:L Kb 29wk � City: &-wVCG-/ State/Province: C6 Zip/Postal Code: Telephone: 'U Fax: Email: Sponsorship Level: ❑ Platinum ($500+) ❑ Gold ($250-500) ❑ Silver ($100-250) ` ronze ($100 and under) *email ashlev.man eus(alcolorado.edu with any questions Please make checks payable to: St. Jude Children's Research Hospital. And reference Tri Delta -Theta Beta Chapter ` 66's%s& /0'tta Thank you for your auction item donation Page 1 of 2 Cantinal-aredo193-Boulder From: Steve Emmett-Mattox [semmettmattox@gmail.com] Sent: Saturday, February 09, 2013 5:52 PM To: CantinaLaredo193-Boulder Subject: FW: Thank you for your auction item donation Hi Andrew, Thank you again for the donation — it really makes a difference! Our tax ID # is 84-1222200. Call or email if you need further documentation. I'll send you details about the event, and invite you to attend. See you soon... Cheers, Steve Emmett-Mattox (and Liz and Adrian) 720-300-3139 From: Shepherd Valley Waldorf School [mailto:svws-auction@biddingforgood.org] Sent: Saturday, February 09, 2013 5:47 PM To: sem@alumni.rice.edu Subject: Thank you for your auction item donation Biddin#ForGood Shepherd Valley Waldorf School - Shepherd Valle Auction Gala 2013 Item Donation Thank you for submitting the following donation to Shepherd Valley Auction Gala 2013 on Feb 09, 2013 07:46 PM, EST of: Quantity: 1 Item Name: Dinner for three at Cantina Laredo Item Description: Enjoy three complimentary entrees (limit $15 each), and Top Shelf Guacamole made fresh at your table ($30 value), at this gourmet mexican restaurant. Located at the 29th Street Mall in Boulder. Great place for children, too! Value: 55 Donor: Cantina Laredo Your support of the auction is crucial to the success of our event and is greatly appreciated! The Auction Team will be reviewing the item you submitted soon and may contact you with any questions. You will receive an email after your item has been reviewed. 2/12/2013 Thank you for your auction item donation If you need to contact us regarding the item you have submitted, please contact us by email at auctionLa@shepherdvalley.org. Please be sure to visit our auction site and check out the items in our catalog! We appreciate your generous support, Shepherd Valley Waldorf School BiddingForGood Run an Online Fundraiser Copyright © 2003-2013 BiddineForGood, Inc. All Rights Reserved. 2/12/2013 Page 2 of 2 DER 'OCHAMBER RCHESTRA ,D r Boulder Chamber Orchestra Supporter, 4735 Walnut St. Ste F Boulder, CO 80301 303 583 1278 www.boulderchamberorchestra.org On March 14, 2013, the Boulder Chamber Orchestra will host its primary fundraiser featuring a live and silent auction at the Rembrandt Yard in Boulder. The event will feature live music, wonderful food and camaraderie. We would like to ask you to please consider donating to the auction. As a donor, you will receive publicity at our event, on our website and in our programs. Donors are also encouraged to provide business cards, flyers, etc. that can accompany their donated item. With a donation valued at $100, we are pleased to provide you with two complimentary tickets to one of our concerts. The BCO reaches a diverse audience, made up of well-established professionals, varied income residents, retired citizens, students and everyone in between! We are proud of our sell out concerts in Boulder and continue to increase our patrons in both Broomfield and Denver. The Boulder Chamber Orchestra was founded in 2004, by Boulder resident and musician, Bahman Saless. Its goal is to fill an important niche in the cultural landscape of Boulder and the surrounding areas. Since its inception BCO has continued to grow in size and recognition. The BCO is a 501(c)3 non-profit organization and all contributions are deductible under section 170 of the IRS Code. Thank you for your kind consideration and support, Sincerely, Elizabeth Kennedy Managing Director Organizational Information: Chamber Music Society of Boulder • Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 BOULDER CHAMBER ORCHESTRA Letter of Agreement 4735 Walnut St. Ste F Boulder, CO 80301 303 5831278 www.boulderchamberorchestra.org Thank you for donating an item for the Boulder Chamber Orchestra (BCO) auction to be held in conjunction with the annual gala on March 14, 2013. In addition to helping BCC) (http://www.boulderchamberorchestra.org) raise funds to present wonderful concerts for the community; this is a unique opportunity for your business to have broad visibility to our constituents. Your item, logo and web link will appear on the BCO website as part of the promotion for the event. Please submit your corporate logo in a graphic file (.GIF, .TIF or .JPG) in a size approximately 180 pixels wide to janice@boulderchamberorchestra.org. BCO retains the right to resize the image but will keep the aspect ratio the same. Name: _ Address: Item donated: Description: _ Web Telephone #: Email: Fair Market Value (FMV): $ Suggested opening bid: $ Donated items are tax deductible at the FMV at the time of the contribution. All donors will be mentioned in our April concert program. We look forward to a spirited auction, the proceeds of which will benefit BCC) as it continues to bring world-class music to your community! Thanks again for your participation Signed and agreed: Name Date Boulder Chamber Orchestra Organizational Information: Chamber Music Society of Boulder • Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 (06 C O N _GE G ATIO N BONAI SHALOM Andrew Richardson Cantina Laredo 1680 29, St. Boulder, CO 80301 Dear Andrew, Thank you for your support of Congregation Bonai Shalom's (CBS) Purim Gift Package Fundraiser. Your generous support helped us not only reach, but exceed our fundraising goal of $20,000, with the final number showing a 25% increase over 2012. Our membership was ecstatic with the Purim Gift Packages and the wonderful things in them, thanks to you. A booklet with your logo and business name was included with the delivery of the Purim Gift Packages to all CBS members, JCC Pre -School Teachers, & CU Hillel Students. A copy of the booklet is enclosed. Your business was also included in: ■ Multiple emails to CBS members; ■ The CBS bimonthly newsletter; ■ Weekly written and verbal announcements. As Congregation Bonai Shalom is a 5016 not-for-profit organization, your contribution is tax- deductible to the extent allowed by law. Our tax ID number is listed below for your reference. Please let us know if you need additional documentation for your donation. We hope you are enjoying the patronage of CBS members now and in the future. We look forward to working with you again next year! 7w: ' i Rhonda Wildman Purim Package Chair Congregation Bonai Shalom Tax ID: 98-0483 1527 Cherryvale Road Boulder, Colorado 80303 • tel: 303.442.6605 • fax: 303.442.7545 www.bonaishalom.org ReachOut Crest View Crest View Elementary 1897 Sumac Boulder, CO 80304 303-443-6363 i Ned Levine Principal Dear Andrew/Cantina Laredo: ReachOut Cr ><e� Plans are underway for the annual Crest View Elementary School Silent Auction to be held on March 16, 2013. Our 600 students and their families are invited to enjoy a night of community fundraising. Please consider supporting our neighborhood school! Did you know that Colorado is ranked 42°d in per -pupil funding for K-12 education, $1,919 below the national average*? And it's only getting worse, as the state responds to the current recession by slashing millions of dollars from Boulder public schools. As a result, fundraising has become a necessity. This can be particularly challenging for a school like Crest View Elementary, where 24% of our students receive free or reduced -price lunches. But thanks to businesses like yours, our auctions have been very successful. Proceeds from our auction help fund many classroom needs like reading programs, computer software, books and playground equipment. The funds have also supported community outreach programs, as well as grants to teachers for special class activities. Please support our students by becoming one of our many donors again this year! In return, your participation will be acknowledged in our Silent Auction brochure, on bid sheets and in a Daily Camera ad thanking all event contributors. ReachOut Crest View is a nonprofit organization and donations are tax deductible as allowed by law. Please have your donation to us by February 15th, 2013. You may mail your donation to me, or call to have it picked up: MOLLIE MCCAIG, 2545 TAMARACK AVE., BOULDER, CO 80304 TELEPHONE: 720.250.6909 Thank you for helping support our North Boulder neighborhood school! Sincerely, MOLLIE MCCAIG The Crest View Silent Auction Tenn *source: Great Education Colorado � THANK YOU To whom it may concern, On behalf of CU Women's Rugby, we would like to thank you for supporting our team by donating to our banquet and silent auction last month. Your donations helped our banquet be the most successful yet with a total of $4,600 for Nationals. Your donations are tax deductible; the code needed is 98-02915. We can provide a formal receipt if needed. We thank you for your continued support in the future. Sincerely, CU Women's Rugby ABoulder County Republicans 2013 AUCTION DONOR/DONATION INFORMATION FORM (The deadline date for submission is Sentember 1. 2013.) Name: 41)Ar!l :�\ iG��GJSoy Date: 7Z24 .201-3 Company Name: ilfeZ11 Iii? a_�//'�Qi PcG% Phone: :30j - `YVY-4U GQ {�y_.12 / \ Address (street, City, state, Zip code): 46 J _.7 / Employer Name (Required if different from Company): Occupation (Required): p a ti ao /114 ngg e ey tired: EJ Description of Donated Iterl l ' Retail Value of Each Donated Item: !, If you n oom for addition enfor atlo , ase continue on the ack of this form. Signature: BCR Rep's Note: We cannot accept checks or donations from corporations. Donated funds or products must be made by individual donors by name. Thank you in advance for your contributions. FeaeS&C 2U1cre Boulder County Republicans Lincoln Dinner 2013 Auction Chair 550 Manorwood Lane Louisville, CO 80027 bwhite@bocogop.org COLORADOCENTER MUSIC FOR FESTIVAL MUSICAL ARTS Office Use Only Item #: Gift Cert. Attached: Category - AUCTION CONTRACT 200 Baseline Rd., Lafayette, CO 80026 Phone 303.665.0599 Federal Tax ID #84-0735716 Please type or print clearly (press firmly) and fill out completely. One contract per item, please. (White Copy - Office, Yellow Copy - w/Item, Pink Copy - Donor) Donor(s): CAN 110 L A/ZE-�;> Contact Person: ANV A'r_ L) AI- Hpr pSoyo Phone:_3 — zz-6 e) Donor Address: 1bF0 29+y s 1 City, State ZIP Fax: Complete item description: Retail Value: This item is a gift $X0301 - E-mail: /5 Expiration Date (if appl.): cater No Do we need to create a gift certificate? (not provided by donor): Yes Special instructions/additional information: CMF & CMA Representative: -re .S/✓I 1T1 Phone: 3-536 // 92-1 Date item to be picked up: Location: CMF & CMA Event item will be used at: Srz:e-L-- Azn/ z' 2d/,3 THANK YOU FOR SUPPORTING THE COLORADO MUSIC FESTIVAL & CENTER FOR MUSICAL ARTS! Jarrow's Big Alight Friday, April 19th, 2013 at Rembrandt Yard Jarrow Montessori School. Item Donation Form Benefiting Jarrow's Financial Aid Program Your (as you would like it in our program) Your Company Contact City, State, Zip Code Telephone Number Fax Number Email Address Description of item(s) donated (50 word maximum) Please list all restrictions (MUST list exact blackout dates, additional costs, expiration dates -may use back of sheet) Approximate Value (as determined by donor) Donor's Signature Date My Donation is: ❑ Enclosed ❑ Please call to arrange delivery My promotion materials are: ❑ Enclosed ❑ Item will be mailed or shipped by (date) ❑ Please create a certificate for my donation ❑ Materials will be mailed or shipped by (date) Please send a JPEG of your logo and/or item (and website link, if applicable) to gavin.green@jarrow.org The school reserves the right to combine your donation with other donated items to create an auction package. Jarrow Solicitor Date Solicited Telephone Return this donation form with your donation to: For Office Use Only Jarrow Montessori School Date Received Attention: Gavin Green Date Completed 3900 Orange Court Boulder, Colo. 80304 JARROW Reference Numbe* Acknowledgement Sent Or email gavin.greenCa jarrow.org MONTESSORI SCHOOL Auction Page/Category OUR DONATION DEADLINE IS MARCH 5, 2013 •T�0 c z �O • D _� � o � C) r >r W Z' •� 24rn o m �► y rn ZZLw-""yuS_.x IlSe s 4-1 U -� C — � to C U °ern N E c r - L U p m U i U O C . 4-1 C V) 4J N`+- C� 0 +J 'n O O cu U�`�° L a� CC: -� Cs _ C3 oCU O Cr a`..E CLa -c °6m 0 § o a`) U Z o m a E o c O LIC cn O v_y > Co m E cu U-0 Ow — o o O m %O m 0N O_O CD O Q Q co Joi 0 U O E4) 0 o �n SCD ,, E �u-m am O0v �0 ZL 3 o m a. m ,... >,o a d 3 0) ca U- � SECL C) -0- c°m >NV Um a C: cc Q m � o C N v) w n c LO U w U) c u q7 .� E o A 0� m LL m s ® Ln C > a •I• N LA " E o CL m v1 vto�� o u_ .�. - 1 D = 0 Q CLL •A O i N vl v10 tu Q/ Q C e lu j s� LL. �J� L CLn L • ro � •l.J C) o°/ aJ 0' a) v `° n R a V1 sue ` _ n m i � •� � 3 0 m to 0 m •ro L •NUS `� O Ln 0 i.• m W O G N = -0 C u E rro 0 C CL O m O CIL Ln • A CL U U p c ,� N -00 ` 1J _ tea" a �_ v rn c m a r 40 ISN Is cs9< Q'> Q) sr A d4 p`t'y",44 cw:�)t LJOOVU os roti ;j VVL � S CD Ln l� c� • _ • Ln Ln • � c� a5 Lina as t u. I WILL NEVER F R.(.. WHAT YOU HAVE DOT,?: FOR ME Cd ami z b O O �3 N .to O O to 0 d CA O 3-y a ao i V `J a �z� > 00 O Ln N .� n O N N C O y � ' C .. N CDvs oo CD o •ti c o U O O C O h u O � c03 u o ,x O C p j V) N O ��-.+-.+.y. i+ O O co N Q O OCD U d Q o o •o o � Q. � V J." d O. Q � O W Z a cc m U oc C.) onlsA IIS;a2I Iloogas poogaogq%iaa aapinog gpoN .ino poddns o; %uidlaq .ioj "ungZ L8£ZI9I--V8 #QI XL (IoouoS Cmluauzajg mQln jsaiD) jdpoa-d uoiluuOa MOIA TsaaD Inp uouaN (sp.mai mo i ioj uoiliod wolloq daax p )iau .real) � 3 /v � - 4 � h r ...AND MORE THANKS 1, ho, n� yin 5o -muA �r cvcvythiff� jou'vo dor) bD make -LWoI �ecial you. hMc) n),) t dca-, how rruAck , � �-T- 4 Pr ate- 2014 From: BHS Panther Club & Athletic Department <marcia.clark-smith@bvsd.org>6f ti Subject: Panther Gala Data: January 15, 2014 12:44:24 PM MST To- <mznewell@gwestoffice.neb Reply -To. BHS Panther Club & Athletic Department <marcia.clark-smith@bvsd.org> 1 Attachment, 645 KS SAVE THE DATE: Boulder High School will be hosting a snorts extravaganza to benefit the athletic programs at our school. Our 1 st annual Auction, "Panther Gala", will be held on at The Elks Club in Boulder, CO. This festive and fun evening will include a fabulous silent and live auction, a VIP reception, music, dinner and a cash bar. At BHS we are focused on creating a team of student athletes who will be prepared to give everything they have to themselves, their team and their school. We need your help! This first annual event will establish regular fundraising for our entire school athletic department, student athletes, and your future community leaders. Boulder Valley School District (BVSD) would like to continue connecting with you via email. To set preferences for which types of messages are sent to your email address, activate your free Contact Manager account. i" you prefer to stop receiving emails.from BVSD, foljgW this link and conflnr: Unsubscribe. Please note that if you unsubscribe, your email address w will be placed on the "blocked list" for the remainder of the cTent school year and will no longer receive BVSD school or district emails that are distributed through our School Messenger service, Sch ool Messenger is a notification service used by the nation's leading school systems to connect with parents, students and staff through voice, . SMS text, email, and social media. Doy � Andrew Cantina Laredo 1680 29th Street Boulder CO 80301 Thank you so much for your support of BCD's recent fundraiser on March 13th at the Rembrandt Yard! We were able to raise over $30,000, and your support will allow Boulder Chamber Orchestra to continue and expand the programming, education, and outreach activities that we offer our community. Boulder Chamber Orchestra is a non-profit, 501(c)3 organization committed to enriching the arts community since 2004. EIN: 84-6036754 Items Donated Item# Title Value 812 Cantina Laredo $ 55.00 3 entrees and 1 table side guacamole Total $ 55.00 Dear Supporter, The 0 Family Learning Center Filing the Pbtmtial of Children and Familia Since 1981, The Family Learning Center has partnered with Boulder County's low-income and culturally diverse children and families to create the tools necessary for self-sufficiency and lifelong success. Each year the Family Learning Center offers educational and basic needs resources for children of all ages including: computer skills training, after-school programming, one-on-one tutoring, bi-lingual Pre -School and Pre K classes, PSAT/SAT preparation, parenting classes, and much more. 20% of Boulder County children are low-income and at risk for dropping out of high school, but children who complete our program graduate from high school 99% of the time. The Family Learning Center is Boulder's only sliding scale educational community center, and we are proud to say that no one is turned away from FLC due to an inability to pay. Creating change happens one person at a time, and we are committed to doing whatever it takes to see our students graduate and go on to be successful community members. This year we will celebrate the accomplishments of our community and work to raise funds for community programming in the coming year at our annual Penfield Tate Humanitarian Awards Dinner and Auction. The event will be held at the CU Stadium Club on September 26, 2014. In order to make the event a success we need your support with live and silent auction items. These items can range fi-om restaurant certificates to sporting event tickets and/or shopping certificates to hotel accommodations, spa packages and vacation packages. Thank you in advance for taking the time to support the great work happening at the Family Learning Center. Your generosity enables us to provide essential services and educational resources to low-income children and families in Boulder County working to break free from the cycle of poverty. Warm Regards, D� From the Volunteers and Staff of the Family Learning Center Y-;Lg../, The Family Learning Center is a 501(c)3 non-profit organization. Our Tax ID # is 74-2240341 3164 34th Street • Boulder, Colorado 80301-2166 • 303-442-8979 • FAX: 303-442-0901 info a flcboulder.org • www.flcboulder.org Boulder High School Panther Club On behalf of Panther Club, we would like to thank you for your generous donation. Panther Club is a qualified 501(c)3 tax-exempt non-profit organization supporting athletic programs at Boulder High School. Our Federal Tax ID number or Employer Identification Number (EIN) is 84-1406282. Andrew Richardson Cantina Laredo 1680 29th St Boulder, Colorado 80301 Estimated Donation Donations Value Silent 244 Gift Cards to Cantina Laredo $35.00 Total Donations $35.00 ell Note: The amount deductible as charitable contributions for federal income tax purposes is limited to the excess of actual purchase price over the "Estimated Donor Value", or fair market value of the item. 2014 Panther Gala Friday, March 28, 2014 Board of Directors April 21, 2014 Linda Treibitz, President John McKieman, Secretary Cantina Laredo 1680 29th Street Al Mizrahi, Treasurer Boulder, CO, 80301 Cammie Cloman Dear Cantina Laredo: Dana Mathes Thank you for your contribution of a Gift Certificate, valued at $50, for William Wei Stories on Stage's Silent Auction 2014, which was on Saturday April 5 in Linda Roberts Zinn Boulder at the Dairy Center & Sunday April 6 in Denver at Su Teatro Cultural and Performing Arts Center. The auction was a huge success thanks to your generosity! Staff We truly appreciate your support in helping us to continue our mission of Anthony Powell combining theatre and literature to encourage mutual understanding Artistic Director among a diverse audience. With the help of your contribution, we are able Abbe Stutsman to bring amazing talent to Denver and present some of the best literature Executive Director available. Lisa McClellan Administrator Thank you for partnering with us to make this year's Silent Auction so successful. We are grateful for your outstanding support. 1 I /I'V" _ 2590 Walnut St f 1!� W rf11 I Boulder, CO 80302 303.494.0523 1 www.storiesonstage.org U info@storiesonstage.org PANalytical Boulder 2555 551h Street Boulder, Colorado 80031 Tuesday, June 03, 2014 Dear Friend, &ASDInc. 15 NOW, PANalytical This year's PANalytical Boulder Chili Cook -off to benefit Community Food Share (CFS) will be held on Wednesday, June 11, 2014 at our office in Boulder. An exciting silent auction will be featured at the event, and we would like to request your help, by asking you to contribute a silent auction item from your business. Who is Community Food Share • Their mission is to ensure that no one in Boulder and Broomfield Counties goes hungry. Population Served • There are over 56,000 people in Boulder and Broomfield Counties who are living at or below 130% of poverty ($30,615 annually for a family of 4) • There are over 14,000 children enrolled in the School Free Lunch program in the Boulder Valley and St. Vrain Valley school districts. • Community Food Share played a vital role in providing food assistance to those affected by the September floods. We are committed to helping with the long-term recovery process, by continuing to provide flood - related food assistance as part of the daily operations of CFS Community Food Share's Response • Founded in 1981, CFS is the central source for food procurement and distribution in Boulder and Broomfield Counties, with the goal of eliminating hunger and food insecurity for all community residents. • ALL FOOD IS PROVIDED FREE OF CHARGE • In 2013, Community Food Share will distribute 7.65 million meals (1 meal = 1 pound). The value of this food is $12.9 million. • The CFS food distribution program "casts the widest net" via multiple distribution points, including a network of 47 local Member Agencies and their own Direct Distribution programs. They serve 35,000 individuals annually. o The member Agencies include food pantries, soup kitchens, shelters and residential treatment homes. Community Food Share provides the majority of the food that many of the agencies distribute to their clients. o The CFS Direct Distribution program helps to ensure that food is being distributed to specific groups of vulnerable populations, including families with children on the School Free Lunch program and low income seniors. How Can You Help? Simply provide us with a silent auction item from your business, along with the approximate retail value for that item, and then sit back and relax, knowing that your donation is helping provide food to those who need it in Boulder and Broomfield counties. Dollars raised at our Chili Cook -off and silent auction will play a major role in helping us ensure that no one in Boulder and Broomfield Counties goes hungry. Please help us fight hunger! We thank you in advance for your support! Sincerely, PANalytical Boulder so asdixom 303.444.6522 12555 55th Street, Suite 100, Boulder, CO 80301 Ind Thank You! �- You Helped us Soar --gin 1 Eagle Way - Broomfield, CO 80020 Dear Broomfield High School Supporter: Thank you for your generous donation to this year's Broomfield High School Eagle Sports Gala. In one evening, eve brought in $63,000 so our athletes do not have to go door-to-door fundraising. loo % of these proceeds go to every sports team at Broomfield High School. Donations made to Broomfield High School and the Boulder Valley School District RE -2 are tax deductible by donor under Section 170 of the Internal Revenue Code. The mission of the Gala was to provide a fun, fund-raising event to assist our athletic programs while offering the opportunity for building community involvement. We thank you very much for supporting Broomfield High School. 2014 Sports Gala Auction Committee Fran Milner Tammie Wristen Stacey Hassell Nancy Ewing Jason Sarno Lisa Hulst Tom Milner Dave Hulst Lisa Whitsell Penny Platnick Leslie Lewis Chris Genge Graham Squire Andrew Wells John Long Your Donation Value: (i415 Broomfield High School Tax Identification number is 98-02383-0000. S�hne 9 w School - --- Sl�yFins 1(tgTi Sc600f •600 �E �2ountaR 'f�iew>[ve. • Log nrtt, CO 80501 • CPfw— 720 494,3741 • TIW303 682-7382 Dear Skyline Football Sponsor: This letter is to authorize the presenter to solicit donations of money, goods or services on behalf of the Skyline Football Touchdown Club. We are currently seeking donations on behalf of our Program Book and Auction (August 16th). We are also seeking donations to help provide meals for our players during the summer and the fall. Finally we are asking for donations to sponsor our major program needs and provide scholarships for kids to our team camp this summer. Each year we rely upon the generous donations of our community supporters to provide the first-class experience to our players that they deserve. Skyline High School traditionally has been a neglected and underfunded school in the Longmont community and YOU ARE HELPING TO CHANGE THAT!! We believe in teaching life through football and in working hard together, doing things the right way and becoming better people, students and athletes. We want our program and players to make a positive impact in the community and achieve in school. Any support you can give to our players is very much appreciated and a very worthy cause. All sponsorship goes directly to Skyline Football and helps provide such important items as equipment, uniforms and meals to our players each year. We are a non-profit organization so any support you provide is tax deductible. Our tax exempt ID number is 98-02634. Thank you from all of our players for your generous support of Skyline Football. Please contact Head Coach Kevin Rice at 303-907-2197 or kevinrice73aamail.com if you have any questions or would like to donate. Thank you in advance for looking over our specific needs below and the attached Donation Levels form and for deciding today to make a difference in the lives of our young people and improving the future of our community! Your amazing generosity will be greatly rewarded now, and well into the future! With the utmost respect, Kevin Rice Head Football Coach 2014 Skyline High School Football Sponsorship Needs: Equipment (helmets. shoulder pads, etc.): $5,000 Uniforms (practice and game): $3,000 Team Practice Wear (shorts, shirts, sweatsuits): $6,000 Scholarships to Team Camp: $6,000 Skyline Football Team Banquet: $5,000 Scoreboard for Skyline Field: $10,000 Weight Room Equipment and Renovation: $50,000 New Sports Turf Playing Surface at Skyline High School: $500,000 it ume of the ' Ekon Skyline High School TOUCHDOWN CLUB: DONATION LEVELS Skyline ah Schoof SI(y M 9fgh School - 600 E- Nmm& n'16ewAve. -Longmont, CO 80501 - Phone 720494-3741 - T4,003682-7392 SKYLINE HIGH SCHOOL FALCON FOOTBALL DONATION FORM Name: Business (if applicable): Address: Phone Number: Email: I am making the followin donation: Financial: $ (_ cash check #) Make checks payable to: Skyline High School Football Other (please specify below): Please return this form to Head Coach Kevin Rice: Skyline High School PO Box 254 Longmont, CO 80502 Fax: 303-684-8912 Email: kevinrice73@gmail.com Website: tiny.cc/shsfootball or tiny.cc/touchdownclub THANK YOU FOR YOUR SUPPORT Board of Directors Andre Williams President Gary Jaycox Secretary Howard (Hy) Harris Treasurer Brenda Lyle Rick Sterling Janice Hughes Steve Clouthier Samara Portis Tim Reynolds Merrilee Peterson Gale Day Stuart Lord Cindy Davis Jennifer Thompson Honorary Penfield Tate In Loving Memory Staff Brenda Lyle Executive Director Mary Schmidt Business Manager Ruthie Chavez Admin. Assistant Ramona Thomas Preschool Director Monica [barna PreK Director Eric S-.hmidi Elementary Dir. Pilar Aguilar Family Literacy & Outreach Coord. Mark Raley IT Coordinator Elton Davis After School Dir. Jamathan Lyle Middle School Dir. Y . �' Foothills United Way The 0 Family Learning Center 1u,W.8dKPb tWdCkU=wdF Tm October 22, 2014 Greetings: On behalf of The Family Learning Center I would like to thank you for your generous donation to this year's 20th Annual Penfield Tate Humanitarian Awards Dinner and Auction. Thanks in large part to your contribution we were able to raise over $125,000.00 to support family and children's programs for over 1800 people. Your commitment to helping families and children in our community is sincerely appreciated. Each year The Family Learning Center continues to advance its mission of "encouraging successful lifelong learning and economic sustainability for families and children of diverse cultures and limited incomes, in a learning environment where families and children feel nurtured, respected, and empowered". Through our early childhood learning, pre -collegiate school-age and family sustainability programs we have seen many lives changed for the better. In particular the pre -collegiate program has enjoyed great success in the past year, with 100% of our low income high school seniors graduating from high school. The goal of Boulder's Family Learning Center is to continue to make a difference in the lives of all families and children in need in our community. With the help of donations from supporters such as you we will continue to see improvements in their lives and the communities in which they live. Thanks again for your generous support of our efforts. We wanted you have a copy of the "Thank You" ad we ran in Boulder's Daily Camera acknowledging your support. We sincerely hope you and your company will consider contributing to our 2015 Silent Auction. Best wishes, Executive Director 3164 34th Street • Boulder, Colorado 80301-2166 • 303-442-8979 • FAX: 303-442-0901 info@flcboulder.org flcboulder.org • http://www.flcboulder.org Family Learning Center Tax Donation Receipt 9/1/2014 Cantina Laredo 1680 29th St Boulder, CO 80301 Thank you for your inkind donation of $25.00. Please keep a copy of this gift receipt with your tax records. Your contribution is tax deductible as allowed by law. No goods or services were given in whole or in part in consideration of your gifts. Patrick J. Mahaffy Grat efuII Rick 4V. Nelson ' Michael Noesen Mary Nutt Ron Id A. Secrist Scott Patten President --------------------------------------------------------------------------- Linda Stancliffe GIFT RECEIPT David Taylor DATE OF GIFT TYPE AMOUNT DESIGNATION Vicki Ttzonbo 11/04/14 Gift In Kind $39.00 November 22, 2014 3 Vouchers Holiday Extravaganza P.O. Box 9019 Boulder, CO 80301-9019 303.440.2167 www.bch.org TaxID#/: 84-0772664 Boulder Community Health Foundation Supporting BCH for over 35 years November 12, 2014 Board of Trustees Ronald A. Secrist Cantina Laredo President 1680 291h Street Bryan J. Pieper Boulder, CO 80301 Chair Nancy Al Stevens Dear Friends, Vice Chair Thank you for your kind gift to the Boulder Community Health Foundation! Richard Al Lirtzntan Secretary Boulder Community Health, your locally owned, governed and not for profit community John T. Greff healthcare system is now in its 92nd year of service to the Boulder Valley. While there have been Treasurer many changes to health care, our communities and region over these decades -----there has been one constant ----BCH is here for you, your family and loved ones with the best trained and Terri Bet Jamin compassionate physicians and medical staff and with the latest in medical technology to help "get you better". We now serve six Boulder Valley communities with 18 clinics and medical John Fleagle, M.D. facilities. Anne Gebardl O Brien Your gift to BCH helps your community healthcare provider to continue to improve, expand David A Gehant services and serve everyone in need in our county. Alan F. Heath Thank you for your kindness and generosity! Helayne Jones CingvLefkoff Wishing you good health, Patrick J. Mahaffy Grat efuII Rick 4V. Nelson ' Michael Noesen Mary Nutt Ron Id A. Secrist Scott Patten President --------------------------------------------------------------------------- Linda Stancliffe GIFT RECEIPT David Taylor DATE OF GIFT TYPE AMOUNT DESIGNATION Vicki Ttzonbo 11/04/14 Gift In Kind $39.00 November 22, 2014 3 Vouchers Holiday Extravaganza P.O. Box 9019 Boulder, CO 80301-9019 303.440.2167 www.bch.org TaxID#/: 84-0772664 Denner Heart Ball '3 Auction Opportunities American • ' �Heart Association. life is why~ DENVER Heart Ball 2016 Event Sponsors & Invitations EMPOWER .ens a C.tu. Hm)th � � o.elna % EY Hmtt atld vasadar 1�chvodc11-.0m. WORM 0 o Envision D 2016 Denver Heart Ball Saturday, February 27, 2o16 G:00 in the evening Hyatt Regeacp at the Colorado Convention Center 65015th Strect, Dcnver, CO 80202 2016 Denver Heart Ball Chairs: John & Maurcen i-L—ep. Retired Presideat & CEO ofunivetaitpor Colorado Hospital 5:30 pm - 6,30 pm, VIP Reception (imitation only) 6,0o psn- 7:00 pm, Reception & SilentAuction 710 pm, Dinner. Program & Live Auction 9,30 pm, Dancing Vier silent avid live auction items and purchase tickats at denverba rtb•ttt,eamorg For more information regardingemk"s, sponsorship opportunities or to make a donation, please mntact BlairPeues at 3o3.8on.4658 or via email atblairpestes6he morg 6=-_ I HeaH BaU F.R r>..aeaow mann6t. ►. j D.—, CO a..,. +v�s1�w WGREATWEST EMPOWER Pk"Ktat a w ■ ■ Envision [I UCHealth 17 a E+ L t o C A a E vNivasm of cRaRAN NoirlLt H.d!h Cemva v r + Col—do Butinen Bank medbvnk tr ,1� �� oe.m.rnu.er DdOkt! ►. j �� IOO[iON +v�s1�w goo �_ �3 INBPIRATCY '` mT Auction Details & Photographs Why donate to the Denver Heart Ball? The funds raised through our auction sales will go directly to improving children's heart health, childhood obesity and healthy awareness programs for children in our community. Everyone wants their company or product to be seen, by donating to the Denver Heart Ball auction, your product and company will be seen by hundreds of qualified buyers in the community. Auction Goal Fair Market Value (FMV) Goal: $200,000 Night of Event Goal: $140,000 Auction Agenda The Denver Heart Ball will have three auction sections; Live, Super Silent and Silent. Guests will arrive to attend a cocktail reception for the first hour and a half of the evening where they will have the opportunity to bid on Super Silent and Silent auction items. The Live auction will take place in the ballroom during the evenings program. Thank you for your interest in the Denver Heart Ball benefiting the American Heart Association. For more information on auction donations please contact: Blair Pesses - Director, Denver Social Events Team 303.8o1.4658 Blair. Pesses Pheart. org 1777 S. Harrison Street, *500 Denver, CO 80210 American Heart Association Tax ID #: 13-5613797 Dear friend, Congregation Bonai Shalom is Boulder's only Conservative Synagogue with over 200 member families. In fact, we are the second largest Conservative Synagogue in Colorado! We are hosting a large Lag B'Omer celebration and bonfire on Sunday, May 18th, 2014 at 5 pm at the home of our Rabbi. This celebration will include a silent auction, with proceeds from the sale used to help offset scholarships that we give to members of our school. Classes begin in kindergarten and go through 7th grade, when our students have a bar or bat mitzvah. Currently, 62 students are enrolled and many of our families are in need of scholarships for school tuition. Please consider donating restaurant gift cards that will be used for our silent auction. We will advertise the silent auction items to our community during the event so that bids can then be placed. Our deadline for receipt of donations is Wednesday, May 14�h, 2014. Please send donations to PO Box 19784 Boulder, CO 80308. Congregation Bonai Shalom is a 501(c)3 organization. Our CO ID number is 98- 04830. Our Federal ID number is 84-0891557. If you would like more information, please contact me. Thank you, Arti Goldstein, Fundraising Chair Cell: 303-653-5776 1527 Cherryvale Road • Boulder, Colorado 80303 • tel: 303.442.6605 • fax: 303.442.7545 9 www.bonaishalom.org F ey/r. y• i View Preschool ;a Place CO 80303 N Every year, Mountain View Preschool holds a highly attended/anticipated fundraising event to help our school thrive by offering "tuition assistance" to families in need and much needed supplies for our classrooms. Our April 25h event marks the 31st time that we are holding a successful fundraising event. As a member of the local business community, you have the opportunity to support our school/community. Founded in 1967, Mountain View Preschool is a nonprofit, community preschool. We serve children from Boulder and surrounding communities and try to keep our tuition rates low so that our school represents an opportunity for children from broad socio- economic backgrounds. Sometimes low tuition isn't enough... We are hugely proud of the fact that not one child has ever been turned away from Mountain View due to economic need, and all of our children have access to educational toys and supplies. We've succeeded in making this happen because of business owners like you helping to make our annual fundraiser a success! WHAT YOU CAN DO FOR US: • Make a tax-deductible donation of your product or service to be auctioned off at our fundraiser event. (Tax ID Number: 84-0569739) • Make a cash contribution to support our Tuition Assistance Fund. THE BENEFITS of SUPPORTING MOUNTAIN VIEW PRESCHOOL: The night of the event, your donation will be displayed with your marketing materials (if supplied) and will be viewed by all event attendees. Your business and generous contribution will be publicized to all Mountain View families through our monthly newsletter. • Your business can anticipate increased support from over 100 Mountain View Preschool families and countless friends. We eagerly support those that support us! Please pledge your support of Mountain View Preschool by contacting us: Marcy Kendall Major Fundraiser Committee 303-619-4767 or Marcy. Kendallna,�mail.corn DELTA SIGMA PI® America's Forrmost Professional Biainess Fraternity %Z� Delta Sigma Pi is a professional fraternity organized to foster the study of business in universities; to encourage scholarship, social activity and the association of students for their mutual advancement by research and practice; to promote closer affiliation between the commercial world and students of commerce, and to further a higher standard of commercial ethics and culture and the civic and commercial welfare of the community. We are the Spring 2014 pledge class of Delta Sigma Pi. We are business and economics students at the University of Colorado, Boulder. Our goals for the semester are to improve on the Fraternity's four pillars: professionalism, brotherhood, leadership, and service. In order to complete our obligations required for full initiation into the brotherhood, we must raise $2,000 for a professional event by April 1 st. For every $50 that we raise, we will donate two hours of our time to local community service organizations. These organizations will include Peanut Butter n Lovin', The Humane Society of Boulder Valley, Community Cycles, Wildlife Restoration, Boulder Shelter for the Homeless, and Boulder Housing Partners. It is very important to our pledge class to continue Delta Sigma Pi's tradition of contributing to the community and bettering ourselves as members of society. We appreciate the time you took to review our request to fundraise together. Our pledge class looks forward to the opportunity of working with Cantina Laredo to achieve our goal. If you have any questions please feel free to contact us at: Tatiana Celentano, VP of Fundraising (310) 944 4079 tace4198@colorado.edu -/k(/ /I,/ Megan Juell, President (720) 403 5418 -4sD C�Ic;p megan.juell@colorado.edu BOULDER CHAMBER ORCHESTRA Dear Boulder Chamber Orchestra Supporter, 4735 Walnut St. Ste F Boulder, CO 80301 303 5831278 winw.boulderchamberorchestra.org On March 13, 2014, the Boulder Chamber Orchestra will host its primary fundraiser featuring a live and silent auction at the Rembrandt Yard in Boulder. The event will feature live music, wonderful food, and camaraderie. This year we are proud to be celebrating our tenth anniversary season, and the theme of the event is a musical masquerade ball. We would like to ask you to please consider donating to the auction. As a donor, you will receive publicity at our event, on our website and in our programs. Donors are also encouraged to provide business cards, flyers, etc. that can accompany their donated item. With a donation valued at $100, we are pleased to provide you with two complimentary tickets to one of our concerts. BCO reaches a diverse audience, made up of well-established professionals, varied income residents, retired citizens, students and everyone in between! We are proud of our sell out concerts in Boulder and continue to increase our patrons in both Broomfield and Denver. The Boulder Chamber Orchestra was founded in 2004, by Boulder resident and musician, Bahman Saless. Its goal is to fill an important niche in the cultural landscape of Boulder and the surrounding areas. Since its inception BCO has continued to grow in size and recognition. The BCO is a 501(c)3 non-profit organization and all contributions are deductible under section 170 of the IRS Code. Thank you for your kind consideration and support, Sincerely, Elizabeth Kennedy Managing Director Organizational Information: Chamber Music Society of Boulder • Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 BOULDER CHAMBER ORCHESTRA Letter of Agreement 4735 Walnut St. Ste F Boulder, CO 80301 303 583 1278 www.boulderchamberorchestra.org Thank you for donating an item for the Boulder Chamber Orchestra (BCO) auction to be held in conjunction with the annual gala on March 13, 2014. In addition to helping BCO (hUp://www.boulderchamberorchestra.org) raise funds to present wonderful concerts for the community; this is a unique opportunity for your business to have broad visibility to our constituents. Your item, logo and web link will appear on the BCO website as part of the promotion for the event. Please submit your corporate logo in a graphic file (.GIF, .TIF or .JPG) in a size approximately 180 pixels wide to Liz@boulderchamberorchestra.org. BCO retains the right to resize the image but will keep the aspect ratio the same. Name: Address: Item donated: Description: Web Address: Telephone #: Email: Fair Market Value (FMV): $ Suggested opening bid: $ Donated items are tax deductible at the FMV at the time of the contribution. All donors will be mentioned on our website and printed program material. We look forward to a spirited auction, the proceeds of which will benefit BCO as it continues to bring world-cIass music to your community! Thanks again for your participation Signed and agreed: Name Date Boulder Chamber Orchestra Organizational Information: Chamber Music Society of Boulder • Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 ..,ARCH 13 6:30PM Rembrandt Yard 1301 Spruce Street, Boulder -'BOULDER. ( CHAMBER ORCHESTRA Musical Masquerade Gala A Fundraising Event for the Boulder Chamber Orchestra LIVE ENTERTAINMENT FOOD o DRINKS LIVE & SILENT AUCTION Tickets $80 u Info & tickets (303) 583-1278 or www.boulderchamberorchestra.org SHEPHERD VALLEY Donation Receipt www.shepherdvalley.org WALDORF SCHOOL Office: (303) 652-0130 Fax: (3013) 652-0133 Trraoking #: Please Circle One: Auction Other **= Required Field Donor Information Please use ball poin. t en, Print I� 'bly, & Press hard Donor/Company Name: Donor Contact Person: Donor Address (include City & Zip Code): -T Donor Phone #: onor Fax#: Donor E-mail: Donor Signature: Date: **Sehool Representative: **Representative's Phone # F -mail: Donated Item Iufonnation Item Name: **Fair Market Value: (quantity: **Description (Quantity. Size, Color and other information to ensure proper understanding of the donated item) For Stiff 'Use Only Category: Tangible Item Class Donation Other (gift certificate, elasses) (Cirele One) Comments (Complete description of donation, incl. quantities, sizes, basket contents, etc.): Promo Material included? YES NO If Yes, list: To be returned to donor? I YES NO Restrictions: expiration dates, blackout dates, size limits, handling requirements, etc. Delivery Status: Donor Will Deliver [or] Arrange. for Pickup [or] Received (Circle one) Taken to Storage (shuffler)? YES NOInitials *Leave yellow copy with item* of shuffler: Gift Certificates: Donor to provide did provide [or] R -SA Auction conamitte& t.&provide N a for tangible items Please retu= forms to Fed tag IID#: 84-1,22,210-9n White: Catalog, Database Shepherd Valley Waldorf School Your donation may be tax Yellow: Item 6500 W. Dry Creek Pkwy deductible. (heck with Pink: Donor Receipt Niwot, CO 80503 your tax advisor. MEW Watershed S C H 0 m L 10" Anniversary & Spring Auction WILD WILD WEST SATURDAY, APRIL 129 2014 D BARN, 136 S. MAIN, LONGMONT QeKe f LEELKS Eke W&Eersked SckooL DONOR INFORMA 10 Name Con - .0, Phone -1 t' 6 0� i#Email Item to be Estimated Retail Valu Item Description (Please be as complete as possible, note any restrictions of use or other information that will be helpful to a bidder. This information will be used in the auction catalogue and other listings.) Solicited by Donor Recei Thank you for yo nati n! rshed S 501(c)(3) organization (Federal ID/EIN 84- 1600705). Donate ar deducti a extent permitted by law. Value: $ Received by WATERSHED SCHOOL 1661 ALPINE AVE BOULDER, CO 80304 303-440-7520 Boulder Community Health Arnbassadors -present- �o�i�ay �px4mvcqanza Saturday, November 22nd, 3.0:30am tri a:oapm Omni Inter!crAen RL-sart, $roornficld, Wofado Dear Community Member, YOU CAN MAKE A DIFFERENCE! a, ISO vCJV-'P'_ tSo The Boulder Community Health Ambassadors (formerly Boulder Community Hospital Auxiliary) is holding their annual Holiday Extravaganza fundraiser and silent auction on November 22, 2014, 10:30am to 2:00pm, at the Onmi Interlocken Resort. WHAT YOU CAN DO! We hope that you will support this local event with your donation to our silent auction. All donors will receive recognition in the events program booklet. In addition, all silent auction items are featured on our Facebook page and website with photos, descriptions, and links to the donating businesses. Your contribution is tax deductible. WHO RECEIVES ALL OF THE PROCEEDS FROM THIS EVENT? BCH Ambassadors has selected the BCH Inpatient Behavioral Health Services Unit as the recipient of all proceeds. This unit provides immediate treatment to patients in crisis and provides an ongoing plan to help patients get their lives back on track. Our 15 -bed, secured unit is the only non-profit hospital in Boulder County and north of Denver that provides inpatient care for adults with mental health issues, including thought and mood disorders, major depression, substance abuse, and more. HOW DO YOU DONATE? We are happy to personally pick up your donation! Please contact Nancy at 720-839-1622, no later than October 27, 2014 to schedule your pick up and to answer any questions you might have. We extend a large thank you for your support of this important local event and its cause. Visit our website atbchambassadors.ora. r Boulder Community Health Ambassadors www.bchambassadors.org 303-440-2066 ;dla398 .Iouoa :Ado luld Sel aslpueq:)jaIN :Ado MollaA ash a:)I;}O :Ado a;!yM anlen Ie;Ol sTad pue uelj}sanb3 ❑ spl)l ao; Tsnf ❑ and Allwed ❑ uol;dljosaa 1aa4S P!9 Jo:)aa awoH ❑ ssau;13 pue 41leaH ❑ ;uawulejjalu3/Sulula ❑ Su!LIIOD Pue'Aalamaf'IJV ❑ :QUI Pie :Plg U!W :# wall :al;!1 wall ❑ laiseg:40 -40 !13nV aAIj a}ea!}1�a0 �}!9o!pnd jual!S AINO 3sn 331330 Bio-iq:)@O}UI gio,j :),MMM IuopBuop snorauaS jnoA jo3 no1C ijimiq L awil a le aw04 auo'anasaj auo 'uewn4 auo •••as.Ioy pageluenpeslp a4; SulAes oT pa;ealpap uollezlue2lio Iliad-uou £(J)TOS a sl an3saa asJOH opejoloD :ajnleu2llS jouod :Ag panlaaaa anleA wall :(wjol jad wa;l auo) paleuoa wall :Ilew3 :auoyd :d!Z :ajeTS :AI!J :ssajppv SullleW :aweN Jouoa :area idixma uopcuoQ xuaeg atmW bTbT-b6b (OZL) 3nOS3H 3SaOH Ems m luowsuoi o a v a o -1 o o ;aa.gS 4159 N 9ssOT t 3 ( 55 fLA-:>T-&t- C; �o & f,b SSI c3 vv\ VA Wvl I � r't C\ VA f t 0 y IC ow,VIA 1 4-(-� Prevention Curriculum FT- Empower Youth —� The Empower Youth Prevent:: _ Program is an engaging multi- ' med a curriculum tool. We ut . ze film, photography and artifacts to train educators and students to recognize and respond to T trafficking and exploitive situations. U ., The curriculum confronts root cause vulnerabili ies such a ow self esteem while equ+pping students to actively respond, r ult- ing in self and peer identification We address potential victims as well as emerging pimp and demand culture. The Empower Youth Prevention Program trains and inspires students and educators to sustainably address exploitative situations in their school and surrounding neighborhoods. 88 In the years that I have taught here, this j� n m is the first event we have ever done that students are actually talking about. L/ -Teacher at New America School Denve-- Campus Want to Help? Get connected at iEmpathize.org g3 k PANalytical Wave Oliver Electrical Engineer Na }•r�caf .R Exce;lence Center T +1 303 444 6522 x137 2555 55th Street F +1 303 444 6825 Suite 101 dave.oliver@panalytical.corn Boulder, CO 80301, USA Wmmasdi.com Prevention Curriculum FT- Empower Youth —� The Empower Youth Prevent:: _ Program is an engaging multi- ' med a curriculum tool. We ut . ze film, photography and artifacts to train educators and students to recognize and respond to T trafficking and exploitive situations. U ., The curriculum confronts root cause vulnerabili ies such a ow self esteem while equ+pping students to actively respond, r ult- ing in self and peer identification We address potential victims as well as emerging pimp and demand culture. The Empower Youth Prevention Program trains and inspires students and educators to sustainably address exploitative situations in their school and surrounding neighborhoods. 88 In the years that I have taught here, this j� n m is the first event we have ever done that students are actually talking about. L/ -Teacher at New America School Denve-- Campus Want to Help? Get connected at iEmpathize.org g3 k WLAJW,vtelCO, OV C�7 u ���,�. cn ..� ', • `--�',���:"•' :,� .(%T -- � - � tea`, `. OrD C) _ ,= 2 CD r� 2m -:1.) =:0 �o30 �_ + CD [D —' y G] N CD D O O O — Q y ��• 4 - _.� :s[: .t- •L7y ^'� -3 (( 3 ^J �' •fit► ' p ' . O ^ CY Ul ;.; m Aa cn I N N 07 _ ;gcn C % l CO fl. ,>E � a V O AM w %0 O o>- i4- M 10 uw 0 ON ^ '7 -&- 1?8 0 U C n cu 000, -.0. C .0 N N O fy p lY C c N +� O �� cn �� pZLn N N V 2 C+ N ti C Cj 0) C Lfu (U 4.j :t:j.� � �L � LT s O O N N � v 1 G O O N �.Cr Cl- rxp OY4O N Y Ncn a mp1 N cC0 O L OM O O L N L G QiN 2015 August 25, 2015 To Whom It May Concern: The Boulder Rural Fire Department is hosting our 17`h Annual Spaghetti Dinner fundraiser on Saturday, October 10, 2015 from 4-7pm. The purpose of this event is to raise money for the Boulder Rural Firefighters Fund, and to provide a fun family experience for the communities we serve. We expect as many as 600 guests to attend. The Boulder Rural Firefighters Fund is used for projects that support people dealing with personal hardships, fallen firefighters and their families, as well as many other charitable causes and functions. We rely heavily on donations for the supplies needed to make this event a success and would greatly appreciate anything you can do for us: • Cash Donations • Gift Cards • Food Products to Serve • Goods and/or Services to Raffle & Silent Auction Thank you kindly for your generosity and we look forward to seeing you at the event! Sincerely, Brent Arbuckle Boulder Rural Fire Department Firefighter/EMT (720) 352-1333 Brent.Arbuckle(2brfd.org 6230 Lookout Rd, Boulder CO 80301 10000010, 9 P -.w tot, Dear Sponsor: MESA Moving to End Sexual Assault 2015 Moving to End Sexual Assault (MESA) — Boulder and Broomfield County's only sexual assault crisis center—invites you to become a sponsor of our youth group Peers Building Justice. By becoming the food sponsor for 1, 2 or 10 of our meetings in 2015 and 2016 (see meeting calendar below), you allow this group to be accessible to youth coming from families of all income levels. Peers Building Justice is a youth group of 15-20 members that uses arts -based projects to promote social justice and resist violence in our communities. The primary source of funding for MESA's sexual violence prevention programming is donations from generous community sponsors like you! Peers Building Justice meets 5pm-7pm 11t, 3rd, and 5th Mondays throughout the school year. 2015 2016 September 7 & 21 January 4 & 18 October 5 & 19 February 1, 15 & 29 November 2, 16 & 30 March 7 &21 December 7 & 21 April 4, 18 & 30 May 2 As you may be aware, in addition to our youth violence prevention programming, MESA serves survivors of sexual assault and their loved ones through our 24-hour English/Spanish hotline, our counseling services, and through medical and legal advocacy. We also provide extensive community education to law enforcement, social services, and other community professionals who work with survivors of sexual assault. Your donation will help MESA support youth develop healthy relationship skills and knowledge, prevent sexual violence before it happens, and ultimately move toward ending sexual assault. Kindly, Amanda Kemphues, Prevention & Education Coordinator 303-443-0400 24 -Hour Hotline: 303.443.7300 Office: 303.443.0400 Fax: 303.443.0187 Email: info@movingtoendsexualassault.org 2336 Canyon, Suite 103, Boulder, Colorado 80302 www.MovingToEndSexualAssault.org kattention HOMES CHANGING LIVES Of YOUTH IN CRISIS Hello Cantina Loredo March 2015 Thanks for taking a minute to read this letter! I work for a nonprofit right downtown Boulder called Attention Homes. Attention Homes, the only runaway and homeless youth shelter in Boulder County, has provided more than 8,200 at -risk girls and boys with critical, life -changing services since 1966. It's our goal to reduce youth homelessness with a continuum of care that guides youth from the streets or in a shelter to a path that includes stable, long-term housing, independence, education and employment so that they can achieve their potential. We are expecting 350 community leaders and business professionals to attend our 8th annual Kaleidoscope gala coming up on May 16, 2015 at CU's Glenn Miller ballroom. Our goal is to raise $155,000 for programs and services provided to the youth we serve. The silent auction is a huge part of our fundraising effort. This year we are doing mystery restaurant certificates at the $25 and $50 level. Volunteers dressed in Le cirque type costumes will weave through the crowd selling mystery dining certificates. The participating restaurants will be highlighted on signage through our event. Would you consider donating a certificate to us? Please call 303-447-1206 ext 129 or email krouland@attentionhomes.ore if you have a gift certificate to contribute or call m Your support helps deepen our impact through our street outreach, day drop-in and overnight emergency shelter. On behalf of the youth we serve, thank you for your consideration to support our event. Cheers, Kimberly Rouland Events Manager 720-343-6116 1443 Spruce Street, Boulder, Colorado 80302 1 p 303-447-1206 1 f 303.447.0623 1 attentionhomes.org T t September 16, 2015 Dear Boulder Business Owner, NATIONAL CENTER FOR ATMOSPHERIC RESEARCI P.O. Box 3000, Boulder, Colorado 80307 USA Telephone: (303) 497-2188 FAX: (303) 497-1804 kmayock@ucar.edu I represent The Employee Activities Committee (EAC) at The National Center for Atmospheric Research (NCAR), a non-profit organization, in Boulder, Colorado. Each year NCAR sponsors a company and community -wide Holiday Market where our employees can show of their homemade products. This year the event will be held at our Center Green office on November 13th and are requesting a donation of a gift certificate or merchandise to be used in Prize Drawings during this event. Enclosed please find our invitation flier that is posted throughout the community. We can offer the following advertising for your donation: 1. List your name and contribution in "UCAR/NCAR Staff Announcements" between now and November 13th in our online newspaper that is emailed to all employees daily. 2. Event is held in an auditorium with state of the art media equipment. We will have a presentation continuously looping which will have the name of your business, address, and a picture as well. 3. Announce your contribution on the PA system at the Holiday Market. Please consider my request and let me know your decision. I am happy to pick up the donation- just call, email me, or feel free to mail it to the address below. Also enclosed is out tax exempt information should it be needed. I look forward to hearing from you. Thank you and have a great day! Sincerely, 'd&4_1 - --- Q , Kar- Mayock C. it EAC 2015 Holiday , arket 303.497.2188 f / 4,-- 6o r�/ kmayockCalucar.edu J 3 % gra-21111"s is o The National Center for Atmospheric Research is operated by the University Corporation for Atmospheric Research under sponsorship of the National Science Foundation -' Forth W-9 Request for Taxpayer Give Form to the (Rev. December 2014) Identification Number and Certification Department o1 the Treasury requester. Do not Internal Revanua Servke send to the IRS. 1 Name (as shown on your Income tax return). Name is required on this line; do not leave this line blank_ University Corporation for Atmospheric Research N 2 Business name/disregarded entity name, ff differerrt from above m rL National Center for Atmospheric Research o W 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: ❑ IndivktueVsole proprietor or ✓❑ C Corporation ❑ S Corporation ❑ Partnership ❑ TrusVestate qem Exemptions (codes apply only to certain entities, not Individuals; see single-member LLC ❑ Umfted liability company. Enter the tax classification (C=C Instructions on page 3): Exempt o` corporation, S S corporation, P=partnership) ► Note. For a single -member LLC that is disregarded, do payee code of army) $ c not check LLC; check the appropriate box in the line above for the tax classification of the single -member owner. Exemption from FATCA reporting a 0 0other (we instructions) ► 501 W 3 Non -Profit Corporation code (if any) !E b Address (number, street, and apt. or suite no.) Requester VPPr,,,,, ,,,,v„ ftkW SJ ° tUde Mi u s name and address (optional) 3090 Center Green 8 City, state, and ZIP code rn Boulder, CO 80301 7 Ust account number(s) here (optional) T7vn�_. Lt..ss:.---a:-- "------- .... Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For Individuals, this Is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other - entitles, It Is your employer Identification number (EIM. If you do not have a number, see How to get a 77N on page 3. or Note. If the account Is In more than one name, see the Instructions for line 1 and the chart on page 4 for Employer Identification guidelines on whose number to enter. I`Z-7 F—F--__ 814; -10141112161618 Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer Identification number (or I am waiting for a number to be Issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Intemal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA codes) entered on this form (If any) Indicating that I am exempt from FATCA reporting Is correct. Certification instructions. You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. For real estate transactions. Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions on page 3. vb•' Signature of Here U.S. person 11- Date No - General General Instructions Section -references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) Is at www.1rs.gov/fw9. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer Identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: • Form 1099 -INT (interest earned or paid) • Form 1099 -DN (dividends, Including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a 71N, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be Issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withhddrig if you are a U.S. exempt payee. if applicable, you are also certifying that as a U.S. person. your allocabie share of any partnership Income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected Income, and 4. Certify that FATCA code(s) entered on this form (ff any) Indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further Information. Cat. No. 10231X Form W- (Rev. 12-2014) 40 C O L O R A D O HORSE RESCUE A non-profit organization that provides shelter, care, rehabilitation and adoption services for horses. September 16, 2015 Cantina Laredo Restaurant 1680 29th St Boulder, CO 80301 Dear Cantina Laredo Restaurant, Thank you so much for your charitable donation of gift certificates valued at $55.00 for our 2015 Mane Event, Rockin' Horses. As a non-profit organization, your support is critical to our ongoing success. This in-kind donation has already helped a horse in need! With your generous support, we are able to continue our mission of providing emergency relief, shelter, care, rehabilitation, and adoption services for disadvantaged horses in the Colorado community and beyond. On behalf of the Board of Directors, staff, volunteers, and the horses, we sincerely appreciate your generosity. Thank you for giving these wonderful horses a second chance at a good life! With Gratitude, Carol E Brice Executive Director * Please note that this letter is not a donation receipt. You should have received a donation receipt at the time you donated. If you did not get a receipt, please contact our office. 10386 N. 65th Street • Longmont, CO 80503 • Phone: 720.494.1414 • Fax: 720.494.1415 • Web: www.chr.org L)Z�. QMd-t.cc.0 -6 Oaui-eV, .h oc C� d�r� c2o�eUr� wu� a 1���.e ,�cc�a anwaa So wucaA+uu n�.ea�rn.a �o �utrf�t -fa � atot �''e J- gti� 2590 Walnut Street, Boulder, CO 80302 303.440.7826 Pax 303.440.71.0-4 WWW.thedairy.org 4735 Walnut St. Ste F BOULDER Boulder, CO 80371 303 5831478 CHAMBER ORCHESTRA www.boulderchamberorchestra.org June 2, 2015 Dear Cantina Laredo, Your gift is instrumental in advancing the musical excellence of the Boulder Chamber Orchestra. Thank you for believing in what we do at BCO! With your support, we are able to fulfill our mission of enhancing the classical musical arts with performances of the highest standard. We are thrilled to be in our second decade of existence, presenting Dodici as our 2015- 2016 concert series. As we celebrate our twelfth season, we also celebrate donors like you. Concerts are made possible with your help and we are deeply grateful for your support. Thank you! If you would like to learn more about BCO, get information about our concert schedule and guest artists, or simply chat about the delight of classical music making, please give us a call at 303-583-1278. Sincerely, e ()(- Courtney uffman Managing Director This is your IN-KIND GIFT RECEIPT. Boulder Chamber Orchestra is a 501(c)(3) nonprofit charitable organization. Gifts are tax deductible as allowed by law. No goods or services were provided in exchange for this contribution. Please retain this letter for your records. Date of Gift: 3/6/15 Estimated Value (as determined by donor*): Description of Gift: 3 Entree's and Quac Gift Type: Gala Auction Donation * Per IRS regulations, placing a dollar value on donated items is the exclusive responsibility of the donor. Organizational Information: Chamber Music Society of Boulder • Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 7 Red Carpet Adventure Boulder. Friday, September 11, 2015 Boulder Theater 2032 14th St., Boulder, CO 80302 SILENT AND LIVE AUCTION ITEMS Restaurant gift certificates, resort stay -and -play packages, overnight getaways, sporting event tickets. PRODUCT DONATIONS Gift certificates from your business, merchandise, consumables, golfing and event related items. Red Carpet Adventure Denver Saturday, September 12, 201 Infinity Park Event Center 4400 E Kentucky Ave, Glendale, CO 80246 TRAVEL SUPPORT Airfare certificates, frequent flyer miles, travel vouchers for airport transfer, cab rides. EVENT SPONSORSHIP Underwrite specific costs for a particular event. Since 2005, There With Care has served nearly 2000 families who have a child battling a life-threatening medical condition. We provide support to these families by easing the burden of life's day-to-day obligations with compassion and care. 2825 Wilderness PI., Suite 100, Boulder, CO 80301 12401 S. Colorado Blvd., Suite A, Denver, CO 80222 303-447-2273 (CARE) 1303-756-2273 (CARE) BOULDER CHAPTER OF HADASSAH SHifibSHANIM f'$1RUNCH The Boulder Chapter of Hadassah is sponsoring a gala at The Boulderado Hotel on April 19, 2015, to honor five outstanding women who have contributed their time and energy to support Boulder's Jewish community. We will have a silent auction table with goods and gift certificates as well as a palette of donated bottles of wine that we plan to sell at our brunch. We are seeking donations from local businesses. Would you be able to help us with a donation? Hadassah is a nonprofit organization that fundraises throughout the year to support the Hadassah Medical Organization's hospitals, clinics, and health programs in Israel. HMO is internationally renowned for its pioneering medical research to treat SLS, macular degeneration and breast cancer. Annually, the organization treats over one million people without regards to race, religion or nationality. Your donation will help our chapter to reach our fund raising goal for this year of $io,000. Please use this page as a receipt for your gift. The tax ID for the Boulder chapter is 14-103-000-90000141; and the federal ID is 3727481• We wi ovate Val ed at $ t ;� to t Signed Thank you for your suer Sincerely, Joy Weinstein 303-442-3112 Volunteer hoshanim Brunch. *If you are unable to mail your donation, I will gladly pick it up. 2015 Crest View Winter Silent Auction Contract & Receipt Please complete the top portion of this contract and return it with your item by February 7th, 2015 to Crest View Elementary, 1897 Sumac Ave. Boulder, CO 80304. For business donation pickup, please contact Mollie or Cori at 720-515-1061 or solicitations@rocv.org to make arrangements. We will accept late items up until February 20th, but they may not appear in our print catalog materials. Note: Our event takes place February 27, 2015. Please make gift certificate expiration dates no earlier than December 31, 2015. (Please print) Item or Service Donated by (Name to appear on donor listing) Address (Necessary for tax receipt) Detailed Description of Donation (Please fill out If you are a Crest View Parent please print Retail Value Email portion! Note any Phone expiration date, etc.): child(ren)'s name, grade and teacher, (Tear here and keep bottom portion for your records) ------------------------------------------------------- Reach Out Crest View Donation Receipt (Crest View Elementary School) Tax ID# 84-1512387 Item Donated Date Thank you for helping to support our North Boulder neighborhood school! 1 Retail Value L P G T r 1C;- XC .,_ Sts. Peter & Paul Greek Orthodox Church �r M xA 5640 Jay Road, Boulder, CO 80301 Ph`o1X_ (303) 581-1434 http_//www.smpererandpaulbouider org — philoptochos@sMWerandpaulboulder.org METROPOLIS of DENVER - November 2014 The Annual Philoptochos Society lAfrnter Dinner, Dance, Raffle & Silent Auction Fund Raiser This letter is a request for a contribution from you and/or your business for the Annual Philoptochos Society Winter Dinner Dance, Raffle & Silent Auction fund raiser to be held at the Boulder Country Club on Saturday, Feb_ 7, 2015- Your contribution is greatly appreciated and will -contribute to helping those in need. This event is hosted by the Philoptochos Society of Sts Peter and Paul Greek Orthodox Church, which is a philanthropic non-profit organization that provides help to the poor and needy, locally, nationally and worldwide_ AD of the funds raised at this event will go towards our philanthropic efforts and over two thirds of our funds assist those in need within the local community. We supportsa wide range of services, including Head Start and local soup kitchens. Our organization is associated with the Greek Orthodox Archdrvicese of North and South America. It was organized in 1894 in New York City and there are active chapters in most Greek Orthodox Churches in America_ We are an IRS 509 tax exempt organization and our Federal ID number is 13-1632516. Please describe your contribution on the Attached aContribution Sheet" and return it with your donation. Any contribution you can give us will be greatly appreciated and will be used 9$ a silent auctian item. All contributors will be gratefully acknowledged at the event - On behalf of the Philoptochos Society of Saints Peter & Paul Greek Orthodox Church, we thank you for your generosity_ If you have any questions or concerns, please feel free to contact Cina Saliba aA303=554-0415 or ci_na.s_aliba@�gmail_corn f addrgss is 7529 Skyway Ci, Boulder, CO 80303 Sincerely, The Philoptochos Society Executive Board In English, the Greek word "Philoptochos" means "Friends of the Poor" SAINTS PETER & PAUL GREEK ORTHODOX CHURCH Philoptochos Society 5640 Jay Road Boulder, CO 80301 (303) 581-1434 Contributor Sheet Contributor: Item Contributed: Description: Restrictions: How Redeemed: Value: Auction/Raffle to be held: Saturday, February 7, 2015 Boulder Country Club Signature of Contributor Boulder, CO Mailing Address Telephone Number wk,"'04% safehouse 11 progressive alliance for nonviolence 835 North Street. Boulder CO 80304. 303 449 8623. www.safehousealliance.org Thank You! On behalf of Safehouse Progressive Alliance for Nonviolence (SPAN), I thank you for your participation in this year's Chocolate Lovers' Fling. This was the 33 n annual Fling, and with your help and support, this event continues to be a unique Boulder tradition. Over the years we have been proud to work with small, local businesses like yours and your support is an integral part of the Fling's success. Thank you! Funds raised through the Chocolate Lovers' Fling help us provide safety and support for victims of domestic violence and their children, as well as work towards justice and equity in our community. SPAN provides comprehensive services, including a 24-hour crisis and information line, safe, confidential emergency shelter, counseling, transitional services, legal and financial information, and community education. These services are changing lives, they are even saving lives, and your support is critical! For more information about the programs your donation helps to support, please visit our website at www.safehousealliance.org. These are challenging times for SPAN but we feel inspired and sustained by people like you, and I am so very grateful that you are part of our community of support. I hope you will consider supporting SPAN again next year at the 34'd Annual Chocolate Lovers' Fling, February 7, 2015! Sincerely, Mary Pierce mary@safehousealliance.org Events Coordinator For your records our 501 (c)3 tax ID # 74-2145368 THE FRIENDS OF HAITI INC. DIRECTORS Please accept this donation receipt. Linda Pilato Organization Name: The Friends of Haiti Inc. Susan Provost Tax ID: 27-3070018 John Provost Organization Address: 2520 Mesa Verde Terrace, Henderson NV 89074 Mary Wagner Organization Website: www.thefriendsofhaitiinc.org Date donation was received: December 1, 2014 Kim Tomsic STUDENT Helping Haiti become a self-sustaining nation through education VOLUNTEER S Student Team: January, 2015 Cayman Tomsic Dear 6917jl m &rt6 , Executive Director Thank you for your generous contribution of $� donated to The Joseph Provost Friends of Haiti Inc. (TFOHI) a 501(c)3 non-profit charity. DIRECTORS Please accept this donation receipt. Linda Pilato Organization Name: The Friends of Haiti Inc. Susan Provost Tax ID: 27-3070018 John Provost Organization Address: 2520 Mesa Verde Terrace, Henderson NV 89074 Mary Wagner Organization Website: www.thefriendsofhaitiinc.org Date donation was received: December 1, 2014 Kim Tomsic STUDENT With gratitude, VOLUNTEER S Student Team: Cayman Tomsic Mei Zachwieja Jason Fontillas Cayman Tomsic, Mei Zachwieja, Jason Fontillas, Andrea Staehelin Andrea Staehelin and Kiran Singh Kiran Singh NEVADA 2520 Mesa Verde Terrace, Henderson IJV 89074 743 Utica Ave Boulder, CO 80304 Kim TomSlc knct(@ ahoo.com 602-321-4006 TFOHI student division Company Name: HUMANE SOCIETY OF BOULDER VALLEY Puttin' On The Leash 2015 - Saturday, April 25, 2015 Restaurant Sponsor Commitment Form C,Nv-T,Q k L-M— General Manager/Owner Name: 2 - Contact Name for Event: Address: I (o$'O 2,9+', S4 - City, State, Zip: C.. Phone Number: 5) 44y-'z2Q-0 Email Address: 0L_ C-�►�%v�1r��^^- Serving at the Event -1,000 bites per item (Please arrive between 4:30 p.m. and 5:00 p.m. on Saturday, April 25th, and be ready by 5:45 p.m. You will be provided with 1 or 2 tables, tablecloths, small plates or bowls, napkins, and plastic utensils.) What item(s) will you serve?: Number of servings: -00 CnM `-CS 2- -P -CL -Event Logistics (please circle): Would you like the same location that you had in 2014? Yes No/A Tables (6ft. banquet): one two Will you need a power outlet: Yes Would you like a volunteer to help you serve food in your booth: Yes No (This is in addition to the volunteer already assigned to you as an Ambassador - see guidelines) Would you like to donate a gift certificate for the silent auction? (!2e� No Please contact Lisa Borgmann at 303-442-4030 x 655 or Tisa.borgmannCa)boulderhumane.org with any questions. FAX this sheet to 303-565-5151, or mail to: Puttin' on the Leash HSBV 2323 55th St. Boulder, CO 80301 Thank you for supporting the homeless animals we serve! HUMANE SOLI ETY OF BOULDER VALLEY Dear Friends of the Animals, We're movin' and shakin'—and getting those tails waggin'! We can rock, and we can roll—but savin' lives is what we really do! We are making plans for our biggest fundraising event of 2015, our Puttin' On The Leash: Whole Lot of Shakin' Going On gala! We invite you to be apart of this year's special event by joining us as a Restaurant Sponsor. Our 23nd annual event is scheduled for Saturday, April 25, 2015 at the Coors Event Center on the Colorado University (CU) campus. Puffin' On The Leash will be the cat's meow with live and silent auctions, heart- warming presentations, incredible food and drink, and more! Our deadline for inclusion in all print media is February 19, 2015. Your generous donation will help us to provide medical care, adoption programs, foster care, behavior modification training and so much more for each homeless animal that comes through our doors. More than 1,000 people are expected to attend the gala event and our goal is to raise $400,000 to help homeless animals in Boulder Valley. Puttin' On The Leash brings together a broad spectrum of Boulder County residents and members of the business community, creating a prime opportunity to reach a wide variety of potential new clients and support the mission of the Humane Society of Boulder Valley. Puttin' On The Leash is a wonderful opportunity to introduce your restaurant to more than 1,000 potential customers while benefiting and helping the homeless animals we serve. Feel free to contact Lisa Borgmann with any questions at 303-442-4030 x 655 or lisa.borgmann@boulderhumane.org. We will be following up with you in the coming weeks to discuss this great event. Sincerely, 4-D Lisa Borgmann Development Manager For your tax records, the Humane Society of Boulder Valley is tax-exempt under Internal Revenue Code Section 501(c) (3), and your contribution is tax-deductible, as provided by law. Our Federal Tax Identification Number is 84-0152768. 2323 55TH STREET, BOULDER, CO 80301 1 p 303.442.4030 f 303.565.5151 1 BOULDERHUMANE.ORG PROTECTING AND ENHANCING THE LIVES OF COMPANION ANIMALS BY PROMOTING HEALTHY RELATIONSHIPS BETWEEN PETS AND PEOPLE IJ so PUTTON' ON THE LEASH ?.015 0144# A 0D CIL �.� ; °� EV EST s .r fy ,i. .- ; Cp®Rs R o 6 ply �J�, �, ,,, u i3ouL®E is �>:;;-., C _ 7 . ! : fr' � i rY ` � a 1 Vit. •� �, ': t, �• i � t <`S r raid•\��r � Ii � +� \ � `qi C1 \'" .\ ti � ,! N-1 . �•'' ` !. �'� k•� l %�.v �.�il.ry �r.i;�itkY`'� 1.5 •hl*1 �; ':,y� '91� �_ t!°�:.��[�'y lr �: �I� L �' �Kk K � r�lk, r '�•r�fi atr. _�t,>t (, �atiP'' P,j. ^�,r '4!" __— � — : � ; 4, ' 1 1; , � rrl 1 �1.�:F r•,. '% � • �. %r �`'i� �.I',teie � —, f '_ KD t �LI l.�\'1- :y. ,y4•• �'S ��L}�.i �4 f�aCB •' ��1�.=- _ � ��� ---3 �' � I�4.5 '. -i'_ x1 t'0 kv rl HUMANE SOCIETY OF BOULDER VALLEY Humane Society of Boulder Valley Puttin' On The Leash 2015 - Food Sponsor Guidelines Benefits: - You get quality one-on-one contact with more than 1,000 attendees and you may provide printed menus, business cards, or other promotional items. - You can showcase your display talents at your booth - especially beneficial for businesses offering catering services. - Your logo will appear on at least two email blasts sent to over 30,000 Humane Society constituents and clients. - Your logo will appear in the program and on the Humane Society website for one month. - Your logo will appear on the PowerPoint presentation at the event. - Your business name will appear in a thank you ad in the Daily Camera. - You will receive two free general admission tickets to the event (in addition to booth staff). Logistics: - You will need to bring a minimum of 1,000 bites of each of your selected menu items. Most sponsors find that they are best represented by two to three offerings. - You will need to arrive at the Coors Events Center between 4:00 p.m. and 5:00 p.m. on the day of the event. You will be greeted by your Restaurant Ambassador, who will take you directly r to your station, and will provide any assistance you might need throughout the evening - refreshing supplies, beverage runs, set-up help, etc. Each ambassador is assigned to one or two restaurants only, so you will get plenty of individual attention. - We have found that the optimal staffing is two people per restaurant - this is a fast -paced event, and you will be better able to interact with our guests with two staff members in your booth. In addition to your Ambassador, we can also provide you with an additional volunteer to assist you in your booth to help you actually serve your food, if needed. Check the appropriate box on the commitment form if you would like a booth volunteer. - HSBV will provide you with one or two 6ft. tables, black tablecloths, small paper plates or bowls, napkins, and plastic utensils. An electrical outlet is also available upon request. A Special Note on Choosing a Menu Item to Serve: Our guests will be enjoying your food as they circulate around the concourse at the Coors Event Center, so we ask for your help in providing finger -friendly, easy -to -eat dishes. The Humane Society prefers that vegetarian food be served at Society functions, and that any meat that is served be from animals that were humanely raised, if possible. We are so grateful for businesses like yours in our community who are committed to animal welfare. Thank you! Deadline for inclusion in the Event Program: March 12, 2015 Maximize your Exposure at the Event! Ask about donating a Gift Certificate for inclusion in our Silent Auction'! ITEM #: ITEM DESCRIPTION: Z Be --Arc see A c -,-As- + Gree- TSG A�ce-+tz,-, RETAIL VALUE $: DONATED BY: NAME: ADDRESS: CITY: STATE: ZIP CODE: PHONE: EMAIL: COMMENTS: UU 1 a-- Romy LaBorde m 5 L� PANTHER Gala (303) 324-6848 (303) 547-8226 Date: March 14th, 2015 2014 Sports Gala Co -Chair 2014 Sports Gala Co -Chair Time: 6pm Location: The Elks Lodge Address: 3975 28th St., Boulder, CO 80301 BOULDER HIGH SCHOOL 1 1604 ARAPAHOE AVE. BOULDER CO 80302 Shirt & Te Event T>. Denner Heart Ball American { Heart Associations DFIIVER heart ball f�*# *# *#*# 0,0 *# 0 40*-** 0 4 0* 0 #-a# *+.* #Off -♦-*+.a# * 4 0 #'a 4 V+ The Event Event Date Saturday, March 14th 2015 Event Attendance 650 individuals Audience Profile Executive business men and women, medical leaders and philanthropic champions. The evening offers exclusive, first-class entertainment and social networking. Attendees experience a night filled with premiere service, dining, entertainment and amenities. 2014 Event Successes • Raised over $700,000 (after expenses) • $95,000 was raised from the silent, super silent & live auction combined, an increase of 132% • The event was sold out with 600 people in attendance The Cause Denver Heart Ball auction sponsors will join the American Heart Association in achieving it's goal of eliminating heart disease and stroke by funding cutting-edge research, conducting lifesaving public and professional educational programs, and advocating to protect public health. The American Heart Association annually invests six -eight million dollars of research in Colorado. Event contributions will directly support funding for congenital heart defects, which is the No. 1 birth defect in American children. It will also fund educational programs designed to reverse a disturbing trend among American children, whose health and longevity are threatened by an obesity epidemic. In addition, much of the money raised at the Denver Heart Ball will go to fund CPR training for children and adults in the greater Denver community, which gives our friends, family and others in the community a better chance of survival if they go into sudden cardiac arrest. Together we can save lives. 2014 Event Sponsors & Executive Leadership x Evev�t spewsam Cer+ara Ha --6h S(LHeatln Stste EmrslaPbaa,ml i;t�slm-i are Umiersiy drCatrr:do Hosphd Goldsporex+rs lst aasdc Archam Shia Cra Bkm Sn)dd tslorrdo BuskR=Ttmk Neale??: sanrspo om AllmdL-3uml Seounty Sc vices f�lb�ad VAne Dlna Ps:osetsFgr A=F.te= Ft58Fl Fant 6 Young PDR Locktan qfp Fund$ FnLML P� qu Dr. wd Swth Deme Gv K*jjVA .,u tc. P.0 [hw.,,,3v of Colorado Health PabMspoasoss A€Ir BMI. Blood C.c^rr bAdmnIIC, P es Cd[orado C.rs, g HOV1W DCP.. iddrwm Lfoctansm Corabucwn PtrJarciara flealrhPartre Sage HasPCWbf Ifhnerzky drLdorado 0eDwbnam.f Pce--,'!tics L)r---Ay Ply - 5280 masmm 7Nem 12ZW 143aW AdnpanryfTe 6EventDcsign Cureaverlures rwrad of ilernsr M -da v m Nolle Product5om smmlar� I -,Pty Liar ,Pwa m f-pw&tdh�7 ;Ie4m Denver Heart Ball Chairs: Grant and Lisa Widdund, Pmadanl d Chief Smwm; »n O iear orF c mpla Lutheran Medka7 Canter �9T1f Lndsa} Looidon Ca sinks John PkO^ Prmard Assurance Jbin Drarg 1st Bank Ann McCu#wgh, Palsirdi - Bdw Kmagar, Bm% Blood C.ntw Cary Spahr PwC Dfdr Moof"4 Colorado Roddeo BasaW Ciub Rapyfa ntashfn9toq, MD, Raf* Owen Ernhaon Healthcare Rocky hlountain Hospital for GWren Scoff Hefhar, Ernst 3 Young John Plemey, Uwuersity ofC,oIorado HognW _ Gary Sdmartx Betray Cal; Lm sten It Sdwmtr, LLP John RwWa4 MD, VA t � Chaffs AW304% Grest Wast Fiean w Mated GaUepher, Wel-, Fargo CeLpdj!d Finance Byron Hasakfan. Hasakkm Construction LM Dane Reddlnpwq WoF4 Fargo RfdUwd Hamm►!x The Medical Center of Aurum 'Sy7e Jhan&A &a, -r �pa 44 G RE AT -WE ST 4-SCL am> Heaith- F I N A N G 1 A L ■sErtvlslon 011 - S. EY A PWC 2015 Executive Leadership Team 2015 Chair Randy Owen Envision Healthcare COO/CFO 2016 Chair John Harney University of Colorado Hospital CEO Grant Wicklund Exempla Lutheran Medical Center CEO 2013 Chair Bill Lindsay Lockton Companies President, Benefits Group 2012 Chair John Ikard 1st Bank CEO 2014 ELT Gary Schwartz BCLS Partner Scott Hefner Ernst & Young Managing Partner Charlie Nelson Great- West Retirement Services President Byron Haselden Haselden Construction LLC President Richard Hammett The Medical Center of Aurora CEO Ann McCullough Polsinelli Partner Cary Spain PwC Partner Reggie Washington MD RMHC Chief Medical Officer John Harney University of Colorado Hospital CEO John Rumsfeld MD VA Head of Cardiology Michael Gallagher Wells Fargo Capital Finance Managing Partner Dana Reddington Wells Fargo Business Banking Division Manager Auction Details & Photographs Why donate to the Denver Heart Ball? The funds raised through our auction sales will go directly to improving children's heart health, childhood obesity and healthy awareness programs for children in our community. Everyone wants their company or product to be seen, by donating to the Denver Heart Ball auction, your product and company will be seen by hundreds of qualified buyers in the community. Auction Goal Fair Market Value (FMV) Goal: $175,000 Night of Event Goal: $115,000 Auction Agenda The Denver Heart Ball will have three auction sections; Live, Super Silent and Silent. Guests will arrive to attend a cocktail reception for the first hour and a half of the evening where they will have the opportunity to bid on Super Silent and Silent auction items. The Live auction will take place in the ballroom during the evenings program. Auction Benefits Live Auction: Total exposure value $11,600 and 6,300 media impressions Accepting seven items that will be featured throughout the year. Items should have a FMV of $5,000 to $10,000. • Activation throughout exclusive events leading up to the Ball (Executive Leadership Kickoff, Denver Heart Ball Kickoff, Auction Preview Party, VIP Reception, Denver Heart Ball) (900 Attendees) • Logo recognition on save the date and event invitation (Valued at $7,500 with 2,500 Impressions) • Listed in event program (Valued at $3,400 with 600 Impressions) • Visibility on website • Recognition on Facebook page to 1,200+ followers • Company signage in cocktail reception (Valued at $700 with 600 Attendees) • Recognized in evening presentation (600 Impressions) Super Silent: Total exposure value of $3400 and 2,600 media impressions Accepting ten items that will be featured throughout the year. Items should have a FMV of $500 to $2,000. • Activation throughout exclusive events leading up to the Ball (Executive Leadership Kickoff, Denver Heart Ball Kickoff, Auction Preview Party, VIP Reception, Denver Heart Ball) (900 Attendees) • Listed in event program (Valued at $3,400 with 600 Impressions) • Visibility on website • Recognition on Facebook page to 1,200+ followers Silent: Total exposure value of $3,400 and 600 media impressions Accepting two hundred items that will be featured throughout the year. Items should have a FMV of $50 to $1,000. • Listed in event program (Valued at $3,400 with 600 Impressions) • Visibility on website • Recognition on Facebook page to 1,200+ followers Thank you for you interest in the Denver Heart Ball benefiting the American Heart Association. For more information on auction donations, please contact: Blair Pesses Development Specialist 1777 S. Harrison Street, #500 Denver, CO 80210 303.801.4658 Blair.Pesses@heart.org Timmy Global Health: Building healthy futures Dear Cantina Laredo, 22 East 22" d Street Indianapolis, IN 46202 Tel 317.920.1822 Fax 317.920.1821 Timmy Global Health is taking a humanitarian service trip to Ecuador and we need your help! From May 16th- May 23`d, eighteen University of Colorado students will participate with eight medical professional volunteers to serve the people of Ecuador by setting up and running medical clinics in communities that would otherwise be without access to healthcare. We hope that the experience will be beneficial not only to the people of Quito, but for the students who are learning the necessary skills and rewards of providing service. Timmy Global Health is a 501(c)3 non-profit organization based out of Indianapolis, Indiana that channels resources to sustainable health projects in developing countries. Timmy Global Health sends a group of volunteers every two -three months to perform medical relief in underserved areas in Ecuador, Guatemala, and the Dominican Republic. Additionally, Timmy Global Health partners with established NGOs and sends monetary support to our partner organizations to support their year-round outreach to the poor. Utilizing the charisma of college students, Timmy Global Health has developed its volunteer base at 22 universities around the United States. Timmy Global Health strives to keep overhead costs as low as possible. As a chapter, we will fundraise all the medications necessary for the trip in the United States and transport them to Ecuador. In addition to the medical supplies, we fundraise money to donate to our international partner organization in Quito, which ensures that care is provided to those who need it year-round. 93% of all donations go towards subsidizing costs of medical care in Ecuadorian hospitals, funding a mobile medical unit that travels to small farming communities outside of Quito, and to the construction of a new hospital/keeping the local clinic staffed five days a week. HOW YOU CAN HELP • Donate Supplies: Children's vitamins, toothbrushes, toothpaste, soap, shampoo, Ziploc plastic bags, over the counter medicines etc. • Donate Gift Certificates and Prizes: Timmy Global Health is holding a "Spread the Love" banquet on Friday, February 15th and we are looking for items to auction and raffle. • Monetary Donations: Checks can be made payable to "Timmy Global Health" with "Attn: CU Boulder" in the memo line. 93% of all monetary donations will be used in support of those abroad in need of healthcare services. By choosing to help this outstanding cause you will receive a thank you card from Timmy Global Health, proper documents for tax purposes, and you will know that 93% of your donations are needed and will go directly to the people of Quito. Thank you for your encouragement and generosity! Sincerely, NXMA41- Nina Zegarra Nize05770co 240-753-8760 C`68AL 1-tEP DO Non -Profit ID# 35-201-2757 timmyglobalhealth.org cutimmy.org u•� April 3, 2015 Cantina Laredo 1680 29th St. Boulder, CO 80303 Dear Andrew, We are thrilled and honored that you have chosen to donate Attention Homes' 8th Annual Kaleidoscope Gala taking place Saturday, May 16, 2015 at CU's Glenn Miller ballroom. We are expecting 350+ community leaders and business professionals to join us. Our goal is to raise $155,000 for programs and services provided to the youth we serve. Your gift certificate that you valued at $25 will help us to achieve our goal. Attention Homes, the only runaway and homeless youth shelter in Boulder County, has provided more than 8,200 at -risk girls and boys with critical, life -changing services since 1966. Your support helps deepen our impact through our street outreach, day drop-in and overnight emergency shelter in the following ways: • Shelter, safety, and security in one of two structured, licensed facilities in Boulder County • Healthy meals, clothing, showers, and laundry • Life skills lessons and behavioral coaching with positive adult role models • Case management with access to education, job coaching and medical/mental healthcare On behalf of the youth we serve, Thank you for your contribution. If you have any questions, please don't hesitate to call 303-447-1206 ext.129 or email KRouland@attentionhomes.org Cheers, Kimberly Rouland Events and Development Manager Auction Donation: Item: gift certificate Value: $25 Attention Homes is a 501(c)(3) nonprofit organization (Tax ID #84-0571145). No goods or services were exchanged for this donation. Please see your tax professional for further information about using the donation as a tax deduction. This letter may be used asyour receipt. 1443 Spruce Street, Boulder, Colorado 80302 1 p 303-447-1206 1 f 303.447.0623 1 attentionhomes.org 11)AIRY CENTER FOR THE ARTS BE MOOVED April 6, 2015 David Cardona, Manager Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear David, � 0 -oat -UC) 1 I am writing to thank you for your in-kind contribution of $450.00 on 4/4/14 for chips, salsa, guacamole, and full trays of chicken and vegetarian quesadillas for the Boulder Arts Week closing party at The Dairy Center for the Arts. The success of our center depends on the generosity of our community and your support is greatly appreciated. As you know, our mission is to provide Boulder and surrounding communities diverse opportunities to create, learn, and participate in high quality performing, cinematic, and C; visual arts experiences. We partner with fourteen of Boulder's finest arts organizations, and work with countless others throughout our community. We inspire people of all ages with dance, music, theatre, literary events, independent cinema as well as visual and media arts in a unique facility that intimately brings together artists and their patrons. Your contribution plays a vital role in that process and we thank you for joining us in making the arts meaningful and accessible to everyone in the Boulder community. On behalf of the board and staff at The Dairy, as well as the countless artists, participants and spectators who connect at The Dairy, thank you so much for your investment in our mission and our work. It is your contribution that makes it all possible! Kindest regards, 1�4` Uk,�2 �'- 160 pct, , �� Ce c w� Ci' ✓�C� U� u o ( c '-671 /d /0'oL Beth Smith U I Development Manager 61)U -t - ACIVOP Oil-,— L� The Dairy Center for the Arts is a 501(c)(3) organization (Tax ID #84 1149609), and your contribution is tax deductible! Accordingly, contributions made to this organization are deductible for federal income tax purposes subject to the following: All cash contributions of $250 or more must be supported by this Statement of Donation. No goods or services were provided in exchange for the contribution listed above, and the entire amount is tax deductible to the full extent allowed by law. 2590 Walnut Street, Boulder, CO 80302 �- - 303.440.7826 fax 303.440.7104 www.tliedairy.org Mark Twietmeyer Senior Pastor Terry Schjang Visitation Pastor Search in Progress Daniel Bock Valerie Hess Coordinator of Music Ministries Leila Heil Adult Choir Director Jeanine Marsh Youth Choir Director Melanie Nehls Burow Office Manager r�l 2200 Broadway Boulder, CO 80302 Ph: 303-442-2300 Fax: 303-545-5527 Email: '-;nityboulder c@ jtmail.com web: www.trinityboulder.org www.facebook.com/ trinityboulder TRINITY LUTHERAN CHURCH A mission outpost in a troubled world Building Homes Changing Lives! M, March , 2015 Dear Thank you very much for your donation of valued at 4 fir;', OC3 for Trini y's Silent uction on Sunday, May 3, 2015. Funds raised will be used for Trinity's mission trips to Mexico and Pine Ridge Indian Reservation in South Dakota. Your donations of gift certificates or other donated items will be auctioned off at a "fun" raising event on May 3rd. The donations received from this event, together with other financial donations, will be used to purchase the supplies needed to build homes in Juarez or make repairs to homes/trailers on Pine Ridge Reservation. All labor, travel expenses, and time are donated by members of Trinity's house building work crews. Thank you for your help as we couldn't do this without you! To give you an idea of what your donation helps to accomplish in Juarez, here are some samples. $750— pays for an entire wall $225 - per door $150— chicken wire used under stucco $ 75— per window $ 50— ceiling fan $ 20— fabric for curtains $ 20— paint for windows and door frames Blessings to you. Missions Committee Trinity Lutheran Church Tax ID #84-0482049 No goods or services N ere provided in exchange for this donation. 0 ( 0-1wtFor care" Fen Facing Critical Illness DONATION RECEIPT Cantina Laredo Andrew Richardson 1680 29th Street Boulder, Colorado 80301 Thank you for your kind donation to There With Care. We are honored to be there for children and families facing critical illness with your help. Description Date Received Amount, Red Carpet Adventure 2015 Auction Item Donation: $55 Gift Card 6/25/2015 $55.00 Total: $55.00 With gratitude, Paula DuPre' Pesmen Executive Director _ h - Cw*} (\CJ46q Lora Covington Community Development Associate Jr�kc ycLJ 5 d cn u &\ '�( �� �Lq tj,Le,U�C I a U �u,�, s\_0 0,114Aj V4-uk' �'� No goods or services were received for'this donation. There With Care is a 501(e)3 non-profit. 131N# 68-(16(163311 2825 Wilderness Place, Suite 100 Boulder, CO 811301 3113.447-CARli(2273) -. — e d e 9� v y O V � s � Cizal -. — e d -TOCA V(O Y�►S'y►;'Waw *Iv"-vov-4 rVnD -SA.r4048 lPrnd OrA?) sAmb ".40�. uo6 QS bw►�v�v�� �.v.o s�u-eqj ;ajnd Iv Wd a 1ecjsS jv( . owl�ov 4ht o��1�er� e�' Anq, T-Pfiv �o� r Y-,Iyg Care of wind �,r r t� ct�e a� C&a,+n�` p� Nil 5C) 91 `\-o Ki10W S 6 �Y) X111U� W�u� d„lyu 1 C<:;� c N Z3 ca �+ t a CL o = + C<:;� c r - V G r m C RECEIPT -jusan G. Komen - Rally For The Cure Tax ID #75-1835298 J Donor Name & Address: Email: Gift Description & Value: . Thank you for your contribution! RALLY FOR THE CURE CCWGA I confirm receipt of the above gift. I further confirm that no direct, tangible benefit will accrue to the donor as a result of this gift. This organization is a 501(c)(3) orAnization, tax ex pt u der th(AUS Internal Revenue Code. Authorized Signature & Date: RALLY FOR THE CURE PRESENTED BY Coal Creek Women's Golf Association DONATION REQUEST 2- t>--MG-A0P V(30VA�� A fun golf day for a great cause! On behalf of Susan G Komen-Rally For The Cure, please consider making a gift card donation to be used as a player award, raffle prize or silent auction item at our upcoming fundraiser. This year's event is taking place on August 11 at Coal Creek Golf Course in Louisville, CO. Donations like yours, are a critical part of the success of this annual event - and in the progress toward a cure for breast cancer. If you choose to support our event, I would be happy to pick up your donation at your convenience. Please call with any questions and thank you so much for your consideration. Event Coordinator: iren Paul, 303.449.8849 • caren@gofarfast.com Susan G. Komen is a 501 (C)(3) organization; tax id #75-1835298 Coal Creek Women's gaff �J� I •,•�• •-ir::�l; `� � � _� - J -• e tit...,- £',. Y. }' Jr. (0 � SLS _ iE�•" .:�•`� - 00 o LO 0 ro Oz c c+ O omz m 7 � n D� C 7 W ® �>> 7 77 z C n 7 m7 Z —� �} n 7ZO 77 �� ---iZ j -j �e� 10386 N 65" Street C 0 L 0 R A D O Longmont, CO 80503 NORSE RESCUE (720) 494-1414 Mane Event Donation Receipt f r Date: Donor Name: � .t• -f.'_. �� � � `_� � � � Mailing Address&� City, 4'�-'Cu State: L .V Zip: Phone: 7�� 4 Email: ,�litflt. )tem D.9nated (one item perform): + { 1 7 0 Item Value: +� . O Received By:` - Donor Signature: Colorado Horse Rescue is a 501(C)3 non-profit organization dedicated to saving the disadvantaged horse... one human, one rescue, one home at a time Thank you for your generous donation! www.chr.org info@chr.org OFFICE USE ONLY Silent Auction i Gift Certificate:, Live Auction I ; Gift Basket o Item Title: Item #: Min Bid: Bid Inc: o Art, Jewelry, and Clothing o Dining/Entertainment Health and Fitness Home Decor Bid Sheet Description: I- Family Fun o Just for Kids o Equestrian and Pets Total Value: White Copy: Office Use Yellow Copy: Merchandise Tag Pink Copy: Donor Receipt Nza- OW 77 > c ~ � U 2O N � O o J U300 CD V OU N cd CL- W V)O m5 ch C) z O_ W~ C7 N fn CD Re cnuiV] cn L^ ¢ N W W Z W Wcn co n �'"' O F- Z W W W f/7 Z tin r^ W J Z¢ o = o Lu a ¢ cn �Z oor CD H O o z `W' o 10 - cc W v O ~ O 0CC, O } Q W O cc w C! W= Cil G_ O O cr Lu = W Z� W Www ¢ 2 o� ¢ cc i CDF W Y U J } Z Z d =O O ¢ Q J H W Q (n F= O LU =o¢ www rrY 03 O~ U Ckt W W =O V]ce-J Z 3 Cl)Li Q Q'LU z U :2 UJ ceZ Y ui r� ^ �✓ corn cm m W VJ Y CD Q r W - C _ ., o a x� O9 coo *• t i «« t: 4-- O M L Q) .Q 0. V) V) H a M X N N C W O On r- 0 O 2 O 410 C 0 f0 40- Q) °Q) V Q) L H L 1— M Ql 0 N Ln 0 4 00 X M 1- 0 C O 0 N L d-+ H .0 E O LL M E S A Moving to End Sexual Assault. our mission We believe that every person has the right to live free of sexual assault. We are moving to end sexual assault and the suffering it causes in our community. We challenge all forms of oppression and recognize their connection to sexual violence. C Mr, w � L �! VS � rd 2016 Boulder B C Chamber 0- Orchestra January, 2016 Dear Cantina Laredo, ' Thank you so much for your generous contribution to our annual fundraising Gala. Your gift is instrumental in advancing the musical excellence of the Boulder Chamber Orchestra. Thank you for believing in what we do at BCO! With your support, we are able to fulfill our mission of enhancing the classical musical arts with performances of the highest standard. We are thrilled to be in our second decade of existence, presenting Dodici as our 2015- 2016 concert series. As we celebrate our twelfth season, we also celebrate donors like you. Concerts are made possible with your help and we are deeply grateful for your support. Thank you! If you would like to learn more about BCO, get information about our concert schedule and guest artists, or simply chat about the delight of classical music making, please give us a call at 303-583-1278. Sincerely, C6 Courtney Ff&fman Managing Director ------------------------------------------ This is your IN-KIND GIFT RECEIPT. Boulder Chamber Orchestra is a 501(c)(3) nonprofit charitable organization. Gifts are tax deductible as allowed by law. No goods or services were provided in exchange for this contribution. Please retain this letter for your records. Date of Gift: 02/03/2016 4 Estimated Value (as determined by donor-): _q0_ Description of Gift: 2 free entree's and a side of chips and guacamole Gift Type: Gala Auction Donation Per IRS regulations, placing a dollar value on donated items is the exclusive responsibility of the donor. Organizational Information: Chamber Music Society of Boulder 9 Operating as: Boulder Chamber Orchestra • EIN: 84-6036754 American Heart Association DENVER heart ball Denver Heart Ball Saturday, February 27th 2016 Hyatt Regency The Colorado Convention Center 2016 Denver Heart Ball Chairs John & Maureen Harney Denver Heart Ball Vice Chairs j- Randy & Dara Owen, - 0/CFO Envision Healthcare Grant Wicklund, CEO of Exempla Lntlieran Medical Center Bill Lindsay, President, Benefit Group -Denver of Lockton Companies Dick Kelly, Former CEO of Xcel Energy John Ikard, CEO of First Bank Holding Company J American Heart Association Southwest Affiliate 1777 S. Harrison Street Denver, CO 80210 Tel 303.801.4630 Pax 303.757.0195 Dear Cantina Laredo, Thank you for your support of our past Denver Heart Ball Auction, your item was a huge success. With your contribution we were able to raise over $114,000 in our 2015 auction! In preparation for our 2016 Denver Heart Ball Auction we would love for you to consider recommitting your generous gift by this fall to help make our auction a success again this year. The finds raised at the 2016 Denver Heart Ball will go towards finding stroke educational programs for children and adults in the greater Denver area. We appreciate your consideration of donating a tax-deductible item to this important event. We are striving towards the goal of raising $130,000 in our auction and $1,200,000 in total for the event which will further our mission of building healthier lives, free of cardiovascular diseases and stroke. We are excited to offer additional exposure through our website and events leading up to the Denver Heart Ball. Items valued over $500 will received two tickets to our Auction Preview Party/Chef Event in January 2016. To make a donation simply fill out the enclosed donation form and return it to the American Heart Association office. Thank you in advance for your contribution to the Denver Heart Ball and the American Heart Association. We are so grateful for your support and we look forward to partnering with you. With heartfelt thanks, Shawn Miller Blair Pesses President I CEO & 2016 Auction Chair Development Specialist Elevation Media Group, Inc. American Heart Association 303-840-5550 303.801.4658 American Heart Association is a 501 c3. Tax ID # 13-5613797. attention HOMES CHANGING LIVES Of YOUTH IN CRISIS Dear Andrew at Cantina Loredo, Date: 1-30-16 Thank you for caring about our community and donating meal certificates to our 2015 Kaleidoscope gala. We exceeded our fundraising goal of $175,000 to provide life -changing services to youth like Jesse, one of 8200 at -risk or homeless youth served by Attention Homes in the last 50 years. Jesse lived with her single mom for the first 16 years of her life. When her mom was sentenced to prison, Jesse moved in with her grandma for 2 years. Last summer Jesse's grandma passed away, leaving her homeless and without support. After 4 months on the streets she found her way to Attention Homes. Getting the support through the myriad of services Attention Homes provides, she now has a job, a savings account, and is moving into an apartment. We hope you will partner with us this year with a $25 or $50 gift card for our dining grab game as we celebrate 50 years of service with 350 supporters who want to make a positive impact in the lives of youth. Guests loved the game! Get your kicks in '66 @ the 9th annual Kaleidoscope Gala a -go-go Saturday, Mayl4th, 2016 Omni Interlocken hotel Dining, drinks, live entertainment and an inspiring program Your donation helps deepen our impact through our street outreach, day drop-in and overnight emergency shelter in the following ways: • Shelter, safety, and security in one of two structured, licensed facilities in Boulder County. • Healthy meals, clothing, showers, and laundry • Life skills lessons and behavioral coaching with positive adult role models • Case management with access to education, job coaching and medical/mental healthcare If you have an item to donate, please email diningout@attentionhomes.org or give us a call. We are happy to pick up your item or you can drop it off or mail it to us. Sincerely, C'1NmI1�?G'y.�lf ��� Kimberly Rouland ,` f Event Manager 1443 Spruce Street, Boulder, Colorado 80302 1 p 303-447-1206 1 f 303.447.0623 1 attentionhomes.org 2016 Sports Extravaganza Fundraiser @MEMO 6 MIE IETREU March 12th, 2016 6:00 pm The Elks Lodge 3975 28th St. Boulder, CO 80301 "We make a living by what we get, we make a life by what we give" -Winston Churchill ITEM DESCRIPTION*: DONATION RETAIL VALUE $: *(Please note: Item Description will appear on bid sheets as it appears here) e 6kL't r&1 I'd DONATED BY: NAME:'�i'Q�' ADDRESS: CITY.1 _ �� 1 1 - STATE: 4f C3 ZIP CODE: PHONE: �z Z�`( —(ma c% EMAIL: -j<:J tC�,0 0-,! t `�{}�-�o cc,r, COMMENTS: Romy LaBorde (303) 324-6848 2016 Panther Gala Co -Chair ITEM #: MB LorS 501(3)CTax ID # 84-140-6282 Roman Martinez (303) 547-8226 2016 Panther Gala Co -Chair Administrative use only C BI TYS - L E IT BN Rrll n r1FR wir w rrwr)rll I irnd apapa op aVF Rrll n nr-P ro f nin*) stories on stake think outside the book March 18, 2016 Board of Directors Andrew Richardson Linda Treibitz, President Cantina Laredo Dana Mathes, Secretary 1680 29th Street Boulder CO 80301 Linda Roberts Zinn, Treasurer Cristin C. Bracken Dear Andrew: Cammie cloman Leslie A. Eaton Thank you for your contribution of three entrees, valued at $45, for Stories on Stage's Silent Auction 2016, which was on Friday, March 11 Marry McGovern in Boulder at Chautauqua & Sunday March 13 in Denver at Su Teatro Erica Stull Cultural and Performing Arts Center. The auction was a huge success thanks to your generosity! Kay Taylor We truly appreciate your support in helping us to continue our mission of William Wei combining theatre and literature to encourage mutual understanding --among a diverse audience. With the help of your contribution, we are able to bring amazing talent to Denver and the surround areas and present some of the best literature available. Staff Thank you for partnering with us to make this year's Silent Auction Anthony Powell so successful. Artistic Director Abbe Stutsman We are grateful for your outstanding support. Executive Director Lisa McClellan Sincerely, Administrator Lisa McClellan Administrator 2590 Walnut Street, Ste 8 Boulder, CO 80302 Please note that this is your official tax receipt for your records. Stories on Stage is a 303.494.0523 501(c)(3) nonprofit organization, and our tax ID number is 84-1583634. Your contribution is tax deductible to the extent allowable by law. We confirm that we did not www.stodesonstage.org provide any goods or services to you in consideration for your contribution. info@storiesonstage.org DELTA SIGMA PI Abnerlca 'v ForemostProfessiond Business Fraternity Delta Sigma Pi is a professional fraternity organized to foster the study of business in universities, to encourage scholarship, social activity and the association of students for their mutual advancement by research and practice; to promote closer affiliation between the commercial world and students of commerce, and to further a higher standard of commercial ethics and culture and the civic and commercial welfare of the community. On behalf of the Delta Sigma Pi pledge class, I would like to thank you for your generous contribution. Your generosity has enabled us to volunteer our time to various organizations. We greatly appreciate your donations and your help in moving us closer to achieving our goals. We look forward to working with you again in the future. Tatiana Celentano, VP of Fundraising (310) 944 4079 tace4l98@colorado.edu Megan Juell, resident (720) 403 5418 megan.juell@colorado.edu 5 Celebrating 50 Fabulous Years of Bal Swan March 17, 2016 Cantina Laredo 1680 29th Street Boulder, CO 80301 Dear Andrew, Thank you for your support of Bal Swan Children's Center by being a valued donor to our 52nd Annual Bal Swan Ball. We appreciate your help in our fundraising efforts and recognize that we cannot reach our goal without you. The Ball is our largest annual event and it would not be possible to have our silent or live auctions without donors like you! Your donation helped us to generate funds to provide to more than 520 children preschool programming, full therapy services and summer camp for school age alumni. Your donation also made it possible for us to raise significant support for the provision of services to children with disabilities and their peers, who are typically developing, enrolled together in our inclusive setting. The profit also enables us to provide over $80,000 in scholarships for those in need of assistance. Additionally, the proceeds will be a starting point for our plans to seek additional funding necessary to address eventual capital improvements, such as a handicap accessible entryway. Your donation of 4 Entree's at Cantina Laredo has a value of $60.00. Bal Swan is possible because of the generosity of the community and we are so thankful for your support. Your donation enables us to provide a loving educational environment for our community's most valuable resource, our children. On behalf of the entire organization, but thank you. Sincerely, Jennifer Davis, Auction Chair ecially the children and families of Bal Swan, we Wurtsbaugh, Associate Director of Development PS: SAVE THE DATE - Please join us for next year's Bal Swan Ball on March 4, 20171! 1145 E. 13th Ave • Broomfield, CO 80020 • 303.466.6308 • Fax: 303.466.1224 • www.Ba[Swan.org HUMANE SOCIETY OF BOULDER VALLEY Puttin' On The Leash 2016 - Saturday, April 16th 2016 Restaurant Sponsor Commitment Form Company Name: ( General Manager/Owner Name: Contact Name for Event: \ Ic-�A. Address: o 1("i:�D f+z City, State, Zip: Phone Number: Email Address: Serving at the Event - 800 - 1,000 bites per item (Please arrive between 4:30 p.m. and 5:00 p.m. on Saturday, April 16', and be ready by 5:45 p.m. You will be provided with 1 or 2 tables, tablecloths, small plates or bowls, napkins, and plastic utensils.) F=i a AeA y i What item (s) will you serve?: C, --F �: ps jr�A-- �4 �� ,ai ItA. S/ Number of servings: Event Logistics (please circle): Would you like the same location that you had in 2015? Yes No N/A Tables (6ft. banquet): 9) two Please Explain when food should be picked up and what supplies volunteers will need to best serve your donation: Vzz- Would you like to donate a gift certificate for the silent auction? <2 A 3r No. QOGLS Please contact Amanda Williams at 303-442-4030 x 636 or Amanda.Williams@boulderhumane.org with any questions. FAX this sheet to 303-565-5151, or mail to: Puttin' on the Leash HSBV 2323 55th St. Boulder, CO 80301 Thank you for supporting the homeless animals we serve! . t S r� °� Zing for Zonta: Boulder's Got Talent! ZONTA FOOTHILLS CLUB OF BOULDER COUNTY AIEMlfA OFIOMA IMFRHATIONAI EMPOWERING WOMEN m THROUGH SERVICE i ADVOCACY What is Zing for Zonta? ' Zing for Zonta is the major annual fund raising event for the Zonta Foothills Club of Bou er County. Each year it raises funds to support efforts to help women and girls realize dreams for an educati n, health, economic stability and safety. This year's event theme is Boulder's Got Talent! The audien a will enj a variety of talent from around Boulder County while coming together for a cause that effectspositi change in he lives of women and girls around the world. 4 When and where is Zing for Zonta? Zing for Zonta 2016 will be held on April 21, 2016 from 5:30 9:OOpm in the fablous ^ own H I, 1536 Spruce Street, Boulder, Colorado. `` I 1 What is eTown Hall? eTown Hall is a multi-purpose building in the heart of downtown Boulder that is world-class liv music venue and full service recording studio with the essence of a community center. We are n d feat re our talent in one of the finest musical venues in Colorado! To learn more about visit: http:w wn.or etown hall/. Who will appear at Zing for Zonta? Local talent from around Boulder County will be featured at Boulder's Got Talent. Our commu ity is brimming with talented people so the evening's entertainment promises to be best! A for loc tal call has gone out and the final performers will be announced in February. The audience will join the fun by voting for their favorites. Who is Ryan Van Duzer? Ryan Van Duzer, TV personality, outdoor enthusiast, cyclist, filmmaker and motivational speaker will be the Master of Ceremonies. A graduate of Boulder High School and active in the community, Ryan can be seen surviving in the jungles of Venezuela on Discovery Channel's "Out of the Wild". What is Zonta Foothills Club of Boulder County? Zonta Foothills Club of Boulder County is a chapter of Zonta International. Together with the Zonta Foothills Foundation it has been working to improve the lives of women and girls in our local community and internationally since 1982. Our all -volunteer membership focus on service, advocacy and fundraising working together to support the education and empowerment of women. www.zontafoothills.org I ZONTA S Zing for Zonta: WBCut Talent! Zing for Zonta Donation Form FOOTHILLS CLUBOF BOULDER COUNTY MEMBER CN'IONSA VrtNNAT10141 EMPOWERING WOMEN ED TNROIIGN SERVICE i ADVOCACY Donor Information Name of Donor (as you would like it to appear in catalog) Business Name (if applicable) Mailing Address city State Zip Phone Fax Email Donation Information Detailed Description of Donation Estimated Fair Market Value Restrictions, if any Please provide details Donation DetailsDelive Certificates & Dis las Miscellaneous ❑ 1 will deliver 11Please contact me to arrange pickup ❑ 1 will provide a gift certificate ❑ Please create gift certificate ❑ 1 have props to enhance the dis la ❑ Cash donation enclosed ❑ Please contact me regarding sponsorship opportunities Arrange for Pickup: Please mail this form to: Please contact Christie at 307-690-9610 or email: Zonta Foothills Foundation president(azontafoothills.org PO Box 19964 Boulder, CO 80308-2964 Deadline for donations April 13, 2016 your support — and assure you that your contribution will be put to good use in our community and around the world. Your donation is tax deductible — IRS 501(C)(3) organization — Federal Tax ID: 41-2148443 www.zontafoothills.org . 4 FF Dear Andrew, l We are marking the Five Year Anniversary of Temple Grandin School in 2016 and to celebrate we have put together a fantastic event in Boulder the evening of Monday, April 4th, 2016. We are hosting a TED talk style event and reception at eTown Hall in Boulder. The speakers for our "Meeting of the Minds" event are Temple Grandin, Phil McKinney, CEO of CableLabs and author David Finch. The topic of the evening will be neurodiversity in the workforce. Frasca Food and Wine will be catering the event and there will be an opportunity to attend a private reception with the speakers before the talk. We have far out grown our space on Jay Road in Boulder and we are planning to move to a larger facility so that we can serve more students with autism. This event will help us reach our goal to move to a larger facility. Your support of our First Annual "Meeting of the Minds" event would mean a great deal to all of us here at TGS. We were hoping you could donate a gift certificate for Cantina Laredo to include in a raffle type fundraiser we will be doing during this event. Thank you for time and attention to this request. I have attached a flyer of the event for your review. Please do not hesitate to cal or email if you have any questions or need additional information. TGS-Mission: Working together with families, we meet the unique needs of students with Asperger's in an individualized, strength -based socio -academic program that builds students' confidence, knowledge, and perseverance and prepares them to fulfill their potential as effective citizens of the 21st century. Warm regards, Rosie Paz PS- My daughter has attended the Temple Grandin o for the p ars and it has been life changing for her. I am grateful for eve ing the school does for h a on't know where she would be with out it. A ne acility would mean more kids wo d ge the help they so desperately need- that " gular" schools can not provide for the e children on the Autism. `l I -- 2E ■ L ■ L -LA go m c_ a) cy3 2 E CL Z E m c $ 15 _ d � m w 7 o T a� o CL c ca F- CD Y a E > $ o ani � ani c t o O 7 c E c O m ca c O Z � � c � c 0 s c m v 3 O0 �j m c O W -Z C 1 `0 Q ID z > 0 0 � o � ID pa) 7 Z � 0 m c c J o - o L 9Z L m 00 O c a m my'3EQ Ui Q D E 6tnm c�i o F E m d oo c -F3 E m off' c :3 'lLcc T) c E E vv z E. av` LL 6E 9i 35 J o Q a� O 0) W O 00 L C a C t0 ° a y E Ci vapg$ 0 Cy �, E N Q .08 E y O Q• (Op N •_ E O m ID l IE m o yy4%�� .L.. C /s�l1 3 � \J c ai m° N w O {6 4) o 0 ci S 0 � C Y LcL 6L (5 0 F M rn o p> o ° M = p 2 CL a7 .O LO °4 CD $ Ln d o co !� a Rw O CD L n EE `° 0) a) o O 9 m o H % - m c a o _ pf `o c w O •_(LOQ C °g ° L « C (p O VJ c` 3 V iii a C O WJ CD w Pj m LS m a� c0 CD c E .>_ � LAJ o m CS N � m '� a� vi a mea = E Sj L c a) N ; _ E i N 3 Ecm Q CD qi J c E `o c0 CD 2 CL o ani Edi O a $ CD U 9 V Boulder Valley School Distlict Excellence and Fquhy March 20, 2016 Dear Local Business, Nederland Elementary School l 1 Sundown Trail Nederland, CO 80466 720-561-4800 Jeff Miller Principal I am on the PTA at Nederland Elementary and I am writing to request a donation of a tangible item or a gift certificate for a Silent Auction being held for Nederland Elementary on May 13, 2016. Nederland Elementary is a rural mountain school 15 miles west of Boulder CO that serves students along the Peak to Peak Highway from a variety of socio-economic backgrounds. The Silent Auction is one of our largest fundraisers and is an important part of ensuring that every student at Nederland Elementary has a rich experience and an opportunity to grow. Many of our students rely on financial assistance and the proceeds from the Silent Auction will give the PTA the opportunity to provide those funds (scholarships for field trips, Outdoor Education, after school enrichment activities, etc). For many students, this financial assistance Is their only means of participation. Additionally, funding helps support our wonderful teachers to provide the exceptional support our children need. * We would like to reciprocate your generosity by providing you with a marketing opportunity. We are holding our physical auction on May 13 where we can display any materials you provide. The auction will also be available online 2 weeks prior and will have visibility to the general public. We can upload your business logo, a link to your website, all of your contact information and any additional information you would like to have posted about your business. We view this fundraiser as a partnership with our donors! If you are able to contribute, please contact the Silent Auction Committee volunteer listed below. Thank you for supporting our elementary school. Your generous and tax deductible gift will help ensure that our Boulder Valley public schools stays strong and viable! Jennifer McLaughlin 303-517-8499 4136 Ridge Rd. Nederland, CO 80466 jen_mclaughlin@mac.com Nederland Elementary is a 501(c)(3) non-profit organization; our federal tax ID number is 84-1474211 and our State of Colorado tax exemption number is 09803264. May 6, 2016 Cantina Laredo 1680 29th St. Boulder, CO 80303 Dear Andrew, We are thrilled and honored that you've chosen to donate to Attention Homes' 9th Annual Kaleidoscope Gala on Saturday, May 14, 2016. Attention Homes, the only runaway and homeless youth shelter in Boulder County, has provided close to 9,000 individuals with critical, life -changing services since 1966. To celebrate 50 years of service, we will travel back in time to 1966 for our Gala a Go - Go. Our fundraising goal for the event is $190,300 for services to guide youth off the streets and mentor them towards stable housing and self-sufficiency. Your gift of Cantina Loredo Gift Cards for 3 entrees and 1 top shelf guacamole that you valued at $55 is sure to play a huge part in reaching that goal. Thank you. Your support helps deepen our impact through our street outreach, drop-in center, and overnight emergency shelter in the following ways: • Shelter, safety, and security • Healthy meals, clothing, showers, and laundry • Life skills lessons, case management, and behavioral coaching • Education, career counseling, mental healthcare, and equine therapy On behalf of therouth we serve, thank you for your contribution and helping us celebrate our 50 anniversary! Kind wishes, Kimberly Rouland Events Manager Auction Item Donation: Value: Date: Gift Canis for 3 entrees and 1 top shelf guacamole $55 5/5/2016 Attention Homes is a 501(c)(3) nonprofit organization (Tax ID #84-0571145). No goods or services were exchanged for this donation. This letter may be used as your tax receipt Please see your tax professional 1443 Spruce Street, Boulder, Colorado 80302 1 p 303-447-1206 1 f 303.447.0623 1 attentionhomes.org May 7, 2016 Cantina Laredo 1680 29th St Boulder CO 80301 Dear Cantina Laredo, Zonta Foothills Foundation would like to thank you for your very generous gift certificate donation at a value of $55. Zing for Zonta is our primary fund raising event held annually and this year our Boulder's Got Talent was a huge success thanks to donors like you. Zonta Foothills supports women's education and empowerment at all levels as a way of improving the status of women. Your donation will have a huge impact on our effectiveness to help women and girls in our community and around the world. The funds we raise support efforts undertaken by local and international organizations whose programs like these which work to improve the lives of women and girls: Ci * Boulder Valley Schools Teen Parent Program * Arapahoe Ridge High School & Children's Library * Boulder High School Z Club �k Zonta EducateZ Lending Libraries at Sister Carmen, EFAA, Community Food Share, Harvest of Hope Food Pantry, Boulder Courthouse, and the Boulder Safehouse �k The Prevention of Mother -to Child Transmission of HIV in Rwanda and the Reduction of Obstetric Fistula in Liberia ZONTA FOOTHILLS FOUNDATION The Zonta Foothills Foundation was formed in 2006 as a tax exempt non-profit organization under the International Revenue Code Section 501(c)(3). It was formed solely for charitable purposes and supports the Zonta Foothills Club of Boulder County's mission to benefit women and girls. Donations to the Zonta Foothills Foundation are tax deductible to the extent allowed by law. Our IRS Identification Number is 41-2148443 For more information, we hope you'll visit our website at www.zontafoothills.ore. Sincere , m ose President of Zonta Foothills Foundation & Zonta Foothills Club of Boulder County Zonta Foothills Club of Boulder County PO Box 19964 Boulder, CO 80308 ZONTA io ILLs CWBUi SOUEOS0. Coum Tn. ZCMA fOOTMdES iW!lC. MWll0.0i iOMAIMERNAl1OWLL EMPOWERING WOMEN rC I O TNNOUCM SEWCE 6 ADVOCACY May 7, 2016 Cantina Laredo 1680 29th St Boulder CO 80301 Dear Cantina Laredo, Zonta Foothills Foundation would like to thank you for your very generous gift certificate donation at a value of $55. Zing for Zonta is our primary fund raising event held annually and this year our Boulder's Got Talent was a huge success thanks to donors like you. Zonta Foothills supports women's education and empowerment at all levels as a way of improving the status of women. Your donation will have a huge impact on our effectiveness to help women and girls in our community and around the world. The funds we raise support efforts undertaken by local and international organizations whose programs like these which work to improve the lives of women and girls: Ci * Boulder Valley Schools Teen Parent Program * Arapahoe Ridge High School & Children's Library * Boulder High School Z Club �k Zonta EducateZ Lending Libraries at Sister Carmen, EFAA, Community Food Share, Harvest of Hope Food Pantry, Boulder Courthouse, and the Boulder Safehouse �k The Prevention of Mother -to Child Transmission of HIV in Rwanda and the Reduction of Obstetric Fistula in Liberia ZONTA FOOTHILLS FOUNDATION The Zonta Foothills Foundation was formed in 2006 as a tax exempt non-profit organization under the International Revenue Code Section 501(c)(3). It was formed solely for charitable purposes and supports the Zonta Foothills Club of Boulder County's mission to benefit women and girls. Donations to the Zonta Foothills Foundation are tax deductible to the extent allowed by law. Our IRS Identification Number is 41-2148443 For more information, we hope you'll visit our website at www.zontafoothills.ore. Sincere , m ose President of Zonta Foothills Foundation & Zonta Foothills Club of Boulder County Zonta Foothills Club of Boulder County PO Box 19964 Boulder, CO 80308 Center on Domestic Violence SCHOOL OF PUBLIC AFFAIRS UN VERSITY OF COLORADO DENVER Growing up, domestic violence was a way of life for NFL Vice President of Football Operations Troy Vincent and his younger brother. They watched helplessly numerous times as their mother was beaten, called 911 as she lay unconscious, and witnessed how she struggled to seek help and find the voice and courage to say "no more." On Thursday, October 27, 2016, the University of Colorado Denver's Center on Domestic Violence will honor Troy with our inaugural Champion for Change Award. Troy has dedicated the last 20 years of his life to influencing positive change and has transformed his experience as a child survivor of domestic violence into hope, advocacy and support for survivors. He now promotes leadership over violence, and engages with men across the nation in working to end domestic violence and sexual assault. We are thrilled to honor Troy at this invitation -only Night to End Violence event to be held at Maggiano's Little Italy Denver from 6pm-9pm. We invite you to join us in the movement to end violence by sponsoring a table or by committing to a lead sponsorship level. Our goal is to increase awareness and support for the work of the Center and with your support we can achieve it! Enclosed is the sponsorship packet, outlining various levels of support ranging from $5,000 to $400 and the respective acknowledgement benefits. Tables of 10 can be reserved with a $1,000 donation and only 15 are available. We anticipate a sold -out event by August 30th, so please respond today if you are interested in joining us on October 27th to honor Troy Vincent, 2016 Champion for Change. Thank you! v 0 Z cis lox Z 0 - `1 0 Barbara Paradiso Director, Center on Domestic Violence 303-315-2736; Barbara.Daradiso@ucdenver.edu 13413�s�G� About the Center on Domestic Violence Founded in 2000, the Center on Domestic Violence's mission is to end gender-based violence by fostering institutional and social change through leadership development, education, research, and community collaboration. It strives to prepare individuals, organizations and communities to effectively address and prevent domestic and sexual violence. SCHOOL OF PUBLIC AFFAIRS/CENTER ON DOMESTIC VIOLENCE Campus Box 142 1 P.O. Box 173364 1 Denver, CO 80217 www.domesticviolence.ucdenver.edu `;PONSORSHIP OPPORTUNITIES Please join the Center on Domestic Violence on Thursday, October, 27, 2016 for our inaugural Champions for Change: An Evening to End Violence, honoring our 2016 Champion for Change, Troy Vincent, Vice President of Football Operations for the NFL. The event will be held from 6 pm to 9 pm at Maggiano's Denver and will honor Troy for 20+ years of advocating for domestic violence surivivors, as well as highlight the CDIrs impact on ending gender based violence in Colorado and beyond. Please consider participating as a sponsor, silent or live auction donor, or as a benefactor of the event. «'e hope to see you on October 27th for an unforgettable evening! Levels of Support* $5,000 PRESENTING SPONSOR • 1 table of 10, with preferred seating and table logo signage • 2 additional seats at the table with Honoree (2016 -Tray Vincent) • Special recognition during the dinner remarks • Logo on event collateral and program (if received by August 15) • Spotlight in the October CDV Newsletter (reach 3,000 individuals) • Prominent banner placement at event 1 CDV informational presentation at your company • Press release announcing sponsorship • Sponsorship acknowledgment on CDV social media pre/post event $2,500 LEADERSHIP SPONSOR $1,000 EMPOWERMENT SPONSOR • Table of 10, with table logo signage • Acknowledgment in event program $400 k HOPE -SPONSOR • 1 table of 10, with table logo signage 2 tickets to event • Special recognition during the dinner remarks Acknowledgment in event program • Logo on event collateral and program (if received by August 15) • Spotlight in the October CDV Newsletter (reach 3,000 individuals) • Sponsorship acknowledgment on CDV social media pre/post event r HURSDAY OCTOBER 27 2016 w�thcaxe°heeCilical Illness DONATION RECEIPT Cantina Laredo Dessie Castillo 1680 29th Street Boulder, Colorado 80301 Thank you for your hind donation to There With Care. We are honored to be there for children and families facing critical illness with your help. Description Date Received " ' Amount Red Carpet Adventure 2016 Auction 8/17/2016 560.00 Item Donation: 2 Entrees and Queso Laredo Total: $60.00 With gratitude, Paula DuPre' Pesmen Katie Hegg Executive Director Community Development Associate el 1} els or sen'tees were received for this donation. Thou With Care is a 501(c)3 non-profit MN# 68-M00330 _825 duness Place_Smm IINI Boulder, CO 8(1101 • 2.101 S Colorado 111% d, $uuu A fAmer, CO 80222 iI P_1__ 0 �J 2017 Denver Heart Ball Saturday, March 11th 2017 Live & Silent Auction Procurement Form 4 American Heart Ball Heart Association. life is why - Donor or Company Name (as itshoula appear to the nearrnau aucnon pruyrumi; �(f,lA LAIR-e—IC0 — Donor� CCm tact -Person (nott lissted fti the a Heart ball auction program): � P �1kk0 _ 1 bsc) 2q1- SX. %j\&v C _) Flb Donor Phone Number: 303-'. * -22(60 Donor Signature uire E]yes, please siCAmita on to the 2017 Denver Heart Ball ' Item Name: Detailed Item Description: (Quantity, size, It Color, Restrictions and any other information which will help us describe the donated item.) idline: January 13th 201 .®Expiration Da (if applicable) Please return to: American Heart Association American Attn: Blair Pesses Heart 1777 South Harrison Street, Suite 500 Association® Denver, CO 80210 life is why -Questions? Please contact Blair Pesses Phone: 303.801.4658 Fax: 303.757.0195 Email: B1air.Pesses@heart.0r _ Donor provides the estimated value above. This document serves as a tax receipt. Please retain a copy for your records. Th American Heart Association is not responsible for valuation of your donation. No goods or services have been provided by th Association in connection with the in-kind donation listed above. Donations may be combined with other items. Tax ID # 13-5613797 Auction Opportuh,ties;, 04 American DENVER Heart Heart Ball Association. life is why- r 2ol6 Event Sponsors & Invitations v EMPOWER Gre Hlb ja !t lwnad vu.d.rnn.ek 'r' •a E"?M 2016 Denver Heart Ball Saturday, February 27, 2o16 Coo in the evening Hy.. Reg—" C.1.-d. C.menti.n Cmrer 65015th Street, D— CO 80ao2 2016 Deaver Heart Ball Chain: J.h. & Mau— H.—q, Retired Pre.(dmr & CEO .ru.irmh7.f C.I—". Hospital 5:30 pm- 6.3o P-1 %1P R.upri..li..ori.n .h) 6,eepm-7,c0pm Revepr6.&58mrAun:.n 7�30pm. Dins, I'mg—& U..A.d.n 9 3- p— D-1-9 1'ie.dl ver a,d li.e..ni.n I.—..d purd— ud<u>t de..erhnrr6d13art..rE For more l.(.rnuri.. eegardingNcYeq spa.mnhip .pp.nuvhinxm ma4ad.mri. pl..r.m.ue 15UIrP—.'3o3.8or 4658..A—H ar 64'vpavea8hearc.rg. �� I hfeart 8aN . 7.I... e�...a...r.t.. .ma u...s... wove. e;.. w..... co a.v. Event Spmnars �TyGREATWEST EMPOWER ■ ■ Envislon [I ucHealth 0 0 .. r. .r+vonr n ®clwa.carvu c mamlae.amt , [. monk LED��w�._ Oe®t0n(0tt NLAt� EY �Br' „a „g� irs=ii Q� -� TRAM3 INSPIRATO 64 MV Auction Details & Photographs Why donate to the Denver Heart Ball? The funds raised through our auction sales will go directly to improving children's heart health, childhood obesity and healthy awareness programs for children in our community. Everyone wants their company or product to be seen, by donating to the Denver Heart Ball auction, your product and company will be seen by hundreds of qualified buyers in the community. Auction Goal Fair Market Value (FMV) Goal: $200,000 Night of Event Goal: $140,000 Auction Agenda The Denver Heart Ball will have three auction sections; Live, Super Silent and Silent. Guests will arrive to attend a cocktail reception for the first hour and a half of the evening where they will have the opportunity to bid on Super Silent and Silent auction items. The Live auction will take place in the ballroom during the evenings program. Thank you for your interest in the Denver Heart Ball benefiting the American Heart Association. For more information on auction donations please contact: Blair Pesses — Director, Denver Social Events Team 1 303.801.4658 B1air.PessesPheart.org 1777 S. Harrison Street, #500 Denver, CO 80210 American Heart Association Tax ID #: 13-5613797 Intercambio Uniting Communities 4735 Walnut St, Ste B Boulder, CO 80301 September 28, 2016 Dear Cantina Loredo, Business partners are essential to nonprofits! J Intercambl'o�} UNITING COMMUNITIES -� Thank you for contributing a $50 gift certificate to Intercambio's La Fiesta 2016 silent auction. Over 1,300 people of various ethnicities and socio-economic classes came together for a night of music, dancing, food, and culture. It was an occasion to celebrate diversity and community, and during this celebration, we raised over $50,000! We couldn't have done it without your generosity. The money we raised will provide English classes for over 1,000 adult immigrants in Boulder County. It will ensure that we can rent space to hold these classes and provide tuition, books, and registration for these students. This money will also allow us to continue our monthly event series, gatherings where students and volunteers can connect with one another and enjoy speaking English outside of the classroom. And the impact doesn't stop there. With the English skills they gain in an Intercambio class, parents can participate in their children's Parent Teacher Conferences. Husbands and wives can earn promotions to better provide for their families. Neighbors can form friendships that a language barrier might otherwise impede. Your contribution directly impacts lives. So, thank you again for generously supporting Intercambio and the community. We are grateful for your contribution to the silent auction. If you have any questions about how your donation was used, please don't hesitate to contact me at 303-996-0275 ext. 106. Sincerely, Jenny esmo Community Events Manager jenny@intercambio.org Mission: Improving immigrant lives through English education, and uniting communities across cultures. 4735 Walnut St., Ste. B I Boulder, CO 803011303-996-0275 1 www.intercambio.org Please consider donating your products or services to support our annual signature event. RED CARPET f! (, ADVENTURE v 2016 �therewlthcare® ,y�1 C��'r, •- •: m For Families and Children Facing Critical Illness'-%� S14 s There With Care serves families facing critical illness. A large portion of our ability to care for families and expand our outreach comes from generous community supporters, donors and local business owners. Denver Friday, September 9 WELLSHIRE EVENT CENTER 3333 S. Colorado Boulevard Denver, CO 80222 'ILENT AND LIVE AUCTION ITEC Restaurant gift certificates, resort stay -and -play packages, overnight getaways, sporting event tickets and more. Gift certificates from your business, merchandise, consumables, golfing and event related items. Boulder Saturday, September 14 LEVIN HALL at the BOULDER JCC 6007 Oreg Avenue Boulder, CO 80303 TRAVEL SUPPORT Airfare certificates, frequent flyer miles, travel vouchers for airport transfers, and cab rides. EVENT SPONSORSHIP Underwrite specific costs for a particular event. Since 2005, There With Care has served more than 2000 families who have a child battling a life-threatening medical condition. We provide ttherewithcare" support to these families by easing the burden of life's day-to-day obligations with compassion and care. 2825 Wilderness PI., Ste. 100, Boulder, CO 80301 1 2401 S. Colorado Blvd., Denver, CO 80222 303.447.2273 (CARE) 1 303.576.2273 (CARE) ht r�Wi � t care For Families and Children Facing Critical Illness Family Support By The Numbers The average length of time that a fam- ily receives support from There With Care is 119 days and the average cost to serve a family through a medical crisis is $3,421. 79% of the families we serve live below poverty level and with the help of our community, we have provid- ed $3,515,486 in donated in-kind items and $3,333,899 in donated volunteer and professional hours. Our Mission About Us There With Care's mission is to provide a wide range of thoughtful and fundamental services to children and families during the critical phase of a medical crisis. We serve families referred by medical agencies by building a network of services and people who ease the burden of life's day-to-day obligations with compassion and care. Our History There With Care was founded in Colorado in 2005. For more than a decade, There With Care has grown to provide support for more than 2,000 families with the help of more than 600 volunteers and local business partners. Each day the Program Team serves on average, 125 families facing a medical crisis. Families We Serve How We Connect There with Care Colorado takes referrals from medical facilities in the Denver Metro, Boulder and Broomfield areas. Families come from across Colorado and seven sur- rounding states to the 15 medical facilities we serve. There With Care of the Bay Area receives referrals from the Lucile Packard Children's Hospital and UCSF Benioff Chil- dren's Hospital. New chapteres on the hori- zon will reach familiies in the Los Angeles, Chicago and Boston Areas. We serve families and children facing critical illness. The programs we offer support the wholeness of a family. To achieve this, There With Care works with the families to identify their day-to-day stresses and provide support to ease their burdens. Some of the ways that There With Care accomplishes this is by providing services to families such as transportation assistance to and from hospital treatments; grocery and meal deliveries; housecleaning for families, many with immune compromised patients; family therapy programs; mentoring; and much more. Because of the flexible and broad range of services that There With Care offers, the organization is able to transition support as the family's needs change during the medical crisis. There With Care supports each family with a team of Program Coordinators, Volunteers and Service Providers who ease the burdens by engaging the community and connecting those who want to help with those who need it. This network of care surrounds the families with meaningful help when they need it most, so they can focus on what's most important, their children. 2825 Wilderness Place, Suite 100 • Boulder, CO 80304 • (303) 447-2273 (CARE) • 2401 S. Colorado Blvd., Suite A • Denver, CO 80222 • (303) 756-2273 (CARE) therewithcare.org • Federal Tax ID: 68-0606330 I Breakfast Invitation Attached Page 1 of 3 Breakfast Invitation Attached Dave Goldstein [daveg@bgsenergy.com] Sent: Thursday, September 15, 2016 3:40 PM To: CantinaLaredo193-Boulder Attachments: Invitation_BaseCampBreakfa—l.pdf (382 KB) This message originated from outside your organization Dessie, I'd like to invite you to join me at my table at the Base Camp Breakfast, hosted by Paradox Sports on September 30 at 7:30 AM. This is a free breakfast at the St. Julien Hotel and Spa in Boulder for people to come and learn more about Paradox Sports. Yes, it is a fundraiser, too. You will be asked to consider making a contribution. There is no minimum or maximum gift requested. It will be the job of the nonprofit to inspire people to want to give. As much as anything, we want people to come and find out about the great programs they provide for the community. I would be delighted if you could join me. The invitation is attached. Respectfully, DMG Dave Goldstein BGS Energy Director- Rocky Mountain Region 595 Canyon Blvd., Suite D Boulder, CO 80302 e� 303.834.2565 daveg(cr bgsenergy.com www.bgsenergy.com N\31 Respectfully, DMG Dave Goldstein BGS Energy Director- Rocky Mountain Region https://west.exch032.serverdata.net/owa/?ae=ltem&t=IPM... 9/15/2016 Breakfast Invitation Attached 595 Canyon Blvd., Suite D Boulder, CO 80302 303.834.2565 daveg _bgsenergy.com www.bgsenergV.com Begin forwarded message: From: Mike Neustedter <mike(c_paradoxsports.orq> Date: September 2, 2016 at 11:35:08 AM MDT To: undisclosed -recipients:; Subject: Updated Breakfast Invitation Attached Good morning Paradox Table Captains, Page 2 of 3 I am excited to announce Boulder Mountain Institute (BMI), a local mountain guide company has agreed to become the Presenting Sponsor of the event. We can now go into the breakfast knowing all expenses are covered by a sponsor and 100% of all donations made that morning will go straight to our mission. Attached is an updated invitation reflecting the major sponsor addition to distribute. A -Lodge, a boutique hotel in Boulder Canyon has also agreed to come on at the "Supporter" level and has been added too. I will have hard copy invites in hand next week, so please let me know if you need any. Thanks everyone for all of your support and helping make this event happen! Mike Michael Neustedter hftps://west.exch032.serverdata.net/owa/?ae=ltem&t=IPM... 9/15/2016 Breakfast Invitation Attached Paradox Sports Executive Director 1911 11th St, Suite 201 Boulder, CO 80302 720-638-5593 www.paradoxsports.org Page 3 of 3 https://west.exch032.serverdata.neVowa/?ae=Item&t=1 PM... 9/15/2016 Re: Boulder Bus to Work Day Support Page 1 of 3 Re: Boulder Bus to Work Day Support Liz Cassi [liz@slatecommunications.com] Sent: Monday, October 03, 2016 3:31 PM To: CantinaLaredo193-Boulder Attachments: BTWD Sticker.pdf (26 KB) This message originated from outside your organization Hi Scott, Thanks again for participating in Bus to Work Day this week with a discount to riders! Attached is what the event sticker looks like if needed. Riders will need to show this sticker to get the discount. Let me know if you need anything else, thanks! - Liz Liz Cassi Slate Communications I Communication Specialist 970.797.2015 ext. 104 htto://slatecommu nications.com On Sep 20, 2016, at 11:04 AM, Liz Cassi <IizCcb-slatecommunications.com> wrote: Great, thanks so much Scott! I'll be in touch with you again as we get closer to let you know what the stickers look like, and it you need anything else from us. Thanks again! - Liz Liz Cassi Slate Communications Communication Specialist 970.797.2015 ext. 4 htto.Hslatecommun1icUations.com On Sep 19, 2016, at 6:22 PM CantinaLaredo193- https://west.exch032.serverdata.net/owa/?ae=ltem&t=IPM... 10/3/2016 Re: Boulder Bus to Work Day Support Page 2 of 3 Boulder <Boulder(a-)cantinalaredo.com> wrote: Hello Liz, Yes we would love to be a part of the event and contribute back to the community! We will offer individuals the following: Savor Your Choice of Complimentary Top Shelf Guacamole or Queso Laredo with entree purchase. Limit one per person, per day with bus pass or sticker. Offered from October 5th- October 10th. Let us know if you need any further information. I attached our logo as well. I am not sure if you need it for any printed materials or not. Have a great day! Scott Smith FOH Manager CANTINA LAREDO 1680 29TH Street Boulder, CO 80301 303-444-2260 From: Liz Cassi [liz@slatecominunications.com] Sent: Monday, September 19, 2016 4:57 PM To: CantinaLaredo193-Boulder Subject: Boulder Bus to Work Day Support This message originated from outside your organization Hi Scott, I just spoke to you about possibly supporting Boulder's inaugural Bus to Work Day, so here is more information. The event will be Wednesday, Oct. 5, and similar to Bike to Work Day, riders will be rewarded with free giveaways, refreshments and more at certain bus stops throughout the day. Would you still be interested in offering some sort of discount to our riders? They would need to show their bus pass or a sticker they got from the event to receive the discount. The promotion length is tip to you, but it could run Oct. 5 12. Please let me know if you have any questions, and you can also learn more about the event at wNNw.bouldercolorado.i,,ov/goboulder/bus-to-work-day. Thanks! https://west.excil032.serverdata.net/owa/?ae=Item&t=IPM... 10/3/2016 Re: Boulder Bus to Work Day Support - Liz Liz Cassi Slate Communications Communication Specialist 970 797.2015 ext. 104 hflo.//slatecommu nications.com This email has been scanned for email related threats and delivered safely by Mimecast. For more information please visit httt://wv/w.mimecast.com <Cantina Logo (2).bmp> Page 3 of 3 https:Hwest.exch032.serverdata.net/owa/?ae=ltem&t=IPM... 10/3/2016 m r IGNITE Adaptive Sports 2016 Receipt for Silent Auction items for 2016 Ignite Tonight. UCS Lr-_ -4 --7,S- /,\j '4, Thank you for your support of Ignite Adaptive Sports and for believing in our mission and our students! Your in-kind support of the items listed below will help to make a difference in our upcoming 2016-2017 season. Your donation will be used to raise funds in our silent auction. Last season Ignite served over two hundred students who received more than 1,000 lessons provided by our 215 volunteers. We couldn't do this without your support. Donations: No goods or services were provided in exchange for this contribution. Name: Company: A 1.r -c. Address: 16 0 Lj Del -A S7. Warmly, Amy Shrum, Volunteer and Silent Auction Chairperson Ignite Adaptive Sports, is recognized as a tax-exempt public charity under Section 501(c) (3) of the internal Revenue Code. Contributions are deductible to the extent allowed by law. Tax ID Number. 84-7098064 Date: _IV V V Address: WTA Dear Friend of +tee Q, �ff..lr. Thank you for Your support of Buffalo Field Campaign will ensure that our only genetically pure, behaviorally unique, migratory wild bison are protected and preserved. We appreciate your generous donation and care for the buffalo! For the buffalo, & Justine and Thia No goods or services of any value were provided in exchange for this donation. Buffalo Field Campaign is a 501 (c) 3 non-profit corporation. Tax ID #36-3964401. P.O. Box 957, West Yellowstone, MT 59758 www.buffalofieldcampaign.org s L7Car-. 1 V , a'd 1 b r kt g�S kb l.l.ir1F_ Oc.y W e `J�e4tly LIZ C"Ssz slatecommunicatians.com 10386 N 65th Street XWC O L 0 R A D 0 Longmont CO 80503 HORSE RESCUE (720) 494-1414 Date: Donor Name: MailingAc{dress: UG City: State: .� Zip: Email: Phone: f lU -7t% :� .!?l f t 1 . Item Donated (one item per form):/ 3 ` --Item Value Received By: T ; L4 Donor Signature: Colorado Horse Rescue is a 501(C)3 non profit organ zation dedicated to saving the disadvantaged horse... one human, one rescue, one home at a time Thank you for your generous donation! www.chr.org Info@chr.org OFFICE USE ONLY Silent Auction o Gift Certificate ❑ Live Auction Gift Basket p Item Title: Item #: Min Bid: Bid Inc: ❑ Art, Jewelry, and Clothing ❑ Family Fun ❑ Dining/Entertainment —Just for Kids ❑i Health and Fitness Equestrian and Pets �n 0[f Home Decor Total Value: Bid Sheet Description: ---------------------------------- ------ White Copy: Office Use Yellow Copy: Merchandise Tag Pink Copy: Donor Receipt - .q ❑o OIL -- a9 I Fw* ,4 � � low 10386 N 65u Street 49 C_ 0 L O R A D 0 Longmont, CO 80503 HORSE RESCUE (720) 494-1414 Date: Donor Name: l .w`' QQ 1110 1 IAA,, Mail!n ddress: fiU City: State: Phone: �7 7114 0 Email: � Item Donated (one item per form):44 —Zip: W -36 Item Value:✓ (/ Received By: — 114,04FO�, .._WENS0 Colorado Horse Rescue is a 501(C)3 non-profit organization dedicated to saving the disadvantaged horse... one human, one rescue, one home at a time Thank you for your generous donation! www.chr.org info@chr.org T 0 s 0 w c N 3 Y C o Silent Auction ❑ Gift Certificate ❑ Live Auction ❑ r Item Title: Item #: Min Bid: Bid Inc: i ❑ Art, Jewelry, and Clothing ❑ Family Fun ❑ Dining/Entertainment ❑ Just for Kids ❑ Health and Fitness d d 321wome Decor m 10386 N 65u Street 49 C_ 0 L O R A D 0 Longmont, CO 80503 HORSE RESCUE (720) 494-1414 Date: Donor Name: l .w`' QQ 1110 1 IAA,, Mail!n ddress: fiU City: State: Phone: �7 7114 0 Email: � Item Donated (one item per form):44 —Zip: W -36 Item Value:✓ (/ Received By: — 114,04FO�, .._WENS0 Colorado Horse Rescue is a 501(C)3 non-profit organization dedicated to saving the disadvantaged horse... one human, one rescue, one home at a time Thank you for your generous donation! www.chr.org info@chr.org T 0 s 0 w c N 3 Y C o Silent Auction ❑ Gift Certificate ❑ Live Auction ❑ r Item Title: Item #: Min Bid: Bid Inc: i ❑ Art, Jewelry, and Clothing ❑ Family Fun ❑ Dining/Entertainment ❑ Just for Kids ❑ Health and Fitness ❑ Equestrian and Pets 321wome Decor m Bid Sheet Description: M Ln Bt O°vc N Twp H •b m CO .0 •i /MyO� C=) SM m o V C y hbi o ..�.� U° CU 0 y y � G d 3 oQ o v i o0 as G� 6a 4M 00 3 = rs N V), O c> > 6 >+ V w ov C O U. 4.1 ?0 m a °o Gil N i 10386 N 65u Street 49 C_ 0 L O R A D 0 Longmont, CO 80503 HORSE RESCUE (720) 494-1414 Date: Donor Name: l .w`' QQ 1110 1 IAA,, Mail!n ddress: fiU City: State: Phone: �7 7114 0 Email: � Item Donated (one item per form):44 —Zip: W -36 Item Value:✓ (/ Received By: — 114,04FO�, .._WENS0 Colorado Horse Rescue is a 501(C)3 non-profit organization dedicated to saving the disadvantaged horse... one human, one rescue, one home at a time Thank you for your generous donation! www.chr.org info@chr.org T 0 s 0 w c N 3 ------------------------------------------------- White Copy: Office Use Yellow Copy: Merchandise Tag Pink Copy: Donor Receipt / OFFICE USE ONLY Silent Auction ❑ Gift Certificate ❑ Live Auction ❑ Gift Basket ❑ Item Title: Item #: Min Bid: Bid Inc: i ❑ Art, Jewelry, and Clothing ❑ Family Fun ❑ Dining/Entertainment ❑ Just for Kids ❑ Health and Fitness ❑ Equestrian and Pets 321wome Decor Total Value: Bid Sheet Description: ------------------------------------------------- White Copy: Office Use Yellow Copy: Merchandise Tag Pink Copy: Donor Receipt / Agenda Item 5 October 5, 2016 City of Boulder Finance Department Tax and License Division Sales and Use Tax • Community Information • Special Event Liquor Liquor License • DogNS2 • Miscellaneous Licenses • Marijuana Business Sent Via Email to: iohnwelsh@comcast.net And Via Certified Mail, Return Receipt Requested John A. Welsh Johnny's Cigars, Inc JOHNNY'S CIGARS License # 26-58437-0000 1801 13th Street, Unit 110 Boulder, CO 80302 And Via US Mail John A. Welsh Johnny's Cigars, Inc JOHNNY'S CIGARS License # 26-58437-0000 751 Eldorado Boulevard, Unit 1821 Broomfield, CO 80021 Re: Tavern Liquor License Renewal Application for 180113" Street, Unit 110, Boulder, CO 80302 Dear Mr. Welsh: Per our conversation on or around September 27, 2016, please allow this letter to serve as written notice that you will be required to attend a hearing to determine if there is good cause for non -renewal of your annual liquor license. To recap, the city is in receipt of the state and city license renewal applications and applicable fees for your license which we received on September 27, 2016. However, your renewal filing date was August 11 and your license expiration date was September 25, 2016. Our local Rules of Procedure preclude me from approving a license renewal via Summary Approval (see attachment 1) if the licensee files after the license expiration date. The city sales tax area has denied your renewal. As such, please contact Mary Kay Hammerle at 303-441-4026 for further information. In addition, the mentioned Rules direct that the Licensing Clerk has City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensing@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) an affirmative duty to review enforcement data related to your establishment. In addition, city licensing neglected to collect the required late filing fee for a renewal filed after your license expiration date. As such, please bring a check in the amount of $500 payable to City of Boulder at the time that you pick up your hearing poster. Therefore, your Corp. will be set for a license renewal hearing before the Boulder Beverage Licensing Authority (BLA). Among other factors at the discretion of the BLA, the conditions that you should be prepared to address in your renewal hearing, include but are not limited to: a. All employees involved in the service of alcohol, including, without limitation, managers, bartenders, and servers, shall attend a state -certified Responsible Vendor alcohol service class within three months from the initial approval of this license. New employees shall take such class within three months of their hire. Re -certification must be undertaken so that they remain current with training. We do expect that you will submit two additional training cards for your two new hires after their October 3, 2016 class. b. Licensee should be prepared to address any questions raised as to non-compliance with § 12-47-412, C.R.S. (pertaining to Tavern type Liquor Licenses). C. Licensee should be prepared to address the operation of their licensed premise in consideration of applicable State law, including, but not limited to § 12-47-103(9), C.R.S. and BLA Rules of Procedure, Subsection 8-1-9 which states, "Subsection 8-1-9 Grounds for Non - Renewal of License. Objections to renewal of a license must be for good cause. Evidence of good cause to deny a renewal may include, but shall not be limited to, the following: (A) Evidence that the licensee or applicant has violated, does not meet, or has failed to comply with any of the terms, conditions, or provisions of the Colorado Liquor Code or any related rules and regulations; (B) Evidence that the licensee or applicant has failed to comply with any special terms or conditions that were placed on its license in prior disciplinary proceedings or arose in the context of potential disciplinary proceeding; or (C) Evidence that the licensed premises have been operated in a manner that adversely affects the public health, welfare or safety of the immediate Neighborhood in which the establishment is located, including a continuing pattern of fights, violent activity or disorderly conduct." "Disorderly conduct" has the same meaning as in § 18-9-106, C.R.S. d. Licensee must explain why city and state license renewal applications were not timely filed (filed after the license expiration date) with the city of Boulder's License Administrator as secretary of the BLA at least 45 days prior to your license expiration date as dictated by § 12-47- 302, C.R.S. You will then be scheduled and are hereby ordered to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado on Wednesday November 16, 2016 at 3:00 PM to determine if there is good cause not to renew your annual liquor license. You may bring a legal representative to this hearing, but are not required to do so. You, or an employee, should visit my office on Wednesday November 2, 2016 after 12 noon to pick up a hearing notification poster, and such poster should be conspicuously posted on your premises (for instance on your front door or front window glass) at least by Saturday November 5, 2016 and should remain posted for the 10 day period until your renewal hearing. City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensine@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) The State Liquor License Code is available for your review at: http://www.revenue.state.co.us/liquor_dir/wrap.asp?incl=lawrules and the city of Boulder Beverages Licensing Authority Rules of Procedures are available at: http://www.ci.boulder.co.us/clerk/liquor/Rules%20of%2OProcedurg.pdf In the alternative, I can provide you with a hard copy of the BLA Rules of Procedure at your request. If you have questions, or require additional information, please contact me at the below listed numbers. Sincerely yours, Mishawn J. Cook Licensing Administrator Certified Municipal Clerk Phone: 303-441-3010 Fax: 303-441-1919 Email: cookm@bouldercolorado.gov Website: http://www.bouldercolorado.gov/licensing CERTIFICATE OF MAILING I hereby certify that on the 5M day of ae,-441- 2016, a true and correct copy of the above correspondence was duly mailed by placing same in the U.S. Mail, certification # ,-0/2 29':z --a 0000 3/0.3 ,9�/�, return receipt requested, postage prepaid, addressed to the following. John A. Welsh Johnny's Cigars, Inc JOHNNY'S CIGARS License # 26-58437-0000 1801 13t" Street, Unit 110 Boulder, CO 80302 ��ME N MEN N W-., City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensine@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) Subsection 8-1-4 Expired Licenses A licensee whose license has been expired for not more than ninety (90) days may file a late renewal application upon the payment of a nonrefundable late application fee to the City. A licensee who files a late renewal application for a license that expires before its Authority hearing, or a licensee who files a renewal not more than ninety (90) days after a license is expired and pays the requisite fee, may continue to operate subject to the limitations set forth in Section 8-1-8, until the Authority has taken final action to approve or deny such licensee's late renewal application. (Section 12-47-302(2)(a), C.R.S.) No late renewal application shall be accepted more than ninety (90) days after the expiration of a licensee's permanent annual license. Any licensee whose permanent annual license has been expired for more than ninety (90) days must apply for a new license pursuant to Sections 12-47-302 and 12-47-311, C.R.S., and shall not sell or possess for sale any alcohol beverage until all required licenses have been obtained. Subsection 8-1-5 Administrative Approval of License Renewal by Licensing Clerk After receiving a complete license renewal application including both State and City renewal forms with applicable fees for both parties, the Licensing Clerk shall review the application, together with the following information covering the period since the initial application or last renewal (whichever is more recent): (i) submissions to the applicant's file; (ii) City department comments; and, (iii) pertinent City records. Unless there is evidence to the contrary, whether contained in the applicant's file or otherwise, it will be presumed that the occupied premises comply with the provisions of the statutes and applicable regulations, that the character of the applicant continues to be satisfactory, and that such renewed license, if granted, continues to meet the reasonable requirements of the neighborhood and the desires of the inhabitants. If no such evidence counters these presumptions, the license renewal application shall be approved by the Licensing Clerk and forwarded to the State Department of Revenue, Liquor Enforcement Division. If the Licensing Clerk finds such evidence countering these presumptions, the Licensing Clerk shall set, for the next available Authority hearing, the license renewal application for a renewal hearing before the Authority. The Authority may, separate from the agreed upon conditions in this Section 6-4, direct at any time (pursuant to notice requirements set forth in Section 4-3) that any license renewal be changed to non -Administrative Approval, thus removing the renewal from possible Administrative Approval (as described in Subsection 8-1-5), and directing the Licensing Clerk to set the next annual renewal of such license for review in a hearing before the Authority, unless and until the Authority directs otherwise. Subsection 8-1-6 License Renewal Hearings by the Authority Whenever objections to the renewal of a license have been raised (by a Party in Interest, the State, or the City) before renewal of the license, the Licensing Clerk shall have the discretion to set the matter for a renewal hearing. An Objection to Renewal C:\Users\lambm2\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8B8SOCIT\BLA Rules of Procedure - Adopted December 2 2014-.doc- 14 - ti a ro D, m 0 m 0 M M O M ru D^ ru ru r—1 0 r - Postage $ enr TO 116fied JOHNNY'S CIGARS sveeti; License # 26-58437-0000 --•— CertiFee 1801 13th Street, Unit 110 CRY State Postmark Retem Receipt Fee Here (Endorsement Required) Restricted Delivery Fee De (Endoraem aernnrad► TotaiPC John A. Welsh enr TO Johnny's Cigars, Inc JOHNNY'S CIGARS sveeti; License # 26-58437-0000 --•— orposm 1801 13th Street, Unit 110 CRY State Boulder, CO 80302 "�` AA City of Boulder Finance Department • Licensing Division 1777 Broadway, Boulder, Colorado 80302.303 441-4192 ANNUAL RENEWAL FOR LIQUOR LICENSES Both State & City renewal forms, fees must be submitted to the City for processing. Do not send your state renewal to the state office - the City will process it after your city renewal is approved. CHECKLIST OF REQUIRED DOCUMENTS State Renewal Application- Licensee will receive this 1 page form about 120 days prior to the license expiration date. If they do not receive this form, a 2 page replacement form can be found on the city website included in Liquor License renewal documents (pages 5 and 6). The fill i the blan form (page 6 of renewal packet) may be used. rCity renewal form- Licensee will receive this form about 90 days before their license expiration date. Answer all questions on the city form and sign/title/date the 2"d page. Attach explanations of any criminal activity for the owners/managers in the past year. Explanations of any suspensions occurring in the last year should also be attached. CV Employee Training Form and associated Certificates or Cards- This information corresponds to a question on the city renewal form. It is a local condition of holding a liquor license that Licensees train all of their employees who serve and sell alcohol within 3 months of the location opening or within 3 months of the employee's hiring, and that the servers are re-trained to stay currently certified. Only in-person classes are state approved (Not E - training). (� Certificate of Good Standing- This Certificate can be obtained from the Colorado Secretary of State's website, by searching in the Business Organizations area. ❑ Renewal Fees: XState Renewal Fee check payable to the Colorado Department of Revenue and —City Renewal Fee check payable to the City of Boulder. The proper amount of the renewal fees depends on the class or type of liquor license being renewed and for details the Licensee should consult the annual fee schedule on the City's applications page. ❑ The state renewal form, state fee check, city renewal form, city fee check, certificate of good standing from the secretary of state's website, and the above listed training information should be all be received by the City of Boulder at least before the 45 days prior to expiration date (this deadline is listed on the city renewal) or licensee will face either a temporary suspension or Beverage Licensing Authority (BLA) hearing. ❑ In addition to the above requirements, if Liquor License is held by a sole proprietor, then City Licensing Office also needs a completed Affidavit of Lawful Presence form and a copy of the Owner's Driver's License or state issued Picture ID for the renewal. Please Note: If both the state renewal form and city renewal form and both fees are not received together by the city, then the entire renewal will be returned to the Licensee by the City of Boulder. Call the Licensing Office if you do not receive the state or city forms because duplicate city renewal forms and alternate state forms can be obtained. State renewal forms require City of Boulder approval. If a Licensee has mistakenly mailed a state renewal form and state fee to the State Liquor Enforcement Division, the check will be deposited by the state, but the state renewal form will be returned to the Licensee. Complete renewals received after the expiration date may result in non- renewal, thus requiring a new liquor license application, but will result in a $500 late filing fee payable to the City of Boulder and a BLA renewal hearing. Date Fees Received: Amount Recd COB: Amount Recd State: CITY OF BOULDER License Number: 26-58437-0000 Date Issued: Expires: To State: LIQUOR LICENSE RENEWAL APPLICATION Current Information: Enter any corrections below: Applicant: Johnny's Cigars, Inc Trade Name: JOHNNY'S CIGARS Address: 3175 17th St jw_ ► �'G!� O t� Boulder, CO 80304-5387 Phone: (303) 589-5829 Email: johnwelsh@comcast.net License Type: Tavern Liquor Location: 1801 13th St, Unit 11.0 All information must be typewritten or legibly printed in black ink. IMPORTANT: This City of Boulder Renewal Application Form AND the State of Colorado Renewal Application Form must both be RECEIVED in the Office of the City Clerk NO LATER THAN the 45th day prior to the date of expiration. Failure to file both renewal forms by August 11, 2016 may result in denial of the renewal. Please complete the forms and return them to: City of Boulder Finance Department Your Existing License Expires: 9/25/16 P. O. Box 791 City Must Receive Complete Renewal By: 8/11/16 Boulder, CO 80306 Attn: Liquor Licensing - - - - - - - - — - --- — Fee Description Amount Application Fee $100.00 License Fee $75.00 Total Payable to City of Boulder $175.00 Have any officers, directors, members, registered managers or any person with a 10% or greater interest in your license been convicted of a crime, or received a ..... _ suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court (do not include traffic violations, unless they resulted in suspension cation of yov,,r driver's license, or you were convicted of driving while impaired or under the influence of drugs or alcohol) since your last license renewal? o Yes If yes, explain in detail on a separate page. Have all of your owners, managers, and employees (i.e. clerks, bartenders, and wait staff) involved in the service and sale of alcohol attended a state -certified Responsible Vendor class approved per CRS 12-47-1002 within three months of your establishment opening or within three months of employee's hire date? Note that this training is a continuous local condition of your license, web based trainings are not allowed, and you must keep employees'/servers' training current by retraining before their training term expires under BLA Rule Section 3-6. No Yes If you checked NO, please explain on the enclosed Plan for Training Compliance your timeline for training. This will help us better jjjVVV evaluate if a renewal hearing should be scheduled. If you checked YES, please fully complete the enclosed Proof of Training listing all alcohol service/sale employees, their hire dates, their training dates, and attach copies for all listed employees of their certificates of class completion or class cards to this summary. Please include a current copy of your Certificate of Good Standing issued by the Colorado Secretary of State (available at: 303-894-2200 or http://www.sos.state.co.us/pubs/business/main.htm )- Certificate enclosed: �4 IMPORTANT: Please complete both pages of this application form. Version 4.01.03 6292016 CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Oath of Applicant: I declare under penalty -of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. Authorized Signature: Title of Signer (if corporation)V O yv f/2 Dat'?Zai Tax Department Action: Approved: ❑ Denied: 1 Date: ` b Signature: Beverages Licensing Authority Action: Approved: ❑ Denied: ❑ Date: Chair: Attest: IMPORTANT: Please complete both pages of this application form. Version 4.01.03 629/20/6 1)1:-Iw l-4' r/,/) R�, 1'� 1� Ijyou checked YES City of Boulder for training on your cityrenewall,pleoseflll Finance De artment • Licensin Division outthlsJorm&attach cords/certiJlcatesoj 1777 Broadway,, Boulder, CO 80302.303.441.4192 tralning joremployees! PROOF OF TRAINING Trade Name: Address: The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all involved in service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, or other evidence of training completion for each listed employee. Employee's Name State Training Type Hire Date b Previous Training Date Latest Training Date J 6 hI? 7AY ur'L s -ZZ Iv t 1�1J LG .s71�liZlrrva c��r�ss`�'''- g �� �,,�• City of Boulder IJyoucheckedNo for training on your city renewal, Finance Department •Licensing Division Please riillout this forml 1777 Broadway, Boulder, CO 80302 •303.441.4192 BEVERAGE LICENSING AUTHORITY PLAN FOR TRAINING COMPLIANCE FOR LICENSE RENEWAL Trade Name: Address: The Beverage Licensing Authority has determined that all owners, managers, and employees (i.e. clerks, bartenders and wait staff) involved in the service and sale of alcohol in the City of Boulder will attended a state -certified responsible vendors class, approved per C.R.S. 12-47- 1002, within three months of your establishment opening or within three months of employee's hire dates, and that such training will be a continuous local condition of your local license and that state -approved classes are valid for the indicated current term from training date. E - training not accepted. Servers must be re-trained to stay current and current training of all servers must be shown on your annual license renewal. Please explain below about your progress toward full training, plans for employee training, and timeline fortraining completion. Oath of Applicant I declare under penalty of perjury in the second degree that I acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the Colorado Liquor and Beer Code and all City of Boulder rules, regulations, codes, and ordinances which affect my license and business property. Applicant/ Licensee business name Authorized signature Date Trade name Print name Title CL 0 UP) Q em 00 co it I LO Q o R- c� CO 0 RCl) 0 �yJ, J Li. � L Q Q � 00 m E 8 ori tm cGoCNI E 0 N Zj m 'a c Z m ' a 0 s U- cn ° °, �a' �}.�° .>, T>a > 91 �� E ° y y b Oq o�> �c fig" �� av�> �''C c r v n �3 S ba ani a MA o,l;_o cc a c 4 u cn F, 3 -0,0! >°, R E , '�.," 3o *.at o w w w ami is la O n0 y >o, m s., o ca b `� ; c _v a v 42 U o o o y aai °= b _` ►� � o u E ° a te° ¢ o �,V E > o ° 08 ... y r. o c caanin, �a o a eo Z+oai Ra°I >ca; f�O u O o a•O -u .°c •ai Lr. >,b Ty :2 yo Q1o+ 7 >a o ° o v) ® 03ovE aii c o>, oE � ca n mN w 7 Q1 a > a 0[ c -L n. >, a) u a) O a ca ayi O d a .n 3 m '2 u "' >' `O" o y •[ T O cc°i v�•3 >,o. - y 3s R �? a r' a' a°,o c N 3 > yb .� ..'0 i. o u m 3; s a o "" 3° L. a u W° s o v� W a .a o en cc O� a m b - R u Q o v o 0 RU°U Ri i o 1 E O pEo a PCl Co M m of Z4 A N N _n � O M v� xa pt1 A � wN Om U) oo 01 C IL g co Wm0 o`t CL 0 co C N ff N a ;r) LZ X�v io a O v u—i co cc EZ E v m m a.0 O o mZ N O C O O c Q GGo O r- m v 04 H ��m Zm cn ° °, �a' �}.�° .>, T>a > 91 �� E ° y y b Oq o�> �c fig" �� av�> �''C c r v n �3 S ba ani a MA o,l;_o cc a c 4 u cn F, 3 -0,0! >°, R E , '�.," 3o *.at o w w w ami is la O n0 y >o, m s., o ca b `� ; c _v a v 42 U o o o y aai °= b _` ►� � o u E ° a te° ¢ o �,V E > o ° 08 ... y r. o c caanin, �a o a eo Z+oai Ra°I >ca; f�O u O o a•O -u .°c •ai Lr. >,b Ty :2 yo Q1o+ 7 >a o ° o v) ® 03ovE aii c o>, oE � ca n mN w 7 Q1 a > a 0[ c -L n. >, a) u a) O a ca ayi O d a .n 3 m '2 u "' >' `O" o y •[ T O cc°i v�•3 >,o. - y 3s R �? a r' a' a°,o c N 3 > yb .� ..'0 i. o u m 3; s a o "" 3° L. a u W° s o v� W a .a o en cc O� a m b - R u Q o v o 0 RU°U Ri i Coll � pEo O U Z4 A 00 _n � O M v� xa pt1 A 9 W N N O z �ow LL in 0 co C N o^° CD U) coo N L U ca EZ E o m `m d m a.0 O o .a m C O O c Q GGo O r- m v ��m Zm • mm N O O N O 1•yy1 U. m cn ° °, �a' �}.�° .>, T>a > 91 �� E ° y y b Oq o�> �c fig" �� av�> �''C c r v n �3 S ba ani a MA o,l;_o cc a c 4 u cn F, 3 -0,0! >°, R E , '�.," 3o *.at o w w w ami is la O n0 y >o, m s., o ca b `� ; c _v a v 42 U o o o y aai °= b _` ►� � o u E ° a te° ¢ o �,V E > o ° 08 ... y r. o c caanin, �a o a eo Z+oai Ra°I >ca; f�O u O o a•O -u .°c •ai Lr. >,b Ty :2 yo Q1o+ 7 >a o ° o v) ® 03ovE aii c o>, oE � ca n mN w 7 Q1 a > a 0[ c -L n. >, a) u a) O a ca ayi O d a .n 3 m '2 u "' >' `O" o y •[ T O cc°i v�•3 >,o. - y 3s R �? a r' a' a°,o c N 3 > yb .� ..'0 i. o u m 3; s a o "" 3° L. a u W° s o v� W a .a o en cc O� a m b - R u Q o v o 0 RU°U Ri i XFINITY Connect John—Cert Card.jpg On Premise Issued_ 8/10/2615 11)#_ 4054681 JOHN WELSH 180113th St Ste 110 Boulder. CO 80302-5387 SAN. xxx-xx-xxxx EXP*=S: 7/27/2018 D.O.D.: xx/xx/xxxx For service visit us online at www Qettips.com 8. Jonathan Balllet, 47289 Lucas—Cert Card.jpg # 0n Prem;se Issued: 8/10/2615 1[)4' 4054680 LUCAS SHUT REWORTH 1801 13th St Ste 110 Boulder, CO 80302-5387 SSN: xxx-xx-xxxx Exp1ivs: 7/77/2018 D-0,13.: xx/x c/xxxx For service visit us online at www.eettips.com B_ Jonathan Balllet, 47289 johnwelsh@comcast.net OFFICE OF THE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF FACT OF GOOD STANDING I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, JOHNNYS CIGARS INC. is a Corporation formed or registered on 03/18/2005 under the law of Colorado, has complied with all applicable requirements of this office, and is in good standing with this office. This entity has been assigned entity identification number 20051094557 . This certificate reflects facts established or disclosed by documents delivered to this office on paper through 09/26/2016 that have been posted, and by documents delivered to this office electronically through 09/27/2016 @ 13:46:55 . I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, and issued this official certificate at Denver, Colorado on 09/27/2016 @ 13:46:55 in accordance with applicable law. This certificate is assigned Confirmation Number 9855508 Secretary of State of the State of Colorado *********************************************End of Notice: A certificate issued electronically from the Colorado Secretary of State's Web site is (idly and immediately valid and effective. However, as an option, the issetance and validity of a certificate obtained electronically may be established by visiting the Validate a Certificate page of the Secretary of State's Web site, http:/iu,ww.sos.state.co.us,he("ertfcate,Search('riteria.do entering the certificate's confirmation number displayed on the certificate, and following tlee instructions displayed. Confirming the issetance of a certificate is merely optional and is not necessary to the valid and effective issuance of a certificate. For more information, visit our Web site, http wuv.so.s.state. co. its click "Businesses, trademarks, trade names "and select "Frequently Asked Questions." DR 6400 (Revised 09/01/12) COLORADO DEPARTMENT OF LIQUOR ENFORCEMENT DMS ON REVENUE RETAIL LIQUOR OR 3.2 BEER SUBMIT TO LOCAL LICENSING AUTHORITY LICENSE RENEWAL APPLICATION JOHNNYS CIGARS 1801 13TH ST SUITE 110 BOULDER CO 80302 PLEASE VERIFY & UPDATE ALL INFORMATION BELOW Fees Due Renewal Fee Storage Permit $100 x Optional Premise $100 x Related Resort $75 x _ $500.00 JOHNNYS CIGARS Liquor License # Amount Due/Paid Make check payable to: Colorado Department of Revenue The State may convert your check to a one-time electronic banking transaction Your bank account may be debd6d as early as the same day received by the State. If converted, your check will not be returned If your check is rejected due to insufficient or uncollected funds, the Department may called the payment amount directly from your banking account electronically. Licensee Name DBA JOHNNYS CIGARS INC JOHNNYS CIGARS Liquor License # License Type Sales Tax License # Expiration Date Due Date 26584370000 Tavern (city) 09/25/2016 108/11/2016 Operating Manager Date of Birth I Home Address Mpnilger Phone Number Email Address Street Address Phone Number 1801 13TH ST #110 BOULDER CO 80302-5387 13034490884 Mailing Address 1801 13TH ST SUITE 110 BOULDER CO 80302 1. Do you have legal possession of the premises at the street address above? YES ❑ NO Is the premises owned or rented? LJ Owned --,S- Rented" *If rented, expiration date of lease $U� 23. Since the date of filing of the last application, has there been any change in financial interest (new notes, loans, owners, etc.) or organizational structure (addition or deletion of officers, directors, managing members or general partners)? If yes, explain in detail and attach a listing of all liquor businesses in which these new lenders, owners (other than licensed financial institutions), officers, directors, managing members, or general partners are materially interested. ❑ YES NO NOTE TO CORPORATION, LIMITED LIABILITY COMPANY AND PARTNERSHIP APPLICANTS: If you have added or deleted any officers, directors, managing members, general partners or persons with 10% or more interest in your business, you must complete and return immediately to your Local Licensing Authority, Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes, along with all supporting documentation and fees. 3. Since the date of filing of the last application, has the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) been convicted of a crime? If yes, attach a detailed explanation. ❑ YES IkNO 4. Since the date of filing of the last application, has the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) been denied an alcohol beverage license, had an alcohol beverage license suspended or revoked, or had interest in any entity that had an alcohol beverage license denied, suspended or revoked? If yes, attach a detailed explanation. ❑ YES -_-Ui--QNO 5. Does the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) have a direct or indirect interest in any other Colorado liquor icense, including loans to or from any licensee or interest in a loan to any licensee? If yes, attach a detailed explanation. ❑ YES --WO AFFIRMATION & CONSENT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct and complete to the best of my knowledge. Type or Print Name of Applicant/Authorized Agent of Business Title Signature f� Date REPORT & AP OVAL OF CITY OR COUNTY LICENSING AUTHORITY The foregoing application has been examined and the premises, business conducted and character of the applicant are satisfactory, and we do hereby report that such license, if granted, will comply with the provisions of Title 12, Articles 46 and 47, C.R.S. THEREFORE THIS APPLICATION IS APPROVED. Local Licensing Authority For Date Signature Title Attest Agenda Item 6 City of Boulder Finance Department Tax and License Division Sales and Use Tax • Community Information • Special Event Liquor Liquor License • Do S2 • Miscellaneous Licenses • Marijuana Business October 10, 2016 Sent Via Email to: kostakorres@gmail.com And Via Certified Mail, Return Receipt Requested Konstantinos Korres Zythos Restaurant Group LLC d/b/a ZYTHOS License # 47-05350-0000 3175 E. Yarrow Circle Superior, CO 80027 And Via US Mail Konstantinos Korres Zythos Restaurant Group LLC d/b/a ZYTHOS License # 47-05350-0000 1320 College Avenue Boulder, CO 80302 Re: Hotel -Restaurant Liquor License Renewal Application for 1320 College Avenue, Boulder, CO 80302 Dear Mr. Korres: Per our conversation on October 7, 2016, please allow this letter to serve as written notice that you will be required to attend a hearing to determine if there is good cause for non -renewal of your annual liquor license. To recap, the city is in receipt of the state and city license renewal applications and applicable fees for your license which we received on October 7, 2016 but your city and state renewal filing deadline was September 13, 2016. As such, your renewal is late filed but not filed after your license expiration date of October 28, 2016. Also, Kristen Huber with the City Licensing office contacted your attorney, Fern O'Brien via City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensin2@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) email on November 2, 2015, on December 1, 2015, and on December 7, 2015 to let you know that your temporary license that was issued as part of your transfer application was set to expire and that we had received your approved state transfer license so needed to set a premise inspection date and time. City licensing received no response from you to these emails. In addition, I sent you emails on April 29, 2016 to try to set up a premise inspection and again on August 23, 2016 including a photo of your inactive restaurant (for city licensing emails from November 2, 2015 to August 23, 2016, see attachment 1). You did reply to my August 23 email on September 21, 2016 (see attachment 2). City licensing does believe that your restaurant has been inactive for a one-year period or more, from at least August 19, 2015 (BLA transfer hearing) contrary to state regulations (see attachment 3) as evidenced by our hearing poster still being posted in the enclosed photo taken on August 23, 2016. Finally, our local Rules of Procedure preclude me from approving a license renewal via Summary Approval (see attachment 4) if the licensee files after the license expiration date. Pertinent to our research on your license renewal, the city sales tax area has denied your renewal. As such, please contact Mary Kay Hammerle at 303-441-4026 for further information. In addition, the mentioned Rules direct that the Licensing Clerk has an affirmative duty to review enforcement data related to your establishment. Therefore, your LLC will be set for a license renewal hearing before the Boulder Beverage Licensing Authority (BLA). Among other factors at the discretion of the BLA, the conditions that you should be prepared to address in your renewal hearing, include but are not limited to: a. All employees involved in the service of alcohol, including, without limitation, managers, bartenders, and servers, shall attend a state -certified Responsible Vendor alcohol service class within three months from the initial approval of this license. New employees shall take such class within three months of their hire. Re -certification must be undertaken so that they remain current with training. You have stated on submitted training documents that you are "non -operational'. b. Licensee should be prepared to address any questions raised as to non-compliance with § 12- 47-411, C.R.S. (pertaining to Hotel -Restaurant type Liquor Licenses), especially but not limited to, "Restaurants shall sell alcohol beverages as provided in this section only to customers of the restaurant and only if meals are actually and regularly served and provide not less than twenty-five percent of the gross income from sales of food and drink of the business of the licensed premises over any period of time of at least one year." C. Licensee should be prepared to address the operation of their licensed premise in consideration of applicable State law, including, but not limited to §12-47-103(9), C.R.S. and BLA Rules of Procedure, Subsection 8-1-9 which states, "Subsection 8-1-9 Grounds for Non - Renewal of License. Objections to renewal of a license must be for good cause. Evidence of good cause to deny a renewal may include, but shall not be limited to, the following: (A) Evidence that the licensee or applicant has violated, does not meet, or has failed to comply with any of the terms, conditions, or provisions of the Colorado Liquor Code or any related rules and regulations; (B) Evidence that the licensee or applicant has failed to comply with any special terms or conditions that were placed on its license in prior disciplinary proceedings or arose in the context of potential City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 Iicensin-g@bouldercoloradogov (303) 441-4192 (303) 441-1919 (FAX) disciplinary proceeding; or (C) Evidence that the licensed premises have been operated in a manner that adversely affects the public health, welfare or safety of the immediate Neighborhood in which the establishment is located, including a continuing pattern of fights, violent activity or disorderly conduct." "Disorderly conduct" has the same meaning as in § 18-9-106, C.R.S. d. Licensee must explain why city and state license renewal applications were not timely filed (filed after the license expiration date) with the city of Boulder's License Administrator as secretary of the BLA at least 45 days prior to your license expiration date as dictated by § 12-47- 302, C.R.S. You will then be scheduled and are hereby ordered to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado on Wednesday November 16, 2016 at 3:00 PM to determine if there is good cause not to renew your annual liquor license. You may bring a legal representative to this hearing, but are not required to do so. You, or an employee, should visit my office on Wednesday November 2, 2016 after 12 noon to pick up a hearing notification poster, and such poster should be conspicuously posted on your premises (for instance on your front door or front window glass) at least by Saturday November 5, 2016 and should remain posted for the 10 day period until your renewal hearing. The State Liquor License Code is available for your review at: http://www.revenue.state.co.us/liquor dir/wrap asp?incl=lawrules and the city of Boulder Beverages Licensing Authority Rules of Procedures are available at: http://www.ci.boulder.co.us/clerk/liquor/Rules%20of%2OProcedure pdf In the alternative, I can provide you with a hard copy of the BLA Rules of Procedure at your request. If you have questions, or require additional information, please contact me at the below listed numbers. Sincerely yours, -...... ".. ✓. -m- Licensing Administrator Certified Municipal Clerk Phone: 303-441-3010 Fax: 303-441-1919 Email: cookm@bouldercolorado.gov Website: http://www.bouldercolorado.gov/licensing City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensing@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) CERTIFICATE OF MAILING I hereby certify that on the r4l*�- day ofQb20/(_0, a true and correct copy of the above correspondence was duly mailed by placing same in the U.S. Mail, certification # :zo /;;L ;2y 7-0 -000 a/n7 %,R3, return receipt requested, postage prepaid, addressed to the following. Konstantinos Korres Zythos Restaurant Group LLC d/b/a ZYTHOS License # 47-05350-0000 3175 E. Yarrow Circle Superior, CO 80027 City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensing@ bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) M (Domestic Mail . • , -0 For delivery information visit our website at www.usps.com.) ' OFFICPAL '- ML r9 Postage $ l/& Certified Fee O Postmark O M Return Receipt Fee (Endorsement Required) Here O Restricted Delivery Fee Er Tote Konstantinos Korres ru Zythos Restaurant Group LLC ru Sent d/b/a ZYTHOS r=1 License # 47-05350-0000 --�-- 0 orad 3175 E. Yarrow Circle city, PS Form .r AUgUst 2006 Superior, CO 80027 See Reverse for lnstructh� to Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery is desired. 13 Print your name and address on the reverse so that we can return the card to you. E Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: Konstantinos Korres Zythos Restaurant Group LLC d/b/a ZYTHOS License # 47-05350-0000 3175 E. Yarrow Circle Superior, CO 80027 A. ❑ Agent _ ❑ Addresse Printed Name) T. Date of Delivei D. Is delivery address different from Item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandls ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Exna Fee) ❑ Yes 2. (transapsArticleNumber (Transfer from service laben 7012 2920 0000 3103 9683 PS Form 3811. February 2004 Domestic Return Receipt 102595.02-M-15 '/ U" /3,20 rp// 9,e, 4v'2 Cook, Mishawn From: Cook, Mishawn Sent: Tuesday, August 23, 2016 12:54 PM To: 'kostakorres@gmail.com' Cc: Huber, Kristen; Mazurkiewicz, Beata Subject: FW: Zythos liquor license on University Hill Attachments: Scanned from a Xerox multifunction device001 Surrender Affidavit form 2.pdf pdf; Zythos on Aug 23.JPG; state and city Hello, over the last 6 months we have tried to contact you in order to inspect the license premise at 1320 College Avenue so that we might release the city and the state transfer liquor licenses to you, but we have not heard back. Today, I went to the location and took the attached picture which shows that your licensed premise is inactive and it appears that you no longer have proper possession of the location. I am sending here your city renewal packet. You may have already received a license renewal from the state. The deadline for filing the renewal documents is on September 13, 2016 and both the state and city renewal documents and fees are to be filed with the city (see checklist of required documents with city renewal). Because it appears that you no longer have proper possession, any filed renewal will require a renewal hearing before the Beverage Licensing Authority and I would set the hearing date at the time that a renewal application is filed. We would also review city sales tax and occupation tax status at the hearing, along with your inactive license status and premise possession. In the alternative, you could complete and return the attached affidavit of surrender and the license would be made inactive -your license number is 47-05350 if you decide to complete the affidavit. Otherwise, the license will expire of its own accord on October 28, 2016. Thank you and please let us know what action you decide to take regarding this liquor license, Mishawn Cook Mishawn J. Cook Licensing Administrator Certified Municipal Clerk O:#303-441-3010 cookm@bouldercolorado.gov Finance Department 1777 Broadway I Boulder, CO 80302 Bouldercolorado.gov -----Original Message ----- From: Print-to-Email@bouldercolorado.gov [mailto:Print-to-Email@bouldercolorado.gov] Sent: Tuesday, August 23, 2016 1:34 PM To: Cook, Mishawn <cookm@bouldercolorado.gov> Subject: Scanned from a Xerox multifunction device Please open the attached document. It was scanned and sent to you using a Xerox multifunction device. Cook, Mishawn From Cook, Mishawn Sent: Friday, April 29, 2016 4:44 PM To: 'kostakorres@gmail.com' Cc: Mazurkiewicz, Beata Subject: Zythos Restaurant opening Hi, we are still holding your issued transferred state license for your premise inspection. We will need a copy of your health department inspection approval too. Could you please give us an update on your opening- your temporary city license is long since expired. Thank you, Mishawn Mishawn J. Cook License & Collection Administrator, CMC City of Boulder, Finance Dept. Main: 303-441-4192 Direct: 303-441-3010 Fax: 303-441-1919 Mail: PO Box 791, Boulder, CO 80306 Office: 1777 Broadway -1st Floor, Boulder, CO 80302 Web page: www.bouldercolorado.gov/licensing Huber, Kristen From: Huber, Kristen Sent: Monday, December 07, 2015 3:55 PM To: kosta korres Cc: Janet Johnson; jeant@earthlink.net; 'Fern O'Brien' Subject: RE: Zythos Liquor License Kosta, To follow-up on our conversation today, we cannot issue the liquor licenses until the health inspection is completed. Please let me know when you have approval from the health department and we will schedule the liquor license inspection. In the meantime, your temporary liquor license will expire on December 15, 2015. After December 15th, you cannot sell, serve, or store alcohol on site until the liquor license inspection is completed and the liquor licenses are issued. Please feel free to call or email if you have any questions. Thank you, Kristen Kristen Huber Licensing Specialist City of Boulder Finance Department Tax and License Division 1777 Broadway, Municipal Building Boulder, CO 80302 Phone: 303.441.3034 Fax: 303.441.1919 From: Fern O'Brien [mailto:fobrienCabfobrienlaw.com] Sent: Monday, December 07, 2015 11:23 AM To: Huber, Kristen Cc: Janet Johnson; kosta korres; jeant(a earthlink.net Subject: RE: Zythos Liquor License Thanks, Kristen. I just left another voice mail for Kosta Korres and I have copied this email to him. Fern O'Brien O'BRIEN LAW P.C. Siena Square Building 2060 Broadway, Suite 280 Boulder, Colorado 80302 Direct: 303.952.1551 fobrien@fobrienlaw.com From: Huber, Kristen [mailto:HuberK@bouldercolorado.sov] Sent: Monday, December 7, 2015 11:03 AM To: Fern O'Brien <fobrien@fobrienlaw.com> Subject: RE: Zythos Liquor License Fern, I am just following up again with a reminder that the temporary license expires on 12/15 and we cannot extend it any further. Thank you, Kristen Kristen Huber Licensing Specialist City of Boulder Finance Department Tax and License Division 1777 Broadway, Municipal Building Boulder, CO 80302 Phone: 303.441.3034 Fax: 303.441.1919 From: Fern O'Brien [mailto:fobrien(5)fobrienlaw.com] Sent: Tuesday, December 01, 2015 10:08 AM To: Huber, Kristen Subject: RE: Zythos Liquor License Thanks, Kristen, I forwarded this email to my client. Fern O'Brien O'BRIEN LAW P.C. Siena Square Building 2060 Broadway, Suite 280 Boulder, Colorado 80302 Direct: 303.952.1551 fobrien@fobrienlaw.com From: Huber, Kristen [mailto:HuberK@bouldercolorado.eovl Sent: Tuesday, December 1, 2015 8:40 AM To: Fern O'Brien <fobrien@fobrienlaw.com> Subject: RE: Zythos Liquor License Fern, I am following up on the email below. Please note the temporary license expires on 12/15. Thank you, Kristen Kristen Huber Licensing Specialist City of Boulder Finance Department Tax and License Division 1777 Broadway, Municipal Building Boulder, CO 80302 Phone: 303.441.3034 Fax: 303.441.1919 2 From: Huber, Kristen Sent: Monday, November 02, 2015 11:17 AM To: 'fobrien@fobrienlaw.com' Subject: Zythos Liquor License Fern, We received the state liquor license for Zythos and are ready to schedule the inspection. Please let me know what dates and times would work for your client. Also, please have him send me a copy of his Boulder County health certificate. Thank you, Kristen Kristen Huber Licensing Specialist City of Boulder Finance Department Tax and License Division 1777 Broadway, Municipal Building Boulder, CO 80302 Phone: 303.441.3034 Fax: 303.441.1919 Cook, Mishawn From: kosta korres <kostakorres@gmail. com> Sent: Wednesday, September 21, 2016 12:09 PM To: Cook, Mishawn Subject: Re: FW: Zythos liquor license on University Hill Hi Mishawn, I was out of the country for a family emergency. I have been held back from completing the project. I still have possession of the property. I realize I am late with renewing the licensing but fully intend to cover that in the following days. Sales taxes etc have been kept up. They are zeros since I am not operational as you very well know. I do not intend to let Oct. 28th come and go, nor relinquish the property or the liquor license. See you soon On Tue, Aug 23, 2016 at 12:54 PM, Cook, Mishawn <cookm@bouldercolorado.gov> wrote:' Hello, over the last 6 months we have tried to contact you in order to inspect the license premise at 1320 College Avenue so that we might release the city and the state transfer liquor licenses to you, but we have not heard back. Today, I went to the location and took the attached picture which shows that your licensed premise is inactive and it appears that you no longer have proper possession of the location. I am sending here your city renewal packet. You may have already received a license renewal from the state. The deadline for filing the renewal documents is on September 13, 2016 and both the state and city renewal documents and fees are to be filed with the city (see checklist of required documents with city renewal). Because it appears that you no longer have proper possession, any filed renewal will require a renewal hearing before the Beverage Licensing Authority and I would set the hearing date at the time that a renewal application is filed. We would also review city sales tax and occupation tax status at the hearing, along with your inactive license status and premise possession. In the alternative, you could complete and return the attached affidavit of surrender and the license would be made inactive -your license number is 47-05350 if you decide to complete the affidavit. Otherwise, the license will expire of its own accord on October 28, 2016. Thank you and please let us know what action you decide to take regarding this liquor license, Mishawn Cook Mishawn J. Cook Licensing Administrator Certified Municipal Clerk O: #303-441-3010 cookm@bouldercolorado.gov Finance Department 1777 Broadway I Boulder, CO 80302 Bouldercolorado.gov COLORADO LIQUOR CODE A4k,� _3 12-47-306. Inactive licenses. The state or local licensing authority, in its discretion, may revoke or elect not to renew a retail license if it determines that the licensed premises has been inactive, without good cause, for at least one year or, in the case of a retail license approved for a facility that has not been constructed, such facility has not been constructed and placed in operation within two years after approval of the license application or construction of the facility has not commenced within one year after such approval. 12-47-307. Persons prohibited as licensees. (1)(a) No license provided by this article or article 46 or 48 of this title shall be issued to or held by: ' (I) Any person until the annual fee therefor has been paid; (11) Any person who is not of good moral character; (11I) Any corporation, any of whose officers, directors, or stockholders holding ten percent or more of the outstanding and issued capital stock thereof are not of good moral character; (IV) Any partnership, association, or company, any of whose officers, or any of whose members holding ten percent or more interest therein, are not of good moral character; (V) Any person employing, assisted by, or financed in whole or in part by any other person who is not of good character and reputation satisfactory to the respective licensing authorities; (VI) Any person unless such person's character, record, and reputation are satisfactory to the respective licensing authority; (VII) Any natural person under twenty-one years of age. (b)(I) In making a determination as to character or when considering the conviction of a crime, a licensing authority shall be governed by the provisions of section 24-5-101, C.R.S. (11) With respect to arts or club license applications, an investigation of the character of the president or chair of the board and the operational manager shall be deemed sufficient to determine whether to issue the arts or club license to the applicant. (2)(a) No license provided by this article shall be issued to or held by a peace officer described in section 16-2.5-121, 16-2.5-122, 16-2.5-123, 16-2.5-125, 16-2.5-126, 16-2.5-128, or 16-2.5-129, C.R.S., or the state licensing authority or any of its inspectors or employees. (b) A peace officer described in section 16-2.5-103, 16-2.5-105, 16-2.5-108, 16-2.5-132, or 16- 2.5-149, C.R.S., may not obtain or hold a license under this article to operate a licensed premises that is located within the same jurisdiction that employs the peace officer. (3)(a) In investigating the qualifications of the applicant or a licensee, the local licensing authority may have access to criminal history record information furnished by a criminal justice agency subject to any restrictions imposed by such agency. In the event the local licensing authority takes into consideration information concerning the applicant's criminal history record, the local licensing authority shall also consider any information provided by the applicant regarding such criminal history record, including but not limited to evidence of rehabilitation, character references, and educational achievements, especially those items pertaining to the period of time between the applicant's last criminal conviction and the consideration of the application for a license. (b) As used in paragraph (a) of this subsection (3), "criminal justice agency" means any federal, state, or municipal court or any governmental agency or subunit of such agency that performs the administration of criminal justice pursuant to a statute or executive order and that allocates a substantial part of its annual budget to the administration of criminal justice. (c) At the time of the application for a license, the applicant shall submit fingerprints and file personal history information concerning the applicant's qualifications for a license on forms prepared by the state licensing authority. The state and local licensing authorities shall submit such fingerprints to the Colorado bureau of investigation for the purpose of conducting fingerprints -based criminal history record checks. The Colorado bureau of investigation shall forward the fingerprints to the federal bureau of investigation for the purpose of conducting fingerprints -based criminal history record checks. An applicant who has previously submitted fingerprints for alcohol beverage licensing .0' Page 21 of 77 CHAPTER 8 POST -ISSUANCE ACTIONS Section 8-1 License Renewal Subsection 8-1-1 Timely Application Required All applications for renewal of alcohol beverage licenses, including both State and City forms with applicable fees for both parties, shall be submitted to the Licensing Clerk in the form prescribed by law no later than forty-five (45) days before the license expiration date together with the required license and renewal application fees. Any application received fewer than forty-five (45) days before the license expiration date shall be considered a late application. Subsection 8-1-1-a Definition of `Timely" Complete renewal applications which are mailed and postmarked on or before the forty- five (45) day deadline will be considered timely filed. If the deadline date lands on a weekend or city government recognized holiday then the application will be considered timely filed if postmarked on the next business day following that holiday or weekend deadline date. Complete renewal applications that are hand delivered to the Licensing Clerk on or before the forty-five (45) day deadline will be considered timely filed. If the deadline (J date lands on a weekend or a city government recognized holiday then the application will be considered timely filed if hand delivered on the next business day following that holiday or weekend deadline date. Subsection 8-1-2 Late Applications Without Objections Received Before Expiration of License The Licensing Clerk may process late applications received before expiration of the license, for which no objections have been received, provided that the licensee agrees to suspend the sale of alcohol beverages during the period between expiration of the license and the date the license is actually renewed. If the licensee does not agree to the temporary post -expiration suspension, the Licensing Clerk shall not allow Administrative Approval (as described in Subsection 8-1-5) and shall set the matter for a renewal hearing before the Authority for the next available Authority hearing. Subsection 8-1-3 Late Applications With Objections Received Before Expiration of License n When objections have been received, the Licensing Clerk shall set any late applications received before expiration of the license for a renewal hearing before the Authority for the next available Authority hearing. C:\Users\lambm2WppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8B8SOCIT\BLA Rules of Procedure - Adopted December 2 2014-.doc- 13 - License Number: 47-05350-0000 Date Fees Received: 1.9 /;7 {pfDate Issued: Amount Recd COB: ? GJ, Q 9 ` 7907 Expires: f Amount Recd State: To State: � S�9 ,Qv / �%�(�� CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Current Information: Applicant: Zythos Restaurant Group LLC Trade Name: ZYTHOS Address: 3175 E. Yarrow Circle Superior, CO 80027 Phone: (312) 217-0215 Email: kostakorres@gmail.com License Type: Hotel -Restaurant Liquor Location: 1320 College Ave Enter any corrections below: All information must be typewritten or legibly printed in black ink IMPORTANT: This City of Boulder Renewal Application Form AND the State of Colorado Renewal Application Form must both be RECEIVED in the Office of the City Clerk NO LATER THAN the 45th day prior to the date of expiration. Failure to file both renewal forms by September 13, 2016 may result in denial of the renewal. Please complete the forms and return them to: City of Boulder -- Finance Department Your Existing`Lice�nse Expires: 10/28/76 B ul Box COic ity Must Receive Complete Renewal By: 9/13/16 Boulder, O 80306 Attn: Liquor Licensing Fee Description Amount Application Fee $100.00 License Fee $75.00 Total Payable to City of Boulder $175.00 Have any officers, directors, members, registered managers or any person with a 10% or greater interest in your license been convicted of a crime, or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court (do not include traffic violations, unless they resulted in suspension or revocation of your driver's license, or you were convicted of driving while impaired or under the influence of drugs or alcohol) since your last license renewal? -"-/—No Yes If yes, explain in detail on a separate page. Have all of your owners, managers, and employees (i.e. clerks, bartenders, and wait staff) involved in the service and sale of alcohol attended a state -certified Responsible Vendor class approved per CRS 12-47-1002 within three months of your establishment opening or within three months of employee's hire date? Note that this training is a continuous local condition of your license, web based trainings are not allowed, and you must keep employees'/servers' training current by retraining before their training term expires under BLA Rule Section 3-6. __.e::fNo Yes If you checked NO, please explain on the enclosed Plan for Training Compliance your timeline for training. This will help us better evaluate if a renewal hearing should be scheduled. If you checked YES, please fully complete the enclosed Proof of Training listing all alcohol service/sale employees, their hire dates, their training dates, and attach copies for all listed employees of their certificates of class completion or class cards to this summary. In accordance with C.R.S. 1247-411 1(a), have you met the 25% in meal sales from gross food/drink totals requirement for a Hotel -Restaurant license as mandated by State Law since your last license renewal date? _/�o Yes If no, explain in detail on a separate page. Please include a current copy of your Certificate of Good Standing issued by the Colorado Secretary of State (available at; 303-894-2200 or http://www.sos.state.co.us/pubstbusiness/main.htm ). Certificate enclosed: -,_ X IMPORTANT: Please complete both pages of this application form. Vrrarnn 4.0103 62912016 CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Oath of Applicant: 1 declare under penalty of perjuryZthe nd degr t this application and all attachments are true, correct, and complete to the best of my knowledge Authorized Signature: Title of Signer (if corporation): Date: owL9e(— Tax Department ction: Signatu Beverages - nsing ority Action: Chair- L�— Version 4.0103 629!1016 lir✓ Approved: ❑ Denied: Date h loo« Comments: Approved: Denied: Date: Attest IMPORTANT: Please complete both pages of this application form. Trade Name: Address: City of Boulder 1(youcheckedNO '� (or troininp on your city renewol, Finance Department - Licensing Division oleasefilloutthes/orml 1777 Broadway, Boulder, CO 80302 - 303.441.4192 BEVERAGE LICENSING AUTHORITY PLAN FOR TRAINING COMPLIANCE FOR LICENSE RENEWAL The Beverage Licensing Authority has determined that all owners, managers, and employees (i.e. clerks, bartenders and wait staff) involved in the service and sale of alcohol in the City of Boulder will attended a state -certified responsible vendors class, approved per C.R.S. 12-47- 1002, within three months of your establishment opening or within three months of employee's hire dates, and that such training will be a continuous local condition of your local license and that state -approved classes are valid for the indicated current term from training date. E - training not accepted. Servers must be re-trained to stay current and current training of all servers must be shown on your annual license renewal. Please explain below about your progress toward full training, plans for employee training, and timeline fortraining completion. Oath of Applicant I declare under penalty of perjury in the second degree that I acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the Colorado Liquor and Beer Code and all City of Boulder rules, regulations, codes, and ordinances which affect my license and business property. -?_ 14\tet 0 Cir"11? -l. k v Date Trade name Print name 71t1r Trade Name: Address: If you checked YES City of Boulder for troining on your city renma4 pleose fll/ Finance Department - Licensing Division out thlsform&ottochcords/certipcotesof P g trolning for employees 1777 Broadway, 8oulder, CO 80302 - 303.441.4192 PROOF OF TRAINING The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all involved in service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, or other evidence of training completion for each listed employee. Employee's NameI State Training Type I Hire Date ITrainingDate Previous I Latest Training Date OFFICE OF THE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF FACT OF GOOD STANDING I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, Zythos Restaurant Group LLC is a Limited Liability Company formed or registered on 04/14/2015 under the law of Colorado, has complied with all applicable requirements of this office, and is in good standing with this office. This entity has been assigned entity identification number 20151254103 . This certificate reflects facts established or disclosed by documents delivered to this office on paper through 10/06/2016 that have been posted, and by documents delivered to this office electronically through 10/07/2016 @ 13:46:23 . I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, and issued this official certificate at Denver, Colorado on 10/07/2016 @ 13:46:23 in accordance with applicable law. This certificate is assigned Confirmation Number 9871975 Secretary of State of the State of Colorado *********************************************End of Notice: A certificate issued electronically from the Colorado Secretary of State's Web site is fidly and immediately valid and effective. However, as an option, the issetance and validity of a certificate obtained electronically may be established by visiting the Validate a Certificate page of the Secretary of State's Web site, h1tp: www.sos.state.cn.us bi= C'ei-tiftcateSearchCi•iteria.do entering the certificate's confirmation number displayed on the certificate, andfollolving the instructions displayed. Confirming the issuance of a certificate is merely optional and is not necessary to the valid and effective issuance of a certificate. For more information, visit ottr Web site, http wisw.sos.state. co. its click "Businesses, trademarks, trade names " and select "Frequently Asked Questions. " DR 8400 (Revised 09101/12) COLORADO DEPARTMENT OF LIQUOR ENFORCEMENT DIVISON REVENUE LIQUOR OR 3.2 BEER LICENSE SUBMIT TO LOCAL LICENSING AUTHORITY RENEWAL APPLICATION Fees Due Renewal Fee Storage Permit $100 x _ Optional Premise $100 x _ Licensee Name DBA 2 nS '7hv A'-1- uli Amount Due/Paid Make check payable to Colorado Department of Revenue The Stale may convert your check to a ane -time electronic banking transaction Your bank account may be debited as early as the same day received by the Slate If convened, your check Wil not be returned. If your check Is rejected due to Insufficient or uncollected funds, the Department may collect the payment amount directly from your banking account ebcbonicady PLEASE VERIFY & UPDATE ALL INFORMATION BELOW RETURN TO CITY • - COUNTY LICENSING AUTHORITYDATE Licensee Name DBA 2 nS '7hv A'-1- uli Z 03 Liquor License # License Type Sales Tax License # I Expiration Dale Dy(e Date • Cq- atm—SN-0-at%.-- `ffl3 t /a / I _ _ _ Street Address -T— ' 32,0 Phone Number ' 4Co �-CECHE f L1� A-- O �(��4�_ Mailing Address 3 \'�r E- • o e.S A.. Er`t o �- G o c3ooZ'1~ Operating Manager Date of Birth Home Address Phone Number �+{L Sc�P o co _ .. _ -- _ 3 t2 2�� 0 2� 1. Do you have legal possession of the premises at the street address above YES L]�- NO -t H Is the premises owned or rented? ❑ OwnedRented' *If rented, expiration date of lease_ 39 2oZo 2. Since the date of filing of the last annual appli tion, has there been any change In financial interest (New notes, loans, owners, etc.) or organizational structure (addition or deletion of officers, directors, managing members or general partners)? If yes, explain in detail and attach a listing of all liquor businesses In which these new lenders, owners (otherlicensed financial Institutions), officers, NO directors, managing members, or general partners are materially interested. L3 YES U NOTE TO CORPORATION, LIMITED LIABILITY COMPANY AND PARTNERSHIP APPLICANTS: If you have added or deleted any officers, directors, managing members, general partners or persons with 10% or more interest in your business, you must complete and return immediately to your Local Licensing Authority, Form DR 6177: Corporation, Limited Liability Company or Partnership Report of Changes, along with all supporting documentation and fees, 3. Since the date of filing of the last annual application, has the applicant or any of its agents, owners, managers, pa�ar lenders (other than licensed financial Institutions) been convicted of a crime? If yes, attach a detailed explanation. L3YESrtnersNO 4. ,- Since the date of filing of the last annual application, has the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) been denied an alcohol beverage license, had an alcohol beverage license suspended or revoked, or had interest in any entity that had an alcohol beverage license denied, suspended or revoked? If yes, attach a detailed explanation. ❑ YES Wr"NO 5. Does the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial Institutions) have a direct or indirect interest in any other Colorado liquor II'c�ase, including loans to or from any licensee or interest in a loan to any licensee? If yes, attach a detailed explanation. ❑ YES -TJ NO 6. SOLE PROPRIETORSHIPS, HUSBAND -WIFE PARTNERSHIPS AND PARTNERS IN GENERAL PARTNERSHIPS: Each person must complete and sign the DR 4679: Affidavit — Restriction on Public Benefits (available online or by calling 303-205-2300) and attach a copy of their driver's license, state -Issued ID or valid passport AFFIRMATION & CONSENT I declare under penalty of perjury In the second degree that this application and all attachments are true, correct and complete to the best of my knowledge. Type or Print Name of Applicant/Aulhodzed Agent of Business Tide A)�-S e'er ---4- j 6W Signature Date R O APPROVAL OF CITY OR COUNTY LICENSING AUTHORITY The foregoing application has been examined and the premises, business conducted and character of the applicant are satisfactory, and we do hereby report that such license, If granted, will comply with the provisions of Title 12, Articles 45 and 47, C.R.S. THEREFORE THIS APPLICATION IS APPROVED. Local Licensing Authority For Date Signature He Attest W) cD cq o m 00 N Z ® r w M LO N O X l�� Cl) 00 �+ ODM 00r� IL rij O � � N O p f/1 U � J LCL J 0 =o Y 0 Q N CD 0 % M d O in > O U) Q < 00 41 c o R �o� s � d � VAm Cj Y N v - m tel Agenda Item 7 City of Boulder (3 FBOV�'�� Finance October 12, 2016 Sent Via Email to: shout@thespotgym.com And Via Certified Mail, Return Receipt Requested Dan Howley The Bouldering Garden, LLC d/b/a SPOT BOULDERING GYM, THE SPOT CAFE License # 15-28327-0000 3240 Prairie Ave Boulder, CO 80301-2630 And Via US Mail Ryan Kempf The Bouldering Garden, LLC d/b/a SPOT BOULDERING GYM, THE SPOT CAFE License # 15-28327-0000 3240 Prairie Ave Boulder, CO 80301-2630 Re: Beer and Wine Liquor License Renewal Application for 3240 Prairie Avenue, Boulder, CO 80301 Dear Mr. Howley: Per my conversation with Ryan Kempf on October 11, 2016, please allow this letter to serve as written notice that you will be required to attend a hearing to determine if there is good cause for non- renewal of your annual liquor license. To recap, the city is in receipt of the state and city license renewal applications and applicable fees for your license which we received on October 11, 2016. However, your renewal filing deadline date was on August 18 and your license expiration date was October 2, 2016. Our local Rules of Procedure preclude me from approving a license renewal via Summary Approval (see attachment 1) if the licensee files after the license expiration date. Therefore, your LLC will be set for a license renewal hearing before the Boulder Beverage Licensing Authority (BLA). Among other factors at the discretion of the BLA, the conditions that you should be prepared to address in your renewal hearing, include but are not limited to: City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensing@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) a. All employees involved in the service of alcohol, including, without limitation, managers, bartenders, and servers, shall attend a state -certified Responsible Vendor alcohol service class within three months from the initial approval of this license. New employees shall take such class within three months of their hire. Re -certification must be undertaken so that they remain current with training. b. Licensee should be prepared to address any questions raised as to non-compliance with § 12-47-409, C.R.S. (pertaining to Beer and Wine type Liquor Licenses). C. Licensee should be prepared to address the operation of their licensed premise in consideration of applicable State law, including, but not limited to §12-47-103(9), C.R.S. and BLA Rules of Procedure, Subsection 8-1-9 which states, "Subsection 8-1-9 Grounds for Non -Renewal of License. Objections to renewal of a license must be for good cause. Evidence of good cause to deny a renewal may include, but shall not be limited to, the following: (A) Evidence that the licensee or applicant has violated, does not meet, or has failed to comply with any of the terms, conditions, or provisions of the Colorado Liquor Code or any related rules and regulations; (B) Evidence that the licensee or applicant has failed to comply with any special terms or conditions that were placed on its license in prior disciplinary proceedings or arose in the context of potential disciplinary proceeding; or (C) Evidence that the licensed premises have been operated in a manner that adversely affects the public health, welfare or safety of the immediate Neighborhood in which the establishment is located, including a continuing pattern of fights, violent activity or disorderly conduct." "Disorderly conduct" has the same meaning as in §18-9- 106, C.R.S. d. Licensee must explain why city and state license renewal applications were not timely filed (filed after the license expiration date) with the city of Boulder's License Administrator as secretary of the BLA at least 45 days prior to your license expiration date as dictated by §12-47- 302, C.R.S. You will then be scheduled and are hereby ordered to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado on Wednesday November 16, 2016 at 3:00 PM to determine if there is good cause not to renew your annual liquor license. You may bring a legal representative to this hearing, but are not required to do so. You, or an employee, should visit my office on Wednesday November 2, 2016 after 12 noon to pick up a hearing notification poster, and such poster should be conspicuously posted on your premises (for instance on your front door or front window glass) at least by Saturday November 5, 2016 and should remain posted for the 10 day period until your renewal hearing. The State Liquor License Code is available for your review at: http://www.revenue.state.co.us/liquor dir/wrap.asp?incl=lawrules and the city of Boulder Beverages Licensing Authority Rules of Procedures are available at: http://www.ci.boulder.co.us/clerk/liquor/Rules%20of%2OProcedure.pdf In the alternative, I can provide you with a hard copy of the BLA Rules of Procedure at your request. If you have questions, or require additional information, please contact me at the below listed numbers. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensing@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) Sincerely yours, Mishawn J. Cook Licensing Administrator Certified Municipal Clerk Phone: 303-441-3010 Fax: 303-441-1919 Email: cookm@bouldercolorado.gov Website: http://www.bouldercolorado.gov/licensing CERTIFICATE OF MAILING I hereby certify that on the iaA day of 20/6 a true and correct copy of the above correspondence was duly mailed by placing same in the U.S. Mail, certification # '7o zaZ.-;k o Pogo -7/o-.3 �6 �fl , return receipt requested, postage prepaid, addressed to the following. Dan Howley The Bouldering Garden, LLC d/b/a SPOT BOULDERING GYM, THE SPOT CAFE License # 15-28327-0000 3240 Prairie Ave Boulder, CO 80301-2630 I City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensing@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) IN /-7-/(6 M Postmark X-Pili� M Return Receipt Fee O (Endorsement Required) Here M Restrkted Delivery Fee (Endorsement Reaulrem rU N Total Pot Dan Howley �entTo The Bouldering Garden, LLC ru d/b/a SPOT BOULDERING GYM,' '-1si'r"eetiApi License # 15-28327-0000 M orPO Box 3240 Prairie Ave crty ware, Boulder, CO 80301-2630 00 Au 2 ust 2006 I' `6- ' ■ Complete Items 1, 2, and 3. Also complete item 4 if Restricted Delivery Is desired. m Print your name and address on the reverse so that we can return the card to you. © Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: Dan Howley The Bouldering Garden, LLC d/b/a SPOT BOULDERING GYM, License # 15-28327-0000 3240 Prairie Ave Boulder, CO 80301-2630 A. Signature X i ❑ Agent ❑ Addresse B. cefv by nted C. Date of Deliver D. !Aellso6 !ellsaddress different from item 1? ❑ Yes If , enter delivery address below: ❑ NO M 3. Service Type ❑ Certified Mail ❑ Registered ❑ Insured Mail ❑ Express Mail ❑ Return Receipt for Merchandis .❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number r (Transfer from service labeo ' -7012 29201 0 0 0 0 i 1 310 3 9 6 9 0 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-15 (Domestic Mail Onl. For delivery informatii r-9 Postage =_� Certified IN /-7-/(6 M Postmark X-Pili� M Return Receipt Fee O (Endorsement Required) Here M Restrkted Delivery Fee (Endorsement Reaulrem rU N Total Pot Dan Howley �entTo The Bouldering Garden, LLC ru d/b/a SPOT BOULDERING GYM,' '-1si'r"eetiApi License # 15-28327-0000 M orPO Box 3240 Prairie Ave crty ware, Boulder, CO 80301-2630 00 Au 2 ust 2006 I' `6- ' ■ Complete Items 1, 2, and 3. Also complete item 4 if Restricted Delivery Is desired. m Print your name and address on the reverse so that we can return the card to you. © Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: Dan Howley The Bouldering Garden, LLC d/b/a SPOT BOULDERING GYM, License # 15-28327-0000 3240 Prairie Ave Boulder, CO 80301-2630 A. Signature X i ❑ Agent ❑ Addresse B. cefv by nted C. Date of Deliver D. !Aellso6 !ellsaddress different from item 1? ❑ Yes If , enter delivery address below: ❑ NO M 3. Service Type ❑ Certified Mail ❑ Registered ❑ Insured Mail ❑ Express Mail ❑ Return Receipt for Merchandis .❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number r (Transfer from service labeo ' -7012 29201 0 0 0 0 i 1 310 3 9 6 9 0 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-15 Subsection 8-1-4 Expired Licenses A licensee whose license has been expired for not more than ninety (90) days may file a late renewal application upon the payment of a nonrefundable late application fee to the City. A licensee who files a late renewal application for a license that expires before its Authority hearing, or a licensee who files a renewal not more than ninety (90) days after a license is expired and pays the requisite fee, may continue to operate subject to the limitations set forth in Section 8-1-8, until the Authority has taken final action to approve or deny such licensee's late renewal application. (Section 12-47-302(2)(a), C.R.S.) No late renewal application shall be accepted more than ninety (90) days after the expiration of a licensee's permanent annual license. Any licensee whose permanent annual license has been expired for more than ninety (90) days must apply for a new license pursuant to Sections 12-47-302 and 12-47-311, C.R.S., and shall not sell or possess for sale any alcohol beverage until all required licenses have been obtained. Subsection 8-1-5 Administrative Approval of License Renewal by Licensing Clerk After receiving a complete license renewal application including both State and City renewal forms with applicable fees for both parties, the Licensing Clerk shall review the application, together with the following information covering the period since the initial application or last renewal (whichever is more recent): (i) submissions to the applicant's file; (ii) City department comments; and, (iii) pertinent City records. Unless there is evidence to the contrary, whether contained in the applicant's file or otherwise, it will be presumed that the occupied premises comply with the provisions of the statutes and applicable regulations, that the character of the applicant continues to be satisfactory, and that such renewed license, if granted, continues to meet the reasonable requirements of the neighborhood and the desires of the inhabitants. If no such evidence counters these presumptions, the license renewal application shall be approved by the Licensing Clerk and forwarded to the State Department of Revenue, Liquor Enforcement Division. If the Licensing Clerk finds such evidence countering these presumptions, the Licensing Clerk shall set, for the next available Authority hearing, the license renewal application for a renewal hearing before the Authority. The Authority may, separate from the agreed upon conditions in this Section 6-4, direct at any time (pursuant to notice requirements set forth in Section 4-3) that any license renewal be changed to non -Administrative Approval, thus removing the renewal from possible Administrative Approval (as described in Subsection 8-1-5), and directing the Licensing Clerk to set the next annual renewal of such license for review in a hearing before the Authority, unless and until the Authority directs otherwise. Subsection 8-1-6 License Renewal Hearings by the Authority Whenever objections to the renewal of a license have been raised (by a Party in Interest, the State, or the City) before renewal of the license, the Licensing Clerk shall have the discretion to set the matter for a renewal hearing. An Objection to Renewal C:\Users\lambm2\AppData\Local\Ivlicrosoft\Windows\Temporary Intemet Ftles\Content.Outlook\SBBSOCrRBLA Rules of Procedure - Adopted December 2 2014-.doc- 14 - License Number: Date Fees Received: q/�� (� /� Date Issued: Amount Recd COB: Expires: Amount Recd State: -, �5 OG' 7 �b % To State: CITY OF BOULDER L LIQUOR LICENSE EXPIRATION NOTICE Current Irifa nation: Enter any corrections below: Applicant: The Bouldering Garden, LLC Trade Name: SPOT BOULDERING GYM, THE SPOT CAFE Address: 3240 Prairie Ave Boulder, CO 80301-2630 Phone: (303) 379-8806 Email: shout@thespotgyFn.com License Type: Beer & Wine Liquor Location: 3240 Prairie Ave All information must be typewritten or legibly printed in black ink--. 15-28327-0000 IMPORTANT: Your Liquor License EXPIRES on October 2, 2016. If you renew after your expiration date: (i) you MUST pay a late filing fee of $500 to renew your license, (ii) you then have 90 days from your expiration date to file a late renewal, and (iii) failure to file by December 31, 2016 will require a new application and public hearing. Please complete the forms and return them to: City of Boulder Finance Department Your Existing License Expires: 10/2/16 P. O. Box 791 Deadline for Late Renewal: 12/31/16 Boulder, CO 80306 Attn: Liquor Licensing - - -- Fee Descrlption Amount Application Fee $100.00 License Fee $48.75 Total Payable to City of Boulder $148.75 Have any officers, directors, members, registered managers or any person with a 10% or greater interest in your license been convicted of a crime, or received a suspended sentence, deferred sentence, or forfeited bail far any offense in criminal or military court (do not include traffic violations, unless they resulted in suspension or revocation of your driver's license, or you were conviaed of driving while impaired or under the influence of drugs or alcohol) since your last license renewal �< No Yes If yes, explain in detail on a separate page. Have all of your owners, managers, and employees (i.e. clerks, bartenders, and wait staff) involved in the service and sale of alcohol attended a state -certified Responsible Vendor class approved per CRS 12.47-1002 within three months of your establishment opening or within three months of employee's hire date? Note that this training is a continuous local condition of your license, web based trainings are not allowed, and you must keep employees'/servers' training current by retraining before their training term expires under BLA Rule Section 3-6. No Yes If you checked NO, please explain on the enclosed Plan for Training Compliance your timeline for training. This will help us better evaluate if a renewal hearing should be scheduled. If you checked YES, please fully complete the enclosed Proof of Training listing all alcohol service/sale employees, their hire dates, their training dates, and attach copies for all listed employees of their certiflcutes of class completion or class cards to this summary. Please include a copy of your Certificate of Good Standing dated within the last two years issued by the Colorado Secretary of Slate (available at: 303-894-2200 or httpJ/www.sos.state.co.ustpubs/business/main.htm ). Certificate enclosed: X IMPORTANT: Please complete both pages of this application form. Vumon 4.01-03 6/27WO16 CITY OF BOULDER LIQUOR LICENSE EXPIRATION NOTICE Oath of Applicant: I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the hest of my knowledge. Authorized Signature: �r Title of Signer (if corporation): Date 1,9 1 Tax Dcpart Acti Approved: y Denied: Date. Qo 1 0 Signatu 0 Comments Beverages ensin uthority Action: Approved: Denied: Date: Chair: Atieet. IMPORTANT: Please complete both pages of this application form. t eninn 4 01.63 6/2W-1016 If you checked YES City of Boulder for training an your city renewal, please flll out this farm & attach cords/certyicates of Finance Department •Licensing Division w trotninpforemployeesl 1777 Broadway, Boulder, CO 90302.303.441.4192 PROOF OF TRAINING Trade Name: TRW -Do AVA?l N9 q eJ LLC, T9yv�({2t —r— Address: 3240 Toub co li0 v ( The Beverage Licensing Authority (BLA) determined that it is a local condition of a liquor license that all involved in service/sale of alcohol are required to attend and pass a state -approved responsible vendor alcohol service training within 3 months of premise opening or 3 months of hire date (or earlier) and that such training is valid for the indicated term from training date. Please note that E -training is not accepted. Please fill out the following form and attach certificates of training, cards, or other evidence of training completion for each listed employee. Employee's Name State Training Type Hire Date Previous Training Date Latest Training Date Tte5 12 9 L3 ,N K—A w ,5 S gr'IS 20 l� —WAR V, IL2-0115 S �C' S t�L6 S tb N l S 2r I Ito IIS aNt.vJ sly TZ P15 L4 to l t" c6 is This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have teamed and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Siin�ncce/erely, oe A—: - 4;p— Adam F. Chafetz President, HCI This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, I L4e Adam F. Chafetz President, HCI This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and takingra positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, 641- Adam '1-Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • 09 On Premise SSN: )UO(-)D(-XXXX Issued: 9/52013 Expires: 8212016 iD#: 3562624 D.O.B.: )V -%XO )UUC KELLY A ANDERSON 2424 Mapleton Ave Boulder, CO 803043754 For service visit us online at www.getUps.com B. Jonathan Balliet, 47289 IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • ° On Premise SSN: )=-)O(-XXXX 7202015 7/122018 Issued: 4039792 Expires: XXDDUXXXX ID#: D.O.B.: TROY C SINGH DEREWA 664 Walden Cir Boulder, CO 80305-7601 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • ° On Premise SSN: XXX-XX-XXXX Issued: 7202015 Expires: 7/152018 ID#: 4039851 D.O.B.: XXrAX/XXXX SARAH K JOHNSON Po Box 213 Eldorado Springs, CO 80025-0213 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 i 1C is 15 your vinclall i ii'3- l.ertincation �-ara. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your. participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, Z- 6 ' 1r Adam F. Chafetz President, HCI This is your Official TIPS' Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) progrAm, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any idformation you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, L"5rz Adam F. Chafetz President, HCI This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, Adam F. Chafetz President, HCI UVJL1rV C 1LAiN 1: Keep a copy of this card for your records. Writedown your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. 0 • On Premise SSN: XXX-XX-XXXX Issued: 4/5/2016 Expires: 3/21/2019 1)#: 4221785 D.O.B.: XX/XX/XXXX RYAN E NEEDLES 2815 Cottonwood Dr Laramie, WY 82070-7335 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • On Premise SSN:--X Issued: 7/20/2015 Expires: 7/15/2018 1D#: 4039850 D.O.B.: XX/XXnUU(X MICHELLE L WATSON For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 IMPORTANT: Keep a copy of this card for your records. Write down your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certification card. There is a minimal charge for a replacement card if your original card becomes lost, damaged or stolen. • AM eTIPS On Premise 2.OSSN: XXX-)O(-XXXX Issued: 10/1/2014 Expires: 10/1/2017 ID#: 3831535 D.O.B.: XX/XX/XXXX Andrew John Zaslove 3240 Prairie Ave Boulder, CO 80301-2830 For service visit us online at www.getdps.com 'This is your Official TIPS® Certification Card. Carry it with you as evidence of your skills and knowledge in the responsible sale and consumption of alcohol. Congratulations! By successfully completing the TIPS (Training for Intervention Procedures) program, you have taken your place in the forefront of a nationwide movement to reduce the tragedies resulting from the misuse of alcohol. We value your participation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or colleagues by using the techniques you have learned and taking a positive approach towards alcohol use. If you have any information you think would enhance the TIPS program, or if we can assist you in any way, please contact us at 703-524-1200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, -4 'Adam F. Chafetz President, HCI IMPORTANT: Keep a copy of this card for your records. Write do your certification number because you will need it when contacting TIPS. For assistance or additional information, contact Health Communications, Inc. by using the information provided on the reverse side of your certific. card. There is a minimal charge for a replacement card if your original ca becomes lost, damaged or stolen. • On Premise SSN: XXX-xx-xxXX Issued: 12/9/2015 Sapires: 12/2/2018 ID#: 4144247 D.O.B.: XX/XX/W TYLER S KEMPNEY 3240 Prairie Ave Boulder, CO 80301-2630 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 City of Boulder IJ you checked NO � Jor troin7nq on your city renewal, r��� --� ✓ Finance Department - Licensing Division . preo�enia�rrhr:�rmr 1777 Broadway, Boulder, CO 80302.303.441.4192 BEVERAGE LICENSING AUTHORITY PLAN FOR TRAINING COMPLIANCE FOR LICENSE RENEWAL Trade Name: Address: The Beverage Licensing Authority has determined that all owners, managers, and employees (Le. clerks, bartenders and wait staff) involved in the service and sale of alcohol in the City of Boulder will attended a state -certified responsible vendors class, approved per C.R.S. 12-47- 1002, within three months of your establishment opening or within three months of employee's hire dates, and that such training will be a continuous local condition of your local license and that state -approved classes are valid for the indicated current term from training date. E - training not accepted. Servers must be re-trained to stay current and current training of all servers must be shown on your annual license renewal. Please explain below about your progress toward full training, plans for employee training, and timeline for training completion. Oath of Applicant I declare under penalty of perjury in the second degree that I acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the Colorado Liquor and Beer Code and all City of Boulder rules, regulations, codes, and ordinances which affect my license and business property. Applicant/ Licensee business name Authorized signature Date Trade name Print name Title OFFICE OF THE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF FACT OF GOOD STANDING I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, THE BOULDERING GARDEN, LLC is a Limited Liability Company formed or registered on 01/19/2001 under the law of Colorado, has complied with all applicable requirements of this office, and is in good standing with this office. This entity has been assigned entity identification number 20011013936 . This certificate reflects facts established or disclosed by documents delivered to this office on paper through 10/07/2016 that have been posted, and by documents delivered to this office electronically through 10/10/2016 @ 15:00:28 . I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, and issued this official certificate at Denver, Colorado on 10/10/2016 @ 15:00:28 in accordance with applicable law. This certificate is assigned Confirmation Number 9874009 Secretary of State of the State of Colorado *********************************************End ofCertificate******************************************* Notice: A certificate issued electronically front the Colorado Secretary of' State's Web site is itlM and intinediatelr valid and effective. However, as an option, the issuance and validity of a certificate obtained electronicalM mqv be established by visiting the Validate a Certificate page of the Secretary of State's Web site, ht1p:1Avvnv.sos.state.co.ttsibic/Ce rtificateSearchCriteria.do entering the certificate's confirmation number displayed on the certificate, and following the instructions displayed. Confirming the issuance of a certificate is merelk optional and is not necessary to the valid and effective issuance of a certificate. For more information, visit our Web site, http: www.sos.state.co.us/dick "Businesses, trademarks, trade narnes"and select "Frequently Asked Questions." OFFICE OF THE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF DOCUMENT FILED I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, the attached document is a true and complete copy of the Filed Document with Document # 20011147455 of THE SPOT BOULDERING GYM, LLC (Entity ID # 20011147455 ) filed by THE BOULDERING GARDEN, LLC consisting of 2 pages. This certificate reflects facts established or disclosed by documents delivered to this office on paper through 10/07/2016 that have been posted, and by documents delivered to this office electronically through 10/10/2016 @ 15:12:29. I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, and issued this official certificate at Denver, Colorado on 10/10/2016 @ 15:12:29 in accordance with applicable law. This certificate is assigned Confirmation Number 9874030 *********************************************End of Notice: .4 certificate issued electronically from the Colorado Secr•etary of State's Web site is f illy and immediately valid and e1%ctive. However, as an option, the issuance and validity of a certificate obtained electronically nnav be established by visiting the Validate a Certificate page of the Secretary of State's Web site, http:/hrl�w.sosstate.co.us/biz:"Corti/icateSearchCriteriu.do entering the certificate's confirmation number displayed on the certificate, and following the instructions displayed. Confli-ining the issuance of a certificate is nnerely optional and is not necessary to the valid and elective issuance of a certificate. For more information, visit our Web site, hitp:llnlrly.sos.state.co.usI click "Businesses, trademarks, trade names " and select "Frequently Asked Questions. " Mail to: Secretary of State For office use only Corporations Section 1560 Broadway, Suite 200 Denver, CO 80202 (303) 894-2251 MUST BE TYPED Fax (303) 894-2242 FILING FEE: $10.00XDn PrrA VIUST SUBNHT TWO COPIES secrtsr,�RYpr9TATp 3 20011147455 M $ 10.00 CERTIFICATE OF SECRETARY OF STATE ASSUMED OR TRADE NAME 07-26-2001 14.28:4 THE BOULDERING GARDEN, LLC, a limited liability company, under the laws of Colorado, being 3esirous of transacting a portion of its business under an assumed or trade name as permitted by 7-71-161, Colorado Etevised Statutes, hereby certifies: 1. The location of its principal office is: 732 Alpine Avenue, Boulder, Colorado 80304 2. The name, other than its own, under which the business is carried on is: THE SPOT BOULDERING GYM, LLC 3. A brief description of the kind of business transacted under such assumed or trade name is: The operation of an indoor bouldering gym. DATED this -�D day of July 2001. THE BOULDERING GARDEN, LLC MEMBERS: le, zt�: W Danie owley 00a"M kiPDA Ct3MPUT, DR 6400 (Revised 09101112) TMENT OF REVE LIQUOCOLORADO ENFORCE ENT DIVISION "ue LIQUOR OR 3.2 BEER LICENSE SUBMIT TO LOCAL LICENSINGAUT14ORITY RENEWAL APPLICATION Fees Due _ Renewal Fee Storage Permit $100 x _ Optional Premise $100 x 21 Lb li street Address Phone Number R4,19A� v�(2 o viol 379 �f$QG Mailing Address Amount Due/Paid Make check payable to Colorado Oeparlment of Revenue The State may convert your check to a ane time eecironc banking transaction Your bank account may be debited as Cady es the same day received by the State If converted your check will not be returned if your check Is rejected due to In"iclent or uncollected funds, the Department may ca ted the payment amount directly from your banking account aiec"nically 1 l : IJ 1 • RETURN TO CITY OR COIINTY I Ir FNSINr- AIM-Ir101TV ov nrrc M." Licensee Name DBA Liquor License # I Licenhe Ve Sa -Tax License # Ex I aUgn Oate Due to 9- W. _ �a S Lb 21 Lb li street Address Phone Number R4,19A� v�(2 o viol 379 �f$QG Mailing Address U o M If 13QQ4)P-(Z-,Sa3o 1 Operating Man ger Datl; of Bijth Home Address Phone Number 14 k c-1ow 1301 wi; 1. Do you have legal possession of the premises at the street address above? g YES ❑ NO Is the premises owned or rented? ❑ Owned A Rented' 'If rented, expiration date of lease OCT . �l 2 Since the date of filing of the last annual application, has there been any change In financial interest (new notes, loans, owners, etc.) or organizational structure (addition or deletion of officers, directors, managing members or general partners)? if yes, explain in detail and attach a listing of all liquor businesses in which these new lenders, own (other than licensed financial institutions), officers, directors, managing members, or general partners are materially Interested. G YES ❑ NO NOTE TO CORPORATION, LIMITED LIABILITY COMPANY AND PARTNERSHIP APPLICANTS: If you have added or deleted any officers, directors, managing members, general partners or persons with 10% or more interest in your business, you must complete and return immediately to your Local Licensing Authority, Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes, along with all supporting documentation and fees. 3 Since the date of filing of the last annual application, has the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) been convicted of a crime? If yes, attach a detailed explanation. ❑ YES 0 NO 4. Since the date of filing of the last annual application, has the applicant or any of Its agents, owners, managers, partners or lenders (other than licensed financial Institutions) been denied an alcohol beverage license, had an alcohol beverage license suspended or revoked, or had interest In any entity that had an alcohol beverage license denied, suspended or revoked? If yes, attach a detailed explanation. ❑ YES a NO 5. Does the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) have a direct or indirect Interest in any other Colorado liquor license, including loans to or from any licensee or interest in a loan to any licensee? If yes, attach a detailed explanation. ❑ YES W NO 6, SOLE PROPRIETORSHIPS, HUSBAND -WIFE PARTNERSHIPS AND PARTNERS IN GENERAL PARTNERSHIPS: Each person must complete and sign the DR 4679: Affidavit - Restriction on Public Benefits (available online or by calling 303-205-2300) and attach a copy of their driver's license, state4ssued 1D or valid passport. AFFIRMATION & CONSENT I declare underpenaMy of perjury In the second degree that this application and all attachments am true, correct and complete to the best ofmy knowledge - Type or Print Name of ApplicantlAuthorized Agent of Business Title Q Signatur Date 1, — to lvltb REPORT & APPROVAL OF CITY OR COUNTY LICENSING AUTHORITY The foregoing application has been examined and the premises, business conducted and character of the applicant are satisfactory, and we do hereby report that such license, if granted, will comply with the provisions of Title 12, Articles 45 and 47, C.R.S. THEREFORE THIS, APPLICATION IS APPROVED. Local Licensing Authority For Date Signature Title Attest Agenda Item 8 CITY OF BOULDER BEVERAGES LICENSING AUTHORITY PRELIMINARY FINDINGS AND REPORT IN THE MATTER OF THE APPLICATION FROM City Club Highland City Club 885 Arapahoe Avenue Boulder, CO 80302 Attn: Sina Simantob Proposed Premise Location: 885 Arapahoe Avenue, Boulder, CO 80302 FOR A New Club Liquor type liquor license TO THE APPLICANT ABOVE-NAMED AND OTHER INTERESTED PARTIES; GREETINGS: Pursuant to C.R.S. 12-47-312(1) and the below referenced State laws and the city of Boulder Beverages Licensing Authority (BLA) Rules of Procedure, you are hereby advised that with regard to the application for a New Club Liquor type liquor license, an investigation has been made and based on the results thereof the following has been determined: 1. APPLICATION PACKET Responsive to C.R.S. §12-47-311(1) and BLA Rules of Procedure Section 4-3, the applicant, as stated above, submitted an application packet, which was substantially complete, to the City Clerk's Office on August 24, 2016. 2. PREVIOUS DENIALS AT THE SAME LOCATION Responsive to C.R.S. §12-47-313 (1)a et seq. and BLA Rules of Procedure, Subsection 5- 1-1 (A), as this is an application for a malt, vinous, or spirituous liquor license, that within two (2) years, preceding the date of the application, the state or the Authority have not denied an application for the same class of license at the same location or within 500 feet of the same location, for the reason that the reasonable requirements of the neighborhood and the desires of the inhabitants were satisfied by the existing outlets. This requirement is not applicable to applications for Bed and Breakfast Permits. 3. POSSESSION OF PREMISES Responsive to C.R.S. §12-47-313 (1)b and BLA Rules of Procedure, Subsection 5-1-1 (B), it appears from the evidence submitted that the applicant is entitled to possession of 1 the premises where the license is proposed to be exercised until March, 2030. 4. ZONING AND HEALTH DEPARTMENT REGULATIONS COMPLIANCE Responsive to C.R.S. §12-47-313 (1)c and BLA Rules of Procedure, Subsection 5-1-1 (C), selling alcohol in the manner proposed in the application is not in violation of any zoning laws of the City of Boulder and the use is consistent with the location's permissible planning conditions and zoning district. The applicant must meet all applicable laws, rules and regulations of the City's Planning Department as to construction and building safety requirements at the premise, and if applicable, the Boulder County Health Department and the State Board of Health for food preparation and service. 5. PROXIMITY TO SCHOOLS Responsive to C.R.S. §12-47-313 (1)d et seq. and BLA Rules of Procedure, Subsection 5- 1-1 (D), the building in which the liquor is to be sold has a local distance waiver enacted or is not located within five hundred (500) feet of any public or parochial school or the principal campus of any college, university or seminary. This requirement is not applicable to applications for Bed and Breakfast Permits. 6. EXISTING OUTLETS IN DESIGNATED NEIGHBORHOOD Responsive to C.R.S. §12-47-312 (2) (a) and BLA Rules of Procedure Section 5-1, this topic was intentionally omitted from investigation by Licensing Clerk. 7. BACKGROUND INFORMATION Responsive to C.R.S. §12-47-307 and BLA Rules of Procedure Subsection 5-1-1 (F), the following criminal history information has been discovered or brought to the attention of the Authority. Applicant (including partners, officers, directors over 10% stockholders): Sina Simantob, Non -Profit's Director, Member and Location Manager: No Criminal Background Results. Source of information: Individual History Report (IHR), CBI and FBI results. Prior Administration and Operational Characteristics: Mr. Simantob disclosed that between 1976 and 1978 he was a 20% owner of Boulder Hotel which had three restaurants with two liquor licenses. Source of information: Individual History Report (IHR) 2 8. APPLICANT FINANCIAL INTEREST Responsive to C.R.S. §12-47-308 and BLA Rules of Procedure Subsection 5-1-1 (G), the applicant's financial interest and associated parties disclosures are to be found in the submitted city of Boulder BLA Financial Statement with attachments, the submitted Colorado Liquor Retail License Application or Colorado Fermented Malt Beverage (3.2% Beer) License Application with attachments, and the submitted Individual History Record with attachments. A copy of each of these mentioned documents should have been retained by the applicant at the time of application and a copy of these mentioned documents will be provided to the BLA for the purposes of local licensing authority deliberations. 9. NEEDS AND DESIRES EVIDENCE Responsive to C.R.S. § 12-47-312 (2) (a) and BLA Rules of Procedure Section 4-1 through Section 4-4, this topic was intentionally omitted from investigation by Licensing Clerk. 10. PUBLIC HEARING INFORMATION Responsive to C.R.S. §12-47-311 and BLA Rules of Procedure Section 5-1, you are hereby notified that the public hearing on this application will be held on Wednesday, November 16, 2016 at 3:00 p.m., in the Council Chambers, 2nd Floor of the Municipal Building, 1777 Broadway, Boulder, Colorado. At said hearing, you will have the opportunity to be heard regarding all matters pertaining to the application, including all matters herein set forth. You are advised to obtain a copy of the State Laws, Rules, and Regulations pertinent to the license class for which you are applying. In addition, you are advised to obtain a copy of the applicable "Rules of Procedures" adopted by the Beverages Licensing Authority of the City of Boulder for use and guidance in holding hearings on liquor license applications. These Rules are available at: http://www.bouldercolorado.gov/files/Clerk/Licensing/Rules%20of%2OProcedure%2007 pdf or a public copy is made available for review at the Licensing Clerk's Office. November 7, 2016 BEVERAGE LICENSING AUTHORITY CITY OF BOULDER COLORADO Mishawn J. Cook, Tax and License Administrator and Board Secretary 3 City of Boulder Finance gF 90V October 28, 2016 Adam P. Stapen, Esq. Dill Dill Carr Stonbraker & Hutchings, PC 455 Sherman Street, Suite 300 Denver CO 80203 RE: City Club Application Re: City Club diagram and question on licensed premise Dear Adam: We discussed briefly my question about the above application at our last hearing on October 19. The reason that I am sending this letter to you and also placing a copy in the BLA November 16 hearing packet when this new Club license application will be heard, is that I may be late to that hearing and so I may not be present to explain my question to the Authority in person. As such, I thought that this letter would suffice. While accepting this application, one question that I had for your firm's paralegal was how the applicant, City Club, will have control of all of the proposed licensed premise, given that it is my understanding that the outdoor area will be utilized by other persons other than the members and guests of the Club and that the first floor hallway is designated as a common hallway, connecting the proposed licensed premises of the basement to the outdoor area. I would ask that you please be prepared to address this issue at the November 16 hearing. The State Liquor Enforcement Division succinctly states the "possession and control" requirement as set forth below: "Licensee in Possession/Control of Premises All alcohol beverage licensees must have possession of the premises at all times, by deed, lease, sub- lease, etc. Licensees may not grant possession of their licensed premises to anyone otherthan the person licensed. Exterior licensed areas must be in possession of the licensee, who must be able to demonstrate control over the areas licensed. For example, access to and from an outdoor patio area is essential to ensure all alcohol beverages purchased from the business, remain on the licensed premises and to keep minors from consuming alcohol beverages. (See Section 12-47-301, C.R.S.)" City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensing@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) Sincerely yours, Mishawn J. Cook License Administrator Certified Municipal Clerk Main: (303) 441-4192 Direct: (303) 441-3010 Fax: (3O3)441-1919 Website: www.bouldercolorado.gov/licensing City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensine@bouldercolorado.sov (303) 441-4192 (303) 411-1919 (FAX) I V N N f'RST FLOOR PLAN Pg;qPtTc, 0�;mt Y WE City Club dba Highland City Club 885 Arapahoe Avenue Boulder, CO 84362 NEW CLUB LICENSE QOIla an Outdoor Area :YQfiAAAAAA6Q>oi Mi 'All d'anemlonaare approxmate Wdoor m Ara AUGUST 2016 O 3: h ch N BASEMENT FLOOR PLAN 0 1-3 ttam; rri�riin:rr p LIQUOR STORAGE City Club dba Highland City Club 13 i $85 Arapahoe Avenue Id Eouldar, CO 80302 NEW CLUB LICENSE tatr "Ail di-narts ns aro approxima[c- AUGUST tots Application: City Club d/b/a Highland City Chub for a New Club Liquor type liquor license at 885 Arapahoe Avenue, Boulder, CO 80302 Total Indoor Sq. Ft.: 3000 Patio Sq. Ft.: 5000 Total Premise Sq. Ft.: 8000 Max. Indoor Seating: 80 Max. Patio Seating: 30 Total Premise Seating: 110 Hours of Operation: 8:00 AM — 10:00 PM Sunday — Saturday, 7 days a week :a Vin❑ t :. � _4RIC, I w 4��i1 J-- v N Z �< U .,... -•tom � i Y_„�3; � ,:c.:��.. - � � �� : w a o .� f 1 fiat _,j.ijT 'LC}: Lilt n '� �•... ,j'! .� 1 J V Qi m Z ��t 4r x a r � • . � a � V, t� � ti So vic'E:I � � r. � �.� f+ � .t _.> Sy�.j \36S, C�t:Lq' �•;V 11 i• � t `'' ti�- y� 4•rx+�, � :z.v=� �, �' � �; � ;pug 1 S3 Y� •t • i �1 N 1 � R i - rLn n r� V Application: City Club d/b/a Highland City Chub for a New Club Liquor type liquor license at 885 Arapahoe Avenue, Boulder, CO 80302 Total Indoor Sq. Ft.: 3000 Patio Sq. Ft.: 5000 Total Premise Sq. Ft.: 8000 Max. Indoor Seating: 80 Max. Patio Seating: 30 Total Premise Seating: 110 Hours of Operation: 8:00 AM — 10:00 PM Sunday — Saturday, 7 days a week CITY OF BOULDER LIQUOR LICENSE APPLICATION This application must be filed in duplicate with the Office of the City CIerk, City of Boulder, 1777 Broadway, P. O. Box 791, Boulder, Colorado 80306. ALL INFORMATION MUST BE PRINTED LEGIBLY IN INK OR TYPEWRITTEN. Name of Applicant(s): City Club Trade Name: Highland City Club Phone No: 303-447-2641 Contact Person: Sina Simantob Business Address: 885 Arapahoe Avenue, Boulder, CO 80302 Mailing address: 885 Arapahoe Avenue, Boulder, CO 80302 Property Owner: Sinco International Investments, Inc. Phone Number (local): 720-308-1449 Property Manager: Sinco International Investments, IncPhone Number (local): 720-308-1449 Property Manager's Mailing Address: 885 Arapahoe Avenue, Boulder, CO 80302 General Manager: Sina Simantob Phone Number (local): 720-308-1449 The applicant(s) hereby applies to the City of Boulder Beverages Licensing Authority for the following local license and tenders the following fees: Type of Application (fee): New License ($1,000.00) Change in Location ($750.00) Change in Class ($750.00) Type of License (fee): Hotel -Restaurant ($75.00) Hotel -Restaurant w/Optional Premises ($75.00) Beer and Wine ($48.75) 3.2% Beer On & Off Premises ($3.75) X Club ($41.25) Race Track ($75.00) 8 Transfer of Ownership ($750.00) Temporary Permit ($100.00) Tavern ($75.00) Retail Liquor Store ($22.50) Brew Pub (75.00) Liquor Licensed Drug Store ($22.50) Arts ($41.25) [] Bed and Breakfast Permit ($125.00 Total) [] Art Gallery Permit ($103.75 Total) Manager Registration — If separate from owners (H&R, Brewpub & Tavern - $75.00) TOTAL FEES: [Fees effective as of July 1, 2010] $1,041.25 APPLICANTS DO NOT FILL THIS AREA OUT STATEMENT OF THE NEIGHBORHOOD. (Not applicable to applications for Transfer of Ownership or applications for Club license.). NEIGHBORHOOD BOUNDARIES WILL BE SET BY THE AUTHORITY AT THEIR MEETING ON The Authority sets the following geographical area as the designated neighborhood which will be served by the license applied for: North Boundary South Boundary East Boundary. West Boundary. ALL APPLICANT'S MUST ANSWER THESE QUESTIONS CITY OUESTIONNAIRE. On a separate sheet of paper please answer the following questions for the Beverages Licensing Authority (BLA). 1) Describe the nature of the proposed establishment and the target market (i.e., restaurant, tavern, sports bar, families, college students, etc.). Please attach a menu for BLA. 2) What are the proposed hours and days of operation for this establishment? 3) What is the seating capacity of the establishment? 4) Have you applied for an "occupant load" for the interior and exterior seating from the Boulder Fire Department? 5) Do you have an emergency plan for your business (exit locations, fire protection system(s), etc.)? (yes or no) 6) How many individuals will be employed at this proposed establishment and how many will be full-time versus part-time? Please provide responsibilities, (i.e., manager, assistant manager, bartender, waitstaff, etc.). 7) Describe your past training and experience in the sale/service of alcohol beverages, include any special or certified training received. 8) Describe your proposed General Manager's past training and experience in the sale/service of alcohol beverages, include any special or certified training received. 9) Besides the state -certified Responsible Vendor classes, what other types of training are proposed for employees at this establishment in the safe and legal sale/service of alcohol beverages? 10) What policies & procedures do you have in place to determine a patron's level of intoxication? 11) What policies & procedures do you have in place to refuse service to a patron? 12) Describe any other types of training or operating procedures that employees will be following in the day-to-day operation of this proposed establishment? l 3) What methods will be used in checking identification for proper age of patrons (at the door, at the bar, etc.) and how will underage patrons be identified so as not to be served alcohol beverages (stamp, mark on the hand, etc.) 14) What types of entertainment will be offered, if any, at this proposed establishment (i.e., music, pool, darts, etc.)? 15) Do you plan to have any exterior amplified sound? 16) What types of security, if any, will be provided at this proposed establishment? 17) What time will your kitchen close each night? Describe your food service plans after your kitchen closes. 18) What is the estimated ratio of food to alcohol beverage sales at this establishment? 19) If you plan on hosting a "Private Party," what extra measures will you take regarding security, staffing and communications with the Boulder Police Department? A private party is defined as: "Ann event where there is a single contact person who represents a group ofpeople who are gathering for social and/or business reasons, the event will be held after 10.00 p.nn., there will be both underage and of -age people present and there will be enough people to constitute an occupancy capacity of 75% or greaten. " OATH OF APPLICANT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor and Beer Code and all City of Boulder rules, regulations and codes which affect my license. Authorized Signature Director Print Name & Title CITY QUESTIONNAIRE 1. Describe the nature of the proposed establishment and the target market (i.e., restaurant, tavern, sports bar, families, college students, etc.). Please attach a menu for BLA. The Highland School is a 125 -year old historic landmark. Highland School has been utilizing the property for an office building with a kitchen, spa and gardens and has leased a portion of the property to City Club for use as a private club which intends to serve food and complementary wine and beer to its members and their guests. 2. What are the proposed hours and days of operation for this establishment? 7 days/week: 8 am to 10 pm 3. What is the seating capacity of the establishment? Approximately 80 4. Have you applied for an "occupant load" for the interior and exterior seating from the Boulder Fire Department? No 5. Do you have an emergency plan for your business (exit locations, fire protection system(s), etc.)? Yes 6. How many individuals will be employed at this proposed establishment and how many will be full-time versus part-time? Approximately 12 employees, ten of whom are full time. 7. Describe your past training and experience in the sale/service of alcohol beverages, include any special or certified training received. None as of yet. City Club has hired OEDIPUS, Inc. which is an authorized, State -Certified Responsible Vendor program establishment to do all the required training in anticipation of acquiring a liquor license. 8. Describe your proposed General Manager's past training and experience in the sale/service of alcohol beverages, include any special or certified training received. Sina Simantob is the Director and General Manager of City Club. In 1976-78, Mr. Simantob was a 20% owner of the Boulderado Hotel which had three restaurants with two liquor licenses. 9. Besides the state -certified Responsible Vendor classes, what other types of training are proposed for employees at this establishment in the safe and legal sale/service of alcohol beverages? All employees who will be involved in the sale/service of alcohol will be required to complete a T.I.P.S. or other approved responsible vendor class, and we will provide regular on-site training to review checking IDs and how to avoid over serving. 10. What policies & procedures do you have in place to determine a patron's level of intoxication? City Club is a private/non-profit social organization where management knows all the members on a first name basis. City Club is a social/educational/civic community that serves only food and alcohol in support of its mission, not for profit as its main goal. 11. What policies & procedures do you have in place to refuse service to a patron? City Club's rules only allow two alcoholic beverages per member, period. Since we do not charge for liquor, we have no incentive to serve more than what is normal and customary for a meal or special event. 12. Describe any other types of training or operating procedures that employees will be following in the day-to-day operation of this proposed establishment? Our employee's most important task is to make sure they know all of our tenants and members on a first name basis; where they are at in life; their field of work; the name of their spouse and children; their habits, customs, mental state, etc. 13. What methods will be used in checking identification for proper age of patrons (at the door, at the bar, etc.) and how will underage patrons be identified so as not to be served alcohol beverages (stamp, mark on the hand, etc.) All Highland tenants and City Club members must be over 21. All members are required to wear a club -issued name badge while on the premises. City Club is in the process of installing parking control to limit access to our parking, and electronic near -field building entry to ensure that only pre -approved tenants and City Club members can access the property. 14. What types of entertainment will be offered, if any, at this proposed establishment (i.e., music, pool, darts, etc.)? Lectures, panel discussions, cultural events, movies, and live classical music. No pool tables, dart boards or TV on the premises. City Club is 'A Safe Place' from the hustle and bustle of daily life with good food, liquor and spa services as support for promoting our goal of social, educational, cultural and civic services. 15. Do you plan to have any exterior amplified sound? Yes, Highland is blessed to have a 50 -seat outdoor amphitheater with a gazebo cover. 16. What types of security, if any, will be provided at this proposed establishment? There are a total of 8 indoor and 8 outdoor cameras that record all activity inside and outside 24/7. 17. What time will your kitchen close each night? Describe your food service plans after your kitchen closes. At this time, City Club's kitchen only serves lunches Monday through Friday, and hosts special evening events approximately once a month. Sandwiches and light snacks will be available any time that the kitchen is not open. We do foresee having more evening events in the future. 18. What is the estimated ratio of food to alcohol beverage sales at this establishment? In the 38 -year history of owning the Highland Building, City Club has never sold any alcohol so the ratio of food to liquor sales is infinite. 19. If you plan on hosting a "Private Party," what extra measures will you take regarding security, staffing and communications with the Boulder Police Department? A private party is defined as: `An event where there is a single contact person who represents a group of people who are gathering for social and/or business reasons, the event will be held after 10: 00 p.m., there will be both underage and of -age people present and there will be enough people to constitute an occupancy capacity of 75% or greater. " On average, City Club currently holds one 'private party' event per month. These events are usually planned for 5:30-9:30 pm. Most of these events serve no alcohol or if they do, it is complementary wine. In our 38 -year history at this location, we have never had an issue regarding noise or alcohol. Management and staff are intimately familiar with and know the host and many of the guests. All 'private parties' must end no later than 9:30 pm; the staff cleans and the club is closed no later than 10:30 pm. DR 8404 (06/28/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division Colorado Liquor (303) 205-2300 Retail License Application ❑ New License ✓❑ New -Concurrent ❑ Transfer of Ownership • All answers must be printed in black ink or typewritten • Applicant must check the appropriate box(es) • Applicant should obtain a copy of the Colorado Liquor and Beer Code: www.co/orado.gov/enforcement/liquor • Local License Fee $ 1. Applicant is applying as a/an ❑ Individual ❑✓ Corporation ❑ Limited Liability Company ❑ Partnership (includes Limited Liability and Husband and Wife Partnerships) ❑ Association or Other 2. Applicant If an LLC, name of LLC; if partnership, at least 2 partner's names; if corporation, name of corporation FEIN Number City Club 2a. Trade Name of Establishment (DBA) State Sales Tax Number Business Telephone Highland City Club 303-447-2641 3. Address of Premises (specify exact location of premises, include suite/unit numbers) 885 Arapahoe Avenue City County State ZIP Code Boulder Boulder CO 80302 4. Mailing Address (Number and Street) City or Town State ZIP Code 885 Arapahoe Avenue Boulder CO 80302 5. Email Address sina@highlandcityclub.com 6711` the premises currently has a liquor or beer license, you must answer the following questions Present Trade Name of Establishment (DBA) Present State License Number Present Class of License Present Expiration Date N/A Section A Nonrefundable Application Fees Section B (Cont.) Liquor License Fees ❑ Application Fee for New License ............................................... $920.00 ❑ Liquor Licensed Drugstore (City)......................................................... $227.50 Il Application Fee for New License w/Concurrent Review ............. $1020.00 ❑ Liquor Licensed Drugstore (County) .................................................. $312.50 ❑ Application Fee for Transfer...................................................... $920.00 ❑ Manager Registration - H & R ............................................................... $75.00 ❑ Manager Registration -Tavem.............................................................. $75.00 ❑ Master File Location Fee ........................$25.00 X Total Section B Liquor License Fees ❑ Add Optional Premises to H & R......... $100.00 X Total ❑ Add Related Facility to Resort Complex $75.00 X Total ❑ Master File Background ...................... $250.00 X Total ❑ Arts License (City)................................................................................ $308.75 El Optional Premises License (City)........................................................ $500.00 El Arts License (County).......................................................................... $308.75 ❑ Optional Premises License (County).................................................. $500.00 ElBeer and Wine License (City) ............ :................................................. $351.25 El Racetrack License (City)...................................................................... $500.00 El Beer and Wine License (County) ........................................................ $436.25 ElRacetrack License (County) .................. :............................................. $500.00 ❑ Brew Pub License (City).................................................................... $750.00 ❑ Resort Complex License (City)............................................................ $500.00 ❑ Brew Pub License (County)................................................................. $750.00 ❑ Resort Complex License (County)...................................................... $500.00 © Club License Ci ................................... $308.75 ❑ Retail Gaming Tavem License (City) .................................................. $500.00 ❑ Club License (County)................:....................................................... $308.75 ❑ Retail Gaming Tavem License (County)............................................. $500.00 ❑ Distillery Pub License (City)................................................................. $750.00 ❑ Retail Liquor Store License (City)........................................................ $227.50 ❑ Distillery Pub License (County)........................................................... $750.00 ❑ Retail Liquor Store License (County).................................................. $312.50 ❑ Hotel and Restaurhnt License (City .................................................... $500.00 ❑ Tavem License (City)........................................................................... $500.00 ❑ Hotel and Restaurant License (County) ............................................ $500.00 ❑ Tavem License (County)...................................................................... $500.00 ❑ Hotel and Restaurant License w/one opt premises (City) ................. $600.00 ❑ Vintners Restaurant License (City) ..................................................... $750.00 ❑ Hotel and Restaurant License w/one opt premises (County)............ $600.00 ❑ Vintners Restaurant License (County) ................................................ $750.00 Questions? Visit: www.Colorado.gov/enforcement/liquorfor more information Do not write in this space - For Department of Revenue use only Liability Information License Account Number Liability Date License Issued Through (Expiration Date) Total Application Documents Checklist and Worksheet Instructions: This checklist should be utilized to assist applicants with filing all required documents for licensure. All documents must be properly signed and correspond with the name of the applicant exactly. All documents must be typed or legibly printed. Upon final State approval the license will be mailed to the local licensing authority. Application fees are nonrefundable. Questions? Visit: www.colorado.gov/enforcement/liquorfor more information Items submitted, please check all appropriate boxes completed or documents submitted I. Applicant information ❑ A. Applicant/Licensee identified ❑ B. State sales tax license number listed or applied for at time of application ❑ C. License type or other transaction identified ❑ D. Return originals to local authority ❑ E. Additional information may be required by the local licensing authority II. Diagram of the premises ❑ A. No larger than 8 1/2" X 11" ❑ B. Dimensions included (does not have to be to scale). Exterior areas should show type of control (fences, walls, entry/exit points, etc.) ❑ C. Separate diagram for each floor (if multiple levels) ❑ D. Kitchen - identified if Hotel and Restaurant ❑ E. Bold/Outlined Licensed Premises III. Proof of property possession (One Year Needed) ❑ A. Deed in name of the Applicant (or) (matching question #2) date stamped / filed with County Clerk ❑ B. Lease in the name of the Applicant (or) (matching question #2) ❑ C. Lease Assignment in the name of the Applicant with proper consent from the Landlord and acceptance by the Applicant ❑ D. Other Agreement if not deed or lease. (matching question #2) (Attach prior lease to show right to assumption) IV. Background information and financial documents ❑ A. Individual History Records(s) (Form DR 8404-1) ❑ B. Fingerprints taken and submitted to local authority (State Authority for Master File applicants) ❑ C. Purchase agreement, stock transfer agreement, and or authorization to transfer license ❑ D. List of all notes and loans (Copies to also be attached) V. Sole proprietor / husband and wife partnership ❑ A. Form DR4679 ❑ B. Copy of State issued Driver's License or Colorado Identification Card for each applicant VI. Corporate applicant information (if applicable) ❑ A. Certificate of Incorporation dated stamped by the Secretary of State ❑ B. Certificate of Good Standing ❑ C. Certificate of Authorization if foreign corporation ❑ D. List of officers, directors and stockholders of Applying Corporation (If wholly owned, designate a minimum of one person as Principal Officer of Parent) VII. Partnership applicant information (if applicable) ❑ A. Partnership Agreement (general or limited). Not needed if husband and wife ❑ B. Certificate of Good Standing (If formed after 2009) Vlll. Limited Liability Company applicant information (if applicable) ❑ A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office) ❑ B. Certificate of Good Standing ❑ C. Copy of operating agreement ❑ D. Certificate of Authority if foreign company IX. Manager registration for hotel and restaurant, tavern licenses when included with this application ❑ A. $75.00 fee ❑ B. Individual History Record (DR 8404-1) ❑ C. If owner is managing, no fee required 7. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders Yes No or directors if a corporation) or manager under the age of twenty-one years? ❑ ❑ 8. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager ever (in Colorado or any other state): (a) Been denied an alcohol beverage license? ❑ (b) Had an alcohol beverage license suspended or revoked? ❑ 12 (c) Had interest in another entity that had an alcohol beverage license suspended or revoked? ❑ 12 If you answered yes to 8a, b or c, explain in detail on a separate sheet. 9. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the Elpreceding "yes", two years? If explain in detail. 10. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of Colorado law, or the principal campus of any college, university or seminary? ❑ EZ or Waiver by local ordinance? Other: ❑ ❑ 11. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager if a Limited Liability Company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list any current financial interest in said business including any loans to or from a licensee. ❑ 12. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownership, lease or other arrangement? 10 ❑ ❑ Ownership Z Lease ❑ Other (Explain in Detail) a. If leased, list name of landlord and tenant, and date of expiration, exactly as they appear on the lease: Landlord Tenant Expires Highland School, LLC City Club 03/2030 b. Is a percentage of alcohol sales included as compensation to the landlord? If yes complete question 13. ❑ c. Attach a diagram and outline or designate the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions, entrances, exits and what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11". 13. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies), will loan or give money, inventory, furniture or equipment to or for use in this business; or who will receive money from this business. Attach a separate sheet if necessary. Last Name First Name Date of Birth FEIN or SSN Interest/Percentage None Last Name First Name Date of Birth FEIN or SSN Interest/Percentage Attach copies of all notes and security instruments, and any written agreement, or details of any oral agreement, by which any person (including partnerships, corporations, limited liability companies, etc.) will share in the profit or gross proceeds of this establishment, and any agreement relating to the business which is contingent or conditional in any way by volume, profit, sales, giving of advice or consultation. 14. Optional Premises or Hotel and Restaurant Licenses with Optional Premises: A ❑ ❑ Has a local ordinance or resolution authorizing optional premises been adopted? Number of additional Optional Premise areas requested. (See license fee chart) 15. Liquor Licensed Drug Store applicants, answer the following: N/A (a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of Pharmacy? ❑ ❑ If "yes" a copy of license must be attached. 16. Club Liquor License applicants answer the following: Attach a copy of applicable documentation ❑� ❑ (a) Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and not for pecuniary gain? (b) Is the applicant organization a regularly chartered branch, lodge or chapter of a national organization which is operated solely for the El El of a patriotic or fraternal organization or society, but not for pecuniary gain? (c) How long has the club been incorporated? Fs.n.e 09/2004 (d) Has applicant occupied an establishment for three years (three years required) that was operated solely for the reasons stated above? Z ❑ 17. Brew -Pub, Distillery Pub or Vintner's Restaurant applicants answer the following: N/A (a) Has the applicant received or applied for a Federal Permit? (Copy of permit or application must be attached) ❑ ❑ 18a. For all on -premises applicants. (If this is an application for a Hotel, Restaurant or Tavern License, the manager must also submit an individual History Record - DR 8404-I) Last Name of Manager First Name of Manager Date of Birth Simantob Sina 18b. Does this manager act as the manager of, or have a financial interest in, any other liquor licensed establishment in the State of ElColorado? 12 If yes, provide name, type of license and account number. Name Type of License Account Number 19. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers, directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue? ❑ If yes, provide an explanation and include copies of any payment agreements. 20. If applicant is a corporation, partnership, association or limited liability company, applicant must list all Officers, Directors, General Partners, and Managing Members. In addition, applicant must list any stockholders, partners, or members with ownership of 10% or more in the Applicant. All persons listed below must also attach form DR 8404-1 (Individual History Record), and submit fingerprint cards to the local licensing authority. Name Home Address, City 8 State DOBPgsition / %oy ed Sina Simantob ' ,boulder, CO 80302 ' embek- NLA Name Home Address, City & State DOB Position % Owned **Please see attached membership list Name Home Address, City & State DOB Position % Owned Name Home Address, City & State DOB Position % Owned Name Home Address, City & State DOB Position % Owned If Applicant is owned 100% by a parent company, please list the designated principal officer on question #20 " Corporations - The President, Vice -President, Secretary and Treasurer must be accounted for on question #20 (Include ownership percentage if applicable) " If total ownership percentage disclosed here does not total 100%, applicant must check this box: d Applicant affirms that no individual other than these disclosed herein, owns 10% or more of the applicant, and does not have ownership in a prohibited liquor license pursuant to Title 47 or 48, C.R.S. Oath Of Applicant I declare under pE of per' the s and egree that this application and all attachments are true, correct, and complete e b o Howl ge. I I acknowledge that itis my responsibility and the responsibility of my agents and empl es to co y with t rovisio of the Colorado Liquor or Beer Code which affect my license. Au orized�ySighat a Printed Name and Title Date — Sina Simantob, Director1(9/22 f Report a d Approval of Local Licensing Authority (City/County) Date application filed with local authority 1pate of local authority hearing (for new license applicants; cannot be less than 30 days from date of 8 ,(LI , _ .20 application 12-47-311 (1) C.R.S.) I I — 16 — wI 6 The Local Licensing Authority HerebyAffi s that each person required to file DR 8404-I (Individual History Record) has: ❑ Been fingerprinted El Been subject to background inves igation, including NCIC/CCIC check for outstanding warrants That the local authority has conducted, or intends to conduct, an inspection of the proposed premises to ensure that the applicant is in compliance with, and aware of, liquor code provisions affecting their class of license (Check One) ❑ Date of inspection or anticipated date ❑ Will conduct inspection upon approval of state licensing authority The foregoing application has been examined; and the premises, business to be conducted, and character of the applicant are satisfactory. We do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires of the adult inhabitants, and will comply with the provisions of Title 12, Article 46 or 47, C.R.S. Therefore, this application is approved. Local Licensing Authority for Telephone Number ❑ Town, City ❑ County Signature Print Title Date Signature (attest) Print Title Date City Club member list. First Name Last Name Customer Type Start Date Partner A. Mitchell Family 11/01/2015 partner of Anne Mitchell Winston Berry Family 10/01/2010 Aval Bright Family 06/01/2008 Aiina Chis Family 06/01/2014 Geoff Cooper Family 01/01/2006 Laura Foreman Family 07/01/2014 Jo Ellen Graybiil Family 07/01/2015 Tony Greco Family 10/01/2006 Valerie Howard Family 08/01/2011 Jill Kamas Family 05/01/2010 Margo King Family 04/01/2005 Paola Lubar Family 06/01/2013 Genna Murphy Family 04/01/2015 Terry Retzloff Family 11/01/2006 Erin Robinson Family 01/01/2015 Peg Sanders Family 10/01/2006 Linda Shoemaker Family 04/01/2005 Charlotte Sorenson Family 01/01/2006 Bemee Strom Family 04/01/2016 Marilyn Walker Family 06/01/2008 Robin Youngleman Family 03/01/2009 Jackson Zapp Family 06/01/2006 Brett Berry Full + 10/01/2010 Stephen Brett Full+ 04/01/2005 David Bright Full+ 02/01/2008 Eric Chis Full + 06/01/2014 Ann Cooper Full+ 01/01/2006 Christopher Foreman Full + 07/01/2014 Kersti Frigell Full + 10/01/2006 Frank Guerra Full + 07/01/2015 Ted Habermann Full + 01/01/2015 John Howard Full + 08/01/2011 Dave Kennedy Full + 05/01/2010 Peter Lilienthal Full + 06/01/2008 Neil Lubar Full + 06/01/2013 Anne Mitchell Full+ 11/01/2015 Mark Retzloff Full+ 11/01/2006 Shauna Ries Full + 04/01/2015 Ed Sanders Full+ 10/01/2006 Bud Sorenson Full+ 01/01/2006 David Spiro Full+ 09/01/2008 John Steiner Full+ 04/01/2005 Mark Strom Full + 04/01/2016 Loretta Zapp Full + 06/01/2006 Jessica Ahmed Full Member 03/01/2009 Cherie Arnold Full Member 04/01/2014 James Bailey Full Member 08/01/2016 8/19/2016 membership_detail_august_2016 Sheetl First Name Last Name Customer Type Start Date Ted Barrett -Page Full Member 06/01/2005 Lewis Barsky Full Member 01/01/2014 Peter Baumgartner Full Member 01/01/2007 Karen Benjamin Full Member 01/01/2007 Howard Bernstein Full Member 12/01/2006 Charles Bloomfield Full Member 09/01/2005 Irene Bock Full Member 08/01/2015 John Bonica Full Member 11/01/2008 Ryan Boykin Full Member 10/01/2006 David Chamberlin Full Member 03/01/2012 Barry Collen Full Member 06/01/2012 David Coombs Full Member 04/01/2008 Tom Cowing Full Member 01/01/2006 Michael Crotty Full Member 01/01/2014 Howard Demuth Full Member 05/01/2009 Heather Dupre Full Member 02/01/2008 Peter Fenicheil Full Member 02/01/2011 Brooks Fisher Full Member 08/01/2009 Peter Ford Full Member 04/01/2010 Carol Frank Full Member 12/01/2008 Dave Fulker Full Member 04/01/2005 Felicia Furman Full Member 12/01/2010 Scott Garen Full Member 07/01/2015 Carolyn Geer Full Member 05/01/2011 Chris Geer Full Member 11/01/2009 Dominique Gettiiffe Full Member 02/01/2007 Bettsee Gotwald Full Member 09/01/2007 Anne Groves Full Member 08/01/2016 Jim Guggenhime Full Member 11/01/2015 Susan Haeger Full Member 01/01/2006 Solomon Halpern Full Member 04/01/2005 Paul Jerde Full Member 12/01/2009 Marty Kaegel Full Member 05/01/2014 Pat Kennedy Full Member 02/01/2008 Ron Kertzner Full Member 01/01/2006 Darrell Laham Full Member 01/01/2006 Marco Lam Full Member 06/01/2005 Sarah Larrabee Full Member 04/01/2005 James Linfield Full Member 02/01/2014 Roger Linfield Full Member 02/01/2016 Alan Littman Full Member 05/01/2016 Howard Lubar Full Member 01/01/2014 Andy Manz Full Member 01/01/2014 Felicia Martinez Full Member 11/01/2009 Tatiana Maxwell Full Member 03/01/2011 Lyn Ciocca McCaieb Full Member 04/01/2005 Sacha Millstone Full Member 04/01/2005 John Moritz Full Member 04/01/2005 Harvey Nichols Full Member 07/01/2009 8/19/2016 membership_detail_august_2016 Sheetl First Name Last Name Customer Type Start Date T.C. North Full Member 01/01/2006 Ben Oelsner Full Member 02/01/2014 Joshua Onysko Full Member 01/01/2016 Alexia Parks Full Member 04/01/2005 Peggy Phillips Full Member 03/01/2016 Chantal Pierrat Full Member 10/01/2013 Jared Polis Full Member 04/01/2005 Richard Polk Full Member 04/01/2005 Octavio Reyes Full Member 07/01/2011 Beau Rezendes Full Member 05/01/2016 Travis Robinson Full Member 08/01/2006 Susan Routt Full Member 01/01/2007 Julie Shaffer Full Member 11/01/2008 Jeptha Sheene Full Member 11/01/2013 Kai Sibley Full Member 08/01/2008 Sine Simantob Full Member 04/01/2005 Steve Smith Full Member 05/01/2006 Howard Snooks Full Member 01/01/2014 Don Straits Full Member 02/01/2016 Jane Trumble Full Member 11/01/2006 David Tusek Full Member 04/01/2014 Casey Verbeck Full Member 03/01/2015 Butch Weaver Full Member 03/01/2013 Dennis Webb Full Member 03/01/2009 David Wechsler Full Member 08/01/2006 Jeruld Weiland Full Member 07/01/2014 Ann Whitehill Full Member 11/01/2015 William Zinke Full Member 01/01/2014 Carol Batrus Honorary 06/01/2005 Ron Billingsley Honorary 10/01/2006 Chris Byrne Honorary 04/01/2005 Joseph de Raismes Honorary 05/01/2016 Jia Gottlieb Honorary 04/01/2005 Eve Ilsen Honorary 01/25/2010 Oakleigh Thome Honorary 01/01/2009 Paul Washington Honorary 11/01/2009 Roger Briggs Scholar in Residence 07/01/2014 Daniel Hessey Scholar in Residence 10/01/2014 Michael Moore Scholar in Residence 02/01/2016 Carolyn Schuham Scholar in Residence 09/01/2009 Kevin Townley Scholar in Residence 11/01/2007 Tony Bacigalupo Special 04/01/2016 Robert Davis Special 04/01/2012 Christian Dean Special 12/01/2015 Matt Emmi Special 02/01/2008 Michael Izatt Special 02/01/2008 Michael Kosacoff Special 05/01/2015 Mark Lubchenco Special 06/01/2008 Aaron Perry Special 06/01/2006 8/19/2016 me m bersh i p_d eta i I_a u gu st_2016 Sheets First Name Last Name Customer Type Start Date Marlena Rich Special 10/01/2015 Kelly Schuh Special 03/01/2016 Amy Segreti Special 04/01/2016 Risaun Simmons Special 08/01/2015 Bill Stewart Special 07/01/2013 Pamela Stewart Special 05/01/2006 Tinbet Tinstman Special 05/01/2013 Howard Alt Special + 10/01/2015 Richard Schuh Special + 11/01/2006 Moxxy Simmons Special + 08/01/2015 Carl Tinstman Special + 04/01/2006 Michael Head Special < 30 10/01/2015 Duncan Horst Special < 30 09/01/2015 ct. = 158 David Barry tenant 01/01/2016 Mike Brady tenant 01/01/2016 Jerry Colonna tenant 01/01/2016 Jim Davis tenant 01/01/2016 Michele Weiner Davis tenant 01/01/2016 Townsend Devereux tenant 01/01/2016 Peter Enichen tenant 01/01/2016 Peter Ford tenant 01/01/2016 Susan Graf tenant 01/01/2016 Jesse Grimes tenant 01/01/2016 Christy Harland tenant 01/01/2016 Wanda Huseman tenant 01/01/2016 David Luce tenant 01/01/2016 Jim Marsden tenant 01/01/2016 David Perlick tenant 01/01/2016 Sylvia Platek tenant 01/01/2016 Virginia Peeples tenant 01/01/2016 Dan Putt tenant 01/01/2016 Pete Rogers tenant 01/01/2016 Sara Ross tenant 01/01/2016 Allison Schultz tenant 01/01/2016 Steve Taffet tenant 01/01/2016 Stephan van der Mersch tenant 01/01/2016 Jack Walker tenant 01/01/2016 Sophie Walker tenant 01/01/2016 Lisa Monet Wayne tenant 01/01/2016 Ginger Witheee tenant 01/01/2016 ct. = 27 total ct. = 185 8/19/2016 mem bersh i p_deta i I_a ugu st_2016 Sheetl I CI'T'Y OF BOULDER BEVERAGES LICENSING AUTHORITY FINANCIAL STATEMENT The applicant hereby agrees that any knowingly false or incomplete answer to the following questions shall constitute cause for the suspension or revocation of the license applied for: Name ofApplicant(s): City Club Trade Name: _,Highland City Club Business Address: 885 Arapahoe Avenue, Boulder, CO 80302 Phone No: 303-447-2641 Contact Person: Sina Simantob Mailing address: _ 885 Arapahoe Avenue, Boulder, CO 80302 Other Liquor Licensed Establishments that principals or managers of Applicants) now holds: None If applicant is a corporation or LP or LLC, names of persons purchasing stock or membership units: I Sina Simantotl Sole Director Is this anew or existing business: New If new business, state approximate investment amount: $ 10,000.00 Where will these fimds Come from? Existing corporate funds of Highland City Club If existing business, state purchase price including inventory: $ N/A Where will these funds come from? 1 If cash is to be invested, please complete the following: (If you need additional space, please attach additional pages) Person or business investing City Club Address of Investor. 885 Arapahoe Avenue, Boulder, CO 80302 Amount of Investment $10.00d.00 Source of Investment: Checking account at Chase Bank - (Checldng, Savings, Bonds, etc.) If loans are to be obtained, please complete the following: (If you need additional space,'please attach additional pages) Name of Lender: Address of Lender. Type of Loan: Amount of Loan: Security: Tema of Obligation: Business Bank Account Information What bank will the business account be maintained at? Chase Bank What name will the account be under? Highiand City Club Who will be auihodzedto sign on the account'! Sina Simantob Applicant hereby agrees to notify the Beverages Licensing Authority of the City of Boulder of any changes in the financing of this business should such changes occur during the period for which this license is issued. OATH OF APPLICANT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my Imowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employ 'Imply with the provisions of the Colorado Liquor and BeerCode and a City of Bo es, ns and codes which affect my license. se. ized Signature Sina Simantob, Director Print Name & Title FILED ON BEHALF OF THE APPLICANT BY DILL DILL CARR STONBRAKER & HUTCHINGS PC DR 8404-1 (03/13/15) (303) 777-3737 COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant or Tavern class of retail license Notice: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business City Club dba Highland City Club Home Phone Number I Cellular Number 720-308-1449 2. Your Full Name (last, first, middle) Simantob, Sina 3. List any other names you have used None 4. Mailing address (if different from residence) Same Email Address sina@highlandcityclub.com 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number City, State, Zip From To - Boulder, CO 80302 05/1984 Current 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To Sinco International Investments, Inc. 885 Arapahoe Avenue, Boulder, CO 80302 CEO / President 07/1979 Current 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, 0 Yes ❑ No furniture, fixtures, equipment or inventory to any licensee? (If yes, answer in detail.) Between 1976 and 1978, Mr. Simantob was a minority investor in the Hotel Boulderado, which at the time,had three restaurants and held two liquor licenses. 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you ❑ Yes W No applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) 042115CG FILED ON BEHALF OF THE APPLICANT BY DILL DILL CARR STONBRAKER & HUTCHINGS PC (303)777-3737 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) ❑Yes No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) El Yes No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes ® No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a Date of Birth I b. Social Security Number c. Place of Birth Iran d. U.S. Citizen Yes El f. When g. Name of District Court 1976 Unknown e. If Naturalized, state where Denver, CO h. Naturalization Certificate Number Unknown i. Date of Certification Unknown j. If an Alien, Give Alien's Registration Card Number I N/A k. Permanent Residence Card Number I N/A I. Height 5'9" m. Weight 1150 In. Hair Color Black o. Eye Color Brown I p. Gender I Male q. Race Caucasian r. Do you have a current Driver's License/ID? If so, give number and state. ®Yes .tate CO 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ 10.000.00 b. List the total amount of the personal investment , made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ 0 * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount None d. Provide details of the corporate investment described in 14 b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount Existing corporate funds N/A Checking Chase Bank $10,000.00 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount None Oath of Applicant I deca der pw(alty ofxerjury t4a this application and all attachments are true correct and complete to the best of my knowledge. Auj" ' Signatute ALVA— yrs Print Signature Sina Simantob Title Director Date 042115CG el'I"1' 01. i101111DE.11 BEVEMAGE LICK,NSING AILITHORI'I-Y ZONING/ PLANNING C.'ON111111ATION L'It1Ost7'0 LWI.NSE A1TJJC'A] ION jAclu_ur Liectme Aimlicant Conmicles Too Portion• Applicant: qLty Club... . _ Tindc Name Highland City Club Applicant Phnne. 303-447-2641 _ Applicanr fitnail. sina@highlandcityclub.com Ilicinisc Achlrcts 885 Aragahoe Avenue, Boulder, CO 80302 Indoor 1'rctnlse Squitrc I-'ooingc: APprrox 3000 sq ft Uutdnut Paiiu St)u:trc 14nu1agc Approx 5000 sq ft Approval Indnor I'minise:_ 80 , and Outdoor Patio: 30 0milmncy 1.418116calilm Capacity. I•Inurs arOpmalicon: _Sunda Y- S gay 9P10— 0 PM ...... X J New (�I'I'tnnsf J;._1 udtlicWion, I iq I iccnsc'I'ypr: Club License T Applicant's Siguahnc: r . r s,' A plicnnt's Primed Name: Sina Simantob Responsive to C.R.S. I2-47-313(1) mud (I)c %hicb spies i eriinent part, "(1) Nu npplicaliun for ilii issuance or any liceuse... shall be received or ncted upon ...(c) fur a I cation in on men whare the sale urnlcnhol bevcntges rte canlemplaled is not pennitted outlet the applicable zoniiiours urtite immicipolily, city and county, of cuumy..." rind Burrage Licencing Aulhotity Itules orl'roccdure, Sfibbeclitin 5-1-1 (c) rimilnble at: Applicant should bring this eheet AND M101109ED PREMISE DIAGRAM complying with FILA Ituie Suction 3-3 et seq. to Licensing Clcrk rur the use or Boulder Planning and Zoning at 1739 tiruadnny-Park Centnul Building, 3`' door, 303-441-1880 to address the ruur below questions. NOTE: This review is for zoning purposes only and Is not approval for any chnnge of occupancy or use pertolnbrg to the building code. A separate building permit Is required for building ruodi(ications, Including n cltnnge of ice or accupmicy. Planning and Zoning Department Complelcs Bodoni Portion: e Is the Use at the Silo Allowed? / j YRS/NO Comments/Limhations: - e3 _— /"7, .x P j / r 1___ / e S Does the Use Require a Use Review or Site Review? tYES/NO Comments: 7�� } I sc/Siie Review is required has u Use Revim/Site Iteview been nppiovcd? Y8S/ NO C tlimenls (such as/Case JNumbeJrl, Date orAppr�o••^vul): • t"`�-. `7 Z- '7 // -T - -7/Z- 7 / _ /O Y`�� �/ Arc lhetc any zoning restrictions or conditions or approval on the prvpety S=r. J/edUC�;-4;/4? � YESMO that would prevent this property i'rutn being open from lite hours or7:00 am to 2.00 mn7 Comments 'mitations: <+,._-%?�-•j ��-C3-�- _ �; ?rte✓c. r . e/ 1'Innner's Signature Planner's Printed Name f , �y�21 Planner's Til le Pluancr's Signature. Dale. Rev. 09/11 NOTICI~ DISPOSITION OF PLANNED DEVELOPMENT You are hereby advised that on 8/9/72 the Gity /Planning Board approved an application for a Cultural Center Planned Development for Education and / on property located at 9th Street and Arapahoe Ave. Applicant: Historic Boulder, Inc. This decision was arrived at based on the purposes and intent of the Land Use Regulations as set forth in Section 37-102 and the standards and requirements of Section 37-506 as applied to the proposed Planned Development and specifically the findings Frere: 1•. Was approved, based on the following findiZgs: a) Preservation of building and trees. •Retains the character of the past and is an asset to the community. b) Proposed ases are compatible in this residential area which is zoned HR -E, High Density Residential. c) Uses should not create 'burdens on circulation and utility systems and reduction ir, parking is justified by type of age and available on -street parking. d) Meets the intent of the Comprehensive Plan, grov.th policies and standards for PUD. 2. And is subject to the following conditions: a) A 25' minimum setback must be maintained along tF.e north and west sides of Highland School. b) Highland School, existing trees xrd Gregory Creel: channel ate part of PUD approval. c) Minimum of 40 off-street parking spaces must be provided by the owner within 300' of the property. ;„ �. Ti _ ,4sZ.�1E,r#_ a -`:t5.'._._. Y•.' — }R. I4 = . . � _ _�}�� � ` C �_ s �.+dJ __ ter' � �`•�„ �1 �_ ��� .._ � _ R e i � t� J-�v.^•^-..•' _ -.rte - Tib +-' ' Y �• •�`•.*'�p.^ -x._. 111 �Q- a' _ - _ -' � ■ _ .. ��;.� � ` 'qtr. _ �` i l j *F¢ •. • � ti+{ Lex - ff• �:� r=L•Y '� �' n.. �r �. [ y i rte.• ' n ,F.� :•: F�J' -- �- 3. �- - i 'Y .,�i ,•;yy}L�� `�°jjY�' fir.. � � c. � r �.- fA '�.. �� _ •-;��'.:,tt s`�'.� i - =]�;i:�s�'��„� ,gam e.Y• lr. iiulis''' F-�L�^. :r ' �: VSs' � � - . � _ �,; 1..r.:z• ._.� �s�'.�ir N0 N FIRST FLOOR PLAN OFFi46-S 36'11" Outdoor Y Area ` Lb M Z. A z ?P o City Club dba Highland City Club 885 Arapahoe Avenue Boulder, CO 80302 NEW CLUB LICENSE *All dimensions are approximate Outdoor Area AUGUST 2016 KretwN 7 eatMgo" N � BASEMENT FLOOR PLAN 59'4" v LIQUOR STORAGE City Club dba Highland City Club o CC IIAK 885 Arapahoe Avenue Boulder, CO 80302 NEW CLUB LICENSE 18'0" *All dimensions are approximate AUGUST 2016 .n U .� z p -,n J LLJ IRO LU S U)CuSd00 CR O .I 2984' R=i240.Od 5'59'58 �U J ZZ WROLI T IRONt` U _� ACGES.. �, In =-PARKING, 5, U. L1 , wd 4 S, 00 , O LLJ PAPK$_h1AIN7PNAt�GE E 'EMEN7 ~ a,t� r�� ¢ FLdOb '-OMTROL _ . , n '_' O 1 c.i ao m Z cr- LU w' ¢rn 1 .--53rL a cc It yt xo rr' Ln 0- z Jr. .parr y j i i t� :1 D 'l in t �, 1 v Td• N CL. :.Y. x � ��•m �•c ,• '? S �� X11',. � t � !} V l� •1� r, % `cod. ,WFC A, r It _ W�44r V' it 3CL a� •'l' 1 fA Q CITY OF BOULDER BEVERAGES LICENSING AUTHORITY STATEMENT OF TRAINING The applicant hereby states that he/she understands the importance of being familiar with and complying with the Colorado Liquor Code and the Colorado Beer Code. Therefore, with respect to applicant(s), management and all other employees who will have any connection or involvement with liquor or fermented malt beverages on the subject premises of this application, the applicant(s) state(s) the following: All employees involved in the service of alcohol, including, without limitation, managers, clerks, bartenders, and waitpersons, shall attend astate-certified Responsible Vendor alcohol serviceclass within three months from the approval of this license. New employees shall take a class within three months of their hire. Any employee participating in aTastings must have already completed a state - certified Responsible Vendor alcohol service class. Training Certification must remain current for employees involved in the service of alcohol. The applicant agrees that the above mentioned training shall be a continuing condition of the license if the Authority approves this application. Oath of Applicant I declare under penalty of perjury in the second degree that I acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor and Beer Codes and all City of Boulder rules, regulations and codes which affect my license. Highland City Club Trade Name ��1Vtj�6)jr1l�� Print Name, Title & Date 1���Q A k%. 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DC7 a, � CY '" t.il �d�' • � Agenda Item 9 CITY OF BOULDER BEVERAGES LICENSING AUTHORITY AMENDED PRELIMINARY FINDINGS AND REPORT IN THE MATTER OF THE APPLICATION FROM Wendy Petrillo -Rundle Lucky's Market of South Boulder, CO, LLC Lucky's Market 6328 Monarch Park Place, Suite 100 Niwot, CO 80503 RE: Lucky's Market of South Boulder, CO, LLC d/b/a Lucky's Market Proposed Premise Location: 695 S Broadway, Boulder, CO 80305 FOR A New 3.2% On/Off Premise type liquor license TO THE APPLICANT ABOVE-NAMED AND OTHER INTERESTED PARTIES; GREETINGS: Pursuant to C.R.S. 12-47-312(1) and the below referenced State laws and the city of Boulder Beverages Licensing Authority (BLA) Rules of Procedure, you are hereby advised that with regard to the application for a New 3.2% On/Off Premise type liquor license, an investigation has been made and based on the results thereof the following has been determined: 1. APPLICATION PACKET Responsive to C.R.S. §12-47-311(1) and BLA Rules of Procedure Section 4-3, the applicant, as stated above, submitted an application packet, which was substantially complete, to the City Clerk's Office on September 14, 2016. 2. PREVIOUS DENIALS AT THE SAME LOCATION Responsive to C.R.S. §12-47-313 (1)a et seq. and BLA Rules of Procedure, Subsection 5- 1-1 (A), as this is an application for a malt, vinous, or spirituous liquor license, that within two (2) years, preceding the date of the application, the state or the Authority have not denied an application for the same class of license at the same location or within 500 feet of the same location, for the reason that the reasonable requirements of the neighborhood and the desires of the inhabitants were satisfied by the existing outlets. This requirement is not applicable to applications for Bed and Breakfast Permits. 1 3. POSSESSION OF PREMISES Responsive to C.R.S. §12-47-313 (1)b and BLA Rules of Procedure, Subsection 5-1-1 (B), it appears from the evidence submitted that the applicant is entitled to possession of the premises where the license is proposed to be exercised until May 31, 2026. 4. ZONING AND HEALTH DEPARTMENT REGULATIONS COMPLIANCE Responsive to C.R.S. §12-47-313 (1)c and BLA Rules of Procedure, Subsection 5-1-1 (C), selling alcohol in the manner proposed in the application is not in violation of any zoning laws of the City of Boulder and the use is consistent with the location's permissible planning conditions and zoning district. The applicant must meet all applicable laws, rules and regulations of the City's Planning Department as to construction and building safety requirements at the premise, and if applicable, the Boulder County Health Department and the State Board of Health for food preparation and service. S. PROXIMITY TO SCHOOLS Responsive to C.R.S. §12-47-313 (1)d et seq. and BLA Rules of Procedure, Subsection 5- 1-1 (D), the building in which the liquor is to be sold has a local distance waiver enacted or is not located within five hundred (500) feet of any public or parochial school or the principal campus of any college, university or seminary. This requirement is not applicable to applications for Bed and Breakfast Permits. 6. EXISTING OUTLETS IN DESIGNATED NEIGHBORHOOD Responsive to C.R.S. §12-47-312 (2) and BLA Rules of Procedure Subsection 5-1-1 (E), please see attached detailed map of the Authority Designated Neighborhood displaying surrounding currently licensed premises. 7. BACKGROUND INFORMATION Responsive to C.R.S. §12-47-307 and BLA Rules of Procedure Subsection 5-1-1 (F), the following criminal history information has been discovered or brought to the attention of the Authority: Applicant (including partners, officers, directors over 10% stockholders): Lucky's Market of South Boulder, CO LLC [LMSB] as LLC Applicant with Lucky's Market Expansion LP [LME] as 1st underlying sole owner, Lucky's Market Expansion GP, LLC [LMEG] as 2nd underlying sole owner, Lucky's Market Parent Company LLC [LMPC] as 3rd underlying sole owner, and with The Kroger Co [Kroger] and Lucky's Founders Holding LLC [LFH] as Sth underlying co-owners, with: Jason Sharon, co-owner of LFH, and Managing Member of LMSB, LMEG, LFH, and CEO of LMPC: No record of arrest per FBI/CBI background check. 2 Andy Pillari, CFO of LMPC: No record of arrest per FBI/CBI background check. Steve Black, President of LMPC: No record of arrest per FBI/CBI background check. Russell Dispense, appointed representative of publicly traded company Kroger: No record of arrest per FBI/CBI background check. Monica Garnes, appointed representative of publicly traded company Kroger: No record of arrest per FBI/CBI background check. J. Michael Schlotman, appointed representative of publicly traded company Kroger: No record of arrest per FBI/CBI background check. Patrick Gilliland, majority owner and managing member of PGH: No record of arrest per FBI/CBI background check. Tim Overlie, Regional Manager of LMSB: No record of arrest per FBI/CBI background check. Source of information: Individual History Report (IHR), CBI results, and FBI Results. Prior Administration and Operational History: Lucky's Liquor, LLC d/b/a Lucky's Liquor held a Retail Liquor License in the City of Longmont, Colorado. City of Boulder licensing office contacted the city clerk in Longmont and received a response from Longmont licensing office about Lucky's Liquor receiving one prior violation for sale to minor in January, 2016. Jason Sharon and Tim Overlie disclosed that Lucky's Liquor, LLC d/b/a Lucky's Liquor received one prior violation in the City of Longmont on 1/26/2016, paid a fine in lieu, and held 5 days in abeyance. The Retail Liquor License in the City of Longmont, Colorado was surrendered in July, 2016. Patrick Gilliland disclosed that he held an importers license that was surrendered in April, 2016. Russell Dispense disclosed that he was an officer for King Soopers and that there have been liquor license violations for King Soopers stores in Colorado. Source of information: Individual History Reports (THRs). 3 8. APPLICANT FINANCIAL INTEREST Responsive to C.R.S. §12-47-308 and BLA Rules of Procedure Subsection 5-1-1 (G), the applicant's financial interest and associated parties' disclosures are to be found in the submitted city of Boulder BLA Financial Statement with attachments, the submitted Colorado Liquor Retail License Application or Colorado Fermented Malt Beverage (3.2% Beer) License Application with attachments, and the submitted Individual History Record with attachments. A copy of each of these mentioned documents should have been retained by the applicant at the time of application and a copy of these mentioned documents will be provided to the BLA for the purposes of local licensing authority deliberations. 9. NEEDS AND DESIRES EVIDENCE Responsive to C.R.S. § 12-47-312 (2)(a) and (b) and BLA Rules of Procedure Section 4-1 through Section 4-4, the applicant is reminded that they have the burden of proof to provide to the Authority for consideration sufficient evidence confirming that the adult residents and business owners and managers within the prior established boundaries of Authority designated Neighborhood both need and desire the proposed new liquor license in type, manner and location. 10. PUBLIC HEARING INFORMATION Responsive to C.R.S. §12-47-311 and BLA Rules of Procedure Section 5-1, you are hereby notified that the public hearing on this application will be held on Wednesday, November 16, 2016 at 3:00 p.m., in the Council Chambers, 2nd Floor of the Municipal Building, 1777 Broadway, Boulder, Colorado. At said hearing, you will have the opportunity to be heard regarding all matters pertaining to the application, including all matters herein set forth. You are advised to obtain a copy of the State Laws, Rules, and Regulations pertinent to the license class for which you are applying. In addition, you are advised to obtain a copy of the applicable "Rules of Procedures" adopted by the Beverages Licensing Authority of the City of Boulder for use and guidance in holding hearings on liquor license applications. These Rules are available at: https://www-static.bouldercolorado.gov/docs/BLA Rules of Procedure-1- 201505081442.pdf or a public copy is made available for review at the Licensing Clerk's Office. November 7, 2016 BEVERAGE LICENSING AUTHORITY CITY OF BOULDER, COLORADO Mishawn J. Cook, Tax and License Administrator and Board Secretary 4 Neighborhood Map for a New 3.2% On/Off Premise Liquor License Lucky's Market - 695 S Broadwav Applicant: Lucky's Market of South Boulder, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On/Off Premise NORTH 1 inch = 1,750 feet City ofro"-P Boulder Ii The information depicted on this map is provided as graphical representation only The City of Boulder provides no warranty, expressed or implied, as to the accuracy and/or completeness of the information contained hereon City of Boulder oFa Finance October 28, 2016 Brian Proffitt, Esq. Foster Graham Milstein & Calisher, LLP 360 South Garfield Street, Suite 600 Denver, CO 80209 Re: Lucky's Market diagram of licensed premise and other interested parties Dear Brian: The purpose of this letter is to provide you with information about the upcoming Lucky's Market new 3.2% Beer On and Off premise license application hearing on November 16, 2016. The reason that I am sending this letterto you and also placing a copy in the BLA November 16, 2016 hearing packet, is that I may be late to that hearing and so I may not be present to address the Authority in person. As such, I thought that this letter would suffice. While accepting Lucky Market's application and in response to a question of mine, Wendy Petrillo -Rundle, paralegal with Lucky's Market, noted that in addition to the standard off -premise 3.2% beer license that many grocery stores hold, that Lucky's on -premise 3.2% beer license if issued, would allow on-site consumption both in the cafe area and throughout the grocery store. The applicant diagram is attached here. Accordingly, at the November 16 hearing, in addition to the control of the cafe, please be prepared to address the issue of control as it relates to consumption in the grocery store, i.e., the control that will be used by Lucky's Market in grocery aisles and in all areas of the store related to the consumption of alcohol. Additionally, at the October 19, 2016 BLA hearing during which the Authority setyourclient's neighborhood boundaries, Ann Coppinger with PettyJohn's Liquor & Wine at 613 S. Broadway, Boulder, CO 80305 provided testimony to request that Petty John's be included in the designated neighborhood boundaries. It is our standard practice when we are aware thatthere may be an interested party for an application to inform the applicant of that fact. Also as part of the October 19 discussion, I stated that I would send Ms. Coppinger information about interested party status and public comment. A copy of that email and hearing pamphlet sent to Ms. Coppinger is attached here for your information. Please feel free to call or email me if you have questions about this letter or the attachments. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensinL,@bouldercc)lorado.gov (303) 441-4192 (303) 411-1919 (FAX) Sincerely yours, Mishawn J. Cook License Administrator Certified Municipal Clerk Main: (303) 441-4192 Direct: (303) 441-3010 Fax: (303) 441-1919 Website: www.bouldercolorado.gov/licensing Cc: Ann Coppinger with Pettyjohns's Liquor and Wine City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensing@bouldercolorado.gov (303) 441-0192 (303) 441-1919 (FAX) ri 11 •1 z { LL ,i�jj �j ` l d i i •Id '!� FI! • �li f �; 11 i� HIM, �. f ... .e .. .�. ...• •..,u u.••:. .j Z- ■ Application: Lucky's Market of South Boulder, CO, LLC d/b/a Lucky's Market for a New 3.2% On/Off Premise type liquor license at 695 S Broadway, Boulder, CO 80305 Total Indoor Sq. Ft.: 37557 1 Patio —Sq. Ft.: 0 Total Premise Sq. Ft.: 37557 Max. Indoor Seating: 60 Max. Patio Seating: 0 Total Premise Seating: 60 Hours of Operation: 7:00 AM — 10:00 PM Monday thru Sunday, 7 days a week City of Boulder Finance November 10, 2016 Brian Proffitt, Esq. Foster Graham Milstein & Calisher, LLP 360 South Garfield Street, Suite 600 Denver, CO 80209 RE: Lucky's Market Application Ann Coppinger Pettylohn's Liquor & Wine 613 S. Broadway Boulder, CO 80305 RE: Interested Party for Lucky's Market application Re: Lucky's Market new license application and supplemental information submitted Dear Brian and Ann: The purpose of this letter is to inform both of you that additional information has been provided in the last week related to Lucky's Market application which is set as Agenda Item 9 on the Beverage Licensing Authority hearing agenda for the Wednesday, November 16, 2016 hearing set to begin at 3 p.m. This additional information will be available on our website after 5:00 today at https://bouldercolorado.goy/licensing; then select "Liquor Licensing" and "BLA Hearing Agendas & Packets -Search" and "2016" and "November" and "Hearing Packet" pdf copy. Because the additional information contains many pages, we prefer to make it available via on-line posting. The materials for Agenda Item 9 include the Applicant's neighborhood petition results from Oedipus, Inc., and materials received from Pettylohns's Liquor & Wine- responsive to this application. Two other items I would note: 1) Pettylohn's has stated that they may submit additional neighborhood petitioning at the BLA hearing on November 16, 2016. 2) City Licensing has been contacted by Bruce Dierking, co-owner of Hazel's Wine and Spirits, who has an interest in providing comment to the BLA at the November 16, 2016 hearing related to City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensing@bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) the SB -197 state board that he serves on and upcoming changes to 3.2% Beer licenses. Please feel free to call or email me if you have questions about this letter or are unable to access the hearing packet via our website. Sincerely yours, Mishawn J. Cook License Administrator Certified Municipal Clerk Main: (303) 441-4192 Direct: (303) 441-3010 Fax: (303) 441-1919 Website: www.bouldercolorado.gov/licensing L-tty of boutaer- t-tnance Dept. 1777 Broadway Boulder, CO 80302 licensing@ bouldercolorado.gov (303) 441-4192 (303) 441-1919 (FAX) Cook, Mishawn From: Cook, Mishawh Sent: Friday, October 21, 2016 3:04 PM To: Ann Coppinger Cc: Markel, Carey; Mazurkiewicz, Beata Subject: Pettyjohn's questions at BLA October 19 hearing Ann, as I mentioned, I would put in the mail to your attention today a pamphlet that explains the abilities of interested parties (testimony, evidence, separate petitioning, applicant cross examination, or your own representing attorney) in BLA public hearings. After you review the pamphlet, please send me an email or give me a call with any questions. I will be drafting a letter to Lucky's attorney, Brian Proffitt, which I will include in the BLA hearing packet so that all parties are aware of City Licensing's perspective on the issues. I will also send this letter to you as well. Should you, another interested party, or your attorney wish to review the pending application, please provide us with a few days notice so that we might redact the application for your in-person file review in our offices. You may request a copy of the prepared petition materials as public information if you wish- these materials may be used by you or your attorney for an opposition or supporting petition in the designated neighborhood. if you will submit a petition or other materials, we would ask to receive those materials from you by Monday November 7 so that we might include them in the hearing packet and also send them to Lucky's attorney with our preliminary findings. Thank you, Mishawn Mishawn J. Cook Licensing Administrator Certified Municipal Clerk City of Boulder ��..' Finance O: #303-441-3010 cookm@bouldercolorado.gov Finance Department 1777 Broadway I Boulder, CO 60302 Bouldercolorado.aov - �1 NA eo` CITY OF BOULDER LIQUOR LICENSE APPLICATION This application must be filed in duplicate with the Office of the City Clerk, City of Boulder, 1777 Broadway, P. O. Box 791, Boulder, Colorado 80306. ALL INFORMATION MUST BE PRINTED LEGIBLY IN INK OR TYPEWRITTEN. Name ofApplicant(s): LLkC LA'S MacY,e.� o Sp .M,'bo LAAe_C, M LZ Trade Name: _1_iJ� �i U ` 5 Gln Ckt✓� Phone No: Contact Person: I&jl, a C tt I-- ►U�!1�12.. Business Address: Lo CI S J • p U,3 Int M e-ct CD Q)O 3 C< Mailingaddress: _��?�% � �(1ti1GtC�11� r��l �c�CQ; �Ut�� [ 1�tU20CC7 00SD3 PropertyOwner: �L► I (r. { a— G Phone Number (local): 3Q 3-o 9 Z - %1DS-7 Property Manager: 1j� 1t i l t- Se tint 5 Lu Phone Number (local): 303— LA y Z —'9 CA -1 Property Manager's Mailing Address: im �-nA ai t�w) t jAO-C ? Co General Manager: T fn oqOAC Phone Number (local): 72Z —ZA j- 9gT7 The applicant(s) hereby applies to the City of Boulder Beverages Licensing Authority for the following local license and tenders the following fees: Tyne of Application (fee): New License ($1,000.00) Change in Location ($750.00) Change in Class ($750.00) Type of License (fee): Hotel -Restaurant ($75.00) Hotel -Restaurant w/Optional Premises ($75.00) Beer and Wine ($48.75) 3.2% Beer On & Off Premises ($3.75) Club ($41.25) Race Track ($75.00) 8 Transfer of Ownership ($750.00) Temporary Permit ($100.00) Tavern($75.00) Retail Liquor Store ($22.50) Brew Pub (75.00) Liquor Licensed Drug Store ($22.50) Arts ($41.25) [] Bed and Breakfast Permit ($125.00 Total) E] Art Gallery Permit ($103.75 Total) Manager Registration — If separate from owners (H&R, Brewpub & Tavern - $75.00) TOTAL FEES: [Fees effective as of July 1, 2010] 4( 5ee A406a APPLICANTS DO NOT FILL THIS AREA OUT STATEMENT OF THE NEIGHBORHOOD. (Not applicable to applications for Transfer of Ownership or applications for Club license.). NEIGHBORHOOD BOUNDARIES WILL BE SET BY THE AUTHORITY AT THEIR MEETING ON The Authority sets the following geographical area as the designated neighborhood which will be served by the license applied for: North Boundary South Boundary East Boundary LR ALL APPLICANT'S MUST ANSWER THESE QUESTIONS CITY OUESTIONNAIRE : On a separate sheet of paper please answer the following questions for the Beverages Licensing Authority (BLA). *See attached responses to each question below 1) Describe the nature of the proposed establishment and the target market (i.e., restaurant, tavern, sports bar, families, college students, etc.). Please attach a menu for BLA. 2) What are the proposed hours and days of operation for this establishment? 3 What is the seating capacity of the establishment? �e a3AC-6 4) Have you applied for an "occupant load" for the interior and exterior seating from the Boulder Fire Department? 5) Do you have an emergency plan for your business (exit locations, fire protection system(s), etc.)? (yes or no) 6) How many individuals will be employed at this proposed establishment and how many will be full-time versus part-time? Please provide responsibilities, (i.e., manager, assistant manager, bartender, waitstaff, etc.). 7) Describe your past training and experience in the sale/service of alcohol beverages, include any special or certified training received. 8) Describe your proposed General Manager's past training and experience in the sale/service of alcohol beverages, include any special or certified training received. 9) Besides the state -certified Responsible Vendor classes, what other types of training are proposed for employees at this establishment in the safe and legal sale/service of alcohol beverages? 10) What policies & procedures do you have in place to determine a patron's level of intoxication? 11) What policies & procedures do you have in place to refuse service to a patron? 12) Describe any other types of training or operating procedures that employees will be following in the day-to-day operation of this proposed establishment? 13) What methods will be used in checking identification for proper age of patrons (at the door, at the bar, etc.) and how will underage patrons be identified so as not to be served alcohol beverages (stamp, mark on the hand, etc.) 14) What types of entertainment will be offered, if any, at this proposed establishment (i.e., music, pool, darts, etc.)? 15) Do you plan to have any exterior amplified sound? 16) What types of security, if any, will be provided at this proposed establishment? 17) What time will your kitchen close each night? Describe your food service plans after your kitchen closes. 18) What is the estimated ratio of food to alcohol beverage sales at this establishment? 19) If you plan on hosting a "Private Party," what extra measures will you take regarding security, staffing and communications with the Boulder Police Department? A private party is defined as: "An event where there is a single contact person who represents a group ofpeople who are gathering for social and/or business reasons, the event will be held after 10:00 p.m., there will be both underage and of -age people present and there will be enough people to constitute an occupancy capacity of 75% or greater. " OATH OF APPLICANT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor and Beer Code and all City of Boulder rules, regulations and codes which affect my license. ��Sj//A,_ q I ei1IL16 Auth ed Signature Date Jason B Sharon, CEO, Manager Print Name & Title Lucky's Market of South Boulder, LLC Statement of the Neighborhood questions. 1) Describe the nature of the proposed establishment and the target market (i.e., restaurant, tavern, sports bar, families, college students, etc.). Please attach a menu for BLA. Lucky's Market is a grocery store that is applying or a 3.2 beer license that Nvill allow customers to purchase 3.2 beer for consumption both on and off premises. Allowing them to purchase a beer while they shop for groceries. 2) What are the proposed hours and days of operation for this establishment? 7:00 am to 10:00 pm 3) What is the seating capacity of the establishment? 60 interior seats in the cafe no exterior seating 4) Have you applied for an "occupant load" for the interior and exterior seating from the Boulder Fire Department? YES 5) Do you have an emergency plan for your business (exit locations, fire protection system(s), etc.)? (yes or no) YES 6) How many individuals will be employed at this proposed establishment and how many will be full-time versus part-time? Please provide responsibilities, (i.e., manager, assistant manager, bartender, waitstaff, etc.). 129 employees 66 Part time and 63 full time. All employees will be TIPS certified. 7) Describe your past training and experience in the sale/service of alcohol beverages, include any special or certified training received. We recently held a Retail Liquor License in Longmont and successfully operated it until it was surrendered this July. 8) Describe your proposed General Manager's past training and experience in the sale/service of alcohol beverages, include any special or certified training received. Tim Overlie was the original manager for the Longmont liquor license for Lucky's Liquor, LLC. While he was on the license there was not violation or issues. The Regional Manager has had TIPS training and has experience with the liquor rules and regulation in Colorado and the City of Boulder 9) Besides the state -certified Responsible Vendor classes, what other types of training are proposed for employees at this establishment in the safe and legal sale/service of alcohol beverages? We conduct our own in house training based on the TIPS program. All employees are held accountable for their action through a signed statement. (See our SOP manual attached.) 10) What policies & procedures do you have in place to determine a patron's level of intoxication? We have a SOP manual in place for alcohol sales. See our attached SOP Manual 11) What policies & procedures do you have in place to refuse service to a patron? All employees are responsible for the t raining they receive and sign a document attesting to the training. See our "Alcohol Service Policy" 12) Describe any other types of training or operating procedures that employees will be following in the day-to-day operation of this proposed establishment? See our attached SOP Manual 13) What methods will be used in checking identification for proper age of patrons (at the door, at the bar, etc.) and how will underage patrons be identified so as not to be served alcohol beverages (stamp, mark on the hand, etc.) We ID all customers who purchase alcohol who appear to be under the age of 40. We have a book of id's that is referenced if ever a question arises to it validity. If still in question employees request assistance from a manager in the store. All employees and managers will be TIPS certified. 14) What types of entertainment will be offered, if any, at this proposed establishment (i.e., music, pool, darts, etc.)? We are licensed through MPLC to allow for movies to be shown in our caf6. 15) Do you plan to have any exterior amplified sound? NO 16) What types of security, if any, will be provided at this proposed establishment? Appropriate signage will be in place to ensure no open containers will leave the property. All employees will be properly trained to assist in keeping all open containers in the grocery store. 17) What time will your kitchen close each night? Describe your food service plans after your kitchen closes. As a full service grocery store our kitchen areas will close at 10:00 p.m. hot and cold food are readily available for consumption 18) What is the estimated ratio of food to alcohol beverage sales at this establishment? Not a requirement for this establishment for a 3.2 beer license. We are however a grocery store with caf6 and readily available hot and cold foods for consumption. Estimated 95% food /5% alcohol. 19) If you plan on hosting a "Private Party," what extra measures will you take regarding security, staffing and communications with the Boulder Police Department? A private party is defined as: "An event where there is a single contact person who represents a group of people who are gathering for social and/or business reasons, the event will be held after 10:00 p.m., there will be both underage and of -age people present and there will be enough people to constitute an occupancy capacity of 75% or greater." NOT APPLICABLE - Lucky's Market of South Boulder closes at 10:00 p.m. each night. Jas n Sharon, CE and Manager ALCOHOL SAFETY OFF PREMISE MARCH 2016 Lucky's Market goal is to establish acceptable standards of practice for selling alcohol beverages. This includes not selling alcohol to intoxicated customers or underage customers. This module has been created to help you understand how to identify intoxicated customers and properly confirm proper age. How Alcohol Affects Your Customers Behavioral Cues Intoxication Rate Factors Blood Alcohol Content Tolerance Behavioral Cues The changes in people's behavior after a few drinks are called behavioral cues. Usually, the more alcohol in the bloodstream, the more obvious the cues. Watch for cues in four areas. Inhibitions Becoming talkative, displaying loud behavior or mood swings, or exhibiting a notable change in behavior can all indicate lowered inhibitions. Judgment Behaving inappropriately, using foul language, telling off-color jokes, annoying others, or becoming overly friendly are signs of impaired judgment. Reactions Glassy, unfocused eyes, talking an moving very slowly, forgetting things, losing one's train of thought, and slurred speech result from slowed reactions. Coordination Stumbling or swaying, dropping belongings, and having trouble picking up keys, change, or other items can indicate a loss of coordination. Intoxication Rate Factors Certain physical traits can help you assess how quickly a person will become intoxicated and can give you an idea of how rapidly that person's Blood Alcohol Content (BAC) will rise. These factors are: Size Smaller people are typically affected more quickly by alcohol than larger people. However, larger people with a high percentage of body fat can become intoxicated faster Gender Women are generally smaller, have more body fat, and tend to reach higher BACs more quickly than men. LUCKY'S MARKET 1 2 Rate of Consumption Gulping drinks and multiple drinks in quick succession will increase the amount of alcohol taken into the system. Strength of Drink Drinks of different types (e.g., straight, carbonated, or juice mixer) have varied effects based on their content. Drug Use Legal illegal drugs can speed up the effects of alcohol and have an unpredictable outcome. Food Intake A full stomach before or during drinking slows the absorption of alcohol into the bloodstream. Tolerance People who drink frequently tend to have a high tolerance. This means they may be able to hide the behavioral cues that would otherwise tell you they are intoxicated. Having a high tolerance has no impact on a person's BAC level. This works in both directions. People who do not frequently drink alcohol may have low tolerance. Even with low BAC levels, such people may show signs of intoxication after consuming even a small amount of alcohol. Legal Information Reasonable Efforts The Law requires that you, as a seller of alcohol, make a reasonable effort to prevent alcohol sales to minors and those who are visibly intoxicated. This can include calling police if necessary. Some examples of reasonable efforts include: • checking IDs • enlisting help from the customer's friend • providing alternate transportation • becoming trained in responsible alcohol sales • refusing a sale • contacting a manager for help • calling the police Understanding Liability Whether you are a seller, manager, or owner of a licensed store, you could be held legally responsible for illegal sales to an underage or intoxicated customer. Two primary types of law apply to licensed establishments - Common Negligence and Dram Shop Liability. LUCKY'S MARKET 1 3 F!� Common Negligence Based on prior court cases, these laws set a minimum standard for the actions a reasonable person should take to prevent problems. Negligence laws can cover a broad range of situations and relied on in many cases where alcohol is alleged to be a factor in an incident Dram Shop Liability Dram Shop Acts make sellers of alcohol beverages responsible for sales to persons under the legal drinking age or those who are visibly intoxicated. For the purpose of these laws, "sale" refers not only to the sale of bottle liquor, but also to the serving of individual drinks at an establishment These laws are designed to make sellers and servers of alcohol beverages liable for any harm caused to a third party by a person to whom they have sold alcohol. ID Checking Process As a seller of alcohol you must make certain that all your customers are of legal age. Check for valid ID from anyone who looks to be under 30 years old. Determining if an ID is valid can be one of the toughest yet most important responsibilities you face. When checking IDs you must be aware of the acceptable forms of ID in your area. Commonly Acceptable Forms of ID Valid photo drivers license Valid photo stat -issue ID card U.S. active -duty military ID Valid Passport Alien registration card Unacceptable Forms of ID Counterfeit IDs Student IDs Altered IDs Expired IDs Order -by -mail IDs Steps to Follow to Check IDs Step 1 Ask the customer to remove the ID from his/her wallet. You may want to compare the ID to the ID Guidebook, which shows all valid IDs from every state and province in the U.S. and Canada. Step 2 Determine whether or not the ID is valid: a. Check the birth date. b. Check the expiration date. c. Examine the lamination. (is it torn, frayed or damaged?) d. Look at teh composition of the ID. (Does it correspond with the ID book?) e. Compare the customers signature with the one in front of your. f. Compare the photograph to the person in front of you. g Shine a flashlight to the back of the ID to spot any cuts or abrasions Step 3 Communicate with the person by asking questions, such as: a. What is your astrological sign? b. When did you graduate from high school? You do not need to know the answers. You are simply looking for hesitation in the person's response that might suggest this is not the person's valid ID. Step 4 If you have any reservations, ask the customer for a second form of ID or tell him/her that you will have to get the ID approved. Step 5 Know where the alcohol is going. If you suspect that a customer is purchasing for an underage person, you cannot make the sale. Step 6 If you still have doubts — don't make the sale! LUCKY'S MARKET 1 4 Safe -Selling Guidelines These quick guidelines will help you maintain good customer service and sell alcohol legally. 1) If in doubt, don't sell. It's not worth a lawsuit or yourjob. Encourage the customer to purchase food or a soda. 2) Prevent an intoxicated customer from driving — check you policy on (providing alternate transportation for a customer or ask for help by contacting a co-worker, your manager, or, if necessary, the police. 3) Use the personal touch. Make eye contact and friendly conversation with each customer as often as you can. Underage Warning Signs A few signs may alert you to a potentially underage person. A customer may: hand money to someone else who is obviously of age hide one's face or look away while you are studying the ID seem nervous and move around frequently state that he is a regular or a friend of an employee get upset when asked for ID Jurisdiction -Specific Information See your supervisor or manager for jurisdiction -specific information such as minimum age to sell or serve alcohol, whether your jurisdiction has a Dram Shop Liability Law, hours that you can sell and serve alcohol, and penalties for violating the liquor laws. Documentation Accurate recdords are important in demonstrating that reasonable efforts have been made to avoid selling alcohol to intoxicated or underage customers. Document any incidents in the Customer Incident Form. The Customer Incident Form can be a valuable line of defense for Lucky's Market defense facing civil or criminal liability lawsuits. Record all reasonable efforts made to prevent illegal alcohol sales. LUCKY'S MARKET 1 5 X Review Questions qz� 1) Behavioral provide information that shows you how much your customers are being affected by alcohol. 2) Under the Cutoff Guidelines, your first statement should clearly express to the customer 3) Alcohol affects behavior progressively in four basic areas: Inhibitions, Judgment, Reactions, and Coordination. Complete the following statements with one of these areas: a) Lowered are noticeable as customers become especially talkative and relaxed. b) A gap between how people think they are behaving and how they actually behave indicates impaired . People may become overly friendly, annoy others, or overrate themselves. c) Slowed can be observed physically, when speech becomes slurred and routine motions become difficult, or mentally, when there is a loss of concentration. d) Losing one's balance, swaying, and dropping items are cues that indicate loss of , 4) Alcohol, unlike other foods, is absorbed rapidly into the 5) A measurement of the level of alcohol in the bloodstream is called b) The strength of a drink, the rate of drinking, whether food is eaten or medication is taken, and the gender, height, and weight of the person are all 7) In most areas legal identification must have both a and the to be considered valid 8) People who drink frequently may have developed a high , which allows them to hide the Behavioral Cues they would otherwise exhibit. q) To effectively refuse a sale, sellers should do these three things: 1o) In many areas, if a drinker becomes intoxicated and goes on to incur damages, the seller/server, manager, and owner can all be held responsible under ii) To protect yourself against liability the law requires that you make alcohol sales. Name (print): Signature: Date: to prevent illegal LUCKY'S MARKET 1 6 ON PREMISE ALCOHOL TRAINING MARCH 2016 Lucky's Market goal is to establish acceptable standards of practice for selling alcohol beverages. This includes not selling alcohol to intoxicated customers or underage customers. This module has been created to help you understand how to identify intoxicated customers and properly confirm proper age. Let's first look at how to identify intoxicated customers. How Alcohol Affects Your Customers Behavioral Cues Intoxication Rate Factors Blood Alcohol Content Tolerance Behavioral Cues The changes in people's behavior after a few drinks are called behavioral cues. Usually, the more alcohol in the bloodstream, the more obvious the cues. Watch for cues in four areas. Inhibitions Becoming talkative, displaying loud behavior or mood swings, or exhibiting a notable change in behavior can all indicate lowered inhibitions. Judgment Behaving inappropriately, using foul language, telling off-color jokes, annoying others, or becoming overly friendly are signs of impaired judgment. Reactions Glassy, unfocused eyes, talking an moving very slowly, forgetting things, losing one's train of thought, and slurred speech result from slowed reactions. Coordination Stumbling or swaying, dropping belongings, and having trouble picking up keys, change, or other items can indicate a loss of coordination. Intoxication Rate Factors Certain physical traits can help you assess how quickly a person will become intoxicated and can give you an idea of how rapidly that person's BAC will rise. These factors are: Size Smaller people are typically affected more quickly by alcohol than larger people. However, larger people with a high percentage of body fat can become intoxicated faster. LUCKY'S MARKET 1 2 Gender Women are generally smaller, have more body fat, and tend to reach higher BACs more quickly than men. Rate of Consumption Gulping drinks and multiple drinks in quick succession will increase the amount of alcohol taken into the system. Strength of Drink Drinks of different types (e.g., straight, carbonated, or juice mixer) have varied effects based on their content. Drug Use Legal illegal drugs can speed up the effects of alcohol and have an unpredictable outcome. Food Intake A full stomach before or during drinking slows the absorption of alcohol into the bloodstream. Blood Alcohol Content (BAC) Blood Alcohol Content is the legal measurement of the amount of alcohol in a person's blood. Here are some points to remember: • The more alcohol a person consumes the higher the BAC level will be. • A customers BAC level can be different each time he or she drinks. • Intoxication Rate Factors affect how quickly the BAC level rises. • The higher the BAC level, the more behavioral cues you are likely to see. • Time is the only thing that can lower a person's BAC level. A iso -pound male customer drinking for one hour on an empty stomach would likely have the following BAC levels: After 2 drinks .05 After 4 drinks .10 After 8 drinks .20 After 12 drinks .30 Tolerance People who drink frequently tend to have a high tolerance. This means they may be able to hide the behavioral cues that would otherwise tell you they are intoxicated. Having a high tolerance has no impact on a person's BAC level. This works in both directions. People who do not frequently drink alcohol may have low tolerance. Even with low BAC levels, such people may show signs of intoxication after consuming even a small amount of alcohol. LUCKY'S MARKET 1 3 Legal Information Reasonable Efforts The Law requires that you, as a seller of alcohol, make a reasonable effort to prevent alcohol sales to minors and those who are visibly intoxicated. Some examples of reasonable efforts include: Checking IDs Enlisting help from the customers friend Providing alternate transportation Becoming trained in responsible alcohol sales Refusing a sale Contacting a manager for help Calling the police Understanding Liability Whether you are a seller, manager, or owner of a licensed store, you could be held legally responsible for illegal sales to an underage or intoxicated customer. Two primary types of law apply to licensed establishments - Common Negligence and Dram Shop Liability. Common Negligence Based on prior court cases, these laws set a minimum standard for the actions a reasonable person should take to prevent problems. Negligence laws can cover a broad range of situations and relied on in many cases where alcohol is alleged to be a factor in an incident Dram Shop Liability Dram Shop Acts make sellers of alcohol beverages responsible for sales to persons under the legal drinking age or those who are visibly intoxicated. For the purpose of these laws, "sale" refers not only to the sale of packaged alcohol, but also to the serving of individual drinks at an establishment These laws are designed to make sellers and servers of alcohol beverages liable for any harm caused to a third party by a person to whom they have sold alcohol ID Checking Process As a seller of alcohol you must make certain that all your customers are of legal age. Check for valid ID from anyone who looks to be under 40 years old. Determining if an ID is valid can be one of the toughest yet most important responsibilities you face. When checking IDs you must be aware of the acceptable forms of ID in your area. Commonly Acceptable Forms of ID Unacceptable Forms of ID Valid photo driver's license Counterfeit IDs Valid photo stat -issue ID card Student IDs U.S. active -duty military ID Altered IDs LUCKY'S MARKET 1 4 Valid Passport Expired IDs Alien registration card Order -by -mail IDs Steps to Follow to Check IDs Step 1 Ask the customer to remove the ID from his/her wallet. You may want to compare the ID to the ID Guidebook, which shows all valid IDs from every state and province in the U.S. and Canada. Step 2 Determine whether or not the ID is valid: a. Check the birth date. b. Check the expiration date. c. Examine the lamination. (is it torn, frayed or damaged?) d. Look at the composition of the ID. (Does it correspond with the ID book?) e. Compare the customers signature with the one in front of your. f. Compare the photograph to the person in front of you. g Shine a flashlight to the back of the ID to spot any cuts or abrasions Step 3 Communicate with the person by asking questions, such as: a. What is your astrological sign? b. When did you graduate from high school? You do not need to know the answers. You are simply looking for hesitation in the person's response that might suggest this is not the person's valid ID. Step 4 If you have any reservations, ask the customer for a second form of ID or tell him/her that you will have to get the ID approved. Step 5 Know where the alcohol is going. If you suspect that a customer is purchasing for an underage person, you cannot make the sale. Step b If you still have doubts — don't make the sale! Cut -Off Guidelines There are times when you must refuse to sell alcohol to a customer. Remember that customer service is key. You people skills can help in resolving situations. 1) Clearly tell the customer "I can't sell you this alcohol." Then, remove the alcohol from the counter and move to the next customer. Be brief and firm and keep the line moving. 2) Give clear reasons and don't judge the customer. Never say. "You're drunk" 3) Do not back down. Call for backup if the customer makes trouble. Safe -Selling Guidelines These quick guidelines will help you maintain good customer service and sell alcohol legally. 1) If in doubt, don't sell. It's not worth a lawsuit or your job. Encourage the customer to purchase food or a soda. 2) Prevent an intoxicated customer from driving — check you policy on providing alternate transportation for a customer or ask for help by contacting a co-worker, your manager, or, if LUCKY'S MARKET 1 5 necessary, the police. 3) Use the personal touch. Make eye contact and friendly conversation with each customer as often as you can. Underage Warning Signs A few signs may alert you to a potentially underage person. A customer may: Hand money to someone else who is obviously of age Hide one's face or look away while you are studying the ID Seem nervous and move around frequently State that he is a regular or a friend of an employee Get upset when asked for ID Jurisdiction -Specific Information See your Supervisor or Manager for jurisdiction -specific information such as minimum age to sell or serve alcohol, whether your jurisdiction has a Dram Shop Liability Law, hours that you can sell and serve alcohol, and penalties for violating the liquor laws. Documentation Accurate records are important in demonstrating that reasonable efforts have been made to avoid selling alcohol to intoxicated or underage customers. Document any incidents in the Customer Incident Form. The Customer Incident Form can be a valuable line of defense for Lucky's Market defense facing civil or criminal liability lawsuits. Record all reasonable efforts made to prevent illegal alcohol sales. Additional information regarding the service or sale of alcoholic beverages include: - Hours of Sale - State Regulations and Laws may vary regarding the sale and service of alcoholic beverages on Sunday's and Government Holidays. Lucky's Market store registers are set up to NOT ALLOW beer and wine sales during restricted times - License Privileges — Team Members nor Customers are permitted to drink alcoholic beverages in the store or adjacent property immediately outside your store. Team Members understand this means before, during and after your scheduled shift - FRONT END Managers NOTE: As a part of their enforcement procedures, an officer of the Liquor Commission or Police Department may require you to provide signed copies of the Lucky's Market Standard Operating Procedures and Alcohol Service Policy Agreement at a moment's notice for your Team Members servicing and selling alcoholic beverages. LUCKY'S MARKET 1 6 Review Questions Please remove from the manual and turn into your trainer. 1) Behavioral provide information that shows you how much your customers are being affected by alcohol. 2) Under the Cutoff Guidelines, your first statement should clearly express to the customer 3) Alcohol affects behavior progressively in four basic areas: Inhibitions, Judgment, Reactions, and Coordination. Complete the following statements with one of these areas: a) Lowered are noticeable as customers become especially talkative and relaxed. b) A gap between how people think they are behaving and how they actually behave indicates impaired People may become overly friendly, annoy others, or overrate themselves. c) Slowed can be observed physically, when speech becomes slurred and routine motions become difficult, or mentally, when there is a loss of concentration. d) Losing one's balance, swaying, and dropping items are cues that indicate loss of 4) Alcohol, unlike other foods, is absorbed rapidly into the 5) The strength of a drink, the rate of drinking, whether food is eaten or medication is taken, and the gender, height, and weight of the person are all b) In most areas legal identification must have both a and the to be considered valid. 7) People who drink frequently may have developed a high , which allows them to hide the Behavioral Cues they would otherwise exhibit. 8) To effectively refuse a sale, sellers should do these three things: 1) 2) 3) q) In many areas, if a drinker becomes intoxicated and goes on to incur damages, the seller/ server, manager, and owner can all be held responsible under 1o) To protect yourself against liability the law requires that you make to prevent illegal alcohol sales. Name (print): Signature: Date: LUCKY'S MARKET 1 7 DR 8403 (06/28/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division r"" �- (303) 205-2300 Colorado Fermented Malt Beverage �C-14 (3.2% Beer) License Application �k7j, C_ Ej New License, ® New -Concurrent ❑ Transfer of Ownership • All answers must be printed in black ink or typewritten • Applicant must check the appropriate box(es) • Local license fee $ 3.75 • Applicant should obtain a copy of the Colorado Liquor and Beer Code: www.colorado.gov/enforcementAiquor 1. Applicant is applying as a/an ❑ Corporation ❑ Partnership (includes Limited Liability and Husband and Wife Partnerships) ❑ Individual 0 Limited Liability Company ❑ Association or Other 2. Applicant(s) If an LLC, name of LLC; if partnership, at least 2 partners' names; if corporation, name of corporation FFiN Lucky's Market of South Boulder, CO, LLC 2a. Trade Name of Establishment (DBA) State Sales Tax No. 301oN11une Lucky's Market jisomMil�-0000 303-530-0782 3. Address of Premises (specify exact location of premises) 695 S Broadway City County State ZIP Code Boulder Boulder CO 80305 4. Mailing Address (Number and Street) City or Town State ZIP Code 6328 Monarch Park Place, Suite 100 Niwot CO '80503 S. Email Address wendyp@luckysmarket.com 6. If the premises currently has a liquor or beer license, you MUST answer the following questions Present Trade Name of Establishment (DBA) Present State License No. Present Class of License Present Expiration Date Section A Nonrefundable Application Fees Section B 3.2% Beer License Fees ❑ Application Fee for New License $920.00 ❑ Retail 3.2% Beer On -Premises (City) $96.25 ® Application Fee for New License - w/Concurrent Review $1020.00 ❑ Retail 3.2% Beer On -Premises (County) $117.50 ❑ Application Fee for Transfer $920.00 ❑ Retail 3.2% Beer Off -Premises (City) $96.25 ❑ Retail 3.2% Beer Off -Premises (County) $117.50 Retail 3.2% Beer On/Off Premises (City) $96.25 ❑ Retail 3.2% Beer On/Off Premises (County) $117.50 ❑ Master File Location Fee ............... $25.00 x To ❑ Master File Background ............... $250.00 x Total Questions? Visit www.colorado.gov/enforcement4iquorfor more information Do Not Write In This Space - For Department Of Revenue Use Only Liability Information License Account Number Liability Date: License Issued Through: (Expiration Date) TOtal $ 1116.25 Application Documents Checklist and Worksheet Instructions: This check list should be utilized to assist applicants with filing all required documents for licensure. All documents must be properly signed and correspond with the name of the applicant exactly. All documents must be typed or legibly printed. Upon final State approval the license will be mailed to the local licensing authority. Application fees are nonrefundable. Questions? Visit: www.colorado.gov/enforcementAiquorfor more information. Items Submitted, Please Check all Appropriate Boxes Completed or Documents Submitted I. A plicant Information ( A. Applicant/Licensee identified B. State sales tax license number listed or applied for at time of application C. License type or other transaction identified D. Submit originals to local authority E. Additional information may be required by the local licensing authority ll. Di gram of the Premises A. No larger than 8 1/2" X 11" ❑9,B. Dimensions included (does not have to be to scale). Exterior areas should show control (fences, walls, etc.) C. Separate diagram for each floor (if multiple levels) ErD. Bold/Outlined licensed premises III. Proof of Property Possession (One Year Needed) �(❑ A. Deed in name of the Applicant ONLY (or) (matching question #2) date stamped/filed with County Clerk B. Lease in the name of the Applicant ONLY (matching question #2) ❑ C. Lease Assignment in the name of the Applicant (ONLY) with proper consent from the Landlord and acceptance by the Applicant ❑ D. Other Agreement if not deed or lease (attach prior lease to show right to assumption) IV. kground Information and Financial Documents Bac A. Individual History Record(s)'(Form DR 8404-1) )( 6 ❑ B. Fingerprints taken and submitted to local authority. (State authority for master file applicants.) ❑ C. Purchase agreement, stock transfer agreement, and or authorization to transfer license fJ/A ❑ D. List of all notes and loans. M IN V. Sole Proprietor/Husband and Wife Partnership IA ❑ A. Form DR 4679 ❑ B. Copy of State Issued Driver's License or Identification Card for each Applicant VI. Corporate Applicant Information (If Applicable) MIA ❑ A. Certificate of Incorporation (and/or) ❑ B. Certificate of Good Standing ❑ C. Certificate of Authorization if foreign corporation ❑ D. List of officers, directors and stockholders of parent corporation (designate one person as "principal officer') VII. Partnership Applicant Information (If Applicable) NIA ❑ A. Partnership Agreement (general or limited). Not needed if husband and wife ❑ B. Certificate of Good Standing (if formed after 2009) VIII. Li ited Liability Company Applicant Information (If Applicable) (A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office) IJ B Certificate of Good Standing if organized more than two years 9 C. Copy of operating agreement a\@ ❑ D. Certificate of Authority (if foreign company) 7. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; Yes No or officers, stockholders or directors if a corporation) or manager under the age of twenty-one years? ❑ 8. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or Last Name t9itp , Ll^G officers, stockholders or directors if a corporation) or manager ever (in Colorado or any other state): Date of Birth (a) been denied an alcohol beverage license? ❑ (b) had an alcohol beverage license suspended or revoked? ❑ R1 (c) had interest in another entity that had an alcohol beverage license suspended or revoked? ❑ If you answered yes to 8a, b or c, explain in detail on a separate sheet 9. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? If "yes," explain in detail. ❑ [y�' 10. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or Attach copies of all notes and security instruments, and any written agreement, or details of any oral agreement, by which any person manager if a limited liability company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the and any agreement relating to the business which is contingent or conditional in any way by volume, profit, sales, giving of advice or business and list any current or former financial interest in said business including any loans to or from a licensee. see attached ❑ 11. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownership, lease or other arrangement? ❑ ❑ Ownership aLease ❑ Other (Explain in Detail) a. If leased, list name of landlord and tenant, and date of expiration, EXACTLY as they appear on the lease: Landlord 1916, LLC attn: Property Manager Tenant Expires WWR Real Estate Services, LLC, 1375 Walnut, Suite 10, Boulder, CO 80302Lucky's Market of South Boulder, CO, LLC 5/31 /2026 b. is a percentage of alcohol sales included as comnensation to the landinrd? If vpC nmmniptp ni ipsfinn 19 rw- c. Attach a diagram and outline or designate the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions, entrances, exits and what each room shall be utilized for in this business. This diagram should be no larger than 81/2" X 11". 12. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies), will loan or give money, inventory, furniture or equipment to or for use in this business; or who will receive money from this business. Attach a separate sheet if necessary. Last Name t9itp , Ll^G First Name Date of Birth FFiN nr ccN U1 ooiv Interest Last Name First Name Date of Birth Interest N/a Attach copies of all notes and security instruments, and any written agreement, or details of any oral agreement, by which any person (including partnerships, corporations, limited liability companies, etc.) will share in the profit or gross proceeds of this establishment, and any agreement relating to the business which is contingent or conditional in any way by volume, profit, sales, giving of advice or consultation. 13.Name of Manager for all on and onloff applicants. r" a1. 11aI i It: I ware nr K3rrn . 4. Does this manager act as the manager of, or have a financial interest in, any other liquor licensed establishment in the State of Colorado? If yes, provide name, type of license and account number. ❑ 5. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers, directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue? ❑ [r If yes, provide an explanation and include copies of any payment agreements. 3 QI' S J 16. If applicant is a corporation, partnership, association or limited liability company, applicant must list all Officers, Directors, General Partners, and Managing Members. In addition, applicant must list any stockholders, partners, or members with ownership of 10% or more in theApplicant. All persons listed below must also attach form DR 8404-1 (individual History Record), and submit fingerprint cards to the local licensing authority. Name Home Address, City & State Date of Birth Position % Owned Lucky's Market Expansion, LP 6328 Monarch Park PI., Ste. 100, Niwot, CO 80503 Member a 0 Name Home Address, City & State Date of Birth Position % Owned *See attached list of officers and ownershi 3 organization chart Name Home Address, City & State Date of Birth Position % Owned Name Home Address, City & State Date of Birth Position % Owned *' Limited Liability Companies and Partnerships -100% of ownership must be accounted for on question #16 ** Corporations - The President, Vice -President, Secretary and Treasurer must be accounted for on question #16 (Include ownership percentage if applicable) Oath of Applicant 1 declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor or Beer Code which affect my license. Authorized Signature Printed Name and Title Date Jason B Sharon, CEO and Manager Report and Approval of Local Licensing Authority (City/County) Date app' on filed with local authority Date of local authority hearing (for new license applicants cannot be less than 30 days from date of application 12-47-311 Q — _ (1) C.R.S.) L v Each person required to file DR 84044 has Been fingerprinted Been subject to background investigation, including NCIC/CCIC check for outstanding warrants That the local authority has conducted, or intends to conduct, an inspection of the proposed premises to ensure that the applicant is in compliance with, and aware of, liquor code provisions affecting their class of license. (Check One) ❑ Date of Inspection or Anticipated Date ❑ Upon approval of state licensing authority The foregoing application has been examined; and the premises, business to be conducted, and character of the applicant are satisfactory. We do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires of the adult inhabitants, and will comply with the provisions of Title 12, Article 46 or 47, C.R.S. Therefore, this application is approved. Local Licensing Authority for Telephone Number El Town, City ❑County Signature Printed Name Title Date Signature (attest) Printed Name Title Date The Kroger Co 55% owner Publicly traded Jason Sharon 25% owner *Russell Dispense, Monica Games & J Michael Schlotman from The Kroger Co are the appointed representatives to undergo review P G Holdings, LLC 100% owned by Patrick Gilliland Managing Member 75% owner Lucky's Founders Holding, LLC 45% Manager: Jason B Sharon Lucky's Market Parent Company, LLC JS 11.25%/PG 33.75% 100% owner *Note* Managers - Jason B Sharon, Monica Games, J Michael Schlotman, Patrick L Gilliland and Russell Dispense Officers Jason Sharon — CEO Andy Pillari — CFO Steve Black — President i Lucky's Market Expansion GP, LLC *Jason B Sharon is themanager of the LLC 100% owner Lucky's Market � Parent Company, LLC as limited partner Lucky's Market Expansion, LP 100% owner *General Partner is Lucky's Market Expansion GP, LLC Lucky's Market of South Boulder, CO, LLC Manager — Jason B Sharon �eucbj� 9harket September 15, 2016 RE: Lucky's Market of South Boulder, LLC Statement of Organization The following individuals have completed the DR8404-1 form for the 3.2 beer application for the Lucky's Market of South Boulder, LLC. • Jason B Sharon • Patrick LGilliland • Russell Dispense • Andrew T Pillari • Stephen D Black • TimOverlie • Monica J Garnes • J Michael Schlotman Each of the individuals are being fingerprinted for the various positions as listed below: Jason B Sharon o Manager of Lucky's Market of South Boulder, LLC o Manager of Lucky's Expansion GP, LLC o CEO, and 11.25% owner of Lucky's Market Parent Company, LLC • Patrick Gilliland o 33.75% owner of Lucky's Market Parent Company, LLC • Russell Dispense, Monica Games and J Michael Schlotman o Appointed representatives of The Kroger CO., a publically traded company, which owns 55% of Lucky's Market Parent Company, LLC • Andrew T Pillari o CFO of Lucky's Market Parent Company, LLC • Stephen D Black o President of Lucky's Market Parent Company, LLC • Tim Overlie o Regional Manager for Lucky's Market of South Boulder, LLC If you require any additional information please let me know. I may be contacted via email at wendyp@luckysmarket.com or my direct phone is 720-378-9177. Jasgn BISharon, CEO and Manager Lucky's Market 6328 Monarch Park Place, Suite 100, Niwot, CO 80503 Lucky's Market of South Boulder, LLC 3.2 Beer. State Application (DR8403) attachment sheet Question 10. Has a liquor or beer license ever been issued to the applicant (including partners; members or manager if a limited liability company... YES, Lucky's Liquor, LLC d/b/a Lucky's Liquor at 700 Ken Pratt Blvd, Unit 202, Longmont, CO 80501 License # 4701417 Question 11. Landlord: 1916, LLC Attn: Property Manager WWR REAL ESTATE SERVICES, LLC 1375 Walnut, Suite 10 Boulder, CO 80302 303-442-8687 QUESTION #16. List of Officers: Jason B Sharon — CEO, Manager 11.25% ownership Andrew T Pillari — CFO rNOW Room �Iilill[41l➢I� 0.0 ownership Stephen Black — President �ircle 0.0 ownership Re : a z q t ,,zB,4�o t, / ;k- 4. Base Rent and Percentage Rent. (a) Commencement of Base Rent. Tenant agrees to pay base rent ("Base Rent") for the Premises in the amount and in the manner specified under this Lease, commencing on the Commencement Date and continuing throughout the Term hereof. "Rent" means Base Rent, Percentage Rent, CAM Charges and Real Estate Taxes defined herein, and all other charges payable by Tenant under this Lease. The Parties hereto acknowledge that all provisions of this Lease other than those relating to the payment of Rent, apply prior to the Commencement Date, and the Parties will be bound by those provisions immediately upon execution of this Lease. (b) Calculations. All Base Rent and payments under this Lease will be calculated on a full 12 -month period commencing on the Commencement Date; provided however, that if the Commencement Date is any day other than the first day of the month, the Lease Year or Lease Month, if applicable, will commence on the first day of the next following month, and Base Rent and other payments for fractional months will be prorated and added to the sums due for the next following calendar month. Tenant will pay Base Rent by check or electronic funds transfer payable to Landlord in equal monthly installments, in advance, on or before the first day of each calendar month of the Term, and such Base Rent will not be decreased, increased or abated except as expressly set forth in this Lease, to the address given for Landlord herein, unless Landlord gives Tenant written notice of a change of address or of the party to whom such Base Rent will be payable along with written documentation reasonably satisfactory to Tenant of such party's right to receive payment under this Lease. Unless otherwise set forth herein, any prorations or adjustments required under this Lease are to be made on the basis of the actual days in the respective month. (c) Payment Schedule. Base Rent will be paid pursuant to the following schedule: Lease Months Annual Base Annual Base Rent Monthly Base Rent Percentage Rent Breakpoint Rent Amount/SF Amount Amount Lease Months 1-60 $13.17 $421,558.53 $35,129.88 $30,000,000.00 Lease Months 61-120 $14.49 $463,810.41 $38,650.87 $30,000,000.00 I" Option Period: Lease Months 121-180 $15.40 $492,938.60 $41,078.22 $40,000,000.00 1" Option Period: Lease Months 181-240 $16.94 $542,232.46 $45,186.04 $40,000,000.00 2" Option Period: Lease Months 241-300 FMV Rent FMV Rent FMV Rent $40,000,000.00 2"d Option Period: Lease Months 301 360 FMV Rent FMV Rent FMV Rent $40,000,000.00 (d) Percenta a Rent. "Percentage Rent" means 1.00 o (the "Percentage Rent Rate") of the amount by which "Gross Sales" (as defined in Section 4(d)(i) below) exceed the unnatural breakpoint set forth in the Payment Schedule above (the "Percentage Rent Breakpoint') for each twelve month period ("Percentage Rent Period"). The Percentage Rent calculation for the first Lease Year shall commence on the Commencement Date. Percentage Rent payments shall be paid semi-annually within 30 -days of the end ofthe prior semi-annual period on a prorata and cumulative basis during each Percentage Rent Period. (i) "Gross Sales" means the total amount of the actual price charged, whether for cash, credit or otherwise, from all sales of merchandise, services, gift certificates and other receipts of any nature of all business conducted or made at, in, on, or from the Premises by Tenant and!or any affiliate of Tenant (including but not limited to deposits not refunded to customers, and mail, telephone and internet 1009070_2 I CITY OF BOULDER BEVERAGES LICENSING AUTHORITY FINANCIAL STATEMENT The applicant hereby agrees that any knowingly false or incomplete answer to the following questions shall constitute cause foii the suspension or revocation of the license applied for. Name ofApplicint(s): Lucky's Market of South Boulder, CO, LLC Trade Name: I Lucky's Market Business Address: 695 S Broadway, Boulder, CO 80305 Phone No: ,303-530-0782 Contactperson: Wendy 1 -Petrillo -Rundle Mailing address: 6328 Monarch Park Place, Sutie 100, Niwot, CO 80503 Other Liquor Licensed Establishments that principals or managers of Applicint(s) now holds: None If applicant is a corporation or LP or LLC, names of persons purchasing stock or membership units: Is this anew or existing business: _ Existing Grocery Store If new business, state approximate investment amount: $ Where will these funds come from? If existing business, state purcbase price including inventory: $ 6500.00 - Where will these funds come from? Business Bank Account at Chase Bank If cash is to be invested, please complete the following: (If you need additional space, please attach additional pages) Person orbusiness investing ,Lucky's Market of South Boulder, CO, LLC Address of Investor: 6328 Monarch Park Place,'Suite 100, Niwot, CO 80503 Amount of Investment: $6500.00 Source of Investment Business Checking account at Chase Bank (Checldng, Savings, Bonds, etc.) If loans are to be obtained, please complete the following: (If you need additional space,'please attach additional pages) Name of Lender: N/a Address ofLender. Type of Loan: Amount of Loan: Security: 'term of Obligation: Business Bank Account Information What bank will the business account be maintained at? Chase Bank - What name will the account be under? Lucky's Farmers Market Holding Company, LLC Who will be authorized to sign on the account? Jason B Sharon Applicant hereby agrees to notify the Beverages Licensing Authority of the City of Boulder of any changes in the financing of this business should such changes occur during the period for which this license is issued. f - - OATS OF APPLICANT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor and Beer Code and all City of Boulder rules, regulations and codes which affect my license. ' tN 1t, tho Signature Date Jason B Sharon, CEO and Manager Print Name & Title The Kroger Co 55% owner Publicly traded Jason Sharon 25° o owner € "Russell Dispense, Monica Games R J Michael Schlotman from The Kroger Co are the appointed representatives to undergo review P G Holdings, LLC 100% owned by Patrick Gilliland Managing Member 75% owner Lucky's Founders Holding, LLC 45% Manager: Jason B Sharon Lucky's Market Parent Company, LLC JS 11.25%/PG 33.75% 100% owner *Note` Managers - Jason B Sharon, Monica Games, J Michael Schlotman, Patrick L Gilliland and Russell Dispense Officers Jason Sharon — CEO Andy Pillari — CFO Steve Black — President Lucky's Market Expansion GP, LLC Jason B Sharon is the manager of the LLC 100% owner Lucky's Market Parent Company, LLC as limited partner Lucky's Market Expansion, LP 100% owner *General Partner is Lucky's Market Expansion GP, LLC Lucky's Market of South Boulder, CO, LLC Manager — Jason B Sharon September 15, 2016 RE: Lucky's Market of South Boulder, LLC Statement of Organization The following individuals have completed the DR8404-1 form for the 3.2 beer application for the Lucky's Market of South Boulder, LLC. ® Jason B Sharon • Patrick LGilliland Russell Dispense • Andrew T Pillari o Stephen D Black Tim Overlie Monica J Garnes • J Michael Schlotman Each of the individuals are being fingerprinted for the various positions as listed below: • Jason B Sharon o Manager of Lucky's Market of South Boulder, LLC o Manager of Lucky's Expansion GP, LLC o CEO, and 11.25% owner of Lucky's Market Parent Company, LLC • Patrick Gilliland o 33.75% owner of Lucky's Market Parent Company, LLC • Russell Dispense, Monica Games and J Michael Schlotman o Appointed representatives of The Kroger CO., a publically traded company, which owns 55% of Lucky's Market Parent Company, LLC • Andrew T Pillari o CFO of Lucky's Market Parent Company, LLC • Stephen D Black o President of Lucky's Market Parent Company, LLC • Tim Overlie o Regional Manager for Lucky's Market of South Boulder, LLC If you require any additional information please let me know. I may be contacted via email at wendyp@luckysmarket.com or my direct phone is 720-378-9177. Jason B�Sliaron, CEO and Manager Lucky's Market 6328 Monarch Park Place, Suite 100, Niwot, CO 80503 DR 8404-1 (0311$/15) COLORADO DEPARTMENT OF REVENUE Liquor Enforcemenl Division (303) 205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any Intended registered manager of Hotel and Restaurant or Tavern class of retail license Notice: This individual history record requires Information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business Lucky's Market of South Boulder, CO, LLC N^^+= cti^^^ " `- Cellular Number 3 ou have used '— Bo Sharon 2. Your Full Name (last, first, middle) Sharon, Jason Bohanan 4. Mailing address (if different from residence) 6328 Monarch Park PI, Ste 100, Niwot, CO 80503 Email Address bo@luckysmarket.com 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number City, State, Zip From To 1 )rive 7177 Four Rivers Road Boulder, CO 80301 06/15 Present Boulder, CO 80301 07/08 06/15 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To Lucky's Market 6328 Monarch Park Place, Suite 100 CEO, Owner 2003 Present 7. L)st the name(s) of relatives working in or holding a financial Interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an interest In a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or Inventory to any licensee? (If yes, answer In detail.) 19'Yes ❑ No Lucky's Liquor, LLC dba Lucky's Liquor License number 4701417. 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) 9Yes ❑ No The Liquor License #4701417 at 700 Ken Pratt Blvd #202 received a violation on 1.26.2016. Fine was paid in lieu of arid 5 days held in abeyance. License was surrendered at expiration 7.8.2016. 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (if yes, explain in detail.) ❑ Yes ((No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) ❑ Yes [�(No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes EZ No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a. nmf. ^r ember c. Place of Birth ,�( I Hollywood, CA d. U.S. Citizen LJ Yes ❑ No state ...._,_ f. When :::]-g6.—Name of District Court h. Naturalization Certificate Number if. Date of Certification j. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number I. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race ,r�. D you have a current DrivpP.q i i ---/ID? If so, give number and state. 5'10" 185 Red B 0 M CAUC [e s No # _State Colorado 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ $6500.00 b. List the total amount of the personal investment, made by the person listed on question #2, In this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ Nnnt? * If corporate investment only please skip to and complete section (d) *` Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount None d. Provide details of the corporate investment described in 14 b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount Cash None Checking Chase Bank $6500.00 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount None Oath of Applicant I declare under altv of perluir that this a lication and all attachments are true correct and com tete to the best of m knowled e. Au orized Signat re Print Signature Title Date Jason B Sharon CEO, Manager DR 0404.1 (03/13/15) COLORADO DEPARTMENT OF REVENUE Liquor Enforcemeni Dlvlsion (303) 205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any Intended registered manager of Hotel and Restaurant or Tavern class of retail license Notice: This individual history record requires Information that is necessary for the licensing investigation or Inquiry. All questions must be answered In their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business Lucky's Market of South Boulder, CO, LLC Home Phone Number 3. List any other names you have user Steve Black 2. Your Full Name (last, first, middle) Black, Stephen Douglas 4. Mailing address (if different from residence) 6328 Monarch Park PI, Ste 100, Niwot, CO 80503 Email Address steve@luckysmarket.com 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number City, State, Zip From TO C� Ro an on Drive Golden, CO 80403 01/15 Present F *See attached 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To None LL 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or Inventory to any licensee? (If yes, answer in detail.) ❑Yes Q�No 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you �/ applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) ❑Yes L1p No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) El Yes �No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a C9( deferred sentence? (If yes, explain in detail.) ❑C9Yes No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes MNo Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information re uiredin uestion #13 is sole) for identification ur oses. �r _.....___. �......_ c. Place of Birth Clinton, OK d. U.S. Citizen Q'Yes ElNo f. When g. Name of District Court h. Naturalization Certificate Number I. Date of Certification j. If an Alien, Give Alien's Registration Card NumbeT7rmanent Residence Card Number I. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race ILEo° you have a cL,—nt nrivnr's License/ID? If so, give number and state. 6'0" 220 Silver Blu M Cauc. LI Yes El No # State Colorado 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ $6500.00 b. List the total amount of the personal investment, made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ None * If corporate investment only please skip to and complete section (d) *' Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount N/a d. Provide details of the corporate investment described in 14 b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans . Account Type Bank Name Amount Cash None Checking Chase Bank $6500.00 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount None Oath of Applicant I decla nder Penaltv odelfiryth t is goolication and all attachments are true correct and complete to the best of m knowled e. Au t riz d ur Print Signature M= Stephen D Black Title I President Date $ lcik, Lucky's Market of South Boulder, LLC 3.2 beer on/off premise license application Attachment to the DR 8404I — Stephen Douglas Black Question #5 List of residences continued: Street and Number City, State, Zip From To 38024 N Boulder View Dr. Boulder, CO 80403 09/13 01/15 7460 E Rid eline Road Scottsdale, AZ 85262 07/12 09/13 1941 W Eastman Ct. Anthem, AZ 85086 07/10 07/12 DR 8404.1 (03/13/15) COLORADO DEPARTMENT OF REVENUE Uquor Enforcement Division (303)205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant or Tavern class of retail license Notice: This Individual history record requires Information that is necessary for the licensing investigation or Inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application, (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business Lucky's Market of South Boulder, CO, LLC Home Phone Number Celhd.r Niimber 3. List any other names you have usec Andy Pillad 2. Your Full Name (last, first, middle) Pillari, Andrew Thomas 4. Mailing address (if different from residence) 6328 Monarch Park Place, Ste 100, Niwot CO 80503 Email Address andyp@luckysmarket.com 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number City, State, Zip From TO Lafayette, CO 80026 03/14 Present F See Attached 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From TO Luck 's Market . 6328 Monarch Park PI., Ste 100 CF O 10/14 Present Consumer Capital Partners 3900 East Mexico Ave, Ste 1400 SVP Analytics & 02/14 10/14 School of Rock 114 Shore Dr. Burr Ride IL 60527 CFO 10/11 01/14 7. List the name(s) of relatives working In or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an Interest In a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory to any licensee? (If yes, answer In detail.) ❑Yes �No 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) ❑Yes No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited ❑Yes U C No bail for any offense In criminal or military court or do you have any charges pending? (if yes, explain in detail.) 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a [v7No deferred sentence? (If yes, explain in detail.) ❑ Yes 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information re uired in uestion #13 is sole) for identification purposes. 13a. Data of R Irth h Snrial Rariirity Ntimher c. Place of Birth Colorado Springs, CO d. U.S. Citizen 9Yes ❑ No f. When g. Name of District Court h. Naturalization Certificate Number i. Date of Certification j. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number I. Height m. Weight in. Hair Color o. Eye Color p. Gender q. Race r�,_,.D,p9 you have a current Driver's License/ID? If so, give number and state. 5'8" 165 Brown Blue M Cauc. LYYes 0N # State Colorado 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ $6500.00 b. List the total amount of the personal investment, made by the person listed on question #2, In this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ None * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e c. Provide details of the personal investment described In 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount None d. Provide details of the corporate investment described in 14 b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or. Equipment Loans Account Type Bank Name Amount Cash N/a checking Chase Bank $6500.00 e. Loan Information (Attach copies of all notes or loans) Name of Lender : -Address Term Security Amount None Oath of Applicant I declare under og-hilltv of Pedury that this aDDlication and all attachments are true correct and complete to the best of my knowledge. Authoriz re Print Signature Andy T Pillari Title CFO Date Lucky's Market of South Boulder, LLC 3.2 beer on/off premise license application Attachment to the DR 8404I — Andrew Thomas Pillari Question #5 List of residences continued: Street and number City, State, Zip From To 304 9th Ave La Grange, IL 60525 04/12 02/14 625 Bowling Green Ct Naperville, IL 60563 11/11 04/12 10025 W 29th Ave Wheat Ridge, CO 80215 04/09 10/11 DR 8404-1 (03/13/15) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant or Tavern class of retail license Notice: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business I Home Phone Number rou i�� ni r tion Lucky's Market of South Boulder, CO, LLC 2. Your Full Name (last, first, middle) s you have uc Gilliland, Patrick L Pat 4. Mailing address (if different from residence) Email Address pat@luckysmarket.com 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number City, State, Zip From To (:iirrant See attached Fort Lauderdale, FL 33304-4377 03/01/15 08/29/16 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To Lucky's Market Parent Company 6328 Monarch Park PI #100 Niwot, CO 8050 Owner/Mgr 04/02/13 08/29/16 Sunflower Farmers Market 2585 Central Ave., Boulder, CO 80301 Owner/Mrg 04/01/03 04/01/13 --7 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, ® Yes ❑ No furniture, fixtures, equipment or inventory to any licensee? (If yes, answer in detail.) I held an importers license that was surrendered this April 2016. 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you [:]Yes ® No applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) ❑ Yes ❑X No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) ❑ Yes ❑x No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes ® No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information re uired in question #13 is solei for identification purposes. 1 qM n�+A of Birth h qnr Al Carl irity Number c. Place of Birth d. U.S. Citizen ®Yes ❑ No f. When g. Name of District Court h, Naturalization Certificate Number i. Date of Certification J. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number e Color p. Gender q. Race r. Do you have a cu—n+ nriver's LicenseAD? If so, give number and state. I. Height m. Weight In. Hair ColorrBl 5' 10" White M White ®Yes El No tate Florida 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. • $ 6500.00 b. List the total amount of the personal investment, made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ None If corporate investment only please skip to and complete section (d) Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name. Amount N/A d. Provide details of the corporate investment described in 14 b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount Cash None Checking Chase Bank 6500.00 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount None Oath of Applicant I declare under penalty of peroury that this application and all attachments are true correct and complete to the best of my knowledge. Authorized r Print Signature Patrick L Gilliland Title Owner e Z"nk, Lucky's Market Parent Company, LLC the parent company of Lucky's Market of South Boulder, LLC 3.2 beer on/off premise license application Attachment to the DR 8404I — Patrick Laurence Gilliland Street and Number City, State, and Zip To From 2130 N Ocean Blvd #6 Fort Lauderdale, FL 33305-0000 09/01/2014 03/01/2015 1859 S Humboldt Street Denver, CO 80210-3333 02/01/2006 09/01/2014 DR 8404-1 (03/13/15) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant or Tavern class of retail license Notice: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "NIK. Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business . !/�/%%A TGFSOl1TN//0C1L1�E� C� LIP - Home Phone Number I r:a11u1ar Number 3. List any other names you have u Russ 2. Your Full Name (last, first, middle) /SADA) 4 4. Mailing address (if different from residence) Email Address 14 -� 5. List current residence address. Include any previous addresses w,..,,,, .,. .___ __ _ parate sheet if necessary) Street and Number City, State, Zip From To r:ivrent C/a CSE F 6_ List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To S T Tart/ ST, ,2,XA1 510,2.2 3 PPtsr0W4;9r- vA,D 2 Ql 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, Yes ❑ No furniture, fixtures, equipment or inventory to any licensee? (If yes, answpr in detail.) OFF/el-1-19F lJi Kfel T. 01L40/1/ GAOe)1A1 4 /G' S F.QG oG / 7"G G / 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you Yes El No applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) lit/ /T1-1 o STDszEs ,S-E/ZE iii V 6Ei1J vio�,� GG�4 XA DU. 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited El bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) YesNo 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a -g deferred sentence? (if yes, explain in detail.) ❑YesNo 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a. Date of Birth I b. Social Security Number C c. Place of Birth CO d. U.S. Citizen ZYes ❑ No f. When g. Name of District Court h. Naturalization Certificate Number I. Date of Certification j. If an Alien, GiveArien's Registration Card NumbeTe`manent Residence Card Number I. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race 1r. Do you have a curr-` ---1 i^oncpnn? If so, givvei number j�nd state. S-114 " / 7 D GK t� Q Al !tel C Yes ❑ No # State l,p�D/`b 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ 6, Soo. `= b. List the total amount of the personal investment, made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ /l%wltE * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount N1 d. Provide details of the corporate investment described in 14 b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount G A S H y O G 14FClc /N6� / e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount Oath of Applicant I declare under Penalty of Pedury that this aRplication and all attachments are true correct and com tete to the best of m k d e. Authoriz d Signat Print Signature Title Date DR 8404-1 (08/10/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303)205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant, Tavern and Lodging and Entertainment class of retail license Notice: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business Lucky's Market of South Boulder, CO, LLC Home Phone Number 3. List any other names you have u, Gordon, Monica, Jean 2. Your Full Name (last, first, middle) Games, Monica, Jean 4. Mailing address (if different from residence) Finail Address 1014 Vine St. Cincinnati, OH 45202 -il.com 5. List current residence address. Include any previous addresses v...., ,., .� .... _ , __. ,. (Attach separate sheet if necessary) Street and Number City, State, Zip From To Current 120 E. Freedom Way Newport, KY 41071 04/29/16 Cincinnati, OH 45202 12/28/15 04/28/16 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To The Kroger Co. 1014 Vine St, Cincinnati, OH 45202 Vice President 11/30/15 Fry's Food Stores 500 S99th Ave, Tolleson, AZ 85353 Vice President 03/13/13 11/29/15 The Kroger Co. 4111 Executive Pwky,Westerville,OH 43081 Management 01/02/95 1 03/12/13 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory to any licensee? (If yes, answer in detail.) El Yes ®No 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) El Yes ®No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) ❑Yes No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) ❑ Yes �fl No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes ® No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a. Date of Birth I b. Social Security Number c. Place of Birth Columbus, OH d. U.S. Citizen ®Yes ❑ No f. When g. Name of District Court h. Naturalization Certificate Number i. Date of Certification j. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number o you have a current Driver's LicenseAD? If so, give number and state. I. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race Wyes 5'9 1165 Brown Brown Female Black ❑ No 4 State Kentucky 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ $6,500 b. List the total amount of the personal investment, made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ $0.00 * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount None d. Provide details of the corporate investment described in 14 (a). You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount Cash N/A Checking Chase Bank $6,500 -F-1 I T e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Tenn Security Amount None Oath of Applicant I declare under enalt of periury that this aDOication and all attachments are true correct and complete to the best of m knowled e. t d Signature LM Print Signature Monica J Games Title I VP of Produce & Floral Date 09/23/16 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number 17 W. Vernon Ave #316 City, State, Zip Phoenix, AZ 85003 From To 06/01/13— 12/27/15 1225 Dobbins Dr. New Albany, OH 43054 03/07/01— 05/31/13 DR 8404-1 (08/10/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant, Tavern and Lodging and Entertainment class of retail license Notice: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business Lucky's Market of South Boulder, CO, LLC Home Phone Number I r:ellular Number 3. List any other names you have 2. Your Full Name (last, first, middle) Schlotman, John Michael 4. Mailing address (if different from residence) Finail Address 1014 Vine St., Cincinnati, OH 45202 jer.com 5. List current residence address. Include any previous addresses (Attach separate sheet if necessary) Street and Number City, State, Zip From To 303 Eden Ave., Unit 7A Crescent Springs, KY 41017 11/01/15 Bellevue, KY 41073 08/01/10 11/01/15 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To The Kroger Co. 1014 Vine St., Cincinnati, OH 45202 mgmt/CFO 10/26/85 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee None 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory to any licensee? (If yes, answer in detail.) ❑ Yes ® No 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) El yes ®No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) ❑ Yes ® No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) ❑ Yes ® No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes ® No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a. Date of Birth I b. Social Security Number e. c. Place of Birth Cincinnati, CH -7 d. U.S. Citizen Eid Yes ❑ No f. When g. Name of District Court h. Naturalization Certificate Number i. Date of Certification j. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number Do you have a current Driver's l irpncallD? If so, give number and state. I. ��{{e•�t rr�,�Weight In Hair Color o. ye Color p Gender q. Race 41yes 6' LiS gram 15lue �I w ❑ No State K' 14. Financial Information. a. Total puurchhaase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. b. List the total amount of the personal investment , made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ -0— ' If corporate investment only please skip to and complete section (d) Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount oome d. Provide details of the corporate investment described in 14 (a). You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount C.Asal n10"i E CheckLn Chas�"��•I<� !oma 0o.00 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount Oath of Applicant I care under Pem-altv of neriury that this anolication and all attachments are true correct and complete to the best of my knowledge. --]Print ut rized S' nat Signature ��""� S Allcl jg �C/h/oT/YfGfil� Title Mna e( Date -xM DR840 -1 t(.03l0311�j COLORAD13 DEPARTMENTOF REVENUE Uquor;En, fDri:emerd DMiinn Individual History �Record To be completed .by the following ;pe.rso.ns„ as applicable: sole proprietors; general partners regardless of percentage ownership;, and l mr Jted partners ,n;*rn;i.an 1 nD/, Qr erre o4f?hp partraersship; �I pdrnriva1 afurs ofi a co!pnratJor, a!I id re_rLor= aafi a �rrpmraiinri. ar!� ani stocKholder,ofarnrporation Dwfting 1D%o,or;more,ofth e,outstand.in,g.stock, imanaging rmembers or,officers ofia lirraited liability comparry, ar?dp.:n s�v�r:nn 1,n�1,r�r snore ,ofitha coram;, anJ anar i nL�raded reg;'ed Rnanaanr,of nQ! r3d ?estate antn�avarn :cuss sof reta; 10- i H;any you ever been convicted of a crime or received a suspended sentence, deferred sentersce, ,Drfr;rWAed Yes ;*j bail for yoffenseincriir:6inal or iridifftary,court ordo you :have any &argespending? (If yes, explain in dew.) '11 Are -.yououTrentlyunde.rprobation parole, or complefing the requirements of a deferred sentence? (If eyes,, ex ain; detail.:) Oyes 0 .pl in 12. Have y o, u :eves bad any , professlan al 11cen-se sris. nd e d, Te. 0". ked, or d e r,-;e d ? (3f yes ex plal n in detail {es No PwsolrW and Financial Info-mation Unless ,ortherwise Provided bylaw., the personal information raqLfired iraquestion #a8 ug be healed as confidential- The persond information irequired Jin question #13 is solely ,for Rderitificadia npurposes. I o nate of birth i I D_ Social So C U afty NU Mb Of c. Place of Bidh rA% V4"r7 MD d.U.S.Ciften KYes IONo 1. When :g. !Name :of District Court h. Naturalization Cerfificate?.NuMber {.L Date .of Certificafion I I j. Itfan Mien,,Give Aften's Registration Card INuniber k. I ermanerd Residence Card Number U.Metght 11 m. Weight In. flair Color o. Eye Color Ip.Gender Iq f.90you bave a awe-' Race rwwpek Ucense/ID? if sogive numberand state.! 7"L'd 14 D Wes ONo 4 -2State' 60 14. [Financial Information. a. Total 7 purchase i 'ice 10.1' i'mvestinent belmq made by the entity,, corporation, paftnem-Np, Jhnded1'C_'btTfty company, other. b. 'List the lotal amourdoffhe,,personW;investment ,made by the person fisfted on queston#Z indais business including any -notes, Wns, cash, senfices,ar eqtApment,operating capital, stock purchases or flees paid. If cotporEde investment only please skip 1.o and complete section {d) Section b should neflectthe itcAalof sections Fc and e c, Pravide -detiaMsof the personal kwa_'merit bescdbed in 14b- You Tpust acommi for all of the sources of thisi-in. vestment (Attach a separate sheet ,if needed) Typ*; Cash, serweasor w'Pr.wnt_ Acwtalt Type link Armunt d. Prmdde det-Mls tf thevarporate fiaysstrnenl described in I4 b. Yau m. rt ,account for all of the sources of INis ims-stment (Attach a separate sheet if needed) Type: Cash, SeWicas or Equ4mwnt Loans A=a.=t Type BaTik Ham Ainviml A-- I.e. LIDan lrif�tkx) (Attach;ccvjes of 21 volas vr)nans) of Lend[37 Address Term Samr.-I&y j Aamunt 081h of APPIW.Int VP ;'re hrn Fj aT.d all atladwen'"t le, trxrpc.� 6e beSt Of My tZgg�o� _V [ LAVL_ 3 MPS ER C1,117%, Oh Ft(?U111WR t ENTRACL LICb NS1NC AUT1I012ITY ZONING / PLANNING C:ONF''1RRIATION PHIOR 7'O JAC EN E APPIACAT1OlN 1.iquurUccitsc Annlicant C:ontnictes Tan Portion: Applicnnl: Luck's Market of South Boulder, CO, LLC Trndc Mune: Lucky's Market Applicant phnnc: _308-5m— Applicant finntil: _wendyp@luckysmarlcet.com Premise Adilrcy, 695S Broadway, Boulder, C080305 Indoor premise Square J:uologc: 37557_ OUldttal Polio Square I:oulagc none Approved Indoor Nrumisc: 60, and Outdoor Pntiu: none. Uccupancy Lnad/Senliug Capacity I•Inul•s of Clpctolinn: 7:00 a.m. to 10:00 p.m. l X7 New 1_11ltntsl'61- (_j h4oditicalion, I iquor LicenseTYpu: 3,2 P= ou/4p Wrilsi-51-21 Applicant's Signaturc: -9 Applicant's Printed Name: Andy T Pillari _ Responsive to C.R.S. 12.47-313(1) anti (I)c which 610105 in perlinenl part, "(1) No application fur the itisututce of any l iceltse... sliull be received or acted upon ...(c) For a location In an nren where the sale of alcohol beverages its contemplated is 1101 permitted under the applicable zoning lows or the municipality, city and county, or county..." and Beverage Licensing Authority Rules of Procedure, Subsection 5-1-1 (e) available at: hlllUlivmw.huuldelealoladu Ln1'/files/C'It rl /LICel1CIR1lIt111CS°lu7ttOl'In2q'muYh,r „,tr Applicant should bring flits sheet AND PROPOSED PRCDiISG DIACIIAM camplying with Ri,A Itule Seetlon 3-3 of seq. to Licensing Clerk for the use of -Boulder Planning and Zoning of 1739 Broadway-i'nrit Centt•sil Building, 3rd Floor, 303441-1880 to address Ih0 four below questions. NOTF?: This reviciv is for zoning purposes only and is not approval for tiny change oroccupauey or use pertaining to the building code. A separate building permit is required for building roodlFlea tioits, including n 01iinge of tts0 or occupancy. —L YES/NO �-eti Y6 /NO VIt YES1 NO Planning and Zoning Department Cunlplctcs Bolton, Portion: Is the Use at the Site Allowed'! l Cominents/Limilations: ��c_tS�.�es� — [e.�..,..ti�,�-� � ��C- z � ��� � Dist• Docs the Use Require a Use Review or Site Review! Comments: If Use/Silc Review is required has is Use Rcvic%v/Site Review boon np 10.0 2 Comments (such as Case Number/ Date of Approval):.4t2k Zeis- / 'e / /- Z 7-16 Arc there any zoning restrictions or conditions of approval on tic property YES/NO that would prevent this property from being open from tic hours of 7:00 ata to 2J)0,1111'! Commenlyi,17 talions: _ Planner's Signaltirmc t / Planner's Printed Name Z3 —14P I'lanncr's')'iUc Planner's Signature Daic Rev. 09/11 CITY OF BOULDER "1AIM) Planning and Development Services 1739 Broadway, Third Floor • P.O. Box 791, Boulder, CO 80306-0791 phone 303-441-1880 • fax 303-441-4241 • web boulderplandevelop. net August 5, 2016 BAUEN STUDIOS LLC 2 W DRY CREEK CIR #100 LITTLETON, CO 80120 RE: Letter of Completion Job Site Address: 695 S BROADWAY Permit Number. PMT2015-04908 Description of Work: Tenant interior remodel to convert former mercantile space into a grocery store (Lucky's Market). Dear Property Owner or Contact of Record: This is to notify you that our records indicate the above referenced project is complete and all required final inspections were approved. The project is in compliance with the minimum standards as required by Boulder Revised Code, 1981, Chapter 10, and other applicable local building code regulations. Please retain this Letter of Completion for your records. Sincerely, Panning� elo me Services Staff 33� Q g y3� aaaaaaaaa � a�a'a°d sEiilC �£"'igL°i��£��[� wwG7iJwC1wIu a� a ��o LLI H fl� Hum � m° � 1 a WO ,G1O011`2 H 11 0 0 a°43 LLI o '� W LLI LLIo 0 �o 4� ,IS) 4 � 4 U m a ��o LLI H fl� Hum � m° � 1 a WO ,G1O011`2 H 11 g@ a°43 W '� W QQyy 0 4� g@ a°43 W '� W QQyy 4� O O N �� 33 qggggqqq 59gg996y6y p 1111 .•e E4E��49�Es�E%ES It 49 g 9 gigsF� 5 ;,bill a t N 1 17 m CITY OF BOULDER BEVERAGES LICENSING AUTHORITY STATEMENT OF TRAINING The applicant hereby states that he/she understands the importance of being familiar with and complying with the Colorado Liquor Code and the Colorado Beer Code. ' Therefore, with respect to applicant(s), management and all other employees who will have any connection or involvement with liquor or fermented malt beverages on the subject premises of this application, the applicant(s) state(s) the following: All employees involved in the service of alcohol, including, without limitation, managers, clerks, bartenders, and waitpersons, shallattend astate-certified Responsible Vendor alcohol serviceclass within three months from the approval of this license. New employees shall take aclass within thne months oftheir hire. Any employee participating in aTastings musthave already completed a state - certified Responsible Vendor alcohol service class. Training Certification must remain current for employees involved in the service of alcohol. The applicant agrees that the above mentioned training shall be a continuing condition of the license if the Authority approves this application. Oath of Applicant I declare under penalty of perjury in the second degree that I acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor and Beer Codes and all City of Boulder rules, regulations and codes which affect my license. Lucky's Market of South Boulder, CO,LLC, Applicant -1)Q o5��� �-� A thori• ed Signature Lucky's Market Trade Name Jason B Sharon CEO, Manager An')16 PrintName,Title& Date Oedipus, Inc. Empirical Data Services 7 November 2016 PETITION & TELEPHONE SURVEYS Liquor & 3.2 Beer Licensing Rezonings Opinion Poll Venue Special Tax Districts LIQUOR LICENSE SITE & ECONOMIC ANALYSIS RECORD/RECEIPT OF DELIVERY Please acknowledge receipt of delivery. Thank you. I verify I received the following document from Oedipus, Inc. as follows: Envelope Addressed To: Ms. Beata Mazurkiewicz, Licensing Spe6ialist-7 City Clerk's Office, Boulder 1777 Broadway Blvd., Boulder, CO 80306 Re: Lucky's Market of South Boulder, CO, LLC, dba Lucky's Market 695 S. Broadway, Boulder, CO 80305 Retail 3.2% FMB License, On/Off Premises Consumption Enclosures: Two (2) + 2 Copies Original Report + 1 Copy Summary Letter Affidavit of Posting with Photographs Package Via:II HAND DELIVERY Date Delivered: 1b Time :, , I&A11f�TR11� PrintedNW r Title/Position: �Mwj �W ©0edipl[s,Th1 Inc., P.O. Box 1012, Lafayette, CO 80026 Tel. (303) 661-0638; Fax. (303) 604-2862 exleg@comcast.net Oedipus'Inc. Empirical Data Services 7 November 2016 Ms. Beata Mazurkiewicz, Licensing Specialist City Clerk's Office, Boulder 1777 Broadway Blvd. Boulder, CO 80306 Lucky's Market of South Boulder CO, LLC, dba Lucky's Market 695 S. Broadway, Boulder, CO 80305 Retail 3.2% FMB License, On/Off Premises Consumption Dear Ms. Mazurkiewicz, P.O. BOX 1012 LAFAYETTE, CO 80026 303 661 0638 303 604 2862 FAX • PETITION & TELEPHONE SURVEYS Liquor & 3.2 Beer Licensing Rezonings Opinion Poll Venue Special Tax Districts • LIQUOR LICENSE SITE & ECONOMIC ANALYSIS Find enclosed two (2) petition packets circulated by Oedipus, Inc. (businesses and residences) together with our Report and an Affidavit of Posting with photographs. Generally, our results are: Retail 3.2% FMB License, On/Off Premises Consumption 159 Signatures Favoring Issuance / 6 Deleted Businesses: 26; Residences: 133 13 Signatures Opposing Issuance / 2 Deleted Businesses: 3; Residences: 10 172 Total Signatures / 8 Deleted I will be attending the upcoming hearing scheduled for the 16' of November 2016 at 3:00 p.m. to testify on the survey methodology and results. Should you have any questions in the meantime, please call. Respectfully, Tina L. Scott Oedipus, Inc. Encl: Two (2) Petition Packets + 2 Copies Original Report + 1 Copy Affidavit of Posting with photographs cc: Renee Miller, Paralegal, Foster Graham Milstein & Calisher, LLP Wendy Petrillo -Rundle, Paralegal, Licensing Specialist, Lucky's Market Via: Hand Delivery ©Oedipus, Inc. AFFIDAVIT OF POSTING Applicant: Lucky's Market of South Boulder CO, LLC Trade Name: Lucky's Market Address: 695 S. Broadway, Boulder, CO 80305 Type of License: Retail 3.2% FMB License, ON/OFF Premises Consumption I, TINA L. SCOTT, hereby confirm the following: 1. The above referenced premises was duly posted with a Notice of Public Hearing pursuant to the local licensing requirements of the City Clerk's office of Boulder. 2. This posting was performed by Oedipus, Inc., on 3 November 2016, as evidenced by the photographs of posting attached hereto. FURTHER THE AFFIANT SAYETH NOT. TINA L. SCOTT STATE OF COLORADO ) ss. COUNTY OF BOULDER ) Subscribed and sworn to before me this 4' day of NOVEMBER , 2016. MAX J SCOTT Notary Public State of Colorado Notary ID 19904013814 rMy Commission Expires Dec 16, 2018 NOT RY PUBLIC Max J. Scott P.O. Box 1012, Lafayette, CO 80026 o0edipus, Inc., P.O. Box 1012, Lafayette, CO 80026 Neighborhood Needs & Desires Petition Summary Applicant: Lucl.t.'s Market of South Boulder CO LLC Trade Name: Luch's Market Business Location: 695 S Broadway Boulder. CO 80305 Occupancy: 60 Square Footage: 37557 Business Description: Luck -,,'s Market is a grocery store that is applying for a 3.2% On/Off Premise ttJpe liquor license that will allow customers to purchase 3.2% beer for consumption both on and off premises, allowing them to purchase a beer while they shop for groceries Operating Hours: 7:00 AM —10:00 PM Monday th_ru Sunday, 7 days a week License Type: New 3.2% On/Off Premise type liquor license Same # of Licenses in area: 1 Date(s) of Petitioning: NOVEMBER 1, 2, 3 & 4, 2016 Defined Neighborhood: North: Dartmouth to Broadway to 27th to H,,vv 36 South: City Limits East: Hwy 36 to Moorhead Circle Extended West: City Limits Total Contacts: 352 Not at Home: 154 Not Qualified: DELETED 0 SIGNATURES 8 Refuse to Sign: 18 MISCELLANEOBS OPPOSING 5 Needs & Desires Already Met: 1 COMMERCIAL USAGE OBJECTIONS 2 Religious Objection: 0 Remained Neutral: 0 Alcohol Usage Objections: 2 NEEDS NOT YET MET 159 No Reason Given: _ TOTAL # IN FAVOR 159 TOTAL # OPPOSED 13 TM Oedipus; Inc Empirical Data Services Lucky's Market of South Boulder CO, LLC dba Lucky's Market 695 S. Broadway Boulder, CO 80305 Retail 3.2% FMB License On/Off Premises Consumption Oedipus,' -"Inc. 303 6610638 • FAX 303 604 2862 • P.O. BOX 1012 • LAFAYETTE • CO 80026 9 www.oedipusinc.com Oedipus'Inc. Empirical Data Services 16 November 2016 Local Licensing Authority Boulder, Colorado Re: Petition/Opinion Poll to Determine Needs and Desires of the Defined Neighborhood in the Application of: Lucky's Market of South Boulder CO, LLC, dba Lucky's Market 695 S. Broadway, Boulder, CO 80305 Retail 3.2% FMB License, On/Off Premises Consumption PETITION/OPINION POLL PROCEDURE P.O. BOX 1012 LAFAYETTE, CO 80026 303 661 0638 303 604 2862 FAX • PETITION & TELEPHONE SURVEYS Liquor & 3.2 Beer Licensing Rezonings Opinion Poll Venue Special Tax Districts • LIQUOR LICENSE SITE & ECONOMIC ANALYSIS Under the direction and control of Oedipus, Inc. management, the Oedipus, Inc. employee was briefed on the application. The employee carried a clipboard with the following: A. Two maps of the area, one of which was provided by the City Clerk's office of Boulder, denoting the proposed location of the license and defined boundaries and a list of similar type licenses within the defined neighborhood, all attached hereto and made part of this Report; B. Petitions provided by the City Clerk's office of Boulder allowing individuals contacted to indicate their opinion with instructions and qualifications for signing; C. A stat sheet to record the opinion of those not signing and not -at -homes. 2. This petition/opinion poll was performed on Tuesday and Wednesday, l and 2 November 2016 (businesses), and Tuesday, Wednesday, Thursday, and Friday, 1, 2, 3 and 4 November 2016 (residences) within the neighborhood defined by the City Clerk's Office of Boulder as Dartmouth to Broadway to 27`h to Highway 36 on the North; City Limits on the South; Highway 36 to Moorhead Circle Extended on the East; and City Limits on the West (see maps). The circulation packets have cover maps, and the areas in which each petition circulation/polling took place are outlined in highlighter. Included in this Report is a master circulation map outlining all areas where circulation/polling was conducted. 3. Individuals were contacted on a random sampling basis, were screened to identify them as parties in interest, and were asked their opinion after they had been informed of the applicant, site location, and type of license being applied for. Their opinion was either recorded on the petition format or on the stat sheet. 4. Two (2) petition packets, one packet representing businesses and one packet representing residences, together with a Summary Letter, this Report and Affidavit of Posting with photographs were prefiled via hand -delivery on 7 November 2016 with the office of Ms. Beata Mazurkiewicz, Licensing Specialist, to comply with the prefiling deadline. ©Oedipus, Inc. Local Licensing Authority, Boulder, Colorado Page 2 Re: Lucky's Market — Retail 3.2% FMB License, On/Off Premises Consumption 16 November 2016 PETITION/OPINION POLL RESULTS 1. Total Doorknocks: Not -at -Homes and/or Business Owners/Managers Not Available 154 Not Qualified to Sign 0 Preferred to Not Participate 18 Parties in Interest that Participated 172 Deleted Signatures 8 Total Base Figure 352 2. Oualified Contacts: A. Signatures and Those Not Signing Signatures Favoring Issuance 159 Businesses 26 Residences 133 Not Signing/Favoring Issuance 0 Signatures Opposing Issuance 13 Businesses 3 Residences 10 Not Signing/Opposing Issuance 0 Total Contacts 172 B. Breakdown of Reasons of Signatures in Opposition: No Need 1 Abhorrence of Alcohol 2 Religious Objections 0 Usage Objections 2 Miscellaneous Reasons 5 No Reason Given 3 Total Signatures 13 Oedipus;"Inc. 303 6610638 • FAX 303 604 2862 • P.O. BOX 1012 • LAFAYETTE • CO 80026 • www.oedipusinc.com Local Licensing Authority, Boulder, Colorado Page 3 Re: Lucky's Market — Retail 3.2% FMB License, On/Off Premises Consumption 16 November 2016 C. Breakdown of Signatures Favoriniz and ODUOsinE: Favoring Issuance (Based on Needs/Desires) 159 = 92.44% Signatures 159 Not Signing 0 Opposing Issuance (Based on Needs/Desires) 1 = 0.58% Signatures 1 Not Signing 0 Abhorrence of Alcohol 2 = 1.16% Signatures 2 Not Signing 0 Religious Objections 0 = 0.00% Signatures 0 Not Signing 0 Usage Objections (Commercial, Traffic, Parking, Crime) 2 = 1.16% Signatures 2 Not Signing 0 Other Miscellaneous Reasons 5 = 2.91% Signatures 5 Not Signing 0 No Reason Given 3 = 1.75% Signatures 3 Not Signing 0 Total Base Figure 172 = 100.00% 3. Needs and Desires Si ng atures: Signatures Favoring Issuance (Based on Needs/Desires) 159 Favoring Issuance/Not Signing (Based on Needs/Desires) 0 } 159 = 99.37% Signatures Opposing Issuance (Based on Needs/Desires) 1 Opposing Issuance/Not Signing (Based on Needs/Desires) 0 } 1 = 0.63% Total Base Figure 160 = 100.00% The petition packets are presented as follows: Cover maps, petitions, affidavit, list of other license. #1 & #2 / Mark Steffek / Businesses & Residences 0edipus,71nc. 303 6610638 • FAX 303 604 2862 0 P.O. BOX 1012 9 LAFAYETTE 9 CO 80026 9 www.oedipusinc.com Local Licensing Authority, Boulder, Colorado Page 4 Re: Lucky's Market — Retail 3.2% FMB License, On/Off Premises Consumption 16 November 2016 CATEGORIES OF SIGNATURES IN OPPOSITION NN NEEDS & DESIRES CRITERIA: Individuals opposed to the license application based on needs and desires criteria per the Colorado Liquor/Beer Codes (currently existing licensed establishments of a same or similar type of license now located within the defined neighborhood are meeting the reasonable requirements of the adult inhabitants of the defined neighborhood at this time). NON NON -USAGE OF ALCOHOL / ABHORRENCE OF ALCOHOL: Individuals opposed to the license application because they do not drink alcohol beverages, do not approve of alcohol consumption, and/or abhor alcohol. RO RELIGIOUS OBJECTIONS: Individuals opposed to the license application based on religious beliefs/reasons. OBJ USAGE OBJECTIONS: Individuals opposed to the license application because of their fear or concern for the potential of parking problems, traffic problems, crime, noise, littering, undesirable people drawn to the area, loss of property value; or individuals who opposed this type of business or applicant, any type of commercial usage in the neighborhood, any new growth in the neighborhood; or, individuals who think this type of business (if issued a liquor/beer license) should not be located near a residential neighborhood, church, or school, etc.; or, individuals who opposed because they are against any alcohol service at this type of facility, location, or atmosphere; or, individuals who favor the service of beer and wine but oppose the service of distilled spirits (on H&R applications). MS MISCELLANEOUS OBJECTIONS: Individuals opposed to the license application for other miscellaneous reasons to include: fear or concern for the possibility of drunk drivers in the area, fear or concern of resulting behavioral problems, individuals who would purchase alcohol beverages then drink and drive, sales to minors/underaged drinking, the location becoming a teen hang-out and the problems that can arise from this, and the effect it could have on family values or their family in general because they have young children or teens; or, individuals who opposed because competition is not desired or how said business may affect the livelihood of existing businesses; or, individuals who compared the "needs and desires" criteria to existing licensed outlets other than the type of license applied for. NR NO REASON GIVEN: Individuals who preferred to not state a reason for opposing. Oedipus;"Inc. 303 6610638 • FAX 303 604 2862 • P.O. 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Vrooa.p e bU r `� \ W?Es- fr oO� oar Creek lR Research c 1 for �QQ.�Parb� R ` cq �qU GYA 1 Atmospheric 7 � � � �. yAR p tr�0009- K6L.x i�S� Research CIR/y� C4 (M1 00 �K nn A3Np OR \� N 0 3�jh�,.��•°�At F�2o,�, I �-'.'a-t ��-�' �l� �, t_—,� V—'�h` Platte r o of J e�vT11dV@iY�� L_ ,7� a 1 Middle FSchool.1- -c !R l� 8 '� FANO Elom. ®Fairview High SC 01 Q " P School0 ' f1ElbECBl7t 9tit a, /� �` �' a JAS eEAFl�i7N. aq lLali GfcWENBBm .. \ • �YrrA, LJAIE 0 — BUSINESSES O as RESIDENCES APPLICANT/TRADE NAME: LUCKY'S MARKET OF SOUTH BOULDER, LLC, dba LUCKY'S MARKET SITE LOCATION: 695 S. BROADWAY, BOULDER, CO 80305 APPLICATION FOR: RETAIL 3.2% FMB LICENSE, ON/OFF PREMISES CONSUMPTION To sell 3.2% beer for consumption ON the licensed premises only - NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES. To also sell 3.2% beer in sealed containers as a grocery item, to be consumed OFFthe licensed premises only, and licensee may deliverat retail fermented malt beverages in sealed containers In conjunction with delivery of food products] Neighborhood Map for a New 3.2% On/Off Premise Liquor License (_ Lucky's Market - 695 S Broadwav Applicant: Lucky's Market of South Boulder, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On/Off Premise NORTH 1 inch = 1,750 feet City of -�/,7�� Boulder The information depicted on this map is provided as graphical represenlatlon only The City of Boulder provides no warranty expressed or impiued as to the accuracy and/or completeness of the nfoumahor: contained hereon BUSINESS PETITIONS ' I I I __r wnc,ar,,,m Flcmmg 0 I}�' I I 4CTP:�•. 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LUCKY'S MARKET OF SOUTH BOULDER, LLC, dba LUCKY'S MARKET SITE LOCATION: 695 S. BROADWAY, BOULDER, CO 80305 APPLICATION FOR: RETAIL 3.2% FMB LICENSE, OWOFF PREMISES CONSUMPTION To sel13.2%beer for consumption ON the licensed premises only - NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES. To also sell 3.2% beer in sealed containers as a grocery Item, to be consumed OFF the licensed premises only, and licensee may deliver at retail fermented malt beverages in sealed containers in conjunction with delivery of food products] 1 Neighborhood Map for a New 3.2% On/Off Premise Liquor License Luckv's Market - 695 S Broadwav Applicant: Lucky's Market of South Boulder, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On/Off Premise 1 inch = 1,750 feet City of Boulder The information depicted on this map is provided as graphical representation only The City of Boulde provides nowarranty expressed or imp: ad as to the acawracy and/or completeness of the nformatxx, contained hereon v v u a u H_ o 'V (�l 0 O ;- a o -a v p N C }~� C � C � G M v • ti ai p r .� 0 o G .N �• o r u v y^. bA O N O •� L', v C � ^ . 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IL L � Broad 27fh W % ar �i-F --- �'4 O Ly Lu t� S,T- NOA O a F / Green Mtn. \� lir ' Cemetery Nati anaII's I,ute of%S na dards .LC j NIST - NOAA�\ 1(arid,Technology Highland ", National��"�6�� b90 iS7?F!F Center GO HOWARD National for ��� Bear c°+� p Greek Atmospheric' T@ \E.S. to Go, t f r Research ��/}ta k or reek JAtmospheric bW00 OR Research �' wodb Eleresa n �Q School •� Jw BEA IYN. DR � al I gRIA IF71liants 1 ge Vlllega S. . 36 c N a psco, Inc. I Gj 4-1, eorge Reynold, 0 Branch' f Library r-�11/ Table Mi Oontessor Elam. p 93 Platte r Middle Sch �p 1 ViC 7 y�♦Fairview High T ryF I,Lak 61aE9BBTAfl w� �gI rTREq. ` y� � .q J� tP Alt, or 01 , Tdbr Masi al. -Tan-11i: d� Meadovva S.( Meadow, • Breneh Lib C ) z JPA IS •' � I APPLICANTITRADE NAME: LUCKY'S MARKET OF SOUTH BOULDER, LLC, dba LUCKY'S MARKET SITE LOCATION: 695 S. BROADWAY, BOULDER, CO 60305 APPLICATION FOR: RETAIL 3.2% FMB LICENSE, ON/OFF PREMISES CONSUMPTION To se113.2%beer for consumption ON the licensed premises only — NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES. To also sell 3.2% beer in sealed containers as a grocery item, to be consumed OFF the licensed premises only, and licensee may deliver at retail fermented malt beverages in sealed containers in conjunction with delivery of food products] Neighborhood Map for a New 3.2% On/Off Premise Liquor License Lucky's Market - 695 S Broadwav Applicant: Lucky's Market of South Boulder, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On/Off Premise A& NORTH 1 inch = 1,750 feet City of " � - 't Boulder The inform at' an dep,cted an this map a provided as graph -Cal representat=on only The Cdy of Boulde, provides no warranty expressed or Impied as to the accuracy and/or completeness of the nfonnalbn contained hereon k 4 v a,rr, N O •= 4-4 0 Ln r - cri cs U O M O O Q R ((mo�o C O 0 u O OEn v N U L4 O rz �N. u �P-4 CT' u > q v U > o des OV. Uv 41 U O ri 0cl w c a z L 4J U ° CV v C r jF xt r .^ r ► �S v zO CJ .. 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Dear Liquor License Applicant: Before approving a liquor license application, the Beverage Licensing Authority (BLA) must consider the reasonable requirements of the neighborhood and the desires of the adult inhabitants as evidenced by petitions, remonstrances, supporting witnesses or other evidence submitted by the applicant and by residents and business owners/managers of the designated neighborhood. Although the law does not require that an applicant petition the neighborhood, it is the most common form of evidence presented at BLA application hearings. Enclosed you will find a blank Business petition form, Resident petition form, Petition Summary, Neighborhood Map, Existing Licenses List, and an Affidavit of Circulator. You will need to make copies of all enclosed documents including color copies of the Neighborhood Map. You will need to make sufficient copies of both the Resident petition form and the Business petition form to collect the signatures necessary to prove to the BLA that application approval is in order. The BLA does not specify a certain number or percentage of signatures that must be acquired; they do expect to see that a good sampling of both residences and businesses in the neighborhood was obtained. Petitions must be circulated within the neighborhood boundaries established by the BLA and outlined on the Neighborhood Map. Each door to door petitioner must carry and show at the door a color copy of the Neighborhood Map and a copy of the Existing Licenses List along with blank signature pages of both the Business petition and Resident petition forms. An individual signing a petition must include his or her first and last name. Each signature and accompanying address must be legible. For resident petitions, all persons signing must be at least 21 years of age and reside in the defined neighborhood. For business petitions, all persons signing must be at least 21 years of age and own and/or manage a business in the defined neighborhood. Each petitioner who has collected petition results door to door must submit a signed and notarized Affidavit of Circulator. Failure to affix a completed affidavit of circulator, including notarization, may cause petition invalidity concerns to be raised by the Authority. Petitions circulated outside the neighborhood boundaries shall not be considered. Please also note that only door to door petitions will be considered by the BLA. If the BLA determines that the petitions submitted are insufficient to support a finding that: (1) the reasonable requirements of the neighborhood establish a need for the issuance of the requested license, and (2) that the desires of the adult inhabitants dictate the issuance of the license, the BLA may either deny your application or continue your hearing an additional month or more to allow you time to conduct more petitioning. As such, full adherence to these procedures, completion of petition documentation, sufficient signatures collection, and timely submittal of petition results is important for your license application. At the conclusion of petitioning, please complete the Petition Summary and submit with your petition materials and affidavits of circulator to the City Licensing office. Your petition materials are due in our office by 5:00pm on Monday, November 7, 2016. P.O. Box 791 1 1777 Broadway, Boulder CO 80302 1 bouldercolorado.gov 10: 303-441-3040 Neighborhood Needs & Desires Petition Summary Applicant: Luc4's Market of South Boulder CO LLC Trade Name: Lucky's Market Business Location: 695 S Broadway, Boulder, CO 80305 Occupancy: Square Footage: 37557 Business Description: Luc4's Market is a grocery store that is apply:tng for a 3.2% On/Off Premise type liquor license that will allow customers to Purchase 3.2% beer for consumption both on and off premises, allowing them to Purchase a beer while they hop for groceries Operating Hours: 7:00 AM —10:00 PM Monday thru Sunday, 7 days a week License Type: New 3.2% On/Off Premise type liquor license Same # of Licenses in area: 1 Date(s) of Petitioning: Defined Neighborhood: North: Dartmouth to Broadway to 27th to Hwy 36 South: City Limits East: Hwy 36 to Moorhead Circle Extended West: City Limits Total Contacts: Not at Home: Not Qualified: Refuse to Sign: Needs & Desires Already Met: Religious Objection: Remained Neutral: Alcohol Usage Objections: No Reason Given: TOTAL # IN FAVOR TOTAL # OPPOSED C) o' O 0 F -D —g z n gd z N ° ° q' O �..� r� rD Z , d a y°- Un-, . y p f/1 N p1 N CrJ M O'- " o O O n- n o F � d r., or`o� n fD r n° pz rD 0 0 ° n 0 n C7�0 = p a.abb ~' o' •d a ( rD cb N N x z y �• O N• � 0' OPV cin Ci �, n 'L7r, f• p tzZ'J � � 0 m � b O o G N N a CD n Z ���o. 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N n n rd rD C �n .d wN o o 0 It. rD E' 9 �' N cn ° . y c O O N ITI p W N O rl Ln G trd D Ln �, o ht rD 5 0 It H O z V) h�7 c^ �n � 5. c a o rb 4,z n '< C! ccnn CD C) °o opo c ; N -+ O a � D O Z L v c Z c 0 o W � �m w 0 0 vi H N c M n v N a C) �-' m rn A m w �D N -i C:) m N v N m o y m rn w M W ro (D I O m m 3 E' m � a N m -0 D M r L^ m w w C3) O C) D a � v -Z F = rD CA m 0 v � o nD o Z of — ro' Affidavit of Circulator I, , do hereby certify that I was the Circulator of the attached petitions and further, that I personally witnessed each signature appearing on the petitions. To the best of my knowledge, each signature thereon is the signature of the person whose name it purports to be, each address given opposite each name is the true address of the person that signed, that each person who signed the petition had the opportunity to read, or have read to them, the petition in its entirety and understood its meaning. All of the undersigned were shown the map and list provided by the City of Boulder's licensing department. I also affirm that no premises, threats or inducements were employed whatsoever in connection with the presentation of this petition and that every signature appearing hereon was given freely and voluntarily. Circulator's Name: Circulator's Signature: Circulator's Address: State of Colorado } ss. County of Boulder } Subscribe and sworn to before me this day of , SE Notary Public My Commission Expires: Opposition toLucky's Market 3.2 Beer License Application Contents NOV 7 RFS D 1,2- Pettyjohns background 3- SB 16-197 RE: 3.2 Beer 4,5,6- Population growth of the neighborhood 7- existing full-strength beer licenses in the Table Mesa Shopping Center 8,9- Lucky's petitions 10,11- Pettyjohns petitions 12, 13,14, 15- Violation history n n • Pettyjohns Liquor and Wine, founded by the Pettyjohn family, opened December 1969 • Ann Coppinger bought Pettyjohns in 1997 after working there since 1978 • Pettyjohns is a member of: 1. The Responsible Hospitality Group 2. The Boulder Chamber of Commerce 3. The Colorado Licensed Beverage Association • Pettyjohns is an active and responsible member of it's community. In 2016 it sponsored or contributed to: Flatirons Climbing Council, Summit Middle School, Boulder Junior Cycling, High Peaks Elementary, The Parent Engagement Network, The Therapeutic Riding Center, Zonta Foothills Club, Mountain View Preschool, The YWCA, Danse Etoile, The Shining Waldorf School, Boulder County 4-H, and The Boulder Valley Humane Society. Pettyjohns is a responsible alcohol retail store. We employ the BARS Program monthly with at least two visits per month. cl) 0 -- -K C--- Pa - CQ New Colorado Law Allows Full -Strength Beer Phase - In At Groceries. DENVER (AP) — Colorado Gov. John Hickenlooper signed a bill Friday to gradually allow grocery stores to sell full-strength beer, liquor and wine, making the biggest change to state liquor laws since the end of Prohibition.Jun 11, 2016 SB 16-197 Starting January 1, 2019 Say Goodbye to 3.2 Beer The new law treats beer differently than wine and distilled spirits. Currently, Colorado is one of just five states (including Kansas, Minnesota, Oklahoma, and Utah) with a 3.2 percent beer provision. Starting in 2019, licensed grocery and convenience stores can ditch the 3.2 beer, which has a lower alcohol content, and start selling full-strength brews without restrictions. 30 S K=*�Co i`�.GSYSE I Rank 61 ^ R�.� Local Data Search Search State, County, City Zip Code or Area Code Colorado Population Growth Rate Zip Code Rank A total of 516 results found. 80305 is ranked #329 with the Population Growth Rate of 0 4301- Show Results on Map - Pick a Topic to Rank: I]+ Popular Topics O EwAkti4n and Races Elncom and Careers O�iousing E Crime, Weather. etc. Selected Ranking Topic: Population Growth Rate Pick Your Location: • Within a Location State Rank within a Distance of a Point Rank By: Zip Select Date of Data: American Community Survey 2010-2014 Limit to Locations with Population: to (number only can be blank) Submit Popular Rankings Fa ltg / Sim Growing States in U.S. RQ3 / Mkml States in U.S by % of Males Employed Best /Worst States in U -S. by % of Females Employed Bir 3 / Wgrst States by Crime Rate in U S R`ches/ _PWr,6 States by Income in U S. Most Exc emm / QheApest Homes by State in U S Most / Least Educated States in U S Most/ lead Populated States in U.S Larggg; / Smalles States by Area in U.S Riches / Poorest Counties by Income in U.S. F,4§tom / Slowest Growing Counties in U S Most / Least Educated Counties in U.S. Ypunoest / Oldest States in U.S. Y12"i t / 21Qe.SI Counties in U.S. Population Growth Ratg Rank V Zip / Population 1. 3,750-82% 8001 s /2.349 2. 1,142.70% 80422 / 4.424 3. 515.05% 81430/572 4. 490.60% 80016 / 45,795 5. 485.17% 80547 / 1,223 6. 451.54% 80504 / 48,431 7. 438.31% $0640 / 11,692 8. 403.22% 80905 / 17,341 9. 328.32% 80542 / 3,705 10. 296.98% 80018 / 10,512 11. 292.56% 80230 / 8,393 12. 248.08% 81155/362 13. 246.06% 80249 / 27,505 14. 242.31% 80453/267 15. 214.21% 80528 / 18,576 16. 170,25% 80925 / 7-032 17. 164.96% 80534 / 13.068 18. 162.92% 80202 / 11,474 19. 160.23% 80516 / 21,987 20. 153.85% 80475/66 21. 153.56% $242,, / 606 22. 143.82% 80426/217 23. 138.32% 80921 / 19,673 24. 128.35% 80831 / 24,009 25. 126.80% 81059/347 26. 126.67% 81248/136 27. 119.49% 80612/428 28. 107.01%0 92 / 26.905 29. 100.71% 80136 / 5,074 30. 98.38% 80549 / 9,540 31. 98.36% aL642 / 121 32. 95.14% 80550 / 22,406 33 91.60% 80125 / 10.540 34. 91.60% 81523 / 1,117 35. 90.88% 80134 / 58,232 36 88.32% 80543 / 6,094 37 87.39% 80478 / 1,531 38. 87.13% 80643 / 3,331 39. 8684% 81243/142 40. 85.07% 80476/248 41. 84.45% 81525 / 1,020 42. 8075% 81244/338 43. 8043% 80§20 / 17,633 44. 80.09% 80442 / 2,759 45. 80.03% 81007 / 30,674 46 8000% 80045 / 612 47. 79.58% 81631 / 8,128 48. 7475% 80817 / 28,157 49 74.32% 805111129 50. 70.09% 80497/364 51 6745% 81253/571 52 6742% 81521 /14,830 53. 6695% 80455/798 54 6552% 80642 / 5,050 55 6414% 80022 / 45,663 56. 62.92% jjk37 / 8,009 57. 61 18% 81221 /274 58. 60.89% 81033/288 Pick a Topic to Rank: I]+ Popular Topics O EwAkti4n and Races Elncom and Careers O�iousing E Crime, Weather. etc. Selected Ranking Topic: Population Growth Rate Pick Your Location: • Within a Location State Rank within a Distance of a Point Rank By: Zip Select Date of Data: American Community Survey 2010-2014 Limit to Locations with Population: to (number only can be blank) Submit Popular Rankings Fa ltg / Sim Growing States in U.S. RQ3 / Mkml States in U.S by % of Males Employed Best /Worst States in U -S. by % of Females Employed Bir 3 / Wgrst States by Crime Rate in U S R`ches/ _PWr,6 States by Income in U S. Most Exc emm / QheApest Homes by State in U S Most / Least Educated States in U S Most/ lead Populated States in U.S Larggg; / Smalles States by Area in U.S Riches / Poorest Counties by Income in U.S. F,4§tom / Slowest Growing Counties in U S Most / Least Educated Counties in U.S. Ypunoest / Oldest States in U.S. Y12"i t / 21Qe.SI Counties in U.S. 270 6.04% 80835/843 271. 6.03% 80923 / 28,292 272. 5.94% 80227 / 34,139 273. 5.93% 00863 / 11,924 274. 5.78% 80221 /40,341 275. 5.59% 80403 / 18,345 276. 5.57% 80226 / 31,616 277. 5.44% 81648 / 2,677 278. 5.43%81149/951 279. 5.33% 80135 / 3,856 280. 5.20% 80603 / 11,502 281 4.96% 80296 / 11,232 282. 4.92% 80109 / 18,986 283 4.72% 01610 /444 284. 4.61% 81321 / 14,284 285 4.59% 80902 / 12,468 286_ 4.53% 80206 / 21,295 287. 4.50% 60470 /3,551 288. 4.49% 80011 / 47,287 289. 4.14% 80205 / 30,956 290. 4.09% 81639 / 2,289 291. 4.01% 50128 / 35,691 292. 3.79% 80120 / 29,957 293. 3.73% 80720 / 2,833 294, 3.68% 80222 / 20,673 295. 3.50% 61212 / 30,211 296. 3.39% 80218 / 18.462 297. 3.29% 80501 / 35.764 298. 3,25% 80466 / 3.269 299. 3.18% 80602 / 28.909 300. 3.06% 81624 / 1,480 301. 3.01% 80105 / 1,165 302. 2.95% 80113 / 21.165 303. 2.78% 9247 / 25,588 304. 2.75% 80829 / 5,717 305. 2.74% 80020 / 49,118 306. 2.65% 80 / 31,455 307. 2.46% 81019 / 1,541 308. 2.42% 044 / 3,345 309. 2.33% 80621 / 11,924 310. 2.14% 81410 / 1,577 311. 2.04% 81201 / 8,888 312. 2.01% 8_.1625 / 12,425 313. 2.00% X1526 / 5,445 314. 1.96% 80121 / 18,616 315. 1.96% 80401 / 39,336 316. 1.81%80723 / 7,099 317. 1.76% 80010 / 43,999 318. 1.71% 80745/178 319. 1.66% 80116 / 3,800 320. 1.63% 81129/187 321. 1.59% 80917 / 30,862 322. 1.54% 80433 / 8,348 323. 1.18% 80904 / 19,884 324. 0.57% 81023 / 1,245 325. 0.56% 80130 / 28,764 326. 0.55% 81235/737 327. 0.50% 0903 / 15,166 4 1/8189 329. 0.43% 80305 / 17,401 330. 0.269/6 81303 331. 0.19% 801 /28,112 332. 0.19% 80729/527 333. -0.07% 81223 / 1,480 334. -0.11% 81403 11, 103 335. -0.11% 80828 / 3,645 336. -0.15% 80517 / 9,133 337. -0.26% 80439 / 23,746 338. -0.34% 80232 / 21,642 339, -0.55% 80220 / 36,162 d 481. -34.57% 81040/354 482. -35.48% &0801 / 100 483. -35.61% 80477/414 484. -36.24% 80750/278 485. -36.39% 81069 /1,554 486. -37.39% 81503 / 14,656 487. -38.05% 80463/140 488 -38.68% 81241/65 489. -38.96% 80434/47 490. -38.99% 81024/97 491. -39.11% 80215 /18,231 492. -39.17% KL26 / 41,667 493. -39.96% 80727/314 494. -40.23% 80830/159 495. -40.25% $1320 / 190 496. -40.48% 8045$ / 350 497. -40.91% N,4 L9 / 26 498. -42.81% 81136/171 �29rsk- - 9/2 5 500 -43.71% 9303 / 23,505 502 -44.12% $0862 / 38 503. 47.65% 81045/78 504. -50.63% 81239/79 505 -5068% 81081/36 506. •50.87% 80110 / 21,457 507. -52.08% 81043/46 508 -56.28% 81335/94 509. -58.71% 80652/237 510. -59.02% 81522/25 511 -62.70% 81640/138 512. -63.25% 80432/104 513 -65.00% 81021 /7 514. -6906% 80913 / 3,269 515. -93.36% 81411/14 516. -9451% 81232/5 Please note that we only rank locations with 'Population Growth Rate' data. The rank above might not be a complete list Locations without 'Population Growth Rate' data are not listed. The USA com website and domain are privately owned and are not operated by or affiliated with any government or municipal authority. C 2016 World Media Group. LLC. Y a Ta Y U Q k M u 5 w F p r p u W O o71CIO a. a o 0 0° u O W w 'b O O '.y V v fn Ir a O v .. v o *�( v cd v +1^ v C b u O Q ° y a g C. v a� O �oC a 14 v ° v u C o cn b +� � Q• -o b .0° b q C `�' ��Cd ��•°ray ❑�❑ U w 6�J O .� G" 6q p'' 0 " v `•' 10. v o' r ° r N cs •� O cn p v N r a o bi 0 bOw fi o 0.-6r, �i V 0 .� v Ccd . > 4i b-0 r b C a v c. Ow 1• y a ° °� C to 0 p fi a i Cd v v o o W vv v a Oxy �'a�x z a o b o cn C) cn :. 3 v0 oa 0 w a v U L �o �7 fi ° a', w '-' v c p, w % �U4 W , u ��-1, E o°U U ° `l' vb z.B OD oa W Qj � v �,^ a v' a a W o071 v0 b y`j V ��• � r Q. o == a vo�N. 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O" ti o o Z $,� O W O o 'n asC � v >, O i wz C v �'1 y p r= U vu r `,,� •O +, b v w u O • sa O > cli ami o�N u o0 v v O C r (n iA u 'G 14 O wy H O r v r ° a� O o 0 actztz r o o bA0 O a y41 a Cl. 11 U r24fi C- g r u zea d `n0� � o C14 VO aW wx vCIO 3 " o O 0 ani fi w u U v j o 0 O r Cl) �, �, a a C; 47 � > C a W C O M ao ti'b r. o.12, 12," r a y -m rO of a, (Uo r ►a Ri I.l y p-, .yy . lu cn r�1n L V U u O v z b '=" o Z fi- p C 'ami C =U O14 fL4 w o a w ! z a W r u .vi V 0 N z m% 1r r o U za, C� ai ol b� o v•j0 Uz r C14 0" ���N� • v ''� X.. w ++ O :J" C O C z 41 o -d v r= b 0 r U W Q � 0 r z� W ci o41 o>0 a,"00 U OR > O by r. (n cC z R w.' 1' O u 00 C C W Rr g°rl a' LON W Fellow Table Mesa Business Owners and Managers- Lucky's Market has applied for an ON/OFF 3.2 liquor license. That means they want to sell 3.2 beer retail and be able to serve it too. They have a 60 seat area to serve beer and they're also proposing that you can buy a beer and drink it while shopping. They canvassed all the businesses this week asking for signatures so they can show a desire from the community to have this service from them. What they did not tell you was that starting January 1, 2019 their 3.2 license will automatically become a full-strength beer license. This is a result of SB197 that became law 7/1/16. In 2016 King Soopers(Kroger) Table Mesa will start selling full-strength beer. Kroger is the majority owner in Lucky's. Having two other retail beer stores in the same shopping center as Pettyjohns will deeply hurt our business. I question how it will affect the restaurants and brew -pubs in Table Mesa. I don't see the need to have two Kroger beer outlets in my parking lot. If you agree with me, I have attached a form you can sign. I will present them to the liquor Board on 11/16/16. Now that I understand that Lucky's Market proposed 3.2 on/off license will allow them to sell full-strength beer starting January 1, 2019, 1 oppose the application. Name Business Business Address Position Date Signature d.• 3 �EL p CL �t a N W -0 U) d CL NZ� N w •- cYiV J O 'a W W 40 p d ~ i O W N Cf)H �i C O = J y d NLL _ = W '— N (y) p •- �. W oWM N 3 y-- C ,Jj Z =_ •>+ — 0 CL co W O •N co a y- .*�ZV•— CD LU >+M O � .� Q =as O = N Z > V t i c tm cn c+� D as Q CL N d L Q m z tmd J c> 03/31/16 Lucky's Liquor LLC d.b.a. Lucky's Liquors, 700 Ken Pratt Blvd., #202 o ignored License #47-01417 o ignored Alleged Violation(s): C.R.S. 12-47- 901(1)(a.5)(I) Sale to a Minor o ignored Sanction Imposed: 10 day suspension, licensee agreed to 5 day suspension held in abeyance for 1 year and a fine in lieu of $3,921.00 in lieu of a 5 day suspension from 12:01 am on April 13, 2016 until 11:59 p.m. April 17, 2016. (State imposed stipulation) Dawn Quintana I Deputy City Clerk City of Longmont 1 350 Kimbark Street, Longmont, CO 80501 (303) 651-8647 j Ion montcolorado. ov Old, /3/2016 License Database Page 1 of 3 Liquor Violations License #: 01-10779-0044 Year, Trade Name: KING SOOPERS 33 Location: 3600 Table Mesa Dr License Type: 3.2% Beer Off Premise Hearing Date: 4/15/2015 Violations Found: Sale to a minor Imposed Applicant: Dillon Companies, Inc Address: PO Box 305103 Nashville TN 37230-5103 ❑ None ❑ Other sanctionstinformation: ❑ Renewal Denied Effective Date: Four suspension days to be served from April 23, ❑ Revoked Total Days: 14 2015 to April 26, 2015 ❑d Suspended Days Served: 4 Days held in abeyance: 10 Fine in lieu of active suspension: License #: 101-10779-0020 Trade Name: EKING SOOPERS 61 Location: 11650 30th St License Type: 3.2% Beer Off Premise Hearing Date: 4/15/2015 Violations Found: Sale to a minor Year: 2014 Applicant: Dillon Companies, Inc Address: PO Box 305103 Nashville TN 37230-5103 anctions Imposed — - ❑ None ❑ Other sanctions/information: ❑ Renewal Denied Effective Date: Three suspension days to be served from April 23, ❑ Revoked Total Days: 14 2015 to April 25, 2015 0 Suspended Days Served: 3 Days held in abeyance: 11 Fine in lieu of active suspension: License #: 01-10779-0031 Year: 2014 Trade Name: KING SOOPERS 28 Location: 1 License Type: Hearing Date: f Violations Found: ; Sanctions Imposed Lookout Rd Beer Off Premise to a minor Applicant: Dillon Companies, Inc Address: PO Box 305103 Nashville TN 37230-5103 ❑ None ❑ Other sanctions/information: ❑ Renewal Denied Effective Date: 14 days of suspension from September 4, 2014 to ❑ Revoked Total Days: 24 September 17, 2014 ❑ Suspended Days Served: 14 Days held in abeyance: 10 Fine in lieu of active suspension: $0.00 Location = 3600 Table Mesa Dr or Applicant = Dillon Companies, Inc or Number = 01-10779-0044 0 11/3/2016 License Database Page 2 of 3 Liquor Violations License* 101-10779-0031 1 Year. Trade Name: IKING SOOPERS 28 Location: t6550 Lookout Rd License Type: 3.2% Beer Off Premise Hearing Date: 10/17/2012 Violations Found: Sale to Minor ISanctions Imposed I Applicant: Dillon Companies, Inc Address: PO Box 305103 Nashville JTN 1 137230-5103 ❑ None C Other sanctions/information: ❑ Renewal Denied Effective Date: 6 days, October 22-27, 2012 ❑ Revoked Total Days: 14 ❑� Suspended Days Served: 6 Days held in abeyance: 8 Fine in lieu of active suspension: ;$0.00 License #: 101-10779-0044 Year: ;2.010 Trade Name: IKING SOOPERS 33 Location: License Type: Hearing Date: Violations Found: Sanctions Imposed 600 Table Mesa Dr .2% Beer Off Premise 2/15/2010 T- ale to Minor ❑ None ❑ Renewal Denied Effective Date: ❑ Revoked Total Days: 14 ❑? Suspended Days Served: 5 Days held in abeyance: 9 Fine in lieu of active suspension: $0.00 License #: 01-10779-0044 Year, Trade Name: KING SOOPERS 33 Location: 13600 Table Mesa Dr License Type: Hearing Date: Violations Found: 13.2% Beer Off Premise E Sanc