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HomeMy WebLinkAbout01.18.17 BLA PacketBEVERAGE LICENSING AUTHORITY JANUARY 18, 2017 PUBLIC NOTICE CITY OF BOULDER BEVERAGE LICENSING AUTHORITY H E A R I N G WEDNESDAY, JANUARY 18, 2017, 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 December 14, 2016 hearing; and hearing agenda issues from licensing clerk. 2. Matters from the Boulder Police Department. 3. Matters from the Responsible Hospitality Group. 4. Discussion session for Beverage Licensing Authority members to provide by quorum Board Input about supply of monthly BLA hearing packets by electronic means. 5. Show cause hearing concerning an October 14, 2016 violation and whether the Hotel - Restaurant type liquor license held by The Noodle Shop Co - Colorado, Inc d/b/a Noodles & Company 146, 1600 28th Street, Suite 1208, Boulder, CO 80301, should be suspended or revoked. 6. Public hearing and consideration of an October 25, 2016 application from The Noodle Shop Co - Colorado, Inc d/b/a Noodles & Company -146, 1600 28th Street, Suite 1208, Boulder, CO 80301; TNSC, Inc., 100% owner with Keith Kinsey, President, Paul Strasen, Vice President, Ryan Peterson, Registered Manager; with a business mailing address of 520 Zang St, Suite D, Broomfield, CO 80021, for a renewal of a Hotel -Restaurant type liquor license. 7. Public hearing and consideration of a November 17, 2016 application from Yarakasu LLC d/b/a Tasuki, 1575 Folsom Street, Boulder, CO 80302; Tsukasa Hibino, Managing Member, and Takashi Saito, Manager of Record; with a business mailing address of 7980 Niwot Rd, Longmont, CO, 80503, for a renewal of a Beer and Wine type liquor license. 8. Public hearing and consideration of a December 5, 2016 application from Wonder Press Pearl LLC d/b/a Wonder Press, 946 Pearl Street, Boulder, CO 80302; Tincup LLC, Owner, with Cecily Runge, Managing Member and Manager, Brooke Jordan, Managing Member, Robyn Reed, Managing Member, High Beam Holdings LLC, Member, with Presley Reed, Manager, and with Freshy Fresh LLC, Member, with Dave Query, Manager; with a premise business mailing address, for a renewal of a Beer and Wine type liquor license. 9. Public hearing and continued consideration of a September 14, 2016 application from Lucky's Market Operating Company, LLC d/b/a Lucky's Market, 695 S Broadway, Boulder, CO 80305; Lucky's Market Operating Company LLC [LMOC] as LLC Applicant with Lucky's Market Parent Company LLC [LMPC] as 11t underlying sole owner, and with The Kroger Co [Kroger] and Lucky's Founders Holding LLC [LFH] as 2nd underlying co- owners, and with Jason Sharon and PG Holdings LLC [PGH] as co-owners of LFH; Jason Sharon as Managing Member of LMOC and CEO of LMPC, Andy Pillari, CFO of LMPC, Russell Dispense, 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 LMOC; with a business mailing address of 6328 Monarch Park Place, Suite 100, Niwot, CO 80503, for a new 3.2% Beer On Premise type liquor license. 10. Public hearing and consideration of a November 10, 2016 application from Ali Baba Boulder, Inc. d/b/a Ali Baba Grill, 3033 28th Street, Boulder, CO 80301; Mahmoud Dukmak, Owner, Fayad Aoutabachi, Owner, Aswad Fadi, Owner, Hasan Aoutabachi, Manager; with a premise business mailing address, for a transfer of a Beer and Wine type liquor license. 11. Public hearing and consideration of a November 14, 2016 application from Bittersweet Cafe LLC d/b/a Bittersweet Cafe, 5385 Gunbarrel Center Court, Boulder, CO 80301; Michael Boselli, Member and Registered Manager, Patrick Walsh, Member, Don Anthony Boselli, Member; with a premise business mailing address, for a new Hotel - Restaurant type liquor license. 12. Matters from the Assistant City Attorney Rulemaking and Discussion session for Beverage Licensing Authority members to provide by quorum Board Input about upcoming amendments to Boulder Revised Code for fees, taxes, and issuance of Lodging and Entertainment, Vintner's Restaurant, Distillery Pub, and Resort Complex licenses, communication with current Tavern licensees, and amendment of BLA Rules of Procedure to allow appointing of a board chair for a single hearing as needed. 13. Matters from the Licensing Clerk a. Neighborhood boundary setting for applications for February 15, 2017 BLA hearing i. Kbc Cycling LLC d/b/a Full Cycle - New Beer and Wine type liquor license at 1795 Pearl Street, Boulder, CO 80302 b. Breweries. Wineries, and Distilleries reauests for local licensing authoritv input on ADMication for Colorado Liquor Sales Room — None this month 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. January Special Events and Temporary Modifications iv. January Liquor License renewal mailing lists v. City Licensing's summary of BLA's input to City Council for 2017 Goals and Changes 14. Matters from the Chair and Members of the Authority Adiournment 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. January 4, 2017 Mishawn J. Cook, Licensing Administrator, CMC Published on Sunday. January 8, 2017, in the Dailv Camera newspaper STATE OF COLORADO COUNTY OF BOULDER ) SS: CERTIFICATE OF PUBLIC NOTICE CITY OF BOULDER ) 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, January 8, 2017 in compliance with the laws of the State of Colorado and the ordinances of the City of Boulder, Colorado. MONDAY, JANUARY 9 2016 City of Boulder PUBLIC MEETINGS COMPLETE AGENDAS Visit w'% Jwu1dcm61joodo sQv,(cale�da or call 303-44E13388 OMICATES THAT A COWISM AGWM 10, 1N TODAY'S MBLIC N0nCES IN ME Ct.A85nMW 5EMON.1 4-7 PM Public Participation Working Group Meeting East Boulder Community Center, Flagstaff Room, 5660 Sioux Dr. haW- /bouldercolorado.gov�-coundVpubh particination-working-SmuD. Comments to: PubbcParticipadonWorkin mpgbouklercolorado.ga 5:300 PM Downtown Management Commission Meeting Downtown Garage Access Control Changes Westview Conference Room, 3065 Center Green Drive Ruth Weiss, weissr@bouldercolorado-SM htipL/bouldercolorado.M/boards-comqimignELnW- downtown-manaeement-commission-nmeting 6 PM Human Relations Commission Meeting Council Chambers, 1777 Broadway .rww.boulderhumannehts.com Carmen Atilano, 303-441-3141, AIanoC@bouldercolorado.egv- TUESDAY, JANUARY 10 -v " '"�4.'• : 3:305:30 PM Public Art Implementation Plan Town Hall Meeting Canyon Theater, Main Library, 1001 Arapahoe Ave. Give us your thoughts for the context and themes of individual projects being considered. RSVP by Jan. 9 to rsvp@bouldercolorado.gov Mandy Vink, Public Art Coordinator, 3034414342 5:30 PM City Council Study Session ELAN MR'I Council Chambers, 1777 Broadway 5:30-7 Inclusionary Housing and Affordable Housing Financing 101 7-8:30 Staff Reporting on Community, Culture and Safety Tax Renewal 8:30-9 Retreat Themes and Agenda 9-9:15 Committee Assignments WEDNESDAY, JANUARY 11 ` i; ' C� 40 6-8 PM Open Space Board of Trustees Meeting (televised) Council Chambers 1777 Broadway .*. Al Business Meeting: 3 1. Updates: Prairie Dog Working Group; Boulder Creek �. Restoration 2. Matters from the Board Study Session 1.BVCP - Open Space - Other Designation Changes: - 311 Mapleton, CU South THURSDAY, JANUARY 12 4 5 PM *Board of Zoning Advents 1777 West Conference Room, 1777 Broadway haM.-Z/bouldercolorado.M/boards-commissions/bO7A r 6 PM *Planning Board Meeting (televised Council Chambers, 1777 Broadway ht�pt 5—//bouldercolorado.g4Y/boards-commissions%lanning board WEDNESDAY, JANUARY 18 3 PM *Beverage Licensing Authority Hearing Council Chambers, 1777 Broadway Mishawn Cook, 303-441-3010, cookm@bouldercolorado.ggy -I Any petitions or remonstrances may be filled at: Licensing s Division, 1777 Broadway, lst floor. Hearing Agenda: s www.bouldercolorado.0 v ' u r THURSDAY, JANUARY 19 6 PM 'Planning Board Meeting (televised) Council Chambers, 1777 Broadway t hts //bouldercolorado.v,Qv/boards-commissions(planning board OTHER EVENTS 2017 Boards and Commissions Recruitment Through February 13. Applications available online at bouldercolorado.gov. For more information, call 303-441-3019 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. If you need Spanish interpretation or other language -related assistance for a meeting, please call (303) 441-1905 at least three business days prior to the meeting. Sl usted necesita interpretation o cualquier otra ayuda con relation al idioma para esta junta, por favor comuniquese al (303) 441-1905 por to menos tres dias antes de la junta. See Next Page Public Notice I Public Notice I Public Notice PUBLIC NOTICE CITY OF BOULDER BEVERAGE LICENSING AUTHORITY H E A R I N G WEDNESDAY, JANUARY 18, 2017,3:00 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 December 14, 2016 hearing; and hearing agenda is- sues from licensing clerk. 2. Matters from the Boulder Police Department. 3. Matters from the Responsible Hospitality Group. 4. Discussion session for Beverage Licensing Authority members to provide by quorum Board Input about supply of monthly BLA hear- ing packets by electronic means. 5. Show cause hearing concerning an October 14, 2016 violation and whether the Hotel -Restaurant type liquor license held by The Noo- dle Shop Co - Colorado, Inc d/b/a Noodles & Company 146 1600 28th Street, Suite 1208, Boulder, CO 80301, should be suspended or revoked. 6. Public hearing and consideration of an October 25, 2016 applica- tion from The Noodle Shop Co - Colorado, Inc d/b/a Noodles & Com- pany -146, 1600 28th Street, Suite 1208, Boulder, CO 80301; TNSC, Inc., 100% owner with Keith Kinsey, President, Paul Strasen, Vice President, Ryan Peterson, Registered Manager; with a business mailing address of 520 Zang St, Suite D, Broomfield, CO 80021, for a renewal of a Hotel -Restaurant type liquor license. 7. Public hearing and consideration of a November 17, 2016 applica- tion from Yarakasu LLC d/b/a Tasuki, 1575 Folsom Street, Boulder, CO 80302; Tsukasa Hibino, Managing Member, and Takashi Saito, Manager of Record; with a business mailing address of 7980 Niwot Rd, Longmont, CO, 80503, for a renewal of a Beer and Wine type liq- uor license. 8. Public hearing and consideration of a December 5, 2016 applica- tion from Wonder Press Pearl LLC d/b/a Wonder Press, 946 Pearl Street, Boulder, CO 80302; Tincup LLC, Owner, with and Cecily Runge, Managing Member and Manager, Brooke Jordan, Managing Member, Robyn Reed, Managing Member, High Beam Holdings LLC, Member, with Presley Reed, Manager, and with Freshy Fresh LLC, Member, with Dave Query Manager; with a premise business mail- ing address, for a renewal of a Beer and Wine type liquor license. 9. Public hearing and continued consideration of a September 14, 2016 application from Lucky's Market Operating Company, LLC d/b/a Lucky's Market, 695 S Broadway, Boulder, CO 80305; Lucky's Market Operating Company LLC [LMOC] as LLC Applicant with Lucky's Market Parent Company LLC [LMPC] as 1st underlying sole owner, and with The Kroger Co [Kroger] and Lucky's Founders Holding LLC [LFH] as 2nd underlying co-owners, and with Jason Sharon and PG Holdings LLC [PGH] as co-owners of LFH; Jason Sharon as Managing Member of LMOC and CEO of LMPC, Andy Pillad, CFO of LMPC, Russell Dispense, Monica Garnes, and J. Mi- chael 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 LMOC; with a business mailing address of 6328 Monarch Park Place, Suite 100, Niwot, CO 80503, for a new 3.2% Beer On Premise type liquor license. 10. Public hearing and consideration of a November 10, 2016 appli- cation from All Baba Boulder, Inc. d/b/a All Baba Grill, 3033 28th Street, Boulder, CO 80301; Mahmoud Dukmak, Owner, Fayad Aoutabachi, Owner, Aswad Fadi Owner, Hasan Aoutabachi, Manag- er; with a premise business mailing address, for a transfer of a Beer and Wine type liquor license. 11. Public hearing and consideration of a November 14, 2016 appli- cation from Bittersweet Cafe LLC d/b/a Bittersweet Cafe, 5385 Gunbarrel Center Court, Boulder, CO 80301; Michael Boselli, Mem- ber and Registered Manager, Patrick Walsh, Member, Don Anthony Boselli, Member; with a premise business mailing address, for a new Hotel -Restaurant type liquor license. 12. Matters from the Assistant City Attorney Rulemaking and Discussion session for Beverage Licensing Authority members to provide by quorum Board Input about upcoming amendments to Boulder Revised Code for fees, taxes, and issuance of Lodging and Entertainment, Vintner's Restaurant, Distillery Pub, and Resort Complex licenses, communication with current Tavern licensees, and amendment of BLA Rules of Proce- dure to allow appointing of a board chair for a single hearing as needed. 13. Matters from the Licensing Clerk a. Feeloh6prh0oP j�p�ndrar#tjna for aoolications for U U3FV 11.5 KKib-c BCLycliing LLC d d/b/a Full Cycle - New Beer and Wine type liquor license at 1795 Pearl Street, Boulder, CO 80302 b. IBreweries Wineries Dand D'tillB5 rPp{�e5t, for local 5censeS R6Dmut None i his monthobriC3tibfl tof L�iorado Liauor 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, 114913th Street, Boulder, CO 80302 - Monthly status renewal report to BLA iii. January Special Events and Temporary Modifications Iv. January Liquor License renewal mailing lists V. City Licensing's summary of BLA's input to City Council for 2017 Goals and Changes 14. Matters from the Chair and Members of the Authority Adiournment 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 re- quired by law whenever possible. However, this practice shall not be used to invalidate any action taken with the minimum notice re- quired by state law. Final on Wednesday. January 4.2017 Mishawn J. Cook, Licensing Administrator, CMC IN WITNESS WHEREOF, I have hereunto set my hand and the official seal of the City of Boulder, C o this Monday, January 9, 2017. Mishawn J. Cook, Tax and License Administrator Secretary to Beverage Licensing Authority Agenda Item 1 CITY OF BOULDER BEVERAGE LICENSING AUTHORITY ***MINUTES*** WEDNESDAY, DECEMBER 14,2016,3:00 P.M. ATRIUM BUILDING CONFERENCE ROOM -1ST FLOOR 1300 CANYON BOULEVARD, BOULDER, COLORADO NAME OF BOARD/COMMISSION: Beverage Licensing Authority (BLA) DATE OF MEETING: December 14, 2016 NAME & PHONE OF PERSON Mishawn Cook, License Administrator (303-441-3010) PREPARING SUMMARY: Kristen Teague, Licensing Specialist (303-441-3034) NAMES OF MEMBERS, STAFF, AND INVITED GUESTS PRESENT: Board Members: Alyssa Lundgren, Lisa Spalding, David Timken, Steve Wallace, and Matthew Califano Staff Present: Carey Markel, Assistant City Attorney, Mishawn Cook, License Administrator, Beata Mazurkiewicz, Licensing Specialist and Kristen Teague, Licensing Specialist QUASI-JUDICIAL MEETING OUTLINE OF AGENDA 1. Administrative Board Matters i) Member Roll Call Roll call was taken. All BLA members were present and a quorum was established. ii) Approval of BLA minutes from October 19, 2016 Member Timken requested clarification of his statements made under section 12. Member Spalding moved that changes be incorporated with a second from Member Califano. Members Timken, Spalding and Califano voted to incorporate the changes and have the minutes signed at the next BLA hearing with Chairman Wallace and Member Lundgren abstaining due to their absence from the October 2016 meeting. Motion passes 3:0. iii) Approval of BLA minutes from November 16 2016 BLA 12.14.16 DRAFT Minutes Page 1 of 7 Member Spalding noted that item 4 listed Lucas Markel Esq., BPD prosecutor as 'Luca'. Member Timken moved to approve the minute with changes with a second by Member Califano. Motion passes unanimously 5:0. iv) Hearing agenda issues from licensing clerk Licensing Administrator Mishawn Cook noted that agenda item 5 would not be convened and will be addressed further in the hearing. 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 with the BPD provided a verbal summary of liquor related BPD actions for the year, most notably 955 fake ID's. BLA members expressed interest in the processing of cases when a fake ID was discovered. Officer Bergh explained process, education to licensees and how, if prosecuted, a case goes through to court. Road blocks for prosecution include companies that produce several ID's with the same name and out of state ID's. BLA members also inquired about an incident that began at one establishment and continued to another. Officer Bergh explained the report just picked up part of the statement and that the incident was actually only at one establishment. 3. Matters from the Responsible Hospitality Group (RHG). Michael Absalom with the RHG noted that the group had not held a regular meeting for December but would be meeting again in February. He reported that the RHG will be represented at a national trades group in Arizona and will report back to the BLA in January. A quarterly aggregate report for activity in 2016 will also be presented. 4. Rulemaking and Discussion session for Beverage Licensing Authority members to provide by quorum Board Input to City Council and suggested annual priorities in Response to Council letter dated October 21, 2016. This discussion occurred after Agenda Item 9. Administrator Cook reminded BLA Members of the City Council letter of October 21, 2016 requesting Board input, by quorum, for suggested annual council priorities. Members discussed public engagement, neighborhood plans, affordable housing, community discussions as well as job and population balance, ordinance enforcement and city property maintenance. The city of Seattle website was discussed as an exemplary model for a community input and project update tool. Consensus of the BLA was to have Administrator Cook summarize Member comments and suggestions to present to City Council as per their request. BLA 12.14.16 DRAFT Minutes Page 2 of 7 5. Public hearing and continued 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 11 underlying sole owner, Lucky's Market Expansion GP, LLC [LMEG] as 2"1 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 5th 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. Administrator Cook reported that the applicant had withdrawn the original application and had resubmitted on November 30, 2016 a new organizational structure and had changed to a 3.2% Beer On Premise type liquor license application. The Public Hearing and consideration will be moved to a January 2017 BLA Hearing date. 6. Public hearing and consideration of an October 7, 2016 application from Coffee & Brew LLC d/b/a SIP, 2810 E College Ave Unit 3, Boulder, CO 80303; Bijan Joobeen, Owner and Manager; with a premise business mailing address, for a transfer of a Beer and Wine type liquor license. Mike Lazio, Esq. appeared as the applicant's attorney. Bijan Joobeen, Owner/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. The Authority discussed the business model, alcohol service and private parties with the applicant. It was noted that the premise diagram must indicate location of the tables, alcohol storage and business records areas. Amendments to the diagram were done as requested. Motion was made by Member Spalding to approve this transfer application with a second by Member Timken. Motion passes unanimously 5:0. BLA 12.14.16 DRAFT Minutes Page 3 of 7 7. Public hearing and consideration of an October 12, 2016 application from Bow Tie Caf6 1, LLC d/b/a Sun Deli and Liquor, 2299 Pearl St Unit B-1, Boulder, CO 80302; Carita Felbermayr, Owner and Manager; with a premise business mailing address, for a transfer of a Retail Liquor Store type liquor license. Carita Felbermayr, Owner and Manager appearing pro se, was sworn in, and confirmed posting for the required 10- day period. Chair Wallace read the Hearing procedure. 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. The Authority inquired of continuing the previous licensee's business model, alcohol delivery service contracts, and the requirement of confirming that transferred inventory and that wholesalers had been paid in full prior to sending transfer application to State LED. It was suggested that the applicant review the state liquor delivery provisions. David Knickerbocker, husband to applicant, was sworn in to provide additional clarification testimony regarding alcohol delivery services. Applicant noted several improvements made to the exterior areas that have positively impacted the nature of the business and have already improved the surrounding neighborhood and businesses. Motion was made by Member Califano to approved this transfer application with a second by Member Timken. Motion passes unanimously 5:0. 8. Public hearing and consideration of an October 18, 2016 application from BeBold LLC d/b/a Vinca, 1141 Pearl Street, Boulder, CO 80302; Tomas Zatloukal, Owner, CEO and Manager; with a business mailing address of 1630A 30th Street, #364, Boulder, CO 80301, for a new Beer and Wine Liquor type liquor license. Dave DiGiacomo, Esq. appeared as the applicant's attorney. Tomas Zatloukal, Owner, CEO and Manager, was sworn in and confirmed posting for the required 10- day period. Hearing procedure reading was waived by the applicant's attorney. The applicant had emailed Mishawn Cook an amended licensed premise diagram on December 13 which had been forwarded to all BLA members for consideration, as the applicant also wished to license the basement floor for alcohol storage. Diagram was entered as Agenda Exhibit 8-1. Member Califano disclosed ex -parte communication but it was not determined sufficient for recusal. No other conflicts of interest were disclosed by any Authority members. No third parties requested to provide public comment or to be made parties in interest in this matter. BLA 12.14.16 DRAFT Minutes Page 4 of 7 Max Scott, petitioner with Oedipus Inc., was sworn in and provided testimony regarding the neighborhood petition results. The Authority discussed education on alcohol service, business concept, and staffing with the applicant, as well as off-site records storage. It was required that the basement diagram be updated to be compliant for the application. Motion was made by Member Lundgren to approve the application with a second by Member Spalding. The motion passes unanimously 5:0. 9. Public hearing and consideration of a November 10, 2016 application from Boulder Museum of Contemporary Art d/b/a Boulder Museum of Contemporary Art, 1750 13th Street, Boulder, CO 80302; David Dadone, Executive Director and Manager, and Andrew Burwick, Acting Board Chair; with a premise business mailing address, for a Special Event Liquor Permit to occur from Saturday December 31, 2016 at 8:30PM to Sunday January 1, 2017 at 2AM. David Dadone, Executive Director, and Lisa Schmidt, Operations and Events Manager, appeared, both were sworn in and confirmed posting for the required 10- day period. 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. Applicant had included the patio area be included as part of the licensed premise for this event for a smoking area and for patrons to be outside with their alcoholic beverages. The Authority discussion regarding this special event application focused on the concerns raised at the applicant's last outdoor special event. Safety, security measures, fire precautions and evacuation preparedness, as well as fencing, crowd control and staff training were all addressed as high priority items. Specific expectations were outlined by the Authority on how the Applicant and event staff will respond to city officials, law enforcement and first responders when contacted at their events. Following the discussion, the consensus of the BLA was to grant the special event permit but to exclude the outside patio area. Applicant did amend the premise diagram. A reminder was given to the applicant in regards to their regular license that every two years with the change in their Board Chair, a corporate change application must be filed with the Licensing Division. Motion was made by Chair Wallace to grant the permit with a second by Member Califano. Motion passes unanimously 5:0. 10. Matters from the Assistant City Attorney BLA 12.14.16 DRAFT Minutes Page 5 of 7 No items were reported for December. 11. Matters from the Licensing Clerk a. Neighborhood boundary setting for applications for January 18, 2017 BLA hearing Bittersweet Cafe LLC d/b/a Bittersweet Cafe — New Hotel -Restaurant type liquor license at 5385 Gunbarrel Center Court, Boulder, CO 80301. The following neighborhood boundaries were discussed: City Limits on the North, Jay Road on the South, 75th Street on the East, and 55th Street on the West. Unanimous consensus of the Authority was to set the neighborhood boundaries for this application as described above. b. Breweries, Wineries, and Distilleries requests for local licensing authoritv input on Application for Colorado Liquor Sales Room — None this month c. Informational items L The Riverside Group Ltd d/b/a Riverside, 1724 Broadway Street, Boulder, CO 80302 - Monthly status renewal report to BLA Administrator Cook noted for the Authority that sales tax would approve this license renewal if submitted at this time and that the licensee had stated that they had filed their license renewal, however there is no record on file. Staff will update in January. ii. 13th Street The Hill, LLC d/b/a Taco Junky, 1149 13th Street, Boulder, CO 80302 - Monthly status renewal report to BLA Administrator Cook noted for the Authority that sales tax would approve this license renewal if submitted at this time. iii. December Special Events and Temporary Modifications This summary list was advised to be in the hearing packet. BLA 12.14.16 DRAFT Minutes Page 6 of 7 iv. December Liquor License renewal mailing lists This summary list was advised to be in the hearing packet. v. Email from Mishawn Cook to Jennifer Korbelik about ITGA/RRF Alcohol Responsibility Program Included in the BLA packet is the email regarding the BLA representative to the Alcohol Responsibility Program. Consensus of the Authority was not to consider participation in the program as a mitigating factor for licensees in BLA enforcement hearings. Member Timken also mentioned that participation by the BLA in the program should not be considered an endorsement by the Authority. Matters from the Chair and Members of the Authority With no further matters, the Chair and Members extended holiday wishes to each other and to staff. ADJOURNMENT Member Califano moved, with a second from Member Timken, to adjourn the meeting. Motion approved 5:0, thus the hearing was adjourned at 5:16 p.m. TIME AND LOCATION OF FUTURE MEETINGS, COMMITTEES OR SPECIAL HEARINGS: 3rd Wednesday of every Month at 3PM in City Council Chambers for 2017. Attested: Approved: Mishawn J. Cook, License Administrator Chair of Beverage Licensing Authority BLA 12.14.16 DRAFT Minutes Page 7 of 7 Agenda Item 2 L ri V; Q) O '- c C 'a v u Y aJ QJ L Y O O O 41 v � aJ p75 fl � C 4o O f0 O L Y Ln O > t''O Q -a C U ++ to O Y tabaJ C t9 d aJ C (1)�' a) Q V 1 Ln aJ C Ln Q ? E GD �p U h0, u C " "O +t.+ \ "O f0 v O N +r J " a) C 'i ry 'x O aJ s �, �, O o to Cl +� O" 0 O aJ a) C O O O aJ a) j Q O Z +- O a Z a cn m m 2 c*o ti m m m N In 4+ C aJ 'O .v Q C ri r� r -I ri N r -I ri N o r, o +J N � 2 a) U W > V1 C coc \ 2 a) o aa) U L.7 O Q N C wy' O " CU u N Ln O N i 7 CL m au 1 O. O E z tA p p " 0 Z Ln Ui H a U O J Y Z CC Q " 9nN a) v O +' N +, 5 N a'3 -o` C + N c'i1cu _tA co ro O m y Mn rM-I a- d rl E r4 O ri .Ln l r I N r'1 O 00 r -I CL ri N r-4 r -I ri r�-I L ri Citations Last Drink Location Month of December 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 Age Violation 1 Citation Location Total: 3100 PEARL 1 G000152837 12/09/2016 0700 18 5-4-3 3100 PEARL PY 743 18TH ST 1 G000152441 12/16/2016 0241 20 5-7-4 743 18TH ST ABSINTHE HOUSE 1 G000152439 12/09/2016 0236 18 5-7-4 1207 AURORA AV LICENSE #1 1 E01617036A 12/26/2016 0123 29 42-4-1301(1)(A) BALSAM AV/BROADWAY UNKNOWN 36 G000156051 12/28/2016 1900 29 5-4-3 1447 PEARL ST T000233773 12/30/2016 1600 40 7-5-17(B) 28TH ST/BASELINE WB ON RAMP E01617179A 12/30/2016 0237 41 42-4-1307(5) 11TH ST/AURORA AV TS00143408 12/31/2016 0009 21 42-4-1301(1)(A) ARAPAHOE AV/FOLSOM ST E01617213A 12/31/2016 0108 19 42-4-1301(1)(A) TABLE MESA DR/US HWY 36 WB E01700001A 12/31/2016 2337 30 42-4-1301(1)(B) 2800-BLK PEARL ST E01616747A 12/17/2016 0119 21 18-6-800.3 213 29TH ST G000155496 12/17/2016 2210 20 5-6-12 1136 PEARL ST G000155497 12/17/2016 2210 19 5-6-12 1136 PEARL ST TS00138721 12/23/2016 0140 20 18-13-122(3)(A) 55TH ST/CENTRAL AV E01616952A 12/23/2016 0315 19 42-4-1301(1)(A) 30TH ST/DIAGONAL HY E01616992A 12/23/2016 1925 28 42-4-1301(1)(A) 800 PEARL ST TS00138719 12/24/2016 0203 30 42-4-1301(1)(A) FOLSOM ST/IRIS AV E01617027A 12/25/2016 0208 33 42-4-1301(1)(A) BROADWAY/SPRUCE ST E01617026A 12/25/2016 0027 47 18-9-117 3180 AIRPORT RD G000153661 12/10/2016 2045 37 5-4-3 1665 33RD ST G000137399 12/11/2016 1625 35 5-7-2 27TH WY/BASELINE RD E01616529A 12/13/2016 0709 35 42-4-1402 2920 BASELINE RD E01616529Z 12/13/2016 0709 35 42-4-1409(1) 2920 BASELINE RD TS00138718 12/16/2016 0033 25 42-4-1301(1)(A) ARAPAHOE AV/BROADWAY TS0138718Z 12/16/2016 0033 25 42-3-114 ARAPAHOE AV/BROADWAY G000139159 12/02/2016 2317 21 5-9-6 1085 BROADWAY #19 CR00124326 12/02/2016 1420 45 18-4-401(2)(C). 1600 29TH ST E01616136A 12/03/2016 0140 23 42-4-1301(1)(A) 21ST ST/PEARL ST E01616131A 12/03/2016 0011 27 42-4-1301(1)(A) BROADWAY/WALNUT ST E01616139A 12/03/2016 0226 28 42-2-138 13TH ST/HIGH ST CR00112710 12/03/2016 1824 27 18-4-501(4)(A) BROADWAY/MAPLETON AV E01616200A 12/04/2016 1645 30 42-4-1307(5) 3158 AIRPORT RD E01616200Z 12/04/2016 1645 30 42-4-1305.5 3158 AIRPORT RD TS00128118 12/04/2016 1553 30 42-4-1301(1)(A) 700-BLKARAPAHOE AV E01616174A 12/04/2016 0054 29 42-2-101(1) 28TH ST/VALMONT RD TS00137065 12/04/2016 0055 17 18-13-122(3)(A) 11TH ST/COLLEGE AV G000156027 12/04/2016 0055 18 5-7-2 11TH ST/COLLEGE AV E01616419A 12/09/2016 2310 33 42-4-1301(1)(A) 55TH ST/DIAGONAL HY E01616419Z 12/09/2016 2310 33 42-4-1007 55TH ST/DIAGONAL HY G000154797 12/09/2016 1900 62 5-7-2 4685 BASELINE RD 5 -Jan -2017 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 WALRUS BAR G000154389 Date Time Age Violation 1 12/04/2016 0145 20 5-6-12 Citation Location 11TH ST/WALNUT ST Total: 41 5 -Jan -2017 Page 2 of 2 Police Reports Last Drink Location Month of December 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: 1 drink at christmas party earlier 1 160016992 12/23/2016 19:25 28 DUI 800 PEARL ST 1 hour prior to accident 1 160016253 12/06/2016 00:20 35 DUI 3500 28TH ST 4065 moorehead 1 160016169 12/03/2016 21:56 21 DV 4065 MOORHEAD AV 901 Canyon Blvd 1 160017026 12/25/2016 02:26 47 PUBLIC PEACE OFFENSE 3180 AIRPORT RD according to arr 12 hours ago 1 160016796 12/19/2016 07:10 18 CRIMINAL TRESPASS 3100 PEARL PY approximately 1500 1 160016508 12/12/2016 15:24 30 THEFT MISDEMEANOR - PETTY 2800 PEARL ST at friend's house 1 160016952 12/23/2016 03:15 19 DUI 30TH ST/DIAGONAL HY At friend's party 1 160016747 12/17/2016 01:19 21 DV 213 29TH ST Avery Brewing 1 160016084 12/01/2016 23:20 44 DUI 6550 LOOKOUT RD Boulder House 1 160017177 12/30/2016 01:22 22 WEAPONS OFFENSE 1109 WALNUT ST denied 1 160016497 12/12/2016 13:14 46 DUI FOLSOM ST/PINE ST friends house 1 160016333 12/07/2016 21:49 22 DUI ITHACA DR/TABLE MESA DR Gunbarrel 1 170000001 12/31/2016 23:37 30 DUI 2800-BLK PEARL ST Home 1 160016529 12/13/2016 07:09 35 DUI 2920 BASELINE RD License No. 1 1 160017036 12/26/2016 01:23 29 DUI BALSAM AV/BROADWAY 5 -Jan -2017 Page 1 of 4 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 Reoort No Date Time Age Nature of Call Location n 160017225 12/31/2016 08:47 64 WARRANT CHAPARRAL CT/SPINE RD 160016889 12/21/2016 13:00 24 WARRANT 1777 6TH ST 160016150 12/03/2016 12:48 48 WARRANT 1650 38TH ST 160016945 12/22/2016 21:57 62 VIOL OF RESTRAINING ORDER 1911 11TH ST 160017116 12/28/2016 13:32 35 DV 3003 VALMONT RD 160016915 12/22/2016 09:36 35 WARRANT 22ND ST/PEARL ST 160016918 12/22/2016 10:29 31 ASSAULT 27TH WY/MOORHEAD AV 160016182 12/04/2016 10:45 45 WARRANT BROADWAY/CANYON BV n/a 160016472 12/11/2016 22:16 39 DV 1365 BEAR MOUNTAIN DR #D 160016085 12/02/2016 00:45 24 ASSAULT 3700 BASELINE RD 160016996 12/23/2016 22:47 19 WARRANT 2800 PEARL ST 160017095 12/27/2016 19:45 17 ASSAULT 1647 ARAPAHOE AV 160016526 12/12/2016 19:45 45 WARRANT 2800 PEARL ST 160016929 12/22/2016 13:06 29 WARRANT 1101 PEARL ST 160016849 12/20/2016 15:35 17 WARRANT 1777 6TH ST 160016162 12/03/2016 17:27 14 PUBLIC PEACE OFFENSE 907 11TH ST 160016599 12/14/2016 11:15 54 WARRANT 2995 30TH ST #112 160016997 12/24/2016 01:45 32 PUBLIC PEACE OFFENSE 3100 BLK/28TH ST 160016928 12/22/2016 13:06 58 WARRANT 1101 PEARL ST 160016207 12/05/2016 07:23 23 CRIMINAL TRESPASS 952 MARINE ST 160016574 12/13/2016 20:05 37 WARRANT 1135 BROADWAY 160016993 12/23/2016 18:23 49 DRUGS POSSESSION 2727 ARBOR GLEN PL 160016304 12/07/2016 10:45 23 WARRANT 1122 PORTLAND PL 160016422 12/10/2016 04:45 23 ASSAULT 4747 ARAPAHOE AV 160016824 12/19/2016 18:05 51 ASSAULT 2121 MESA DR 160016138 12/03/2016 02:19 18 WARRANT 790-BLK FLAGSTAFF RD na 160016512 12/12/2016 16:04 34 WARRANT 2833 BROADWAY 160016995 12/23/2016 19:14 20 CRIMINAL TRESPASS 3405 CASE CR 160016368 12/08/2016 19:27 14 WARRANT 1777 6TH ST 160016412 12/09/2016 17:15 56 WARRANT 2580 BASELINE RD 160017041 12/26/2016 03:13 38 WARRANT 2700 CANYON BV 160016684 12/15/2016 22:17 28 CRIMINAL MISCHIEF NON -GF 1651 BROADWAY 160016994 12/23/2016 18:06 20 CRIMINAL TRESPASS 449 HARVARD LN Nitro 160017179 12/30/2016 02:37 41 DUI 11TH ST/AURORA AV Total: 8 18 7 1 5 -Jan -2017 Page 2 of 4 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 13 160017076 12/27/2016 04:44 29 WARRANT 30TH ST/PEARL ST 160017103 12/28/2016 00:42 22 WARRANT 1480 CANYON BV 160016396 12/09/2016 13:22 52 VIOL OF RESTRAINING ORDER 490 QUAIL CR 160017166 12/29/2016 18:20 32 WARRANT JAY RD/ST CROIX ST 160017034 12/25/2016 17:29 51 DV 555 30TH ST #117 160015857 12/13/2016 23:18 26 SUPPLEMENTAL 1290 FOLSOM ST 160017216 12/31/2016 03:04 27 WARRANT 28TH ST/VALMONT RD 160017070 12/26/2016 20:11 52 WARRANT BROADWAY/CANYON BV 160016216 12/05/2016 09:54 30 WARRANT 2845 WILDERNESS PL 160016910 12/22/2016 04:31 31 WARRANT FRONTIER AV/PEARL ST 160017224 12/31/2016 08:00 36 WARRANT 3805 47TH ST 160017042 12/26/2016 03:13 24 WARRANT 2700 CANYON BV 160016191 12/04/2016 12:50 24 WARRANT 3050 BROADWAY Purchased alcohol on own 1 160017104 12/27/2016 23:25 35 CHILD ABUSE 555 30TH ST Ruben's restaurant 1 160016474 12/12/2016 03:10 22 DV 1155 MARINE ST#111 stated 1 hour prior to contact 1 160017211 12/31/2016 00:09 21 DUI ARAPAHOE AV/FOLSOM ST stated several hours prior 1 160016688 12/16/2016 00:33 25 DUI ARAPAHOE AV/BROADWAY sundown 1 160017027 12/25/2016 02:08 33 DUI BROADWAY/SPRUCE ST Sundown Saloon 1 160016136 12/03/2016 01:40 23 DUI 21ST ST/PEARL ST the walrus 1 160016139 12/03/2016 02:26 28 MISCELLANEOUS OFFENSE 13TH ST/HIGH ST U 2 160016135 12/03/2016 01:49 20 WARRANT 1200 COLLEGE AV 160016128 12/02/2016 22:49 23 WARRANT 20TH ST/BROADWAY unk 4 160016906 12/21/2016 17:31 46 WARRANT 2580 BASELINE RD 160016764 12/17/2016 18:34 43 CRIMINAL TRESPASS 1128 PINE ST 160016290 12/06/2016 20:15 62 WARRANT 2850 BASELINE RD 160017043 12/26/2016 07:12 30 ASSAULT 4747 ARAPAHOE AV 5 -Jan -2017 Page 3 of 4 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 unknown 160016378 160017207 160016081 160016951 160016748 160016124 160016371 160016198 160016998 160017024 160016869 160016375 160017129 160017022 160016758 160016858 160016177 160017217 160016419 160016946 160016950 vehicle 160016334 160016361 12/09/2016 06:42 20 GOVT OPERATIONS OFFENSE 12/30/2016 17:18 42 DV 12/01/2016 21:12 27 D U I 12/23/2016 02:42 45 WARRANT 12/17/2016 02:17 38 WARRANT 12/02/2016 19:50 43 VIOL OF RESTRAINING ORDER 12/08/2016 22:09 26 WARRANT 12/04/2016 15:53 30 D U I 12/24/2016 02:03 30 DUI 12/24/2016 22:55 44 VEHICLE STOLEN 12/21/2016 06:59 31 WARRANT 12/09/2016 02:30 47 WARRANT 12/28/2016 19:00 29 CRIMINAL TRESPASS 12/24/2016 22:56 42 MISCELLANEOUS OFFENSE 12/17/2016 15:44 27 WARRANT 12/20/2016 17:56 56 WARRANT 12/04/2016 04:54 49 WARRANT 12/31/2016 04:14 22 DUI 12/09/2016 23:10 33 DUI 12/22/2016 22:56 49 WARRANT 12/23/2016 01:40 20 DUI 12/06/2016 23:52 36 DUI 12/07/2016 23:52 36 DUI week prior per suspect 160016930 12/22/2016 14:22 72 SUPPLEMENTAL within 2 hours 160016761 12/17/2016 16:48 64 WARRANT 3700 BASELINE RD 1934 18TH ST #7 FRONTIER AV/PEARL PY 1655 33RD ST 1050 ARAPAHOE AV 2525 ARAPAHOE AV 28TH ST/DIAGONAL HY 700-BLK ARAPAHOE AV FOLSOM ST/IRIS AV 1901 SPRUCE ST 1800 28TH ST 1810 30TH ST 1447 PEARL ST 2765 28TH ST #324 1795 FOLSOM ST 1600 PEARL ST 28TH ST/COLORADO AV 29TH ST/ARAPAHOE AV 55TH ST/DIAGONAL HY 4805 BASELINE RD 55TH ST/CENTRAL AV 2500-BLK 49TH ST 2500-BLK 49TH ST 55TH ST/BASELINE RD 2800 PEARL ST Total: 21 2 1 1 100 5 -Jan -2017 Page 4 of 4 Agenda Item 3 Agenda Item 4 City of Boulder Finance �F BOV To: Beverage Licensing Authority members From: Mishawn Cook, License Administrator (cookm@bouldercolorado.Rov ) Date: January 10, 2017 Re: Beverage Licensing Authority (BLA) packet distribution and other city board and commission responses to e -packet distribution BLA Members, in January, 2016, City Licensing began to explore board packet distribution via electronic means. I have collected board liaisons responses for your review below. I have also included some of my additional comments under the Summary and Request heading. Question 1: How do you provide packet materials to your boards for their meetings or hearings (i.e. paper packets or electronic copies of packets)? Replies: From Ruth Weiss on January 7 who works with the Downtown Management Division: 1 email pdf packets through the appointment in Outlook along with the link to the commission website where it is posted. From Cindy Spence on January 7 who works with Planning Board, Design Advisory Board (DAP), and Board of Zoning Adjustment (BOZA): Packets are provided to my boards electronically. If we have large sets of plans, then 1 courier the plans. 1 place the packets on the "Next Meeting" pages for each board. From Sarah DeSouza on January 7 who works with the Parks and Recreational Advisory Board: Packets are provided to my boards electronically. 1 place the packets on the PRAB web page each month. From Sandy Briggs on January 7 who works with the Environmental Advisory Board: *1 send a link to the City website where the packet has been uploaded. * From Leah Case on January 11 who works with Open Space Board of Trustees: provide paper packets to four out of five of our members (one opted out - he gets it from our website) From Matthew Chasansky on January 15 who works with the Library Commission: We email PDF files on the Thursday before the meeting. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensine@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) Question 2: If you provide packet materials to your board members in electronic form, do you supply the members with an electronic device to read the copies, such as a laptop, i -Pad, or e -readers pre- loaded with those packet materials for their review? Replies: From Ruth Weiss on January 7 who works with the Downtown Management Division: My commissioners need to use their own resources to view packets. From Cindy Spence on January 7 who works with Planning Board, DAB, and BOZA: 1 do not provide the members with electronic devises. I send an email with the packet is complete and loaded onto the website. In the email, I provide a link to the webpage for them to view the packet. From Sarah DeSouza on January 7 who works with the Parks and Recreational Advisory Board: I do not provide the members with electronic devises. I send an email with the packet is complete and loaded onto the website. In the email, l provide a pdf document and a link to the webpage for them to view the packet. From Sandy Briggs on January 7 who works with the Environmental Advisory Board: *No.* From Leah Case on January 11 who works with Open Space Board of Trustees: We do not provide laptops, etc. We do however send an e-mail each month with a link pointing them to our OSBT page where the packet is loaded. From Matthew Chasansky on January 15 who works with the Library Commission: We do not supply a device to read the digital files. Question 3: If you supply packet materials electronically and a board member prefers a paper copy, will you print the paper copy for them and courier it to them or do you direct them to the website so that they print it themselves? Replies: From Ruth Weiss on January 7 who works with the Downtown Management Division: I do not courier and most use their personal tablets/computers. From Cindy Spence on January 7 who works with Planning Board, DAB, and BOZA: Very rare occasion that a paper copy would be asked for, but yes, 1 will print the packet for them if necessary. From Sarah DeSouza on January 7 who works with the Parks and Recreational Advisory Board: Very rarely a paper copy would be asked for, but yes, I will print the packet for them if necessary. I also bring one printed packet to the meeting for public review. From Sandy Briggs on January 7 who works with the Environmental Advisory Board: *1 bring one or two hard copies to the meeting but otherwise let the board members print their own if they want a hard copy. * From Leah Case on January 11 who works with Open Space Board of Trustees: We print out hard copies (for four of the five) and send via courier. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensine@bouldercolorado.20V (303) 441-4192 (303) 441-1919 (FAX) From Matthew Chasansky on January 15 who works with the Library Commission: Were it the case, we would provide a paper copy to a commissioner that requested it. Question 4: If you provide board members with packet materials in electronic form and supply them with an electronic device to review the materials, how do you deliver those devices to your members i.e. by courier, require that they pick them up, other? From Ruth Weiss on January 7 who works with the Downtown Management Division: N/A... 1 also bring a few hard copies to the meeting for commissioners and the public. From Cindy Spence on January 7 who works with Planning Board, DAB, and BOZA: N/A From Sarah DeSouza on January 7 who works with the Parks and Recreational Advisory Board: N/A From Sandy Briggs on January 7 who works with the Environmental Advisory Board: *I do not supply electronic devices. * From Leah Case on January 11 who works with Open Space Board of Trustees: N/A From Matthew Chasansky on January 15 who works with the Library Commission: N/A Question 5: Do you have a deposit or anything else in place if members lose or break their electronic devices that you supply to them? From Ruth Weiss on January 7 who works with the Downtown Management Division: N/A From Cindy Spence on January 7 who works with Planning Board, DAB, and BOZA: N/A From Sarah DeSouza on January 7 who works with the Parks and Recreational Advisory Board: N/A From Sandy Briggs on January 7 who works with the Environmental Advisory Board: N/A From Leah Case on January 11 who works with Open Space Board of Trustees: N/A From Matthew Chasansky on January 15 who works with the Library Commission: N/A Summary and Request As you can see, eight of the nine responding city boards provide their meeting packets electronically, either emailing it to their board members or posting it on the board website then directing their board members to the web -link. None of the nine responding boards provide their members with computer devices to read the a -file packets either at home or at their meetings, and so also none of the nine responding boards courier out the readers. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensine@bouldercolorado.aov (303) 441-4192 (303) 441-1919 (FAX) Five of the Nine boards have stated that they will very occasionally provide paper meeting packets upon request but most seem to fulfill those requests for a paper copy by bring one or two publicly available printed paper copies to their meetings, instead of separately couriering out those paper copies directly to the requesting board members. My suggestion then is as follows: 1) That we proceed to change our hearing packet distribution to an a -copy posted on our website with a link in a hearing reminder email sent to board members and to city staff who attend the monthly hearings to guide them to the packet location on our website. We already scan in so as to create a packet copy on the liquor website so we would just direct the BLA members also there for their application reviews. 2) That we prepare two paper copies of the hearing packet available for use at the BLA hearings, one can be supplied as available for the public's review and one supplied for the BLA members to all reference at their desk. We then would only need to recycle these two copies, since our permanent hearing packet is posted on our website, along with hearing exhibits distributed at the hearings. 3) That we play by ear, although we should set aside necessary funds in the first year, the need for purchasing e -readers for the five BLA board members to use at the hearings only, but that we not courier the reader devices and that we not allow the board members to remove the readers from the hearing room in any event. Given that BLA members refer to application pages and applicant representations often during hearings, I do have a suspicion that we will eventually need to supply e -reader devices on your desks so that you can refer to the applications, but this is out of the norm for other boards so I would like for there to be a concrete and actual need before we make that purchase. The savings described below should more than pay for purchasing seven e -readers (five for each board member and two as replacements when technology fails as it does). We estimate that the printing of our BLA hearing packets, which average anywhere between 300 pages to 600 pages in length each month, costs us on average $350 each month. We have our hearings once a month so the total printing cost each year is $4,200 each year. In addition, the couriering out of the printed BLA packets costs $6 each multiplied by 5 members for a total cost of $30 a month or $360 total a year. If we make this change, this would seem then to save us $4,560 a year from the liquor licensing budget. In my opinion, it will have negligible additional cost to make two paper copies here on-site at the city. It should be an even switch for staff time spent, i.e. emailing printing company°e-packet, receiving back paper packets, preparing packets for courier versus scanning, emailing board members with packet web -link once posted, and printing two copies by hand for use at the hearing. By way of this memo, City Licensing requests the opinion by quorum from the Beverage Licensing Authority about this suggested change to the provision of our monthly hearing packet. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 IicensinE! bouldercolorado.2ov (303) 441-4192 (303) 441-1919 (FAX) Agenda Item 5 cc F-2- IV BEVERAGE LICENSING AUTHORITY, CITY OF BOULDER, COLORADO IN THE MATTER OF THE HOTEL -RESTAURANT TYPE LIQUOR LICENSE OF THE NOODLE SHOP CO — COLORADO, INC. d/b/a NOODLES & COMPANY 146, 1600 281' STREET, SUITE 1208, 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, January 18, 2017 for the following violations: 1. On October 14, 2016, at approximately 8:39 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 day ofj�P, omlr, 20, a true and correct copy of the above and foregoing Notice of Hearing and Order to Show Cause was duly mailed by placing same in the U.S. Mail, certification no. -1 ()�2 2,q 2,o nncp ti � q S3 return receipt requested, postage prepaid, addressed to the following: The Noodle Shop Co — Colorado, Inc. d/b/a Noodles & Company 146 520 Zang St., Suite D Broomfield, CO 80021 Via Regular U.S. Mail Attn: Manager The Noodle Shop Co — Colorado, Inc. d/b/a Noodles & Company 146 1600 28'b Street, Suite 1208 Boulder, CO 80301 2 1 (Domestic Mail Only; No Insurance Coverage Provided) Ln D-iClAL USF Certffr--�lf FOP E3 Postmadc M Return Recelpt Fee Here ED (Endorsement Required) O Restricted Dever Fee 1:3(Endorsement Requir" ru D" Total Postage& RaeAnn Kachinski ru The Noodle Shop Co - Colorado, Inc ru sent To NOODLES & COMPANY 146 o License # 24-84389-0003 orPOBoxft. 520 Zang St, Suite D City 9966 ZlP+4 Broomfield, CO 80021-8223 PS Form :rr CITY OF BOULDER COPIES Original: Deputy City Clerk Request for Show Cause Hearing Copy 1: BPD Legal Advisor Copy 2: Originating Officer Copy 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 The Noodle Shop Co — Colorado, Inc Noodles & Company 146 Mailing Address 520 Zang St., Suite D Broomfield, CO 80021-8223 Violation License Type Hotel -Restaurant Location 1600 28t' St. 41208 Boulder, CO 80301 License No. 24-84389-0003 Date Case No. License License Issued Expires 12/09/16 Officer 1. UNLAWFUL ACTS: on Oct. 14, 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- 10/14/16 16-13825 D. Bergh 47-901 (1)(a.5)(I) UNDER THE COLORADO REVISED STATUTE, AS AMENDED. Hearin ate Hearin Time Previous Violations Days in Abey. am- �� gY Y Originating Officer Daniel Bergh City Attorney Lucas Markley Deputy City Clerk Mishawn Cook Signature zw_7//4z__ Signature Signature Date / 0/2 vl2we. Date /Ws//6 Date 1-2— NOTES -Z NOTES The Noodle Shop Co- Colorado, Inc. d/b/a/ Noodles & Company 146 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 October 14, 2016, Sergeant D. Thomas 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 #1 was a volunteer for this operation. Operative #1's date of birth is 02/02/2000. He 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 him as he appeared that evening was taken. Before the operation began, I verified the following about the underage operative: • He did not have fraudulent or false identification on their persons. • He had no pending criminal or traffic offenses. • He 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 his 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, The Noodle Shop Co -Colorado, Inc., doing business as Noodles & Company 146, holds a Hotel -Restaurant type liquor license, number 24-84389-0003. At approximately 2039 hours Sergeant Thomas and I transported the operative to Noodles and Company, 1600 29th Street, unit #1208 where he made his way inside in an attempt to purchase alcohol. Operative #1 went to the counter and told the cashier/server, later identified as Jena Hadlock, that he was waiting for a friend and wished to order a beer. Operative #1 asked for an Ellie's Brown Ale. Hadlock requested to see his identification. Operative #1 provided the ID to Hadlock who took it, looked at it (for approximately 5 seconds) and then returned it to Operative #1. Hadlock then accepted payment for the beer and handed it to Operative #1. Operative #1 alerted me that he had been served. Sergeant Thomas and I entered the restaurant and located operative Page 1 The Noodle Shop Co- Colorado, Inc. d/b/a/ Noodles & Company 146 #1 seated alone at a table near the doors. He had an open, twelve ounce bottle of Avery Ellie's Brown Ale on the table in front of him. Operative 41 described the server as female with blonde hair wearing a black "Noodles" hat and uniform. Operative 41 then returned to our parked vehicle. I contacted a male at the front counter and asked for the manager. He pointed to a female (Hadlock). I told Hadlock that I was conducting a compliance check and that someone matching her description had served alcohol to minor. Hadlock admitted that it was likely that she had been the one. I asked her if she had checked the ID. She said that she had. I asked Hadlock how long she had worked at Noodles. She said that she had been at this particular location for about one year. I asked if she had received age -verification training. She said that her manager, "went over it with her." I asked if she had attended a formalized training program from an outside source. She said that she had not. Hadlock was cooperative during my contact with her. The restaurant was very busy and it appeared that the staff were preparing for closing. Hadlock admitted that she was hurried and didn't pay close enough attention to the ID. I issued Hadlock a summons. Based upon the above information, I believe there is probable cause to show that on Friday, October 14, 2016 at approximately 2039 hours, the owner/licensee, The Noodle Shop Co — Colorado, Inc, doing business as Noodles & Company 146 at 1600 28`h St. #1208, City/County of Boulder, State of Colorado violated the following: 1. UNLAWFUL ACTS: on October 14, 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 revok for th above v' lation. w .�iolao) �j Affiant —Daniel ergh / Date Notary P�;1ic / Date KADY ECKSTROM NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20024024201 MY COMMISSION EXPIRES JULY 29, 2018 Page 2 d('r-l39zs UNDERAGE OPERATIVE'S SUMMARY OF FAILED COMPLIANCE CHECK Your Name: () e (('tea' i\ I e, I DATE: 1 QN \4\\ DAY OF WEEK: rr Pdwf TIME: :X17 BUSINESS NAME:-MOOA\e,C QvN; e �p LOCATION: e, eei' Approximate number of people in business: — \ Business checking I.D.'s at the front door? ❑ Yes ID No Did you have an I.D.? 3 Yes ❑ No If so, what age was shown on the I.D.? Did an employee ask for your I.D.? 2 Yes ❑ No Did an employee look at your I.D.? 0 Yes ❑ No Where did you sit? ,�I �ni-� '\p.r t'j 1 C Q., Were other operatives with you? ❑ Yes El No Who ordered the alcohol? Did an employee accept payment for alcohol? M Yes ❑ No Type and brand of alcohol ordered: C.,1\ 1�(o C," t\ \2 r The words used to request alcohol: �Na, Ir n4 i'cir G` (1eI`d r rj\N Brief description of employee who served alcohol: 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. qv') r Say ► c; M tnla.j �i �� �O < t\ �� e�r1 . C�a' Re, }- Vz. forAFP I'O X Made \ xo�s M) We, fir- (-vel �� en � � ��� ; � cc►�Sl� fr,� ��� � � � �1� d e� ra9�\� � c c� i eJ�� so+ 09' Q,, Wen ked �- WQ, b *o lb i �n (3m -e, ok�--,cers o u�- } Sco)qr of City of Boulder tll:,� Finance 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 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 Certificates of Completion or Class Cards from the state -certified Responsible Vendor alcohol service trainings for all of your 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 completed proof of training chart and above certificates or cards to Mishawn J. Cook, Tax and License Manager, 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 Facts evidence no later than nine days prior to your hearing. Failure to turn in these documents or to turn in these documents by the deadline may be viewed by the Authority as an "aggravating" factor and could potentially increase any suspension days imposed. The prosecutor is Lucas Markley, City Attorney's Office Prosecutor for the Boulder Police Department, the telephone number is 303-441-3020 and the mailing address is City Attorney's Office, P.O. Box 791, Boulder, CO 80306. Please be advised that it is your responsibility as a liquor licensee to know the state and local liquor codes and regulations. Mr. Markley will discuss the issues involved in your pending Hearing, but they cannot provide you with legal advice as to defense of your case. A copy of Boulder Liquor Authority "Penalty Schedule" for 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. Dates of Suspension are selected by the BLA, and generally start on the Monday after the hearing date. 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. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 liecui,ma a boulderculorado.4o1 (303) 441-4192 (303) 441-1919 (FAX) 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 September 22, 2016 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 Training Programs- initial and on-going. Responsible Vendor Training and supplemental. Must be current. Written Policies Supervision Procedures Self -check programs Use of birth -date input cash registers Aggravating Factors Failure to submit Mitigating Factor evidence at least nine days before hearing to City Licensing Prior Offenses in the past five (5) Years Violations occurring outside of compliance checks (aka "Stings") Lack of effective operational/training programs 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 Failure to Accept Responsibility for Violation of 11 yearly meetings) 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. Suspension dates are selected by the Authoritv, but eenerally start on the Mondav after the hearins date. Also. Fines in lieu of suspension days served are eenerally not wanted by Authoritv. Code Violation Sale/Service to a Minor 1 count 2 counts 3+ counts Second Offense within 1 year Conduct of Establishment 1 count 2 counts 3+ counts Second Offense within 1 year Sale/Service to Intoxicated Person First Offense 1 count 2 counts 3+ counts Second Offense within 1 year All Other Liquor Store All Other Liquor Store Licenses Tavern License Licenses Tavern License Days Served Days Served Abeyance Days Abeyance Days 5 3 9 6 10 6 20 12 15 9 30 18 10 6 20 12 8 6 6 3 13 9 17 9 18 12 27 15 20 11 20 12 5 3 9 6 10 6 20 12 15 9 30 18 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 3 1 count 2 1 5 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 5 3 9 6 First Offense 10 6 20 12 Second Offense 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 Tavernsl correct) [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.sov/licensins 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. ■ iL���-'I� ;`�,Ct?�ki•%--/�;�.+ ll-„ 1 ;_.1�„ ;i'��� 'V�'�`t•:L1= �-�`•kr;:?-�1�-•1.�� Lu a 0 f��..ji1?:rr�:,i, �, f� Z Q 2 z o LLI V) CD 0 O U) di r LLI 0 e—mU) U1 z in N )moo c to 0 L w )M= I= 4) m CO IX (.) _j (1) 0 — (.) "0 V —i cc ■ Lu a 0 U) c Z Q 2 z o LLI V) CD 0 O U) di r LLI 0 e—mU) U1 z in N )moo c to 0 L w )M= I= 4) m CO IX (.) _j (1) 0 — (.) "0 V —i cc r Ztr C cc 0 > on rg in N W:3 - 0 4 c ca 17 > :3 cc kb C)oc cn cn cm Noas Mft. Im r••i► v cm a Z o E ca 0 z 0 uj CL z to 0 ui CL fit a 34' oedipus; Inc. Empirical Data Services P.O. Box 1012 t.AFAYME, CO 80026 303 661 0638 303 604 2862 FAX • PETMON & TELEPHONE SURVEYS Liquor & 3.2 Beer Licensing Rezonings Opinion Poll Venue Special Tax Districts • LIQUOR LICENSE SITE & ECONOMIC ANALYSIS Certificate of Training of Responsible Vendor Pursuant to the recommended server training of Liquor Enforcement (Colorado Department of Revenue), and per C.R.S. 12-46, C.R.S. 12-47, The Colorado Liquor Code, the Colorado Code of Regulations, the United States and Canada Version 2016 I.D. Checking Guide, and Oedipus, Inc. training and testing procedures, Sally Swenson, General Manager Donathan Palmer, Asst. General Manager Zachary Primrose, Assistant General Manager NOODLES & CO. 1600 - 28th Street, #1208, Boulder, CO 80301 Have been trained, tested and certified on 8 January 2017, to dispense on premises retail Iicenses only, to include Hotel & Restaurant Class License. Max*coft,., resident Oedipus, Inc. ooediper,'Inc. �EfW/ C'��J�A�0 D1z+�S��N! Driver License I Instruction Permit I Identification Card The Colorado DMV will begin issuing driver licenses, instruction permits and identification cards with new designs and enhanced features in 2016. The card design includes an entirely new format and enhanced features, including laser -engraved information in grayscale, as well as new card material. CURRENT CARDS WILL REMAIN VALID UNTIL THEIR EXPIRATION DATE r COLORA T�0 v.4 9 DRIVER LICENSE 1 SAMPLE 2 DRR/ER LICENSE s 1881 FIERCEST. LAKEWOOD. CO 80214 3 DOH 481s 98 ErAkwun aaR 1�Na4I1B�$ 04%24/2Q15 M •Id ��� t2 O r,Raxtrk9ona 9 OD PWAMM Type 9 VaNde daaa9kau" 12345878910 A R 1S Sax 16Hgt F 5-04' r� 16 Eva 17 Woo VES BRN 120 lb 19PAW 0-4 BRN �°�Mt9i6 FRONT • Background design features Mt. Sneffels, one of Colorado's peaks over 14,000 feet, and blue, yellow and green coloring • Large "Colorado" across the top of the card coupled with "USA" and the Colorado border in the color that corresponds with the card type: • Green - Driver License and Instruction Permit • Red - Identification Card • Layout of the design corresponds to card holder's age: • Horizontal -Adult • Vertical - Minor (Under 21 Years of Age) • Primary photo, document type and customer information (name, date of birth, etc.) laser engraved in grayscale • Raised print of specific customer and license information • Semitransparent window with the customer's photo BACK • Primary design featuring the Colorado State Capital, with a snowflake -like design, in blue and green coloring • Standard and 2D barcodes • Metallic "C" from the Colorado state flag • State of Colorado and Department of Revenue logos COLORADO Department of Revenue Division of Motor Vehicles MORE INFORMATION AT WWW.COLORADO.GOV/DMV/NEWLOOK card size increased to show detail Agenda Item 6 December 7, 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: rkachinski@noodles.com And Via Certified Mail, Return Receipt Requested The Noodle Shop Co - Colorado, Inc NOODLES & COMPANY 146 License # 24-84389-0003 520 Zang St, Suite D Broomfield, CO 80021-8223 Attention: RaeAnn Kachinski Re: Hotel -Restaurant Liquor License Renewal Application for 1600 28" Street Unit #128 Dear Ms. Kachinski: Per the emails of October 25 and November 10 requesting the submittal of proof of training as part of the renewal application, please allow this letter to serve as written notification that as of the date of this notice the City has not received the requested materials. To recap, the city is in receipt of the state and city license renewal applications for your license which were received on October 25, 2016. All fees were submitted and sales tax and occupancy tax staff would allow renewal of your license. However, all applicable renewal requirements must also be met for us to process your renewal administratively and City Licensing had set a license condition from the previous 2016 license that all that server training must be in compliance. As such, our local Rules of Procedure preclude me from approving a license renewal via Summary Approval (see attachment 1). Therefore, your Company 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 are attaching here an employee training summary sheet for you to complete and attach employee certificates and training cards to (see attachment 2). We note that on your license renewal, you state that your business is not compliant with the training condition at this time. Any training list and cards should be provided to city licensing by Monday January 9. City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 Iicensin!zftouldercolorado.aov (303) 441-4192 (303) 441-1919 (FAX) b. Licensee should be prepared to address any questions raised as to compliance with 12-47-411, C.R.S. (pertaining to Hotel -Restaurant type Liquor Licenses -see Attachment 3), including but not limited to, food and meal availability and mandatory percentages. 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. You will then be scheduled and are hereby ordered to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado on January 18, 2017 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 January 4, 2017 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 January 7, 2017. The State Liquor License Code is available for your review at: http://www.revenue.state.co.us/liuuor dir/wran.ast)?incl=lawrules and the city of Boulder Beverages Licensing Authority Rules of Procedures are available at: httn://www.ci. boulder.co.us/clerk/liu uor/Ru les%20of%2OProcedure.]Ddf 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.2ov Website: htti)://www.bouldercolorado.2ov/licensin2 City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 licensine@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) CERTIFICATE OF MAILING I hereby certify that on the 7 day o 20 *, a true and correct copy of the above correspondence was dul mailed by placing same in the U.S. Mail, certification # �IZ- ;9 2 Q` , return receipt requested, postage prepaid, addressed to the following. The Noodle Shop Co - Colorado, Inc NOODLES & COMPANY 146 License # 24-84389-0003 520 Zang St, Suite D Broomfield, CO 80021-8223 Attention: RaeAnn Kachinski City of Boulder 1777 Broadway P.O. Box 791 Boulder, CO 80306 Iicensin2@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) COMPLETE ■ 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. 13 Attach this card to the back of the mallpi r -gift or on the front if space permits. 1. Article Addressed to: A ❑ Agent ❑ Addresser B e ted Name C. Date of Deliver D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below- ❑ No III1111111111IgIIII III, I�i'lulllllnt RaeAnn Kachinski The Noodle Shop Co - Colorado, Inc NOODLES & COMPANY 146 3. S Ice Type License # 24484389-0003 TCertifled Mail ❑ press Mail 520 Zang St, Sude D U Registered etum Receipt for Merchandise Broomfield, CO 80021-8223 ❑ Insured Mail ❑ C.O.D. 2. Article Number 4. Restricted Delivery? (Extra Feel 13Yes (transfer from service fabeo 7 012 2920 0000 3104 0 313 Ps For, 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 Postal MAIL,,, RECEIPT (DomesticCERTIFIED Mail Only;Provided) M o - .qq oiiG�l rq Postage $ M C3 Certified Fee { Postmar 0 C3 Retum Receipt Fee (Endorsement Required) I Here E3 Restricted Delivery Fee (EndorsemenM uired) nJ Total Postage & Fees $ L ef��,� l U �6 I CA riS r rU Sent To / �Mt- 0 rl O 1•`- /fl -- ----^--- greet dpt No.; `aO (Z orPOBoxNo. -J cJG '- -' --------------------- � cJ .__, City, State, ZIP+4 �i,D / a PS Form :,. August 2006 p�� eta See Reverse for Instructions COMPLETE ■ 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. 13 Attach this card to the back of the mallpi r -gift or on the front if space permits. 1. Article Addressed to: A ❑ Agent ❑ Addresser B e ted Name C. Date of Deliver D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below- ❑ No III1111111111IgIIII III, I�i'lulllllnt RaeAnn Kachinski The Noodle Shop Co - Colorado, Inc NOODLES & COMPANY 146 3. S Ice Type License # 24484389-0003 TCertifled Mail ❑ press Mail 520 Zang St, Sude D U Registered etum Receipt for Merchandise Broomfield, CO 80021-8223 ❑ Insured Mail ❑ C.O.D. 2. Article Number 4. Restricted Delivery? (Extra Feel 13Yes (transfer from service fabeo 7 012 2920 0000 3104 0 313 Ps For, 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 Teaque, Kristen From: Cook, Mishawn Sent: Tuesday, December 06, 2016 3:03 PM To: Teague, Kristen Subject: FW: Noodles 146 renewal Reminder email Mishawn J. Cook Licensing Administrator Certified Municipal Clerk r ► City of Boulder 4 Finance O: #303-441-3010 cookm @ bouldercolorado.gov Finance Department 1777 Broadway I Boulder, CO 80302 Bouldercolorado.aov From: RaeAnn Kachinski [mailto:rkachinski@noodles.com] Sent: Thursday, November 10, 2016 2:48 PM To: Cook, Mishawn <cookm@bouldercolorado.gov> Cc: Mazurkiewicz, Beata <MazurkiewiczB@bouldercolorado.gov> Subject: RE: Noodles 146 renewal Thank you, I just send another email reminder to the restaurant. Thanks again, RaeAnn From: Cook, Mishawn[mailto:cookm@bouldercolorado.sov] Sent: Thursday, November 10, 2016 2:42 PM To: RaeAnn Kachinski <rkachinski@noodles.com> Cc: Mazurkiewicz, Beata <MazurkiewiczB(n_)bouldercolorado.eov> Subject: RE: Noodles 146 renewal Hi, I have not heard back from you regarding the training information for this renewal. I also noticed that I did not provide you with a deadline for that information. We will need the training summary list and cards by November 18 or we will be weighing whether we need to schedule a renewal hearing. Thank you and please let me know if you have any questions, Mishawn Mishawn J. Cook Licensing Administrator Certified Municipal Clerk City of Boulder Finance O: #303-441-3010 cookm @ bouldercolorado.aov Finance Department 1777 Broadway I Boulder, CO 80302 Bouldercolorado.aov From: Cook, Mishawn Sent: Tuesday, October 25, 2016 3:48 PM To:'rkachinski@noodles.com' <rkachinskiPnoodles.com> Cc: Mazurkiewicz, Beata<MazurkiewiczB@bouldercolorado.eov> Subject: Noodles 146 renewal Hi RaeAnn, we received the renewal mailing today. For the renewal, we had a condition on the license for last year that they training must be in compliance for the 2017 renewal, perhaps because it was not compliant last year. Please then let me know when the servers listed will attend a training class and when you will send us the confirming training cards- we will need those to process the renewal so please let us know ASAP about the training. As to the reg mgr change, I am going to send that back to you- we need Ryan's print card (not received) and the $38.50 check needs to be payable to the City of Boulder. You will see that in the mail. Thanks, Mishawn Mishawn J. Cook Licensing Administrator Certified Municipal Clerk City of Boulder ..� Finance O: #303-441-3010 cookm @ bouldercolorado.aov Finance Department 1777 Broadway I Boulder, CO 80302 Bouldercolorado.aov Cook, Mishawn From: Sent: To: Cc: Subject: Cook, Mishawn Tuesday, October 25, 2016 3:48 PM 'rkachinski @ noodles.com' Mazurkiewicz, Beata Noodles 146 renewal Hi RaeAnn, we received the renewal mailing today. For the renewal, we had a condition on the license for last year that they training must be in compliance for the 2017 renewal, perhaps because it was not compliant last year. Please then let me know when the servers listed will attend a training class and when you will send us the confirming training cards- we will need those to process the renewal so please let us know ASAP about the training. As to the reg mgr change, I am going to send that back to you- we need Ryan's print card (not received) and the $38.50 check needs to be payable to the City of Boulder. You will see that in the mail. Thanks, Mishawn Mishawn J. Cook Licensing Administrator Certified Municipal Clerk City of Boulder Finance O: #303-441-3010 cookm @ bouldercolorado.00v Finance Department 1777 Broadway I Boulder, CO 80302 Bouldercolorado.aov G License Number: Date Fees Received: r 9 l �'J (o : �i Date Issued: Amount Recd COB:�, p9 ZO�f�3 0 Expires: Amount Recd State: meq, 3 / To State: CITY OF BOULDER 6L__ LIQUOR LICENSE RENEWAL APPLICATION Current Information: Applicant: The Noodle Shop Co - Colorado, Inc Trade Name: NOODLES & COMPANY 146 Address: 520 Zang St, Suite D Broomfield, CO 80021-8223 Phone: (720) 214-1900 Email: rkachinski@noodles.com License Type: Hotel -Restaurant Liquor Location: 1600 28th Street, Suite 1208 Enter any corrections below: r i All information mist be typewritten or legibly printed in black ink. 24-84389-0003 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 October 25, 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: 12/9/16 P. O. Box 791 City Must Receive Complete Renewal By: 10/25/16 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 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 tra�ning 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 certificates of class completion or class cards to this summary. In accordance with C.R.S. 12-47-411 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? No 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 httpl/www.sos.state.co.uslpubs/business/main.htm ). Certificate enclosed: IMPORTANT: Please complete both pages of this application form. Version 4.01.03 612912016 CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Oath of Applicant: 1 declare under penalty of pedury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. Authorized Signature: I Title of Signer (if corporation): 1 Date: LSC Tax Deparknsinggi Approved: A Signature:BeveragesrityAction: Approved: Chair: Denied: ❑ Date: Comments: Denied: Date: Attest: IMPORTANT: Please complete both pages of this application form. Version 4.01.03 612912016 City of Boulder Finance Department • Licensing Division 1777 Broadway, Boulder, CO 80302 • 303.441.4192 PROOF OF TRAINING If you checked YES for training on your city renewal, please fill out this farm & attach cards/certificates of training for employees! Trade Name: 1�ae�1� tin (,ow�pwy Address: _rv,t vly .1Q: n ik Sk�� l I to�� Z�dkt� Sk t IZO`d (oo_r, CO 8 0 ) 0 1 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 I�yu,.. PC�2fSun State Training Type Hire Date Previous Latest Training Date Training Date �jecv6u�c, CSL,, stere ANJ 1 �, ILPJ S�..f 2 ',Vr A S r' s v 5 �F� IA If you checked YES j� City of Boulder for training on your city renewal, pleasefill out this form & attach cards/certificates of Finance Department •Licensing Division trainingforemployees! 1777 Broadway, Boulder, CO 80302 - 303.441.4192 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 Previous Latest Training Date Training Date �,/!� �• City of Boulder If you checked NO /� �� for training on your city renewal, Finance Department • Licensing Division please fill out thisforml 1777 Broadway, Boulder, CO 80302 - 303.441.4192 BEVERAGE LICENSING AUTHORITY PLAN FOR TRAINING COMPLIANCE FOR LICENSE RENEWAL Trade Name:P Address: 1I�-�� .� ll�� cJT 1�� C• R �� V �� �lJ��il 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 for training completion. A 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. lat, At00�e xnti), � yc�- r_�\r�cr�r}��i�c—� Applicant/ Licensee business name Trade name 14 Authorized signature Print name Q Date Title v DR 8400 (Revised 09/01/12) COLORADO DEPARTMENT OF LIQUOR ENFORCEMENT DIVISION REVENUE RETAIL LIQUOR OR 3.2 BEER SUBMIT TO LOCAL LICENSING AUTHORITY LICENSE RENEWAL APPLICATION NOODLES & COMPANY 520 ZANG ST STE D BROOMFIELD CO 80021-8239 PLEASE VERIFY & UPDATE ALL INFORMATION BELOW Licensee Name NOODLE SHOP CO COLORADO INC Liquor License # License Type 24843890003 Hotel & Restaurant (city) O erating M a er, Date of Birth �n o �P3kvS(� Vi I Ma4er PhonQ Number Fees Due Renewal Fee Storage Permit $100 x Optional Premise $100 x _ Related Resort $75 x Amount Due/Paid $500.00 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 debited as early es 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 collect the payment amount directly from your banking account electronically DBA NOODLES & COMPANY Sales Tax License # Expiration Date Due Date 12/09/2016 10/25/2016 I Home AddrPc% i n sLn vz;� 1, c�rl�i n�k� ��r11F s .cam Street Address Phone Number 1600 28TH ST. SUITE 1208 BOULDER CO 80301-1031 46`F�L Mailing Address 520 ZANG ST STE D BROOMFIELD CO 80021-8239 1. Do you have legal possession of the premises at the street address above? A YES ❑ NO 1 Is the premises owned or rented? ❑ Owned M Rented* *If rented, expiration date of lease 1al-A�q 119. 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, anaging membe r 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. W 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 j�' NO 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 ❑ NO &ff- Gt�Ch� 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. JU YES ❑ NO c� CtaC AFFIRMATION 8r CONSENT 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. Type or Print Name of Applicant/Authorized Agent of Business Title Signature Date 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 46 and 47, C.R.S. THEREFORE THIS APPLICATION IS APPROVED. Local Licensing Authority For Date Signature I Title Attest 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, NOODLES & COMPANY is an entity formed or registered under the law of Delaware , 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 20021364021 . 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 c@i 10:54:20 . 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 c@i 10:54:20 in accordance with applicable law. This certificate is assigned Confirmation Number 9873402 M e Secretmti' of State of the State of Colorado *********************************************End of Notice: A certificate issued electronicalh, from the Colorado Secretary of State's Web site is frdh, and immediately valid and effective. However• as an option. the issuance and validity ofNv m a certi/icate obtained electronicaay be established by visiting the Validate a Certificate page of the Secretiny of State's Web site, hitp:/iivww.sos.state.co.us/biJCertgicnieSearchCriteria.do entering the certificate's confirmation mrmber displaved on the certificate, and following the instructions displaved. Confirmine the issuance ofa certificate is mereh, ontional and is not necessary to the valid and effective issuance ofa certificate. For more information. visit our Web site, http://wwit,.sos.state.c•o.its, click "Businesses, trademarks, trade noires " and select "Frequently Asked Questions. " 102 North Boulder 1245 Alpine Avenue Boulder CO 80304 1303) 440-4340 103 Applewood 3294 Youngfield Unit F Wheat Ridge CO 80033 (30_3) 232-6688 105 Broomfield 1100 Hwy. 287 100 Broomfield CO 80020 (303) 404-3400 106 6th and Broadway 550 Broadway Unit B Denver CO 80203 (303) 832-6000 107 Highlands Ranch 9563 South University Blvd Highlands Ranch CO 80126 (720) 348-1522 108 Interlocken 635A Flatiron Marketplace Drive Broomfield CO 80021 (720) 887-5700 109 16th and Market 1460 16th Street Denver CO 80202 (720) 904-9590 110 Louisville 1100 West Dillon Road Suite 1 Louisville CO 80027 (303) 665-6226 111 Fort Collins 4733 S. Timberline Road Suite 104 Fort Collins CO 80528 (970) 223-2808 112 Lakewood 7740 West Alameda Avenue Lakewood CO 80226 (303) 716-3550 114 C470 & Kipling 9956 Remington Space A-5 Littleton CO 80128 (303) 979-7585 116 Lone Tree 9400 Heritage Hills Circle Suite 100 Littleton CO 80124 (303) 662-8866 117 Parker 11153 A South Parker Road Parker CO 80134 (720) 842-5330 118 Arvada 8071 Wadsworth Blvd. Unit 1-C Arvada CO 80003 (303) 432-0066 119 Colorado Springs 7234 North Academy Blvd Colorado Springs CO 80920 (719) 264-0022 120 Arapahoe & Peoria 12023 East Arapahoe Road Unit 100 Centennial CO 80112 (303) 792-5454 121 Aspen Grove 7301 South Santa Fe Drive Littleton CO 80120 (303) 738-3900 122 Westminster 10355 Federal Blvd Unit H Westminster CO 80260 (303) 404-0032 123 Colorado Blvd 1502 S. Colorado Blvd Denver CO 80222-370( (303) 504-0082 125 Longmont 1087 S. Hover Street Unit D Longmont CO 80501 (303) 776-5664 126 Stapleton 7401 E. 29th Avenue Bldg 13 Denver CO 80238 (303) 780-0044 127 Broadmoor 1812 Southgate Road Colorado Springs CO 80906 (719) 385-0800 128 Greeley 4318 West 9th Street Road Suite 7 Greeley CO 80634 (970) 336-0303 129 125 Hampden 6300 East Hampden Suite K Denver CO 80222 (303) 759-3817 130 Powers & Barnes 5844 Barnes Road Colorado Springs CO 80922 (719) 597-4950 131 College Avenue 648 S. College Avenue Fort Collins CO 80524 (970) 472-2023 132 Englewood 697 West Hampden Avenue Englewood CO 80110 (303) 781-0225 133 Loveland 1550 Fall River Drive Suite 190 Loveland CO 80538 (970) 612-0982 134 Fitzsimons 13700 E. Colfax Suite D Aurora CO 80011 (720) 262-4451 135 Southlands 6200 South Main Street Suite 101 Aurora CO 80016 (303) 243-5270 136 Highlands Ranch Town Cent 1601 Mayberry Dr Space 104 Highlands Ranch CO 80129 (303) 346-4322 137 Broomfield Corners 4530 W 121st St Ave Broomfield CO 80020 (303) 460-7044 138 Quincy Place 4261 S Buckley Road Aurora CO 80013 (303) 400-0947 139 Southglenn 2370 E Arapahoe Ste 926 Centennial CO 80122 (303) 730-2707 140 University Village 5166 N. Nevada Ave Colorado Springs CO 80918 (719) 598-7777 141 Havana 10550 E. Garden Dr Ste 106 Aurora CO 80012 (303) 695-6000 142 University of Denver 1737 E Evans Ave Denver CO 80210 (303) 722-1912 146 29th Street 1600 28th St Ste 1208 Boulder CO 80301 (303) 546-9000 147 Dillon 265 Dillon Ridge Rd (PO Box 4346) Dillon CO 80435 (970) 468-1222 148 16th Street Mall 303 16th St Ste 150 Denver CO 80202 (303) 623-1700 150 Basemar 2602 Baseline Road Boulder CO 80305 (720) 304-2044 151 Belleview 8000 E Belleview Suite 101 Greenwood Village CO 80111 (303) 741-4469 152 Colfax Gaylord 2205 East Colfax Ave Denver CO 80206 (303) 355-2889 153 Castle Rock 34 E Allen St Ste 400 Castle Rock CO 80108 (303) 814-1148 154 North Longmont 2255 Main St Longmont CO 80501 (303) 776-8686 156 Pueblo 825 West US Hwy 50 Pueblo CO 81008 (719) 544-1539 157 Wads and Belleview 8555 West Belleview Ave Ste H300 Littleton CO 80123 (303) 904-0870 158 Grand Junction 2474 Hwy 6 & 50 Unit A Grand Junction CO 81505 (970) 245-7652 159 Montebello 2455 Montebello Square Dr Colorado Springs CO 80918 (719) 594-5871 160 Horsetooth 3519 South College Ave Fort Collins CO 80525 (970) 282-9357 161 Denver West 14025 W. Colfax Dr. Lakewood CO 80401 (303) 278-0582 162 Fountain 6825 Mesa Ridge Pkwy Ste 100 Fountain CO 80817 (719) 382-3287 163 Thornton 3824 E. 120th Ave Thornton CO 80233 (303) 280 2033 164 170 and Tower 3450 North Tower Rd Aurora CO 80011 (303) 371-6889 166 Arvada 64th and Yank 6408 Yank Way Ste A Arvada CO 80004 (303) 423-3800 167 2nd and Union 375 Union Blvd Lakewood CO 80228 (303) 985-7000 168 Hwy 287 and S. Boulder Rd 534 W. South Boulder Rd Unit A Lafayette CO 80026 (303) 665-0441 169 Highway 287 Loveland 225 East 29th Street Loveland CO 80538 970-663-9366 170 Orchard Park Place 14375 Orchard Parkway Suite 600 Westminster CO 80023 303-450-5202 171 Highway 34 Greeley 4650 Centerplace Drive Greeley CO 80643 970-339-3162 172 Leetsdale and Cherry 4590 Leetsdale Drive Denver CO 80246 303-377-1119 173 Jordan Road 17051 Lincoln Ave Unit N Parker CO 80134 (720) 842-5117 195 Toronto TD Centre 66 Wellington Street West Toronto Ontario M5K IA1 647-347-0600 197 Pickering 1899 Brock Road, Unit 31B Pickering Ontario L1V 4H7 905-427-1133 201 State Street 232 State Street Madison WI 53703 (608) 257-6393 202 Westside 7050 Mineral Point Madison WI 53717 (608) 829-0202 203 Monona 6520 Monona Drive Monona WI 53716 (608) 226-9500 204 Fox Point 8781 N. Port Washington Road Milwaukee WI 53217 (414) 540-6601 205 Pewaukee 1390 Capitol Drive Suite 2 Pewaukee WI 53072 (262) 695-7500 206 Oakland Ave. 3121 North Oakland Avenue Milwaukee WI 53211 (414) 962-9100 207 Fitchburg 2981 Triverton Pike Drive Fitchburg WI 53711 (608) 276-7600 208 Brookfield 17000 W. Bluemound Road Unit H Brookfield WI 53005-596( (262) 780-1500 209 Menomonee Falls W 176 N 9336 Rivercrest Drive Menomonee Falls WI 53051 (262) 502-7800 210 Wauwatosa 7700 West State Street Wauwatosa WI 53213-264( (414) 443-9300 211 Eastside 4280 East Towne Blvd Madison WI 53704 (608) 244-4000 212 Green Bay 2665 South Oneida Street Green Bay WI 54303 (920) 490-8600 213 University Avenue 3600 University Avenue Madison WI 53705 (608) 268-2900 214 New Berlin 15630 West National Avenue New Berlin WI 53151 (262) 782-4600 215 28th & Oklahoma 2729 West Oklahoma Avenue Milwaukee WI 53215-432( (414) 383-0400 216 Hales Corners 5794 S. 108th Street Hales Corners WI 53130 (414) 525-8200 217 Appleton 4333 Wisconsin Avenue Appleton WI 54913 (920) 734-4859 218 West Bend 425 West Paradise Drive West Bend WI 53095 (262) 365-0001 219 Janesville 2259 Humes Road Janesville WI 53545-025F (608) 756-9700 220 Mount Pleasant 5720 Washington Avenue Mt Pleasant WI 53406 (262) 633-2600 221 Delafield 3260 Golf Road Delafield WI 53018 (262) 646-4811 222 Kenosha 7224 118th Ave Suite A Kenosha WI 53142 (262) 857-3168 223 W. Capitol 12132 West Capitol Suite 0 Wauwatosa WI 53222 (414) 462-0432 224 Grafton 1351 North Port Washington Road Grafton WI 53024 (262) 474-0280 225 Greenfield 4859 S. 76th Street Greenfield WI 53220 (414) 831-2910 226 Waukesha 1210 W Sunset Dr Waukesha WI 53189 (262)574-0109 227 E. Appleton 3719 E. Calumet St Appleton WI 54915 (920) 830-7887 228 Oak Creek 8609 S. Howell Ave Oak Creek WI 53154 (414) 571-4206 229 Eastpointe 544 Ogden Milwaukee WI 53202 (414) 273-9705 231 Hudson 1055 Pearson Drive Hudson WI 54016 (715) 386-5266 232 Mequon 10942 N. Port Washington Rd Mequon WI 53092 (262) 240-8406 233 East Green Bay 2450 E. Mason Rd Green Bay WI 54302 (920) 469-3095 234 Wisconsin Dells 75 Gasser Rd Ste E Baraboo WI 53913 (608) 253-1963 235 Sheboygan 555 S. Taylor Dr Sheboygan WI 53081 (920) 452-0566 236 Oshkosh 1560 S Koeller Street Oshkosh WI 54902 920-232-2424 238 Middleton 1601 Deming Way Suite 100 Middleton WI 53562 608-829-0099 239 Miller Parkway 1310 Miller Park Way Milwaukee WI 53214 (414) 509-5192 240 Beloit 2900 Milwaukee Road Beloit WI 53511 608-362-1677 241 Fond du Lac 729 West Johnson Street Fond Du Lac WI 54935 TBD 242 Manitowoc 4530 Calumet Drive Suite 101 Manitowoc WI 54220 920-682-3200 243 Lake Geneva 351 Peller Road Suite 1 Lake Geneva WI 53147 (262) 248-3644 244 Sun Prairie 2812 Prairie Lake Drive #101 Sun Prairie WI 53590 TBA 250 Lake Buena Vista 12529 State Road 535 Ste 531 Orlando FL 32836 (407) 560-8325 251 South Orange Avenue 2855 South Orange Ave Orlando FL 32806 407-849-3690 252 Dr Phillips 7822 W. Sand Lake Rd Orlando FL 32819 (407) 354-1301 253 Fashion Square Mall 3683 East Colonial Drive Orlando FL 32803 407-228-9870 254 Lake Mary 850 South Sun Drive Lake Mary FL 32746 407-333-0207 256 The Loop 3268 N John Young Parkway Suite 300 Kissimmee FL 34741 (407) 944-0220 280 Cherry Street 1551 East 15th S Street Suite 103 Tulsa OK 74120 (918) 295-7727 281 Woodland Hills 9205 East 71st St. Tulsa OK 74133 918-249-0511 282 Broken Arrow 1556 N. 9th Street Broken Arrow OK 74012 918-250-0510 283 Pioneer Square 611 N Perkins Road Suite A Stillwater OK 74075 405-624-0990 301 Calhoun 3040 Excelsior Blvd 101 Minneapolis MN 55416 (612) 915-6440 302 Maple Grove 7840 Main Street Maple Grove MN 55369 (763) 416-1404 303 Plymouth Center 3425 Vicksburg Lane N Suite 200 Plymouth MN 55447 (763) 559-4336 304 Woodbury 7455 Currell Blvd. Space 101 Woodbury MN 55125 (651) 738-2222 306 Rochester 3944 Marketplace Drive NW Rochester MN 55901 (507) 285-1111 307 Highland Park 2110 Ford Parkway St. Paul MN 55116-181: (651) 695-9300 308 Coon Rapids 3479 River Rapids Drive Coon Rapids MN 55448 (763) 427-8666 309 Apple Valley 14879 Florence Trail Apple Valley MN 55124 (952) 891-5600 310 Eden Prairie 13300 Technology Drive Suite 100 Eden Prairie MN 55344 (952) 975-0002 311 Eagan 1340 Town Centre Drive Eagan MN 55123 (651) 994-1144 313 Maplewood 2865 White Bear Avenue St. Paul MN 55109 (651) 748-1144 314 Mankato 1600 Warren Street Suite 15 Mankato MN 56001-496( (507) 385-1166 315 Richfield 7630 Lyndale Avenue South Suite 100 Richfield MN 55423 (612) 869-3386 317 Golden Valley 7808 Olson Memorial Highway 318 West St. Paul 1590 Robert Street South 320 St. Cloud 4011 West Division Street 321 South Rochester 4607 Main Avenue SE 322 Rogers 13590 Northdale Blvd 324 St. Louis Park 5326 16th St West 325 Mall of America 60 E. Broadway 326 Roseville 1655 County Rd B-2 327 Burnsville 901 County Rd 42 328 Blaine 10340 Baltimore St 329 Ridgedale 12977 Ridgedale Dr 330 Midway 470 Hamline Ave North 331 Wayzata 1179 Wayzata Blvd East 332 Duluth 1600 Miller Trunk Hwy 333 St. Cloud State 211 5th Ave S. 334 Stadium Village Flats 820 Washington Ave SE 335 Nordeast 300 E. Hennepin Ave 336 South Eagan 2000 Rahncliff Ct 337 Cedar Point 1732 E. 66th Street 338 Minnetonka South 4937 County Road 101 339 East Woodbury 580 Woodbury Drive 340 Shoreview 3833 Lexington Ave. North 341 Stillwater 13301 North 60th St 342 Knollwood Mall 8120 Hwy 7 343 Elk River 18130 Zane St NW 344 Crystal Gallery 5592 West Broadway 345 Cottage Grove 7180 E. Point Douglas Rd 347 Chanhassen 945 West 78th Street 348 White Bear Lake 1020 Highway 96 East 349 Columbia Heights 5220 Central Ave NE 350 Savage 55122 380 East Brunswick 683 Rt. 18 South 381 Monmouth Mall 180 Route 35 South 382 Fair Lawn 2140 Promenade Blvd 383 Clark Commons 1255 Raritan Road, Unit F4B 401 Pentagon Row 1201 S. Joyce Street 402 Fairfax 10296 Main Street 403 College Park 7320 Baltimore Avenue 404 Kentlands 177 Kentlands Blvd 405 Silver Spring 905 Ellsworth Drive 406 Hunt Valley 114 Shawan Road 408 Pikesville 3755 Old Court Road 409 Vienna 201 Maple Avenue East 410 Columbia 6191 Old Dobbin Lane 411 Alexandria 3105 Duke Street 413 Rockville - Congressional Pla 1609-B Rockville Pike 414 Waldorf 3055 Waldorf Market Place 415 Kingstowne 5900 Kingstowne Blvd 417 Manassas 9646 Liberia Ave 418 White Marsh 5350 Campbell Blvd 419 Central Park 1212 Carl D. Silver Parkway 420 Merrifield 8190 Strawberry Lane 421 Owings Mills 10450 Owings Mills Blvd 423 Annapolis 2323 Annapolis Mall 425 Crystal City 2011 Crystal Drive 426 Mechanicsville 7291 Battle Hill Drive 427 Ballston Commons 4238 Wilson Blvd 434 West Chester 15785 WC Main St 436 Willow Lawn 1601 Willow Lawn Dr 437 Towson 825 Goucher Blvd 438 Largo 2801 Campus Way North 439 Mt. Vernon 7702 B Richmond Hwy 441 Harbor Place 301 Light St 442 Leesburg 1607 Village Market Rd quina IVIIY .»477-G J7C (011) 800-8415 Golden Valley MN 55427 (763) 544-1325 West St. Paul MN 55118 (651) 251-9850 Suite 1 St. Cloud MN 56301 (320) 251-0216 Suite 201 Rochester MN 55904 (507) 292-6996 Rogers MN 55374 (763) 428-0100 Minneapolis MN 55416 (952) 545-6422 Ste 5342 Bloomington MN 55425 (952) 854-5538 Ste D Roseville MN 55113 (651) 633-3999 Ste 220 Burnsville MN 55306 (952) 892-0992 Ste 180 Blaine MN 55449 (763) 780-3111 Ste 101 Minnetonka MN 55305 (952) 546-1129 St Paul MN 55104 (651) 646-8285 Wayzata MN 55391 (952) 473-0993 Ste F13B Duluth MN 55811 (218) 722-1670 Ste 200 St Cloud MN 56301 (320) 253-5153 Minneapolis MN 55414 (612) 331-4865 Minneapolis MN 55414 (612) 378-6011 Ste 100 Eagan MN 55122 (651) 454-5883 Richfield MN 55423 (612) 869-3691 Minnetonka MN 55345 (952) 406-8559 Saint Paul MN 55125 (651) 735-0933 Ste 109 Arden Hills MN 55126 (651) 765-1330 Stillwater MN 55082 (651) 439-0057 Ste 346 St. Louis Park MN 55426 (952) 933-3004 Elk River MN 55330 (763) 441-9191 Minneapolis MN 55428 (763) 535-5533 Cottage Grove MN 55016 (651) 459-3200 Suite 110 Chanhassen MN 55317 952-401-3407 Vadnais Heights MN 55127 651-653-3394 Columbia Heights MN 55421 763-572-7783 East Brunswick NJ 08816 (732) 390-0367 Ste 20004C Eatontown NJ 07724 732-820-3288 Fair Lawn NJ 07410 (201) 797-2802 C/O Clark Cc Clark NJ 07066 732-388-0427 Suite C-3 Arlington VA 22202 (703) 418-0001 Fairfax VA 22030 (703) 218-4400 College Park MD 20740-320( (301) 779-5300 Suite 100 Gaithersburg MD 20878 (301) 926-5901 Silver Spring MD 20910 (301) 588-5312 Suite 2 Hunt Valley MD 21030 (410) 785-1839 Pikesville MD 21208 (410) 580-5886 Vienna VA 22181 (703) 281-6544 Suite 930 Columbia MD 21045 (410) 872-3729 Alexandria VA 22314 (703) 212-0008 Rockville MD 20852 (301) 468-9191 10 Waldorf MD 20603 (301) 885-2538 Suite 130 Alexandria VA 22315 (703) 971-0179 Manassas VA 20110 (703)393-9998 Suite H Baltimore MD 21236 (410) 931-0765 Fredericksburg VA 22401 (540) 786-2183 Suite 4 Falls Church VA 22042 (703) 560-0158 Owings Mills MD 21117 (410) 753-4706 Unit 1713 Annapolis MD 21401 (410) 266-3526 Arlington VA 22202 (703) 979-1525 Suite A Mechanicsville VA 23111 (804) 730-8777 Unit 1130 Arlington VA 22203 (571) 527-1232 Midlothian VA 23113 (804) 379-0990 Richmond VA 23230 (804) 288-9777 Space 100B Towson MD 21286 (410) 296-0778 Lanham MD 20706 (301) 772-7402 Ste A Alexandria VA 22306 (703) 718-2126 Ste 1517 Baltimore MD 21201 (443) 220-0060 Ste L-112 Leesburg VA 20178 (703) 443-1284 443 Montgomery Mall 7101 Democracy Blvd Ste 2464 Bethesda MD 20817 (301) 365-5050 444 Herndon 2405 Centerville Rd Herndon VA 20171 (703) 466-4120 446 Bowie Town Center 3916 Town Center Blvd Bowie MD 20716 (301) 262-7080 447 Springfield 7020 Old Keene Mill Rd Springfield VA 22150 (703) 451-6145 448 Sterling 46038 Cranston St Ste 100 Sterling VA 20165 (703) 444-1774 451 Falls Church 7511 Leesburg Pike Ste 101 Falls Church VA 22043 (703) 442-7525 452 Reston 11648 Plaza America Dr Reston VA 20190 (703) 435-9651 453 Chantilly 13958 Lee Jackson Memorial Hwy Chantilly VA 20151 (703) 378-0195 455 Germantown 20952 Frederick Road Germantown MD 20876 (301) 515-1636 457 Mark Center 1480 N Beauregard Alexandria VA 22311 (703) 671-1482 458 North Frederick 200A Shorebird St Fredrick MD 21701 (301) 644-2058 459 Charlottesville 2035 Bond St Ste 110 Charlottesville VA 22901 (434) 984-9621 460 BelAir 615 Baltimore Pike Bel Air MD 21014 (410) 638-9560 461 Westview 5221 Buckeystown Pike Frederick MD 21704 (301) 663-6504 462 K Street 1667 K Street NW Washington DC 20006 (202) 296-3111 463 Christiana Mall 715 Christiana Mall Ste 1840 Newark DE 19702 (302) 738-4126 464 Concord 4737 Concord Pike Ste 830 Wilmington DE 19803 (302) 477-1018 465 Woodbridge 13900 Shoppers Best Way Woodbridge VA 22192 (703) 680-7659 466 Lexington Park 46360 Lexington Village Way Ste 100 Lexington Park MD 20653 (301) 862-3284 467 Severna Park 552B Governor Ritchie Hwy Severna Park MD 21146 (410) 544-0351 468 Williamsburg 4640 Casey Blvd Ste 100 Williamsburg VA 23188 (757) 253-6524 470 VCU 814 West Grace Richmond VA 23220 (804) 353-2836 471 Centreville 14241 B Centreville Square Centreville VA 20121 (703) 815-2605 473 Chesterfield 1401 Alverser Dr Midlothian VA 23113 (804) 893-4820 474 Fair Lakes 12961 Fair Lakes Center Fairfax VA 22033 (703) 818-3834 476 Laurel Town Center 14700 Baltimore Ave Suite P-1 Laurel MD 20707 (301) 490-2700 477 Glen Burnie 6710 Governer Ritchie Hwy Glen Burnie MD 21061 (410) 553-0694 478 Lynnhaven 687 Lynnhaven Parkway Ste 13.0 Virginia Beach VA 23452 (757) 340-5384 479 Dover 1037 North DuPont Highway Dover DE 19901 (302) 674-5100 480 Hagerstown Valley Mall 17328 Valley Mall Rd Hagerstown MD 21740 (301) 582-0310 481 Eldersburg 6400 F Ridge Road Suite 3 Sykesville MD 21784 410-795-2965 482 Ghent Norfolk 1520 Colley Avenue Norfolk VA 23517 (757) 622-1200 483 Jefferson Avenue 12274 Jefferson Ave Newport News VA 23602 (757) 269-4900 485 Bethesda 4929 Elm St Bethesda MD 20814 (301) 718-2890 488 Military Highway- DEAD 1081 North Military Highway Norfolk VA 23502 489 Peninsula Town Center 3961 Kilgore Ave Hampton VA 23666 490 Columbia Mall 10300 Little Patuxent Parkway Suite 1340 Columbia MD 21044 410-730-0207 510 Valparaiso 71 Silhavy Rd Ste A-1 Valparaiso IN 46383 (219) 548-0921 512 Mishawaka 4342 Grape Rd Mishawaka IN 46545 (574) 247-4443 513 Munster 9140 Calumet Ave Ste 101 Munster IN 46321 (219) 836-6018 514 Ft Wayne 4602 Illinois Rd Ste 101 Ft Wayne IN 46804 (260) 436-0091 515 Schererville 69 US Hwy 41 Shops E, Ste Schererville IN 46375 (219) 865-3723 516 Lafayette 3640 South Street Lafayette IN 47905 765-447-2288 517 Elkhart 405 E County Road 6 Suite C Elkhart IN 46516 574-264-5511 518 Noblesville North 17015 Mercantile Blvd Noblesville IN 46060 (317) 774-9200 519 Keystone Fashion Mall 8702 Keystone Crossing Space VC04 Indianapolis IN 46240 TBD 523 Cypress 526 Almaden Ranch 5130 Cherry Ave Unit 10 San Jose CA 95118 TBD 527 Folsom 2770 E Bidwell Street #600 Folsom CA 95630 (916) 983-7815 531 Ames 400 South Duff Ave Ames IA 50010 (515) 233-4312 532 Coralville 2451 2nd Street Coralville IA 52241 (319) 338-5979 533 Cedar Rapids 310 Collins Rd Cedar Rapids IA 52402 (319) 373-1827 534 Valley West Mall 1551 Valley West Dr West Des Moines IA 50266 (515) 223-6121 535 Iowa City 201 S. Clinton Ste 158 Iowa City IA 52240 (319) 351-3824 536 Waterloo 2833 Crossroads Blvd Waterloo IA 50702 (319) 232-6369 537 Ingersoll 2105 Ingersoll Ave Des Moines IA 50311 (515) 288-2541 538 Merle Hay 5840 Douglas Ave Des Moines IA 50310 (515) 278-4294 539 Jordan Creek 6630 Mills Civic Pkwy Ste 6110 West Des Moines IA 50310 (515) 221-2341 540 Ankeny 2325 SE Delaware Ave Ste 200 Ankeny IA 50021 (515) 965-4419 542 Westdale 2360 Edgewood Rd. SW, Suite 60 Suite 600 Cedar Rapids IA 52404 319-396-8100 551 Encinitas 260-C North EI Camino Real Encinitas CA 92024-285, (760) 634-3010 552 San Marcos 591 Grand Avenue Suite G102 San Marcos CA 92069 (760) 591-9854 554 The Fountains 1186 Roseville Pkwy Roseville CA 95678 (916) 780-1441 559 Sports Arena 3650 Rosecrans Street San Diego CA 92110 (619) 223-3200 563 Elk Grove 7405 Laguna Blvd Ste 170 Elk Grove CA 95758 (916) 478-0373 565 567 569 570 571 572 573 574 575 576 577 578 581 582 584 585 586 587 590 592 594 595 601 602 603 604 605 606 607 608 610 611 612 613 615 616 617 621 622 623 624 626 627 628 629 630 631 634 636 638 639 640 641 643 644 645 647 648 649 652 654 657 658 659 Loehmann's Plaza 2435 Fair Oaks Blvd Metreon 155 4th St San Ramon 3141 Crow Canyon Place Market Street 575 Market St Citrus Heights 6123 Sunrise Blvd Cupertino 20735 Stevens Creek Blvd Vacaville 1640 E. Monte Vista Ave Carlsbad 2521 Palomar Airport Rd Sierra and Douglas 3984 Douglas Blvd Rocklin 5198 Commons Drive La Costa 3410 Via Mercato EI Camino and Vista Way 2267 S. EI Camino Real Orange 2214 North Tustin Chico 1910 East 20th Street Downey 8908 Apollo Way Valley Fair Mall 2855 Stevens Creek BLVD Rancho Cordova 3151 Zinfandel Drive Concord CA 1110 Concord Avenue Tempe Market Place 2000 East Rio Salado Parkway Deer Valley Towne Center 2805 West Agua Fria Freeway Arrowhead Mall 7541 W Bell Road Santan 2975 South Market Street Naperville 207 South Washington Wheaton 2019 South Naperville Road Deer Park 20530 North Rand Road Geneva 1310 Commons Drive Arlington Heights 66 S. Arlington Heights Road Evanston 930 Church Street Orland Park 14662 La Grange Road Bolingbrook 137 N. Weber Road Elgin 895 South Randall Road La Grange 1 East Burlington Avenue Lake in the Hills 315 N. Randall Road Glenview 1851 Tower Drive Crystal Lake 4912 Northwest Highway Niles 5681 West To u by Avenue Oakbrook Terrace 18 W 64 West 22nd Street Lincolnshire 900 Milwaukee Avenue Park Ridge 510 W. Touhy Gurnee 6681 Grand Avenue Lakeview 2813 N Broadway Street South Naperville 2727 W 75th Street Old Orchard 4999 Old Orchard Center Schaumburg 1400 N. Meacham Road Michigan Ave 180 North Michigan Avenue South Barrington 100 W. Higgins Rd Woodridge 100175th Street Glen Ellyn 706 Roosevelt Rd Rockford 6430 E. State St River Forest 7215 Lake St DeKalb 2561 Sycamore Rd Clybourn 2000 N Clybourn Vernon Hills 700 N. Milwaukee Rolling Meadows 1327 Golf Rd Deerbrook 110 S. Waukegan Buffalo Grove 1209 West Dundee Rd Schaumburg and Barrington 2610 W Schaumburg Rd Clark and Monroe 47 South Clark Southport 3419 N Southport Ave Yorktown Center 342 Yorktown Shopping Center Bradley Commons 2024 Rte 50, Unit 21 Peoria 4712 N. University St Norridge 4157 N. Harlem Oswego 2336 Rte 34 .iru LL LV1L JP11 LJ cau %-M Sacramento CA Ste 1050 San Francisco CA Suite A San Ramon CA San Francisco CA Citrus Heights CA Cupertino CA Vacaville CA Ste 107 Carlsbad CA Roseville CA Rocklin CA Ste 104 Carlsbad CA Oceanside CA Suite B Orange CA Suite 100 Chico CA Downey CA Suite 2461 Santa Clara CA Unit 5 Rancho Cordova CA Suite E Concord CA Suite 1218 Tempe AZ Unit 8 Phoenix AZ Suite 101 Peoria AZ Suite 101 Gilbert AZ Naperville IL Wheaton IL 201 Deer Park IL Geneva IL Arlington Heights IL Evanston IL Unit B-1 Orland Park IL Bolingbrook IL Elg:�n IL LaGrange IL Lake in the Hills IL Glenview IL Crystal Lake IL Niles IL Oakbrook Terrace IL Suite A Lincolnshire IL Parkridge IL Gurnee IL Chicago IL Naperville IL Suite F-26 Skokie IL Suite A Schaumburg IL Suite 104 Chicago IL Ste 1-60 South Barrington IL Suite 189A Woodridge IL Glen Ellyn IL Ste 118 Rockford IL River Forest IL DeKalb IL Chicago IL Unit 149 Vernon Hills IL Rolling Meadows IL Ste 110C Deerfield IL Buffalo Grove IL Schaumburg IL Chicago IL Chicago IL Lombard IL Ste A-9 Bourbonnais IL Unit Peoria IL Norridge IL Oswego IL 9G I// tO7O) 770-0711 95825 (916)484-7250 94103 (415)979-0793 94583 (925) 275-8105 94105 (415)543-5700 95610 (916)726-0585 95014 (408)343-1154 95688 (707)469-1400 92011 (760)930-1369 95661 TBD 95677 (916)652-5140 92009 (760)944-1077 92054 (760)433-5700 92865 714-685-1700 95928 530-342-3131 90242 (562)803-1330 95050 408-247-0853 95670 916-631-1301 94518 (925)691-3844 85281 480-921-3500 85027 623-587-0767 85382 (623)979-9477 85295 (480)963-0255 60540 (630)369-3332 60187 (630) 221-0011 60010-723(847)726-1000 60134 (630)262-6400 60005 (847)577-1500 60201-312((847)733-1200 60462 (708)403-4400 60440 (630)771-9999 60123 (847)888-0500 60525 (708)579-1100 60156 (847)854-1500 60026-778:(847)729-5555 60014 (815)459-4400 60714 (847) 647-2544 60181 (630)678-0965 60069 (847)793-0514 60068 (847) 292-6502 60031 (847) 406-5488 60657 (773)661-0977 60565 (630)718-2063 60077 (847)324-4910 60173 (847) 944-8980 60601 (312) 981-7110 60010 (847)428-9400 60517 (630)427-1980 60137 (630)790-0964 61108 (815)397-7910 60305 (708) 488-9040 60115 (815)756-2145 60614 (773) 868 0990 60061 (847) 816-3910 60008 (847) 981-1175 60015 (847)559-9172 60089 (847) 483-9925 60194 (847) 798-8636 60603 (312)263-1927 60657 (773)248-3985 60148 (630) 620-9080 60914 (815)939-3810 61614 (309)691-7302 60706 (708)457-8470 60543 (630)554-6264 670 North Aurora 2365 North Farnsworth Aurora IL 60502 (630) 499-7175 672 Franklin Street 1 South Franklin St Chicago IL 60606 (312) 634-2132 673 Canal and Taylor 1022 S. Canal Chicago IL 60607 (312) 588-1982 674 Frankfort 21075 S. La Grange Rd Frankfort IL 60423 (815) 464-1775 675 Lake Bluff 303 Waukegan Rd Lake Bluff IL 60044 (847) 482-1680 678 Machesney Park 1247 West Lane Rd Machesney Park IL 61115 (815) 633-0400 679 Evergreen Park 2442 West 95th Street Evergreen Park IL 60805 708-229-8061 680 Northbrook East 794 Skokie Blvd Northbrook IL 60062 (847) 272-5211 681 Roscoe Square 3336 N. Western Ave Chicago IL 60618 (773) 248-8787 682 East Peoria 358 W. Washington St East Peoria IL 61611 (309) 698-8640 683 Touhy and McCormick 3304TouhyAve Skokie IL 60076 (847) 675-7190 684 Shorewood 920 Brook Forest Ave Shorewood IL 60404 (815) 254-5566 685 Tinley Park 15915 S Harlem Ave Tinley Park IL 60477 708-444-1810 686 St. Charles 3871 E Main Street Unit 3871 Saint Charles IL 60174 630-584-2183 701 Murray 5207 South State Street Murray UT 84107-481: (801) 284-5757 702 Suearhouse 1152 East 2100 South Salt Lake City UT 84106 (801) 466-8880 703 Fort Union 6901 South 1300 East Midvale UT 84047 (801) 565-7256 704 400 South 358 South 700 East Suite A Salt Lake City UT 84102 (801) 359-8315 705 Orem 293 East University Parkway Orem UT 84058-763! (801) 226-0776 706 N & C Layton 748 West Antelope Drive Suite E Layton UT 84041-163: (801) 525-2257 707 Draper 191 East 12300 South Suite M-7 Draper UT 84020 (801) 495-5909 708 Sandy 10340 S. State Street Sandy UT 84070 (801) 572-5168 710 Logan 1430 North Main St Logan UT 84321 (435)753-2629 712 Riverdale 4245 S. Riverdale Rd Ste D Ogden UT 84405 (801) 621-4180 713 West Valley City 2682 South High Commons West Valley City UT 84120 (801) 456-5892 714 West Jordan 7632 S. Campus View Dr Ste 110 West Jordan UT 84084 (801) 280-2095 715 South Jordan 11429 District Drive Ste 500 South Jordan UT 84095 (801) 495-4933 716 Provo 62 W Bulldog Blvd Ste 100 Provo UT 84604 (801) 373-9670 717 Farmington 1032 West Park Lane Bldg W Farmington UT 84025 801-451-8464 730 Oakland 3805 Forbes Ave Oakland PA 15213 (412) 621-0890 7301 Bishops Corner 333 North Main Street West Hartford CT 06117 (860) 206-9986 7302 Glastonbury 41 Hebron Ave Glastonbury CT 06033 TBD 7303 Southington 832 Queen Street Southington CT 06489 860-426-3500 731 Market Square 476 McMaster Way Pittsburgh PA 15222 (412) 562-2191 732 Cranberry 2030 MacKenzie Way Ste 100 Cranberry Townsh PA 16066 (724) 772-0350 733 State College 244 W. College Ave State College PA 16801 (814) 235-0703 734 Monroeville 3820 William Penn Hwy Monroeville PA 15146 (412) 380-7083 735 N & C Wexford 10638 Perry Hwy Wexford PA 15090 (724) 933-7010 737 Lancaster Central 2099 Fruitville Pike Lancaster PA 17601 (717) 560-0500 738 Peters Township 3855 Washington Road Canonsburg PA 15617 (724) 942-5100 739 Washington PA 113 Old Mill Blvd Washington PA 15301 (724) 225-3800 740 York South Queen Street 2108 South Queen Street York PA 17403 717-699-2220 742 Colonial Commons 5108 Jonestown Rd Harrisburg PA 17112 (717) 651-7780 743 South Hills Village 301 South Hills Village Ste FC14 Pittsburgh PA 15241 412-835-3900 746 Crossgate Commons 161 Washington Ave Extension Albany NY 12205 518-456-0080 747 Cross County Shopping Cent 1060 Mall Walk Unit 5A50 Yonkers NY 10704 914-709-8690 748 Latham Crossing 800 Loudon Road Latham NY 12110 (518) 785-3293 750 Bridgeville 160 Millers Run Road Bridgeville PA 15017 751 Grandview 1390 W. 5th Ave Columbus OH 43212 (614) 487-8253 752 Upper Arlington 4740 Reed Road Suite 109 Upper Arlington OH 43220 (614) 453-1090 753 Lane & High 2124 North High Street Columbus OH 43201 (614) 453-1095 754 Polaris 1528 Gemini Place Columbus OH 43240 (614) 468-0500 756 Hyde Park 3707 Isabella Avenue Cincinnati OH 45208 (513) 351-3451 757 Tylersville Rd 7791 Cox Lane West Chester OH 45069 (513) 759-1565 758 Clintonville 5032 North High Street Columbus OH 43214 (614) 468-0600 760 Reynoldsburg 2166 Baltimore-Reynoldsburg Road Reynoldsburg OH 43068 (614) 759-2952 762 Westerville 630 N. State St Westerville OH 43082 (614) 899-5112 763 Tuttle 6104 Parkcenter Circle Dublin OH 43017 (614) 210-8240 764 Kenwood 7800 Montgomery Road 7 Cincinnati OH 45236 (513) 791-6259 765 Florence 4960 Houston Rd Suite I Florence KY 41022 (859) 283-2370 766 Powell 9733 Sawmill Pkwy Ste D2-1 Powell OH 43065 (614) 659-0047 767 The Greene 11 Greene Blvd Beavercreek OH 45432 (937) 429-2893 768 Hamilton & Morse 5065 N. Hamilton Rd Columbus OH 43230 (614) 337-1228 770 Mason 9368 Mason Montgomery Rd Mason OH 45040 (513) 336-6666 771 Western Hills 6475 Glenway Ave Cincinnati OH 45211 (513) 574-1180 •••^• ^•• �-+�� uuu�..0 __ \Uiullluua VII 4J1.1J k01'+j 000-3JUu 773 Tri County 11725 Princeton Pike Suite 811 Springdale OH 45246 513-671-5444 776 Newport Pavilion 193 Pavilion Pkwy Newport KY 41071 (859) 431-7600 777 778 Austin Landing University of Cincinnnati 3400 Rigby Road 7 East Martin Luther King Drive Dayton Cincinnati OH OH 4_5342 45219 937-866-4655 (513)221-5100. 779 Colerain 9719 Colerain Avenue Cincinnati OH 45251 513-245-1652 781 Nanuet 44 Rockland Plaza Nanuet NY 10954 845-624-6934 ^� 790 Meridian 2274 N. Eagle Rd Ste 100, Spa Meridian ID 83646 (208) 884-3379 791 Boise Mall 535 N. Milwaukee Boise ID 83704 (208) 375-5022 792 Boise State 1233 Broadway Ave Boise ID 83706 (208)433-9979 793 Twin Falls 1833 Blue Lakes Blvd N Twin Falls ID 83301 208-736-6241 794 Grand Teton Mall 1870 S 25th East Idaho Falls ID 83404 208-528-7366 795 Pocatello 4013 Yellowstone Ave A Chubbuck ID 83202 208-237-9070 797 Grove City- DEAD 4145 Buckeye Parkway Grove City OH 43123 810 Beaverton 4655 SW Griffith Drive Suite 135 Beaverton OR 97005 (503) 350-0591 8101 St Johns Town Center 4624 Town Crossing Dr Suite 113 Jacksonville FL 32246 (904_)516-7757 811 10th & Couch 100 NW 10th Avenue Portland OR 97209 (503) 223-1057 812 Hillsboro 7216 NE Cornell Road Hillsboro OR 97124 (503) 648-4783 815 Clackamas 12190 SE 82nd Avenue Clackamas OR 97086 (971) 233-0330 817 Eugene 1053 Valley River Way Eugene OR 97401 (541) 485-9044 818 East Vancouver 19151 SE Mill Plain Blvd Ste 106 Vancouver WA 98683 (360) 260-4839 819 Highway 217 & Greenburg F 10218 SW Washington Square Road Tigard OR 97223 503-598-0988 820 Lake Oswego 4823 Meadows Rd Lake Oswego OR 97035 503-635-3790 8201 Midland 7007 Eastman Ave Midland MI 48642 989-495-2520 821 Wilsonville 29991 Southwest Town Center Loop Wilsonville OR 97070 503-570-0866 822 Springfield Gateway Mall 2820 Gateway Street Suite 102 Springfield OR 97477 541-726-2615 823 Vancouver Mall 4311 NE Thurston Way Suite 100 Vancouver WA 98662 (360) 254-7614 830 Turkey Creek 11083 Parkside Dr Knoxville TN 37934 865-675-1869 831 Green Hills Mall 2116 Green Hills Village Dr Nashville TN 37215 (615) 383-7740 833 Cool Springs 995 Meridian Blvd Franklin TN 37067 (615) 771-3013 834 U Tenn Knoxville 1700 Cumberland Ave Knoxville TN 37916 (865) 540-1655 836 Clarksville 2702 Wilma Rudolph Blvd Ste B Clarksville TN 37040 (931) 551-9556 851 Pavilion 2608 Erwin Road Durham NC 27705 (9_19) 383-5600 852 South End 2201 South Blvd Suite 110 Charlotte NC 282_03 (704) 334-2980 853 Chapel Hill 214 W Franklin Street Chapel Hill NC 27514 (919) 967-7320 854 Arboretum 8016 Providence Road Suite 150 Charlotte NC 28277 (704) 752-7803 855 Cameron Village 403 Daniels St Raleigh NC 27605 _ (919)_755-0282 856 Cary 200 Crossroads Blvd Ste 110 Cary NC 27518 (919) 851-5080 857 Brier Creek 8411 Brier Creek Pkwy Raleigh NC 27617 (919) 806-1330 858 Park West Village 2016 Market Center Dr Morrisville NC 27560 (919) 466-0082 859 Greenville 3030 Evans St Greenville NC 27834 (252) 756-6735 861 Jacksonville 1345 Western Blvd Ste 110 Jacksonville NC 28546 (910) 219-1431 862 Mooresville 489 River Highway Mooresville NC 28117 (704) 658-0640 863 Wendover Avenue 4205 West Wendover Ave Greensboro NC 27407 336-294-6979 864 University Place 8926 J.M. Keynes Drive Suite A Charlotte NC 28262 704-549-0188 865 Parkside Town Commons 1120 Parkside Main St Cary NC 27519 919-466-0900 866 Apex 1055 Beaver Creek Commons Dri Unit 160 Apex NC 27502 919-362-9153 867 Whitehall 8156 South Tryon Street Unit G Charlotte NC 28273 (704) 504-0116 869 Gastonia 2230 E. Franklin Blvd Suite 140 Gastonia NC 28054 (704) 864-8071 880 Zanesville- DEAD 3573 Maple Avenue Zanesville OH 43701 881 Skibo Road 1926 Skibo Road Fayetteville NC 28314 TBD 918 Woodlands Mall 1555 Lake Woodlands Dr Spring TX 77380 (281) 298-5642 919 Richmond and Sage 5174 Richmond Avenue Houston TX 77056 713-622-7140 926 Baybrook Passage 19325 Gulf Freeway TX 77598 281-332-2428 930 Carmel - Rangeline Road 1 East Carmel Drive _Web_ster Carmel IN 46032 (317) 587-8800 931 Trader's Point 5710 West 86th Street Indianapolis IN 46278 (317) 471-8100 932 Broad Ripple 927 Broad Ripple Indianapolis IN 46220 (317) 254-1200 933 Bloomington (Von Lee) 517 E Kirkwood Avenue Bloomington IN 47408 (812) 323-1400 934 IUPUI 903 Indiana Avenue Indianapolis IN 46202 (317) 638-0340 935 Chauncey Hill 102 N. Chauncey Avenue Suite A West Lafayette IN 47906 (765) 743-4444 936 Noblesville 13230 Harrell Parkway Noblesville IN 46060 (317) 774-9950 937 Greenwood Place 7853 South US 31 Suite C Indianapolis IN 46227 (317) 882-9100 938 Plainfield 190 S Perry Rd Plainfield IN 46168 (317) 839-8600 939 West Maryland St 121 West Maryland Street Indianapolis IN 46225 (317) 638-1300 940 Muncie 1416 W McGalliard Rd Muncie IN 47304 (765) 288-9900 941 Pyramid Place 3450 W 86th Street Indianapolis IN 46268 (317) 876-7500 942 Fishers 8654 E. 96th Street Unit A Fishers IN 46038 (317) 578-9800 943 Castleton 5265 E. 82nd Street Indianapolis IN 46250 (317) 578-9700 944 Eastland Plaza 2560 E. 3rd Street Bloomington IN 47401 (812) 558-0080 945 Columbus Center 3040 Columbus Center Columbus IN 47203 (812) 307-4664 951 Olathe 15208 West 119th Street Olathe KS 66062-560' (913) 829-4848 952 Overland Park 13448 Metcalf Avenue Overland Park KS 66213 (913) 239-8424 954 Zona Rosa 8538 NW Prairie View Rd Kansas City MO 64153 (816) 505-2061 955 Lee's Summit 659 NW Blue Pkwy Space 4B Lee's Summit MO 64086 (816) 246-8400 956 N & C Lawrence 8 West 8th St Lawrence KS 66044 (785) 841-4300 957 Independence 2140 Independence Center Drive Independence MO 64057 (816) 795-0002 958 Plaza 540 Nichols Rd Kansas City MO 64112 (816) 561-6100 959 Oak Park Mall 11339 95th St Overland Park KS 66214 (913) 541-4064 960 State Line 7600 State Line Rd Ste 208B Prairie Village KS 66208 (913) 381-4280 964 Towne East Mall 7700 E. Kellogg Ste 1014 Wichita KS 67207 (316) 681-2220 965 Rock Road 3300 North Rock Road Wichita KS 67226 (316) 630-8009 966 Manhattan 705 3rd St Manhattan KS 66502 (785) 539-5373 968 Topeka 2110 SW Wanamaker Rd Topeka KS 66614 (785) 271-2317 970 Legends 1703 Village West Parkway Kansas City KS 66111 913-299-8866 972 Liberty West 9140 NE Barry Road Kansas City MO 64157 (816) 407-9089 Liquor Law violations.for Noodles & Company restaurants (owned) *Unless noted otheriise noted otherwise, in each instance alcohol was served to a person under the legal drinking age - updated 7/1/2016 Store LOCATION OF DATE OF RESULT ENTITY Number VIOLATION: VIOLATION HOLDING LIQUOR LICENSE 111 Ft. Collins, CO 10/3/2003 Paid a fine of $200.00 in lieu of license The Noodle Shop, suspension Co. — Colorado, Inc. 309 Apple Valley, MN 10/16/03 Paid Fine The Noodle Shop, Co. — Colorado, Inc. 104 Boulder, CO 04/21/2004 Paid a fine of $400 in lieu of license The Noodle Shop, suspension Co. — Colorado, Inc. 302 Maple Grove, MN 07/22/2004 Paid a fine of $500 The Noodle Shop, Co. — Colorado, Inc. 704 4 South, Salt Lake City, 11/09/2004 Paid a fine of $3,000 The Noodle Shop, UT Co. — Colorado, Inc. 701 Murray, UT 02/03/2005 Served five-day suspension of the liquor The Noodle Shop, license. Co. — Colorado, Inc. 612 Lake In The Hills, IL 07/2005 Paid a fine of $2,000 The Noodle Shop, Co. — Illinois, Inc. 208 Brookfield, WI Fall 2005 Wayne Kimmell, personally as resident The Noodle Shop, agent of The Noodle Shop, Co. — Co. — Wisconsin, Inc. Wisconsin, Inc. paid a fine in lieu of suspension. 602 Wheaton, IL 11/2/05 Paid fine The Noodle Shop, Co. — Illinois, Inc. 303 Plymouth, MN 09/01/06 Served a five day suspension of the liquor The Noodle Shop, license and paid a fine of $500 Co. — Colorado, Inc. 312 Minneapolis, MN 09/15/06 Paid a fine of $500. The Noodle Shop, Co. — Minnesota, Inc. 404 Gaithersburg, MD 9/15/06 Paid a fine of $500. The Noodle Shop, Co. — Montgomery County, Inc. 414 Waldorf, MD 1/20/07 Paid a fine of $550.00 The Noodle Shop, Serve a 2 -day suspension (5/14/07 and Co. — Charles 5/15/07) County, Inc. Trapper Martin Eric Jeter 111 Timberline 3/6/07 Paid a fine of $200.00 and will serve one The Noodle Shop, Fort Collins, CO year probation in lieu of a 15 day Co. — Colorado, Inc. suspension. 612 Lake In The Hills, IL 4/12/07 fine of $4,000 in lieu of suspension. The Noodle Shop, Co. — Illinois, Inc. 315 Richfield, MN 4/13/07 Fine of $1,000 and a 5 days suspension of The Noodles Shop, license. Co. — Colorado, Inc. 312 Minneapolis, MN 5/21/07 $3,000 fine (paid $1,500 and got a stay of The Noodle Shop, remaining $1,500 pending probation Co. Minnesota, Inc. period). 116 Lone Tree, CO 6/28/07 Served 3 -day suspension of license; 1 year The Noodle Shop, probation; paid $250 fine. Co. -- Colorado, Inc. 309 Apple Valley, MN 8/31/07 Paid $75.00 Fine The Noodle Shop, Co. — Colorado, Inc. 623 Gurnee, IL 10/14/07 Paid $500 fine The Noodle Shop, Co. - Colorado, Inc. 1 Store LOCATION OF DATE OF RESULT ENTITY Number VIOLATION: VIOLATION HOLDING LIQUOR LICENSE 951 Olathe, KS 5/22/08 Paid $500 fine The Noodle Shop, Co. — Kansas, LLC 404 Gaithersburg, MD 6/08 Paid $1,000.00 Fine The Noodle Shop, Co. — Montgomery County, MD 605 Arlington Heights, IL 8/21/08 Paid $1,000 fine plus court costs The Noodle Shop, Co. — Illinois, Inc. 116 Lone Tree, CO 9/22/08 Served 5 -day suspension of license; 1 year The Noodle Shop, probation; $250 fine Co. — Colorado, Inc. 116 Lone Tree, CO 11/20/08 Served 10 -day suspension of license; pay The Noodle Shop, $250 fine and submit records of ServSafe Co. — Colorado, Inc. training for 1 year. 612 Lake In The Hills, IL 3/16/09 Serve 14 day suspension and pay $4,000 The Noodle Shop, fine Co. — Illinois, Inc. 603 Deer Park, IL 5/13/09 Received Warning The Noodle Shop, Co. — Illinois, Inc. 405 Silver Spring, MD 9/17/09 Paid Fine The Noodle Shop, Co. — Maryland, Inc. 309 Apple Valley, MN 3/6/10 Paid $500 fine The Noodle Shop, Co. — Colorado, Inc. 102 Boulder, CO 9/30/10 Served 5 day suspension; 1 year probation The Noodle Shop, Co. — Colorado, Inc. 113 Boulder, CO 9/30/10 Served 5 day suspension; 1 year probation The Noodle Shop, Co. — Colorado, Inc. 133 Loveland, CO 10/10 *Served 1 Year Probation for failure to The Noodle Shop, timely register manager. Co. — Colorado, Inc. 311 Eagan, MN 7/14/11 Paid $500 Fine The Noodle Shop, Co. — Colorado, Inc. 209 Menomonee Falls, WI 8/21/11 No fine or suspension. Dismissed against The Noodle Shop, Agent. Co. — Wisconsin, Inc. 951 Olathe, KS 8/27/11 Failure to maintain invoices and post The Noodle Shop, licenses. Paid $400 fine Co. — Kansas, LLC 413 Rockville, MD 9/6/11 Paid $100 Fine The Noodle Shop, Co. — Maryland, Inc. 965 Wichita, KS 11/19/11 Paid fine of $500.00 The Noodle Shop, Co. — Kansas, LLC 217 Appleton, WI 12/7/11 Lost 80 points with City's point system The Noodle Shop, Co. — Colorado, Inc. 965 Wichita, KS 1/25/12 Fine of $950.00 The Noodle Shop, Co. — Kansas, LLC 643 Rolling Meadows, IL 2/9/12 *Paid $100 fine for failure to properly The Noodle Shop, display sales tax certificate Co. — Colorado, Inc. 132 Englewood, CO 2/23/12 1 year probation plus $300 fine. The Noodle Shop, Co. — Colorado, Inc. 629 Chicago, IL 3/12 Paid $250 fine for failure to appropriately The Noodle Shop, display State Liquor License. Co. — Colorado, Inc. 731 Pittsburgh, PA 1/18/12 $350 fine; The Noodle Shop, *Cited for failure to properly display license Co. — Delaware, Inc. 702 Sugarhouse, Salt Lake 7/27/12 Paid $2,000 fine The Noodle Shop, City, UT Co. Colorado, Inc. 309 Apple Valley, MN 8/28/12 Paid $500 fine The Noodle Shop, Co. Colorado, Inc. 2 Store LOCATION OF DATE OF Number VIOLATION: VIOLATION 336 Eagan, MN 10/23/14 534 Des Moines Iowa 11/14/14 125 Longmont, CO 12/5/14 623 Gurnee, IL 12/18/14 413 Rockville, MD 1/7/15 414 Waldorf, MD 2/13/15 714 West Jordan, UT 2/24/15 443 Bethesda, MD 3/15/15 456 Georgetown, DC 3/31/15 605 Village of Arlington 3/16/15 463 Newark, DE 4/9/15 463 Newark, DE 4/1/15 464 Wilmington DE 4/1/15 328 Blaine, MN 4/25/15 622 Park Ridge, IL 5/14/15 621 Lincolnshire, IL 5/15/15 647 Schaumburg, IL 6/11/15 150 Boulder, CO 6/19/15 343 Elk River, MN 7/8/151 303 Plymouth, MN 7/14/15 136 Highland Ranch, CO 9/16/15 339 Woodbury, MN 9/29/15 621 Lincolnshire, IL 10/1/15 RESULT ENTITY HOLDING LIQUOR LICENSE Paid fine $500 The Noodle Shop, Co. — Colorado, Inc. Paid fine $500. The Noodle Shop, Co. - Delaware, Inc. Paid fine $200. The Noodle Shop, Co. - Colorado, Inc. Paid fine $500 The Noodle Shop, Co. - Colorado, Inc Paid fine $1000 The Noodle Shop, Co. - Maryland, Inc Paid fine $650 The Noodle Shop, Co. - Charles County, Inc Paid fine $1000 The Noodle Shop, Co. - Colorado, Inc Paid fine $1000 The Noodle Shop, Co. - Maryland, Inc Failure to maintain books, records and The Noodle Shop, invoices for 3 years $1000 fine paid; Co. - Colorado, Inc Failure to have a designated ABC Manager on premises $500 fine paid Paid fine $2000 The Noodle Shop, Co. - Colorado, Inc Paid fine $500 The Noodle Shop, Co. - Delaware, Inc Paid fine of $115 for failure to renew The Noodle Shop, license by designated date. Co. - Delaware, Inc Paid fine of $115 for failure to renew The Noodle Shop, license by designated date. Co. - Delaware, Inc Paid fine $1000 The Noodle Shop, Co. - Colorado, Inc Paid fine $350 to City The Noodle Shop, Paid fine $150 to ILLC Co. - Colorado, Inc Paid fine $500 The Noodle Shop, Co. - Colorado, Inc Paid fine $250 The Noodle Shop, Co. - Colorado, Inc Served 4 day license suspension The Noodle Shop, Co. - Colorado, Inc. Paid fine $500 The Noodle Shop, Co. - Colorado, Inc Paid fine $500 The Noodle Shop, Co. - Colorado, Inc. Three day suspension 12/27/15 to 12/291-'15 The Noodle Shop, Co. - Colorado, Inc. Paid fine $500 The Noodle Shop, Co. - Colorado, Inc. Paid fine $1000 The Noodle Shop, Co. - Colorado, Inc. 4 Store LOCATION OF DATE OF RESULT ENTITY Number VIOLATION: VIOLATION HOLDING LIQUOR LICENSE 714 West Jordan, UT 11/6/12 Paid fine of $227.00 The Noodle Shop, *Cited for failure to produce record of Co. -- Colorado, Inc. server training records, post Warning sign and wear identification badges. 631 Woodridge, IL 11/28/12 Received a warning The Noodle Shop, Co. — Colorado, Inc. 966 Manhattan, KS 1/17/13 Paid fine of $500 The Noodle Shop, Co. — Kansas, LLC 404 Kentlands, MD 2/8/13 Received fine of $2,500 The Noodle Shop, Co. — Maryland, Inc. 160 Fort Collins, CO 2/7/13 Received fine of $200 The Noodle Shop, Co. — Colorado, Inc. 535 Iowa City, IA 03/14/2013 Paid fine of $500 The Noodle Shop, Co. — Delaware, Inc. 205 Pewaukee, WI 06/29/2013 Received Warning The Noodle Shop, Co. — Wisconsin, Inc. 448 Sterling, VA 06/11/2013 $2,000 fine The Noodle Shop, Co. — Virginia, Inc. 831 Nashville, TN 06/21/13 *cited for improper posting of required The Noodle Shop, signs and failure to have server training Co. — Colorado, Inc. cards with all employees who serve food. Pending 810 Beaverton, OR 08/15/13 Paid fine of $1480 The Noodle Shop, *Cited for failure to have updated server Co. — Colorado, Inc. certificates from the OLCC 302 Maplegrove, MN 10/13/13 $2,000 fine and 2 day suspension The Noodle Shop, Co. — Colorado, Inc. 427 Ballston Commons, VA 11/5/13 Paid $2,000 fine and served 3 -day The Noodle Shop, suspension Co. — Virginia, Inc. 714 West Jordan, UT 10/16/2013 Paid fine of $1,000 The Noodle Shop, Co. — Colorado, Inc. 325 Mall of America, MN 11/21/2013 Paid fine of $500 The Noodle Shop, Co. — Colorado, Inc. 327 Burnsville, MN 12/9/13 Paid fine of $1,000 The Noodle Shop, Co. — Colorado, Inc. 734 Monroeville, PA 11/X/13 Paid fine The Noodle Shop, Co. — Delaware, Inc. 117 Parker, CO 12/20/13 Required to submit proof of server training The Noodle Shop, Co. — Colorado, Inc. 457 Mark Center, VA 2/18/14 Paid fine $2,000 The Noodle Shop, Co. — Virginia, Inc. 331 Wayzata, MN 6/18/14 Paid fine $500 The Noodle Shop, Co. — Colorado, Inc. 836 Clarksville, TN 7/10/14 Paid fine of $650 for license not posted and The Noodle Shop, three servers without permits Co. — Colorado, Inc. 313 Maplewood, MN 8/1/14 Paid fine of $500 The Noodle Shop, Co. - Colorado, Inc. 956 Lawrence, KS 8/5/14 Paid fine of $200 for failure to maintain The Noodle Shop, invoices on Premises Co. — Kansas, LLC 147 Dillon, CO 8/23/14 Paid fine of $200 The Noodle Shop, Co. — Colorado, Inc. 792 Boise, ID 8/26/14 Paid fine $1000 The Noodle Shop, Co. — Delaware, Inc. C Store LOCATION OF DATE OF RESULT ENTITY Number VIOLATION: VIOLATION HOLDING LIQUOR LICENSE 173 Parker, CO 11/6/2015 Warning and 1 year probation. The Noodle Shop, (any suspension 3/28/16-4/1/2016) Co. - Colorado, Inc. 712 Riverdale, UT 11/5/15 Paid fine $1000 plus court costs (total The Noodle Shop, $1127) Co. - Colorado, Inc. 462 Washington, DC 11/23/15 No certified manager. The Noodle Shop, Paid fine of $500 Co. - Colorado, Inc. 303 Plymouth, MN 11/10/15 Paid fine $1000 and 5 day suspension The Noodle Shop, 1/3/16-1/8/16 Co. - Colorado, Inc. 957 Independence, MO 12/12/15 Paid fine of $200 - State of Missouri The Noodle Shop, Hearing 3/29/19 - City of Independence - Co. - Kansas, LLC 1 year suspension held in abeyance for 2 years. 302 Maple Grove, MN 12/16/15 Paid fine of $2000 and served 5 day The Noodle Shop, suspension Co. - Colorado, Inc. 313 Maplewood, MN 12/19/15 Paid fine of $1000 The Noodle Shop, Co. - Colorado, Inc. 137 Broomfield, CO 2/11/16 Paid fine of $200. Five day suspension help The Noodle Shop, in abeyance for one year if no further Co. - Colorado, Inc. violations. 951 Olathe, KS 3/1/2016 No license posted. Paid fine of $400. The Noodle Shop, Co. - Kansas, LLC 131 Fort Collins, CO 4/1/2016 Show Cause hearing scheduled for 5/18/16 The Noodle Shop, at 1pm. Agree to $200 fine and to provide Co. - Colorado, Inc. ServSafe training certificates by 7/18/16. Submitted certs 7/12/16 via Fedex. 703 Fort Union, UT 3/31/16 Paid fine $1000 plus court costs (total The Noodle Shop, $1127) Co. - Colorado, Inc. 404 Kentlands, MD 5/18/16 Paid fine $3100. The Noodle Shop, Co. — Maryland, Inc. 130 Colorado Springs, CO 6/2/16 Paid fine of $200. The Noodle Shop, Co. 161 Lakewood, CO 6/14/16 Service to Minor - Pending The Noodle Shop, Co. 302 Maplewood, MN 6/29/16 Service to Minor - Pending The Noodle Shop, Co. W, Agenda Item 7 City of Boulder Finance December 8, 2016 Sent Via Email to: tsukasahibino@email.com and nobuk33@aol.com And Via Certified Mail, Return Receipt Requested Tsukasa Hibino Yarakasu LLC TASUKI License # 47-02220-0000 7980 Niwot Rd Longmont, CO 80503 Re: Beer& Wine Liquor License Renewal Application for 1575 Folsom Street Dear Mr. Hibino: Please allow this letter to serve as written notification that your Beer and Wine Liquor License #47-02220-0000 expired at midnight on December 8, 2016 and you will be required to attend a Beverage Licensing Authority 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 for your license which were due by October 24, 2016, 45 days prior to the expiration date of December 8, 2016. The Licensing staff received the incomplete renewal application on November 17, 2016. You were notified via email on that same day of the items that were needed in order to perfect the applications along with a form giving you the option to voluntarily suspend alcohol sales if the State license was issued after December 8 or you could decline and be scheduled for a renewal hearing. A deadline of December 2 was set for you to decide. As of the date of this notice, no form has been submitted to City Licensing. On December 6 we received an email on your behalf from Rainier Wheeler with questions regarding the renewal hearing in which he confirmed that you would attend the hearing. Our response re -iterated the instructions sent November 17 on what was needed immediately by close of business December 8 and the date scheduled for the renewal hearing. Those items are: • Training is not currently compliant -Need the Proof of Training employee list completed and TIPs training cards • Both the city renewal and state renewal applications were signed by the manager, not the owner -both need signed by the owner. • The state renewal application is missing the lease expiration date. • The state renewal fee for $351.25 made payable to Colorado Department of Revenue City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 IicensineC bouldercolorado.sov (303) 441-4192 (303) 441-1919 (FAX) needs to be submitted so that the city may submit it if the renewal is approved. The Sales Tax Division has denied the renewal on both November 17 and December 8. Please contact Sales Tax at 303-441-4079 for further information on how to cure this deficiency. You have submitted the city annual renewal fee. The city occupation tax have granted their approval for this renewal. Per both State and local Rules of Procedure (see attachment 1), your Company 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 are attaching here an employee training summary sheet for you to complete and attach employee certificates and training cards to (see attachment 2). We note that on your license renewal Plan for Training Compliance form you state that your business hired six new employees between October 17 and November 19, 2016. None of these employees were listed on your Proof of Training list nor did the plan detail a training timeline. You should be prepared to discuss this issue and provide all updated training proofs of training at the BLA hearing. b. Licensee should be prepared to address any questions raised as to compliance with 12-47-409, C.R.S. (pertaining to Beer and Wine type Liquor Licenses -see Attachment 3), including but not limited to, food and meal availability and mandatory percentages. 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 with the city of Boulder's Licensing Clerk as secretary of the BLA at least 45 days prior to your license expiration date as dictated by §12-47-302, C.R.S. City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 Iicensin2C bouldercolorrdo.eo% (303) 441-4192 (303) 441-1919 (FAX) You will then be scheduled and are hereby ordered to be at the City Council Chambers, Municipal Building, 1777 Broadway, Boulder, Colorado on January 18, 2017 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 January 4, 2017 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 January 7, 2017. The State Liquor License Code is available for your review at: httr)://www.revenue.state.co.us/liquor dir/wrap.aso?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.odf 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.aov Website: htto://www.bouldercolorado.aov/licensinp, City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensineC bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) CERTIFICATE OF MAILING I hereby certify that on the day o 0 L a true and correct copy of the above correspondence was duly mailed by placing same in the U.S. Mail, certification # 2g2V WM 3 101 63D 7,1-eturn receipt requested, postage prepaid, addressed to the following. Tsukasa Hibino Yarakasu LLC TASUKI License # 47-02220-0000 7980 Niwot Rd Longmont, CO 80503 K ste Teague, C&-LQiegSpecialist II City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 Iicensin2@bouldercolorado.e0v (303) 441-4192 (303) 441-1919 (FAX) ruM (Domestic. . • Provided) l VWk r=1 Postage $ M 1Z-�—r_ � Cerlined Fee lD � Return Receipt Fee Postmark Here a(Endorsement Required) Restricted Delivery Fee O (Endorsement Requlred) ru Ir Total Postage & Fees ru ru Serlt70 �� p 010 C3 sneat,apc7vo.: ^� N or PO Box No. 1 � � ... A. ,L _Y_ P± ----- J is—A--. _PS Form 3800, August 2UC-i See Reverse for Instruction) Attachment 1 SS 8-1-5 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 K:\CMLB\BL.A Rules of Procedure - Adopted December 2, 20 l4-.doc- 14 - Attachment 2 City of Boulder Finance Department Licensing Division 1777 Broadway, Boulder, CO 80302 - 303.441.4192 PROOF OF TRAINING Proof of Training Cth:)hsj7crm ou checked YES Your city renewal, please pil attach cords/certificates of ng Jor emplayaes� 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 IF .N Previous Latest Training Date Training Date r 11Z6 z�i 1j(""0 II /�aA93 Itn4/ i�� Attachment 3 12-47-409 Beer and Wine COLORADO LIQUOR CODE drugstore: (I) Through a common carrier, a contract carrier, or on vehicles owned by the wholesaler; and (II) Only to the business address of the liquor -licensed drugstore. (7) (a) A liquor -licensed drugstore licensed under this section on or after January 1, 2017, shall have at least one manager permitted under section 12-47-425 who works on the licensed premises. The liquor - licensed drugstore shall designate at least one permitted manager on the licensed premises to conduct the liquor -licensed drugstore's purchases of alcohol beverages from a licensed wholesaler. A licensed wholesaler shall take orders for alcohol beverages only from a permitted manager designated by the liquor -licensed drugstore. (b) A liquor -licensed drugstore that is involved in selling alcohol beverages must obtain and maintain a certification as a responsible alcohol beverage vendor in accordance with part 10 of this article. (c) An employee of a liquor -licensed drugstore who is under twenty-one years of age shall not deliver or otherwise have any contact with malt, vinous, or spirituous liquors offered for sale on, or sold and removed from, the licensed premises. 12-47-409. Beer and wine license. (1) A beer and wine license shall be issued to persons selling malt and vinous liquors and fermented malt beverages for consumption on the premises. Beer and wine licensees shall have sandwiches and light snacks available for consumption on the premises during business hours, but need not have meals available for consumption. (2) (a) Every person selling malt and vinous liquors and fermented malt beverages as provided in this section shall purchase malt and vinous liquors and fermented malt beverages only from a wholesaler licensed pursuant to this article or article 46 of this title; except that, during a calendar year, any person selling malt and vinous liquors and fermented malt beverages as provided in this section may purchase not more than two thousand dollars' worth of: (I) Malt and vinous liquors from a retailer licensed pursuant to section 12-47-407 or 12-47-408; and (II) Fermented malt beverages from a retailer licensed pursuant to section 12-46-104 (1) (c). (b) A beer and wine licensee shall retain evidence of each purchase of malt and vinous liquors from a retailer licensed pursuant to section 12-47-407 or 12-47-408 and each purchase of fermented malt beverages from a retailer licensed pursuant to section 12-46-104 (1) (c), in the form of a purchase receipt showing the name of the licensed retailer, the date of purchase, a description of the malt or vinous liquor or fermented malt beverages purchased, and the price paid for the purchase. The beer and wine licensee shall retain the receipt and shall make it available to the state and local licensing authorities at all times during business hours. (3) It is unlawful for any owner, part owner, shareholder, or person interested directly or indirectly in a beer and wine license to conduct, own either in whole or in part, or be directly or indirectly interested in any other business licensed pursuant to this article or article 46 of this title; except that the person may have an interest in a license described in section 12-46-104 (1) (c), 12-47-401 (1) 0) to (1) (t), (1) (v), or (1) (w), or 12-47-410 (1) or in a financial institution referred to in section 12-47-308 (4). 12-47-410. Bed and breakfast permit. (1) In lieu of a hotel and restaurant license, a person operating a bed and breakfast with not more than twenty sleeping rooms that offers complimentary alcohol beverages for consumption only on the premises and only by overnight guests may be issued a bed and breakfast permit. A bed and breakfast permittee shall not sell alcohol beverages by the drink and shall not serve alcohol beverages for more than four hours in any one day. (2) An applicant for a bed and breakfast permit is exempt from any fee otherwise assessable under section 12-47-501 (2) or 12-47-505 (4) (a), but is subject to all other fees and all other requirements of this article. (3) A local licensing authority may, at its option, determine that bed and breakfast permits are not available within its jurisdiction. 0 Page 42 of 77 City of Boulder 1/you checked NO �� Jor trolning on your city renewal. Finance Department • Licensing Division oleasefilloutthislorml 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 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. T.wk J j:.-_4 L,fetes � f Applicant/ Licensee iness name Trade name .a 1.y ltd Authorized signature Print name Date ` Title Date Fees Received: 11 ��G Amount Recd COB: / �, Amount Recd State: License Number: Date Issued: Expires: To State: CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Current Information: Applicant: Yarakasu LLC Trade Name: TASUKI Address: 7980 Niwot Rd Longmont, CO 80503 Phone: (303) 652-0238 Email: tsukasahibino@gmail.com; nobuk33@aol.com License Type: Beer & Wine Liquor Location: 1575 Folsom St Enter any corrections below: All information must be typewritten or legibly printed in black ink. v : c 47-02220-0000 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 Me both renewal forms by October 24, 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: 12/8/16 P. O. Box 791 Boulder, CO 80306 City Must Receive Complete Renewal By: 10/24/16 Attn: Liquor Licensing Fee Description 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 for any offense in criminal or military court (do not include traffic violations, unless they resulted in suspension or reyocation 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 trai mg 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 certificates of class completion or class cards to this summary. Please include a current copy of your Certificate of Good Standing issued by th C lorado Secretary of State (available at: 303-894-2200 or http://www.sos.state.co.us/pubs/business/main.htm ). Certificate enclosed: IMPORTANT: Please complete both pages of this application form. Version 401.03 6/19/2016 CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Oath of Applicant: 1 declare under penalty of pedury in the second degree that this application and ally attachments are true, correct, and complete to the best of my knowledge. 1 Authorized Signature: Title of Signer (if corporation): Date: Tax Department Action i Signature: Beverages Licensing A ority Action Chair: Approved: ❑ Approved: ❑ Denied: [�No 12 16 Date: I (o Comments: Denied: Date: Attest: IMPORTANT: Please complete both pages of this application form. Version 4.01.03 61-79P016 If you checked YES z City of Boulder for training on your city renewal, please fill out this form & attach cords/certificates of Finance Department •Licensing Division training for employees I 1777 Broadway, Boulder, CO 80302 - 303.441.4292 PROOF OF TRAINING Trade Name: Address:1 6 '� 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 r - l Iry % �Ir � n t Previous Latest Training Date Training Date 1 r -14 - City of Boulder IJVoucheckedNO oiFinance Department • Licensing Division oleasefilloutthis(orm! 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. l ie- irAti°i r f (trk Aa it-zx�G'�c., \ f r fid �l i V1 0. 4 T 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 Trade name ))A Authorized signature Print name Date Tite DR 9400 (Revised 09101/12) COLORADO DEPARTMENT OF REVENUE LIOL'9R ENFORCEMENT DIVISION LIQUOR OR 3.2 BEER LICENSE ' SUBMIT TO LOCAL LICENSING AUTHORITY RENEWAL APPLICATION Fees Due Renewal Fee Storage Permit 5100 x Optional Premise $100 x Amount Due/Paid Make check payabe to Colorado Department of Revenue The Slate may convert your check to a one-time electronic banking transaction Your bank account may be debited as eady as the same day received by the State If converted, your check Pill not be returned If your check is rejected due to Insufficient or uncollected funds, the Department may collect the payment amcunt directly from your banking account electronically PLEASE VERIFY & UPDATE ALL INFORMATION BELOW RETURN TO CITY • - COUNTY LICENSING AUTHORITYBY Licensee Name DBA Liquor Lice e # ense ype "q Sa_le_s ax cense # kk Expiration Date Due D to d ,a UVF.,,s� I iZ/3 t /zo t7 �z[ �fa�� Street reX,'S 1/-, j r one um er Mailing Address r1 0 erating Manager Date of Birth I "erne Address Phone Number 1. Do you have legal possession of the premises at the feet address above? `&YES L3 NO 600 Z5 Is the premises owned or rented? Ll Owned Rented' 'If rented, expiration date of lease_ZL� 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, owners (other th licensed financial institutions), officers, directors, managing members, or general partners are materially interested. ❑ YES P 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. Sincq the date of filing of the last annual application, has the applicant or any of its agents, owners, managers, partno or lenders (other than licensed financial institutions) been convicted of a crime? If yes, attach a detailed explanation. ❑ YES 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 ipIKYentity that had an alcohol beverage license denied, suspended or revoked? If yes, attach a detailed explanation. L3YES U 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 iicepse, including loans to or from any licensee or interest in a loan to any licensee? if yes, attach a detailed explanation. ❑ YES ta NO 6. SOLE PKOPRIEiORSHIPS, 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 1D or valid passport. AFFIRMATION & CONSENT 1 declare under penalty of perjuryin the second degree that this application and all attachments are true, correct and complete to the best of my knowledge. Typp nr Print Name of Aoolicant/Authorized Agent of Business Title SignatuEe- Date V/ 1 REPORT & APPROVAL Ur O i 'f OR COUNTY LICENSING AUTHORITY I 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 Dale Signature I Title Attest OFFICE OF THE SECRETARY OF STATE OF THE STATE OF COLORADO CERTIFICATE OF FACT OF GOOD STANDING 1, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to the records of this office, Yarakasu, LLC is a Limited Liability Company formed or registered on 09/27/2012 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 20121540192 . This certificate reflects facts established or disclosed by documents delivered to this office on paper through 11/16/2016 that have been posted, and by documents delivered to this office electronically through 11/17/2016 @ 15:46:09 . 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 11/17/2016 @ 15:46:09 in accordance with applicable law. This certificate is assigned Confirmation Number 9933963 ......... . ++.frtlr .. � .I.ttllt+•y~ �. _ ZIII 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 immediatelv valid and effective. However, as an option, the issuance 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, hup: it it sos.state.co.us/bi_/CerlificateSearchCriieria.do entering the certificate's confirmation number displayed on the certificate, and foilowing the instructions displayed. Confirminz 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 our Web site, !mp• iruvsr.so.s.srate.co.nk click "Businesses, trademarks, trade names"andselect "Frequently Asked Questions." Cook, Mishawn From: Cook, Mishawn Sent: Wednesday, December 07, 2016 4:49 PM To: 'Rainier's Gmail' Cc: 'tsukasahibino@gmail.com' Subject: RE: Regarding hearing for license renewal Hi, we will plan to schedule him for the hearing. His hearing date will be January 18, 2017. He will receive a separate hearing notice on where and when for the hearing. He needs to perfect his renewal application by the end of business tomorrow since tomorrow is his license expiration date. If he does that, then he may sell and serve alcohol at least until the BLA hearing. He has until the Jan. 18 date to complete item 5 below but 1 to 4 should be done now. The below are items that I included in my November 17 email to him that he needs to Ior his renewal: \rj 1 Training is not currently compliant- need emplo� list completed and APs training cards received Both the city renewal and the state renewal were only signed by the manager, not Tsukasa Hibino as owner - both of them need to be signed by owner -3�- State renewal needs to indicate the lease expiration date -4� Need state renewal check in the amount of $351.25 payable to Colorado Department of Revenue t at. The sales tax area has denied the renewal so you will need to contact Kristen Jensen at 303-441-4079 to address Thanks, Mishawn 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: Rainier's Gmail [mailto:rainier.wheeler@gmail.com] Sent: Tuesday, December 06, 2016 9:55 AM To: Cook, Mishawn <cookm@bouldercolorado.gov> Subject: Regarding hearing for license renewal Hello Mishawn, I'm contacting you on behalf of Tsukasa from sushi bistro Tasuki. He plans on attending a hearing for the renewal of the license. He wanted to know whether we would receive an extension for the renewal date 12/8/16 if he signs up for a hearing. Which date is available? Should he bring properly completed paper work to the hearing or submit it before the hearing? Agenda Item 8 City of Boulder Finance OF BOV December 8, 2016 Sent Via Email to: brooke@wonderoress.co And Via Certified Mail. Return Receiot Reauested Brooke Jordan Wonder Press Pearl, LLC WONDER PRESS License # 47-01993-0000 946 Pearl Street Boulder, CO 80302 Re: Beer& Wine Liquor License Renewal Application for 946 Pearl Street Dear Ms. Jordan: Please allow this letter to serve as written notification that your Beer and Wine Liquor License #47-01993-0000 expired on November 26, 2016 and that you will required to attend a Beverage Licensing Authority hearing to determine if there is good cause for non -renew your annual liquor license. To recap, the city is in receipt of the state and city license renewal applications for your license which were due by October 12, 2016, 45 days prior to the expiration date of November 26, 2016. The Licensing staff received the renewal application on December 5, 2016. You have submitted the annual renewal fees and the required late filing fees in addition to the Agreement to Temporary Suspension of Alcohol Sales dated November 30, 2016. The sales tax and occupation tax city staff have denied your license renewal. As such, please contact Sales Tax at 303-441-4079 and Occupancy Tax at 303-441-3010 for further information. Per both State and local Rules of Procedure (see attachment 1), your Company 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 City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 licensine@bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) current with training. We are attaching here an employee training summary sheet for you to complete and attach employee certificates and training cards to (see attachment 2). We note that on your license renewal Plan for Training Compliance form you state that your business hired six new employees between October 17 and November 19, 2016. None of these employees were listed on your Proof of Training list nor did the plan detail a training timeline. You should be prepared to discuss this issue and provide all updated training proofs of training at the BLA hearing. b. Licensee should be prepared to address any questions raised as to compliance with 12-47-409, C.R.S. (pertaining to Beer and Wine type Liquor Licenses -see Attachment 3), including but not limited to, food and meal availability and mandatory percentages. 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 with the city of Boulder's Licensing Clerk 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 January 18, 2017 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 January 4, 2017 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 January 7, 2017. 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%20Procedure.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 lice nsineCa, bouldercolorado.20V (303) 441-4192 (303) 431-1919 (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.Rov/licensing CERTIFICATE OF MAILING - ,/ I hereby certify that on the % / day of 20 � a true and correct copy of the above correspondence was duly mailed by placing same in the U.S. Mail, certification # 1 IZ 'Z-97-0 37, return receipt requested, postage prepaid, addressed to the following. Brooke Jordan Wonder Press Pearl, LLC WONDER PRESS License # 47-01993-0000 946 Pearl Street Boulder, CO 80302 5riisf('e'n Teague,MC- icensing Specialist II City of Boulder- Finance Dept. 1777 Broadway Boulder, CO 80302 IicensineC bouldercolorado.eov (303) 441-4192 (303) 441-1919 (FAX) r - m M 0 0 M O O O O O rU D. rU Postage $ Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees U kmit,A -" not Iz_q_I(� Postmark Here rU sent Io rq O [� or PO Box No. Oq ----------------- C/ty, State, ZIP+4 � CD PS Form :rr August 2006 See Reverse for Instruc Attachment 1 SS 8-1-5 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 K:\CMLB\BLA Rules oCProcedure - Adopted December 2, 2014-.doc- 14 - Attachment 2 Proof of Training Zg1ocrie u checked YES / City of Boulder ourctyrenewatpkasefill Finance Department - Licensin Divislon attah cards/certi/Jcatesof1777 Broadway, Boulder, CO 80302.303.441.4192mployeesl i� PROOF OF TRAINING Trade Name: W6 r j-V,c VSs 'Pec( 1 LLG Address: Cl Hi2 'i�P,<.1 it lS� p P �JI�VI,I(J1 �i (`7 O�6Z- 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 Latest Training Date Training Date 7+>s on Red/tfo,_ b3/ry jwj(o 61o,-Jzbj b o o/6--IZoI(0 ' 7309okQ C OtAaA T za Qcwt&e ou Q � �-�' 9 /Z/ZO t5 cCcA ► A- Zv,& 5 r gcpaw� abyljcr- 1 o )S l zo is AAA 4?:�—s�' 5 7ipsonR�MOV. D-(fZU70 CZ016 IG-rcave. /.. CarSk Rlpti� Z01(o i1 140LA�iavt Ti�S conA' .Mtn -e. [ �.AV ��I�Ag S n em(51 o f is 0 ZD 1S I City of Boulder If you checked No for trolningonyour cityrenewal, Finance Department - Licensing Division aleasefill out thbforml 1777 Broadway, Boulder, CO 80302.303.441.4192_ j : -s�-•� BEVERAGE LICENSING AUTHORITY PLAN FOR TRAINING COMPLIANCE FOR LICENSE RENEWAL Trade Name: (J I �(��,V �1 C� �S Pi?ark L -LC, Address: L_�i l� L1 r \ 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 for training completion. We �.�s�- klce.& 6 ru-w � I'�P�o� 2��, 600-w-ec,'1 I01 ��-1Zf�tco ;z�- I II191z(Z)(co, k-)kiVP_ kk) (2- i aA-Q a.(�, ` cam 0,_v1<& i\ P,V-UO U�JZ n v1 V 4. r +tea VV\ TIPS c e, v� i ��n �� i o V��l �o ✓Lc� OJ QAS �k,� e Oma( e .M e(0 Pe5 Vin W.(Vt J C2c� Oath of Applicant 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. 00vi(� e� i r�s5 ?(2rA-(� Applicant/ Ucensee buslness name -Authorized signature i113z©I Date Trade name _a-bn �fe PrInt name Ma V10LYMF(X (+VC Title J ` Attachment 3 12-47-409 Beer and Wine COLORADO LIQUOR CODE drugstore: (1) Through a common carrier, a contract carrier, or on vehicles owned by the wholesaler; and (II) Only to the business address of the liquor -licensed drugstore. (7) (a) A liquor -licensed drugstore licensed under this section on or after January 1, 2017, shall have at least one manager permitted under section 12-47-425 who works on the licensed premises. The liquor - licensed drugstore shall designate at least one permitted manager on the licensed premises to conduct the liquor -licensed drugstore's purchases of alcohol beverages from a licensed wholesaler. A licensed wholesaler shall take orders for alcohol beverages only from a permitted manager designated by the liquor -licensed drugstore. (b) A liquor -licensed drugstore that is involved in selling alcohol beverages must obtain and maintain a certification as a responsible alcohol beverage vendor in accordance with part 10 of this article. (c) An employee of a liquor -licensed drugstore who is under twenty-one years of age shall not deliver or otherwise have any contact with malt, vinous, or spirituous liquors offered for sale on, or sold and removed from, the licensed premises. 1247-409. Beer and wine license. (1) A beer and wine license shall be issued to persons selling malt and vinous liquors and fermented malt beverages for consumption on the premises. Beer and wine licensees shall have sandwiches and light snacks available for consumption on the premises during business hours, but need not have meals available for consumption. (2) (a) Every person selling malt and vinous liquors and fermented malt beverages as provided in this section shall purchase malt and vinous liquors and fermented malt beverages only from a wholesaler licensed pursuant to this article or article 46 of this title; except that, during a calendar year, any person selling malt and vinous liquors and fermented malt beverages as provided in this section may purchase not more than two thousand dollars' worth of: (1) Malt and vinous liquors from a retailer licensed pursuant to section 12-47-407 or 12-47-408; and (11) Fermented malt beverages from a retailer licensed pursuant to section 12-46-104 (1) (c). (b) A beer and wine licensee shall retain evidence of each purchase of malt and vinous liquors from a retailer licensed pursuant to section 12-47-407 or 12-47-408 and each purchase of fermented malt beverages from a retailer licensed pursuant to section 12-46-104 (1) (c), in the form of a purchase receipt showing the name of the licensed retailer, the date of purchase, a description of the malt or vinous liquor or fermented malt beverages purchased, and the price paid for the purchase. The beer and wine licensee shall retain the receipt and shall make it available to the state and local licensing authorities at all times during business hours. (3) It is unlawful for any owner, part owner, shareholder, or person interested directly or indirectly in a beer and wine license to conduct, own either in whole or in part, or be directly or indirectly interested in any other business licensed pursuant to this article or article 46 of this title; except that the person may have an interest in a license described in section 12-46-104 (1) (c), 12-47-401 (1) 0) to (1) (t), (1) (v), or (1) (w), or 12-47-410 (1) or in a financial institution referred to in section 12-47-308 (4). 12-47-410. Bed and breakfast permit. (1) In lieu of a hotel and restaurant license, a person operating a bed and breakfast with not more than twenty sleeping rooms that offers complimentary alcohol beverages for consumption only on the premises and only by overnight guests may be issued a bed and breakfast permit. A bed and breakfast permittee shall not sell alcohol beverages by the drink and shall not serve alcohol beverages for more than four hours in any one day. (2) An applicant for a bed and breakfast permit is exempt from any fee otherwise assessable under section 12-47-501 (2) or 12-47-505 (4) (a), but is subject to all other fees and all other requirements of this article. (3) A local licensing authority may, at its option, determine that bed and breakfast permits are not available within its jurisdiction. 0 Page 42 of 77 DR 8400 (Revised 09/01/12) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION SUBMIT TO LOCAL LICENSING AUTHORITY RETAIL LIQUOR OR 3.2 BEER LICENSE RENEWAL APPLICATION MVEI)WONDER PRESS NOV 2 8 2016 P-0 DON 7,330 OfgCQ TQo,,c\BRQGq�fYXIL 11711711 20011 S� EIE DIVISM Fees Due Renewal Fee $351.25 Storage Permit $100 x } (D (OD Optional Premise $100 x WONDER PRESS PEARL LLC Related Resort $75 x Amount Due/Paid Sales Tax License # Expiration Date Co 8O 30—z_'_ �� Make check payable rt Colorado Department of Revenu `i The State may convert your check to a one-time electron banking transaction. Your bank account may be debited as ear as the same day received by the State. If converted, your cher will not be returned If your check is rejected due to insufficient uncollected funds, the Department may collect the payme amount directly from your banking account electronically. PLEASE VERIFY & UPDATE ALL INFORMATION BELOW • •' • •' = Licensee Name DBA WONDER PRESS PEARL LLC WONDER PRESS Liquor License # License Type Sales Tax License # Expiration Date Due Date 47019E I Beer & Wine (city) 111/26/2016 110/12/2016 Operating Man�a er I Date of Birth .evzgo4ce. (1a�� r I Home Address _ _ r t �3Dkd&,E r I CO F3 d ;fJ q -- Manager rPPhone Number / �U _ S 3 Z —W� - - I Email Address r ,. _ -I� _ �/tJ lyVjlCl–P� nez j _ (..� Street Phone Number 946 PEARL ST BOULDER CO 80302 13037265582 Mailing Address 9t-{ Ce P-eGvC� �ee.`� Bdl,,<&2i te) 8 O3 0 88X1 , Z 1. Do you have legal possession of the premises at the street address above? ® YES ❑ NO nn Is the premises owned or rented? ❑ Owned N Rented* *If rented, expiration date of lease ZO 127. 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 J@ NO 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 a NO ..1 noss thp. Annlinsnt nr qny of its ans] ntc nwninrc rnPna0Prc nartnorc Qr Ionrlcrc 1nt!1mr than Iiceanced financial instifrificri') 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 AFFIRMATION & CONSENT 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. Type or Print Name of Applicant/Authorized Agent of Business Title 14a vL a-3 Signature Date t l 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 46 and 47, C.R.S. THEREFORE THIS APPLICATION IS APPROVED. Local Licensing Authority For Date Signature ! Title Attest �� License Number: 00 (2 _ C�v � � r / Date Issued: Date Fees Received: J,r Amount Recd COB:. (pAjJ75 ✓.�)3 7 Expires: Amount Recd State:S-en+ To State: 4'p Sic.��L�1 CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION Current Information: Applicant: Wonder Press Pearl LLC Trade Name: WONDER PRESS Address: 946 Pearl Street Boulder, CO 80302 Phone: Email: c License Type: Beer & Wine Liquor Location: 946 Pearl St Enter any corrections below: two U3�_e_cess co All information must be typewritten or legibly printed in black ink. 47-01993-0000 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 October 12, 2016 may result in denial of the renewal. Please complete the forms and return them to Fee Description Application Fee License Fee Total Payable to City of Boulder City of Boulder Finance Department P. O. Box 791 Boulder, CO 80306 Attn: Liquor Licensing Your Existing License Expires: 11/26/16 City Must Receive Complete Renewal By: 10/12/16 Amount $100.00 $48.75 $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 for any offense in criminal or military court (do not inelude 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. 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 certificates of class completion or class cards to this summary. Please include a current copy of your Certificate of Good Standing issued by the Col ado Secretary of State (available at: 303-894-2200 or http://www.sos.state.co.us/pubs/businessimain.htm ). Certificate enclosed: IMPORTANT: Please complete both pages of this application form. Version 4 01.016292016 CITY OF BOULDER LIQUOR LICENSE RENEWAL APPLICATION 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. Authorized Signature: , Title of Signer (if corporation): n� C (� t n Date: I j� Tax Department Action: Approved: I Denied: Date: _ Signatur Comments: 1BPLL - 6U—Y---D Beverages Licensing Authority tion: Approved: ❑ Denied: ❑ Date: Chair: Attest: IMPORTANT: Please complete both pages of this application form. Version 1.01.03 6292016 If you checked YES ;/ City of Boulder for troiningonyourc►tyrenewa►,p/easeflll r out this form & attach cards/certifcates of Finance Department - Licensing Division trainingforem to es! 1777 Broadway, Boulder, CO 80302.303.441.4192 p PROOF OF TRAINING Trade Name: /IA � p_� �(,eSS 4� �� LLC 1 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 yeoIn F, t�rbo�rP �o an I C � Ivy A- R ,,L& -e 1CW& e. /.. Care3s�n I�Cjet�n [: iIanck I e State Training Type Hire Date Previous Latest Training Date Training Date TPS on ` 4W_cP b-3Ityjwj(o WlOrr]Zbjb 040/6--JZoko TOS va PCWIS�2 OUVW-c TZ./Z615 res ()V 9CP_(A� 0).)ytk(_ 10 s t zo lS %i,S on i This is your Official TIPS® Certification Card. Cary 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-I200. Thank you for your dedication to the responsible sale and consumption of alcohol. Sincerely, Gam_- Lor 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, -Z &-"- 4r 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, a- Lor 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 cat becomes lost, damaged or stolen. r . On Premise SSN: )=-XX-)D= Issued: 10/22/2015 Expires: 10/14/2018 ID#: 4110695 D.O.B.: XXnO(/X)= KATELYN BLACHETTE 946 Pearl St Boulder, CO 80302-5109 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 � l 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. a On Premise Issued: 9/2/2015 ID#: 4072713 SSN: XXX -XX --)000( Expires: 8/20/2018 D.O.B.: XXnOUX)= BROOKEAJORDAN 946 Pearl St Boulder, CO 80302-5109 For service visit us online at www.getdps.com Iva Townsend, 40535 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 cap becomes lost, damaged or stolen. i • ^ On Premise SSN: )00( -XX -X)= Issued: 10/5/2015 Expires: 9/24/2018 ID#: 4097106 D.O.B.: X(/)0(/)00()( CECILY A RUNGE 1928 Pearl St Boulder, CO 80302-4428 For service visit us online at www.getfps.com Iva Townsend, 40535 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, G&- Lr�' 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, Gf�r�.�- L�V< 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 car becomes lost, damaged or stolen. For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 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 ca} becomes lost, damaged or stolen. r� e SSN: On Premise )XX-)O(-XX)O( Issued: On Premise SSN: )=-)O(-)000( Issued: 10/22/2015 Expires: 10/14/2018 ID#: 4110694 D.O.B.: XX/XX/ID00( ROBYN C KNOWLAN 946 Pearl St Boulder, CO 80302-5109 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 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 ca} becomes lost, damaged or stolen. r� e SSN: On Premise )XX-)O(-XX)O( Issued: 10/8/2015 Expires: 9/26/2018 ID#: 4100523 D.O.B.: XX/XXDom ELIZABETH ANDERSON 613 North St Boulder, CO 803043219 For service visit us online at www.gettips.com B. Jonathan Balliet, 47289 ale and consumption of alcohol. congratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) rogram, you have taken your place in the forefront of a nationwide movement D reduce the tragedies resulting from the misuse of alcohol. We value your anticipation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or olleagues by using the techniques you have learned and taking a positive pproach towards alcohol use. If you have any information you think would enhance the TIPS program, or F we can assist you in any way, please contact us at 703-524-1200. Thank you or your dedication to the responsible sale and consumption of alcohol. Sincerely, Adam F. Chafetz President, HCI Chis is your Official TIPS® Certification Card. :arty it with you as evidence of your skills and knowledge in the responsible ale and consumption of alcohol. -ongratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) rogram, you have taken your place in the forefront of a nationwide movement reduce the tragedies resulting from the misuse of alcohol. We value your articipation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or olleagues by using the techniques you have learned and taking a positive pproach towards alcohol use. If you have any information you think would enhance the TIPS program, or we can assist you in any way, please contact us at 703-524-1200. Thank you :)r your dedication to the responsible sale and consumption of alcohol. Sincerely, or Adam F. Chafetz President, HCI Chis is your Official TIPS® Certification Card. :arry it with you as evidence of your skills and knowledge in the responsible ale and consumption of alcohol. '.ongratulations! By successfully completing the TIPS (Training for Intervention ProcedureS) rogram, you have taken your place in the forefront of a nationwide movement reduce the tragedies resulting from the misuse of alcohol. We value your articipation in the TIPS program. You will help to provide a safer environment for your patrons, peers and/or olleagues by using the techniques you have learned and taking a positive pproach towards alcohol use. If you have any information you think would enhance the TIPS program, or we can assist you in any way, please contact us at 703-524-1200. Thank you )r your dedication to the responsible sale and consumption of alcohol. Sincerely, or -Zaz 6"rr Adam F. Chafetz PrPcidpnt T4('1 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. e M` On Premise SSN: )XX-XX-XXXX Issued: 6/7/2016 Expires: 5/26/2019 ID#: 4273937 D.O.B.: XX/)OUXXXX ANDIE ESTES 5440 Conestoga Ct Boulder, CO 80301-2724 For service visit us online at www.gettips.com Iva Townsend, 40535 i 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: 6/7/2016 Expires: 5/26/2019 ID#: 4273938 D.O.B.: XX/XXDUUUC ERIN E BRADY 946 Pearl St Boulder, CO 80302-5109 For service visit us online at www.gettips.com Iva Townsend, 40535 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. r• � On Premise SSN: XXX-XX-XXXX Issued: 6/7/2016 Expires: 5/26/2019 ID#: 4273939 D.O.B.: XX/XX/XXXX GRACE L CAROSIO 946 Pearl St Boulder, CO 80302-5109 For service visit us online at www.gettips.com Iva Townsend, 40535 Kr 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, Wonder Press Pearl, LLC is a Limited Liability Company formed or registered on 01/24/2013 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 20131054753 . This certificate reflects facts established or disclosed by documents delivered to this office on paper through 11/30/2016 that have been posted, and by documents delivered to this office electronically through 12/02/2016 @ 19:29:32 . 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 12/02/2016 @ 19:29:32 in accordance with applicable law. This certificate is assigned Confirmation Number 9956234 ffftttt �11 Zll Z(Z�Z11~ / Secretary of State of the State of Colorado **ssssss**ss*ssssssssss**sssssss*************End of Cettificatessssssssssssssssss*****s****sssssssssssssss Notice: A certificate issued electronically from the Colorado Secretary of State's Web site is fully and immediately valid and effective. However, as an option, the issuance 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, hilpalwww-vos.vtate.co.us/biJCertifcateSearchCriteriado entering the certificate's confirmation number displayed on the certificate, and following 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 our Web site, http:N www osstate.colis click "Businesses, trademarks, trade names " andselect "Frequently Asked Questions." 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 Operating Company, LLC Lucky's Market 6328 Monarch Park Place, Suite 100 Niwot, CO 80503 RE: Lucky's Market Operating Company, LLC d/b/a Lucky's Market Proposed Premise Location: 695 S. Broadway, Boulder, CO 80305 FOR A New 3.2 % On 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 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, withdrew the original application of September 14, 2016 and submitted an amended application packet, which was substantially complete, to the City Clerk's Office on November 30, 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 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. 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) 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 Operating Company, LLC [LMOC] as LLC Applicant with Lucky's Market Parent Company LLC [LMPC] as 11t underlying sole owner, and with The Kroger Co [Kroger] and Lucky's Founders Holding LLC [LFH] as 2nd underlying co- owners, and with Jason Sharon and PG Holdings LLC [PGH] as co-owners of LHF; Jason Sharon as Managing Member of LMOC and CEO of LMPC, Andy Pillari, CFO of LMPC, Russell Dispense, Monica Garnes and J. Michael Schlotman as appointed representatives of publicly traded company Kroger, Patrick Gilland as majority owner and Managing Member of PGH, and with Tom Overlie as Regional Manager of LMOC; Jason Sharon, co-owner of LFH, and Managing Member of LMOC, LMPC, LFH, and CEO of LMPC: No record of arrest per FBI/CBI background check. Andy Pillari, CFO 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 LMOC: 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 (IHRs) self- disclosure and City of Longmont City Clerk. 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, January 18, 2017 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: httos://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. January 10, 2017 BEVERAGE LICENSING AUTHORITY CITY OF BOULDER, COLORADO Mishawn J. Cook, Tax and License Manager And Board Secretary Neighborhood Map for a New 3.2% On Premise Liquor License Lucky's Market - 695 S Broadway c Cascade AV .�' �' Iw 0 M � � � � �p•n Dr 2'aibot Dr C' N W W sn {n --j d s r CA t s +' w}� w Basellne Baseline Rd N N N - ion N c j L -MariposaAv N Q"� 3 Pinon Dr W Bluebell Av El�� R Ch t i -- p Ki i Av Kgv--sngAv maeca NIS. p w w _ 1 rn "Ash 1- �. t1 t •c Sioux Dr V CAI C4rie C" CCw � �'4f�iyh .A mai XW' �p �j� �9 Or �i te nsa in Dr Table Mesa pr irm—/artmauthrAv` Lucky's Market 8r t Dr a�4, r .KohlerDr�Stafipo �l 'Vassar Dr '9D` �� y l- �,� sir y I Q , ` Hartiord Dr r '+ o b r 5 0 m�� meq, ._ 1.: _ fid �..- daaa� `Vhaca Dr p`� ArmerAv o i 14blot :r C t ie Rd ooh' a46 Darle AV °' o �,: 6s0 °BjQ,LL Y f�i oo a4 4 O,�: ti <a�a Il, n. c LSF, Grinnell P`' GordoDr JO w t�-O .p _ t % Ob Emerson Av rt1i'� o �1r►a . ' Y y �► �a ston- �� Or� j� 1 11 Heidelberg G,` Green'?0�1 1 -a @�A lliff St t �, f , 1J-1 5 •n..rnv r °�ij '� �j- �ui111ard SPie Dr itte Or ve A� f tfh r Lf Applicant: Lucky's Market Operating Company, LLC Trade Name: Lucky's Market NORTH Location: 695 S Broadway License Type: New 3.2% On Premise 1 inch = 1.750 feet t m 'Py Cr A. City of Boulder' The infomret on dep:clad an this map is provided as graphical representation only The City of Boulder provides no warrardy, expressed or knplied, as to the accuracy and/or ccingeteness of the nfonna9c contained hereon c' �tfl A ao"N: 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 of Applicant(s); wd�t,o AD r`- vm_m_-�m com (R n { t E Trade Name: Lucky's Market Phone No: 720-378-9177 Contact Person: Wendy Petrillo -Rundle Business Address: 695 S Broadway, Boulder, CO 80503 Mailing address: 6328 Monarch Park Place, Suite 100, Niwot, CO 80503 PropertyOwner: 1916, Inc. Phone Number (local): 303-442-8687 Property Manager: WWR Real Estate Services, LLC Phone Number (local): 303-442-8687 Property Manager's Mailing Address: 1375 Walnut St., Ste 10, Boulder, CO 80302 General Manager: Tim Overlie Phone Number (local): 720-243-9497 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): 9 New License ($1,000.00) Change in Location ($750.00) E] Change in Class ($750.00) Type of License (fee): Hotel -Restaurant ($75.00) Hotel -Restaurant w/Optional Premises ($75.00) ine ($48.75) 3.2% Beer O &Off Premises ($3.75) u ($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) E] Bed and Breakfast Permit ($125.00 Total) n Art Gallery Permit ($103.75 Total) E] Manager Registration — If separate from owners (H&R, Brewpub & Tavern - $75.00) TOTAL FEES: [Fees effective as of July 1, 2010] $ 1003.75 4( 3ep- A*m6l 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 Boundant West Boundary ALL APPLICANT'S MUST ANSWER THESE QUESTIONS CITY OUESTIONNAME: 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? 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 -tune 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," Nvhat 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 10:00p.m., there will be both underage and of -age people present ancj 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 itis 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. ; Au th ed Signature Date Jason B Sharon; CEO, Manager Print Name & Title Lucky's Market Operating Company, 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 will allow customers to purchase 3.2 beer for consumption on 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? 6:00 am to 10:00 pm 3) What is the seating capacity of the establishment? 60 interior seats in the cafe 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 hoIN many will be full-time versus part-time? Please provide responsibilities, (i.e., manager, assistant manager, bartender, wait staff, 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, marl: 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 cafe. 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 cafe 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 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. kyu�—QA _�,Jas n Sharon,CEand Manager DR 8403 (06128116) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 r Colorado Fermented Malt Beverage (3.2% Beer) License Application 17 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.i5 Applicant should obtain a copy of the Colorado Liquor and Beer Code: tAvvii colorado.gov/enforcement/liquor 1. Applicant is applying as a/an ❑ Corporation ❑ Individual ❑ Partnership (includes Limited Liability and Husband and Wife Partnerships) 0 Limited Liability Company ❑ Association or Other 2. Q ,plicant(s) If an LLC, name of LLC; if partnership, at least 2 parthers' names; if corporation, name of corporation ,l FEIN 2a. Trade 'el oofEsta - it then vB State Sales Tax No. Business Telephone Lucky's Market tea_; F a .:'•" ; 1303-530-0782 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 5. 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. I Present Class of License I 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 fdr 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 Orr -Premises (City) $96.25 ❑ Retail 3.2% Beer Oft Premises (County) $117.50 Retail 3.2% Beer On/Of Premises (City) $96.25 ❑ Retail 3.2% Beer OnfOff Premises (County) $117.50 ❑ Master File Location Fee ............... $25.00 x To ❑ Master File Background ............... $250.00 x Total Questions? Visit vlviw.colorado.gov/enforcement/liquorfor more information Do Not Write In This Space - For Department Of Revenue Use Only Liability Information License Account NumberI Liability Date: License Issued Through: (Expiration Date) Total i ( c$ 1116.25 1 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: tiwvty.colorado.gov/enforcement/liquorfor more information. Items Submitted, Please Check all Appropriate Boxes Completed or Documents Submitted 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 II. Dipgram 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 control (fences, walls, etc.) © C. Separate diagram for each floor (if multiple levels) L1 D. Bold/Outlined licensed premises III. Proof of Property Possession (One Year Needed) ❑lA. Deed in name of the Applicant ONLY (or) (matching question #2) date stamped/filed with County Clerk L 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 ETA . Individual History Record(s) "(Form DR 8404-1) X (j ❑ 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 Q f .A ❑ D. List of all notes and loans. fv IN V. Sole Proprietor/Husband and Wife Partnership ❑ A. Form DR 4679 ❑ B. Copy of State Issued Driver's License or Identification Card for each Applicant Vl. Corporate Applicant Information (If Applicable) NJ A ❑ 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 Cif formed after 2009) Vlll. Limited Liability Company Applicant Information (If Applicable) El A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office) V0B Certificate of Good Standing if organized more than Mo years C. Copy of operating agreement a\P 0 D. Certificate of Authority (if foreign company) 7. Is thea applicant (including an of the artners, if a partnership; members or manager if a limited liability company; Yes No PP ( 9 Y P, P p 9 tY 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 officers, stockholders or directors if a corporation) or manager ever (n Colorado or any other state): (a) been denied an alcohol beverage license? ❑ (b) had an alcohol beverage license suspended or revoked? ❑ (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 S. Hasa 3.2 beer license for the premises, to be licensed been denied within the preceding one year? If "yes," explain in detail. ❑ V 10. 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 or former financial interest in said business including any loans to or from a licensee. see attached g ❑ 11. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownership, El or other arrangement? El Ownership L� Lease ❑ Other (Explain in Detail) a. If teased, list name of landlord and tenant, and date of expiration, EXACTLY as they appear on the lease: Landlord 1916, LLC attn: Property Manager Tenant . r_ _ _ empires VVWR Real Estate Services, LLC, 1375 Walnut, Suite 10, Boulder, CO 80302 f ;1 i tCk t� S 4 Y�I t7� itlrt �QMpal 5131 /2026 b. Is a percentage of alcohol sales included as compensation to the landlord? If yes complete question 12. J ❑ c. Attach a diagram and outline or designate the area to be licensed (including dimenslons) which shows the bars, brewery, walls, paititions, 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 First Name ( Date of Birth FEIN or SSN Inter�st l9l(n� LLC, t%� QI)LoRb� 11. r - P,. Last Name First Name Date of Birth InteN/aI 1FElNorSSN 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 on/off applicants. Last Name I First Name I Date of Birth Overlie I Tim 1 14. 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. ❑ EZ 15. 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. 16. If applicant is a corporation, partnership, association or limited liability company, applicant must list all Officers, Director, General Partners, and Managing Members. In addition, applicant must list any stockholders, partners, or member 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 t �; 'M328 PAonarch Park PI., Ste. 100, Niwot, CO 80503 Member Lucky's MarkeA4?_qre4Name - Home Address, City & State Date of Birth Position % Owned 'See attached list of officers and ownershi ) 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 416 (Include ownership percentage if applicable) 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 or Beer Code which affect my license. Authorized Signature Printed Name and TitleDate I ` f I Jason B Sharon, CEO and Manager S Report and Approval of Local Licensing Authority (City/County) Date application filed with local authority Date of local authority hearing (for new license applicants cannot be less � / _ 2 0 ` 6 than 30 days from date of application 112-47-311 (1) C.R.S.) 1-0- 17 Each person required o ile DR 8404-I has Been fingerprinted EI 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 .r 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 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) Pavment Schedule. Base Rent will be paid pursuant to the following schedule: Lease Months Annual Base Annual Base Rent Monthlv Base Rent Percentage Rent Rent Amount Amount Breakpoint Amount/SF 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 $40,000,000.00 151 Option Period: Lease Months 181-240 $16.94 $542,232.46 $45,186.04 $40,000,000.00 2°d 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) Percentage Rent. "Percentage Rent" means l .0° 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 Breakooint") 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 Lucky's Market Operating Company, 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 5414 Westridge DriN,e Boulder, CO 80301 11/18/1979 11.25% ownership Andrew T Pillari -- CFO 604 Mills Street Lafayette, CO 80026 02/05/1978 0.0 wmaership The Kroger Co 55% wmaer Publicly traded Jason Sharon 25% owner *Russell Dispense, Moni�a Games & J Michael Schlotman from The Kroger Co are tl\e appointed representatives to undergo revie�� 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% oNNrner *Note* Managers - Jason B Sharon, Monica Games, J M'chael Schlotman; Patrick L Gilliland and Russell Dispense Officers Jason Sharon — CEO Andy Pillari — CFO Lucky's Market Operating Company; LLC *Jason B Sharon is the manager of the LLC 100% o«nler September 15, 2016 p?F—p_.P-ri rsla CDiAPW`f RE: Lucky's Market r, 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-Smrth- ot+der,-tk�. O pe- r.-�-�-�Co rr PrLOL� O Jason B Sharon Patrick LGilliland Russell Dispense Andrew T Pillari n .-Step-remD-g1an-}�— 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 Garnes 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�ss Market Parent Company, LLC • 6tepiSen-D-Biack Si�ti� O iPlret-oft=i,/J IG GII�GtT�e}�l-L-�ir 'd ri Z-L� • 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 Sharon, CEO and Manager Luck --,-'s Market 6328 Monarch Park Place. Suite 100. Niwot. CO 80503 I( W V- Aj.� December 2, 2016 City Of Boulder Mishawn Cook 1777 Broadway Boulder, CO 80302 Re: Officer Resignation Dear Ms. Cook, I am writing to inform you that effective November 22, 2016, Stephen D. Black has resigned from Lucky's Market Parent Company, LLC and is no longer with our company. Sincerely, J n B Sharon CEO * z Lucky's Market Parent Company, LLC 6328 Monarch Park Place Suite 100 Niwot, CO 80503 Main: 303.530.0782 Fax: 303.479.8754 I CITY OF BOULDER imYF,RAGES LICENSING AU MORITY FINANCIAL STATEMENT The applicant hereby agrees that any knowingly false or incomplete answer to the fbEowiug questions shall constitute cause foi the suspension or revocation of the license applied for. Name ofApjhcant(s): ��LCGCLjI ►5 GtrlN.Q fZ'� i l L Trade Name: I Lucky's Market $usiness Address: 695 S Broadway, Boulder, CO 80305 phone No: ,303-530-0782 Contactperson: Wendy L -Petrillo -Rundle Mailing address: 6328 Monarch Park Place, Sutie 100, Niwot, CO 80503 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: r Is this anew or existing business: Existing Grocery Store If neve business, state approximate investment amount: $ Where will these funds come from? If existing business, state purobase price includinginventory: $ 6500.00 Where will these funds come from? Business Bank Account at Chase Bank If cash is to be invested, please complete the following: (Hyou need additional space, please attach additional pages) Person orbusiness investing F LtERtf `S MCAJ Cape_-rzt�L�r} [�,m���� Ll-� 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 (Checking 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 of Lender. Type of Loan: Amount of Loan - security:. Wean of Obligation: Business Bank Account Information What bank wRl the business account be maintained at? Chase Bank What name will the account be under? Lucky's Farq+efs-Market I-tatttirrgCompany, 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. OATS OF APPLICANT I mare under penalty of peajmy in the seoond degree that 0& application and all attacbme& are five, c@aw� and complete to the best of my lmowledge. I also ad mowledge that it is my mWonsib* and the responmbft ofmy agents and employees to complywith theprovlsions of the Colorado Liquorand Beer Code and all City of%Wder vales, mVAaiions and codes which affectmy homise. Signature Date Jason 8 Sharon, CEO and 4Aanager r" T&tName &Title r DR 8404-1 (03113115) 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 "NIA". 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 N^^ ��^^- I Cellular Number Lucky's Market of South Boulder, CO, LLC 2. Your Full Name (last, first, middle) 3 ou have used Sharon, Jason Bohanan Bo Sharon 4. Mailing address (if different from residence) Email Address 6328 Monarch Park PI, Ste 100, Niwot, CO 80503 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 )rive Boulder, CO 80301 06/15 Present 7177 Four Rivers Road 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 Nitnrnt rn Rnini 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, dyes i] No furniture, fixtures, equipment or Inventory to any licensee? (If yes, answer In detail.) 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 I1Yes ❑ No applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) The Liquor License #4701417 at 700 Ken Pratt Blvd #202 received a violation on 1.26.2016. Fine was paid in lieu of and 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 Ly,�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 dNo 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes fA 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 rpquir In question #13 is solely for identificat''or) purposes. 13a n�r� ^!l� t "umber c. Place of firth �,( ^ Hollywood, CA I d. U.S. Citizen LJ Yes ❑ No e.: ___, state f. When fig. Name of District Court h. Naturalization Certificate Number I. Date of Certification I j. If an Alien, Give Alien's Registration Card Number I k. Permanent Residence Card Number 1. Height m. Weight n. Hair Color o. Eye Calor p. Gender q. Race ,r�.�f you have a current Drivar'e i i--JID? If so, give number and state. 5'10"I 185 I fled BR O I M I CAUC I L`es ❑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. $ NnnP * 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 Cash Loans Account Type None Checking e. Loan Information (Attach copies of all notes or loans) Name of Lender Address None Bank Name Chase Bank Term Security Amount $6500.00 Amount Oath of Applicant I declare under D all of perjury that this al) ,lication and all attachments are true, correct and complete to the best of my knowledge. Au orized Signa E re Print Signature I�itle Date Jason B Sharon CEO, Manager DR 8404.1 (03/13115) 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 Home Phone NumberI Cell- a-. N,imber Lucky's Market of South Boulder, CO, LLC I2. Your Full Name (last, first, middle) 3. List any other names you have usec Pillari, Andrew Thomas Andy Pillari 4. Mailing address (if different from residence) Email Address 6328 Monarch Park Place, Ste 100, Niwot CO 80503 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 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.) 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 AD Dyes 9No 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 6328 Monarch Park PI., Ste 100 Lucky's Market Niwnt (10 R0.ri0 i CFO 10/14 Present Consumer Capital Partners 3900EastEastgM�exico Ave, Ste 1400 SVP Analytics & 02/14 10/14 Strateav School of Rock 114 bPhofe lJr�210 Burr Ridqe, 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 I 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.) 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 AD Dyes 9No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited MIN.bail for any offense In criminal or military court or do you have any charges pending? (If yes, explain in detail.) E]Yes 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) ❑ Yes YNo 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes 9No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal jrfognatioft re?�rired in question #13 is solely for identification purposes. 3a. [tate n RI h i h Snrial l4er irfty Niimher C. Place of Birth Colorado Springs, CO d. U.S. Citizen 9Yes ❑ No f. When I g. Name of District Court h. Naturalization Certificate Number 1. Date of Certification I J. If an Alien, Give Alien's Registration Card Number Ik. Permanent Residence Card Number I. Height m. Weight n. Hair Color o. Eye Color p. Genderq. Race 5'8" 165 I Brown Blue I M I Cauc. 14. Financial Information. r.�Dp you have a current Driver's License/ID? If so, give number and state. LYYes EJ No 9. _State Colorado 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 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address None Term Security $6500.00 Amount Oath of Applicant I declare c(j n Itv of penury that this q plication and all attachments are true, correct, and complete to the best of my knowledge. Authoriz re rit Signature Title Date Andy T Pillari I CFO Lucky's Market Operating Company, LLC 3.2 beer on 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 91h 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 Lucky's Market of South Boulder, CO, LLC 2. Your Full Name (last, first, middle) Gilliland, Patrick L 4. Mailing address (if different from residence) I Home Phone Number I(=IhiInr Kh ems %=r s you have u, - Pat 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 (.i irrant Fort Lauderdale, FL 33304-4377 03/01/15 08/29/16 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 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. 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.) 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 applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) EJ Yes ®No 110. 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 informatioq required in question #13 is solely for identification purposes. 1,An nnto nFRirfh Ih sn6;;1 �ariirity Number c. Place of Birth C1 irv- b n -1AI d. U.S. Citizen ®Yes ElNo f. When g. Name of District Court h. Naturalization Certificate Number I. Date of Certification Ij. If an Alien, Give Alien's Registration Card Number Ik. Permanent Residence Card Number 1I. Height m. Weight n. Hair Color o. Eye Color P. Gender q. Race r. Do you have a cunt nriver's LicenseAD? If so, give number and state. 5' 110" I White Blue I M I White Yes ❑Not 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 Ic. 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 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address None Term Security 6500.00 Amount Oath of Applicant I declare under penalty of perjury that this ap I cation and all attachments are true, correct �and complete to the best of my knowledge. Authorized r not Signature I lle M"nA, e Patrick L Gilliland I Owner Lucky's Market Operating Company, LLC 3.2 beer on premise license application Attachment to the DR 8404I — Patrick Laurence Gilliland Street and Number City, State, and Zip To From , f 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 WK. 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 Home Phone Number I f:allidar Number I,/Ir�V�/1%A,eIiFTG�'SOIJTN/ J[1U��� Cd; LLC �- 2. Your Full Name (last, first, middle) 3. List any other names you have u /ISi°E/!J S� /-- J. BUSS 4. ailing address (if di erent from residence) Email Address 5. List current residence address. Include any previous addresses w,�,,... ___ .. parate sheet if necessary) Street and Number City, State, Zip From To ("wrent elwC4E X4R,e F P14 rO 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 ,�/NG SooPE2S lQ S T�JO�I/ ST. 124fA/. 5-10a,2 3 f f51OE427- A 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, furniture, fixtures, equipment or inventory to any licensee? (If yes, answpr in detail.) Yes ❑ No GFF/��/2 FDS Kms- SG�s'�5, � try.�rlC r. � /J/«oN eos d- �.dPo�it/T�D /;D/1 /%F/lJY 4/G,5 -,V f�-:;' RRory a Oell 7-6 2olh 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 El No t,Y / r1-1 /s -o 5722X 0s 7- E Vi4 vE 4X,Eti 7-ioti5 1W e 41 4 WAV U. 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 XNo 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (if yes, explain in detail.) ❑ Yes XNo 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes IV 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 idej�tificatJ'*g Durposes. 13a. Date of BirFh I b. Social Security Number c. Place of Birth % P'�e�v" C Q d. U.S. Citizen ZYes ❑ No c f. When I g. Name of District Court h. Naturalization Certificate Number i. Date of Certification Ij. if an Alien, Give Arien's Registration Card Number I k. Permanent Residence Card Number I. Height Im. Weight n. Hair Color o. Eye Color p. Gender 1q.RaceJr.Do you have a currc-` 1 i�ancpnn? If so, give number nd state. �r a s 16 /7,0 13Lk 45AAl /t-/ C [Yes ❑No #_ State rwvr" 0 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ G, Sc>a. 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. $ /IJ(JW% 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 IVIA 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 C A S /-/ /V,::;) G 14 FC/c/ate 211,4 S'nz- e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security (p, J-00, '- Amount Oath of Applicant I declare underpenalty of veriury that this apylication and all attachments are true, correct and comalete to the best of my knowledge. Authorized Signa u Print Signature Title Date ��� Ru55EGL j ?J�SO% /LSC- (/.�0XXR /`10,xIW4� I�I�I6 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 2. Your Full Name (last, first, middle) Games, Monica, Jean 4. Mailing address (if different from residence) 1014 Vine St. Cincinnati, OH 45202 Home Phone Number I hl—w- 3. l—w-- 3. List any other names you have u, Gordon, Monica, Jean Finail Address ,il.com 5. List current residence address. Include any previous addresses w....... _ , __. . (Attach separate sheet if necessary) Street and Number City, State, Zip From To Current Newport, KY 41071 04/29/16 120 E. Freedom Way 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 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.) 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 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 N 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 Birt b. Social Security Number c. Place of Birth Columbus, OH I d. U.S. Citizen ®Yes El No f. When g. Name of District Court h. Naturalization Certificate Number I. Date of Certification Ij. If an Alien, Give Alien's Registration Card Number I k. Permanent Residence Card Number I. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race r. Do you have a current Driver's LicenseAD? If so, give number and state. 5'9 1165 I Brown Brown I Female I Black Wes ❑ 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 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address None Term Security $6,500 Amount Oath of Applicant I declare under penalt Aut d Si nature ap lication and all attachments are true, correct and complete to the best of my knowledge. PrintSi nature Title Date of :VZ3IVP ��Moni a J Games of Produce & Floral 109/23/16 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 17 W. Vernon Ave #316 Phoenix, AZ 85003 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 Home Phone Number I C:Pllular Number Lucky's Market of South Boulder, CO, LLC 2. Your Full Name (last, first, middle) 3. List any other names you have'; Schlotman, John Michael 4. Mailing address (if different from residence) Finail Address 1014 Vine St., Cincinnati, OH 45202 1er.com 5. List current residence address. Include any previous addresses (Attach separate sheet if necessary) Street and Number City, State, Zip From To Crescent Springs, KY 41017 11/01/15 f r*n+ 303 Eden Ave., Unit 7A 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.) 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 ❑ Yes ®No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited El Yes ® 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 El Yes ® No deferred sentence? (If yes, explain in detail.) 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 cluestion #13 is solely for identification purposes. 13a. Date of Birth I b. Social Security Number c. Place of Birth Cincinnati, OH d. U.S. Citizen aYes ElNo e. f. When Ig. Name of District Court h. Naturalization Certificate Number i. Date of Certification Ij. If an Alien, Give Alien's Registration Card Number Ik. Permanent Residence Card Number I.�t Wit rr�,right Hair Color o. yYe Color p Gender q. Race r. Do you have a current Driver's l iranca/ID? If so, give number and state. 6' LILis In grown Blue I N I W I91Yes ❑ No _ State xx 14. Financial Information. a. T6ha Total purchase 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. * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e Ic. 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 II�OnI� 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 CAS44 1Jon1 e Che.ck,Lnr\ e. Loan Information (Attach copies of all notes or loans) Name of Lender • Address Term Security jo -�-00.00 Amount Oath of Applicant 11 declare under Mayof perjury that this aq lication and all attachments are true, correct and comclete to the best of my knowledoe. IttP, rized Sjgna�� Print S�i/g�natulre J _ - _ Title Date DP,.8404-1 t(.03/13/15) COLORADO DEPARTMENT OF REVENUE LiouorEn,form-nerd Lei isior (3r-3) 205-2391101 Individual History Record To be completed by the following persons. as applicable: sole proprietors; general partners regardless of percentage ownership, and .Jutted pp2rtrars ,awning 1(1°•_ .or mc -,re D.f tFp p2rtrerzhin• 2!I P"tnr;o?I cffir>: rs of a rr.+mnrc+inn, all ftirnrtprc of ?,„_r,�nrafiinn_ snit an`� stockholder of a corporation owning 10% or.more of the outstanding stock; ,managing members or officers of a limited liability company, ?,P. mem;barg,owrtin9, 10°l .'_?r.mr' e of the C`Mpo-PV, arid enY/ mf_epded'rE4isfe. asJ.rna-on rof H;Dtei sad esty_ L,^ant :rTaverin zpi s^ f rev it ft'e:ns= ; Notice: This iindivid ual ,history ;record ireyuires information that is necessary for the ficer,sing investigation or iinquiry_ 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 deBberate misrepresentation or material ,omission may jeopardize the license application. (Please :attach a separate sheet id'necessary to enable you to answer questions completely) 1. !Name .of Business II Home yPhone Number Cellular Number L�c�'s m�ru�TaF5orl��f�vUct�o,�L� -- 2.'Your Full NAme .(last, first, ,middle) 13.'L'ist any other names you have uc o v F-9, LII�-- 4.,Iailing address (if dderent from residence)I Email.Address !F -M Wa LV CK Y--S-c-. c4>w\. b.'Ust currerd residence address. Include any previous addresses viiftn the :last five years. (Attach se.W.-de sheet'if:necessary) Street and Nurnber J city, State, Zip From TO Current 60 uL_+�Q�. , &D $0304 I o► t Previous 6. List all employment Within the last five years. Include any selff emp.Ioyrrent. (Attach separate sheet if nece=ssary) erne of Errrployor or Susineas Address (Street, Number, CifY, SteZ�l Positron Held From To (—vc.K�'s rut s�c.�-� 3q(�o t32a�wa 66 i y ate. 7. i isi the name.(s) of relatives workin.91n or holding a ;financial itrrterest €n the Colorado .alcohol :t�everage industry Nie of Relaitre :I Relationrsii, to You ! Position Held Mame of Licertsee 1 Have you ever applied for, held, or had an intc-est in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equi.w1ent or inventoryto arty ficentsee? (ff 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 El Yes XNo applied for or'been denied a',liquor.or 'beer license anyvdhere in the tlrtited States? (if yes, explain in detail.) 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or for -Wiled 6 bail -for any offense in .criminal or,rnilita court or Bio you.have a chd goes .pend',na? . If yes, ex n in .detail. �-) Yes �No .� y _ ry Yo any ( P�� ) 11. Are you ourrertly ,under pronation (supeniised or 'Unsupervised), parole, or completing the requirements of a dslerr�d:sentence? .(If yes, explain 'in detail.) ❑Yes No 12. Have you t ever hall any profession?I ;'cense suspended, revdred, or cleared? (If yes, explain -',in detail.) O Yes )4o Personal and Financial Information Unless alharvvise provided by lave, the }ersonal in!armatison -,squired in qn estion #13 w -U be i_reated as confidential. The personal lnforfnaboR;re�uired in cuestion#93 is solely for idgrrtifi io�,mnposes. ate? of i h l b_ Social Security Number I c. Place o Br h PMA, a�' >�� I d. U.S. Citizen KYes ONO ' If. When ::g. Name ofi oistnd Court h. Naturalization Certificate'Number i. Date of Certification j. If an Alien, Give Alien's trafion Card Number ' k Permanent Residence Card Number I � I-Height ht� ;I m. Weight ; n.:.Hair Color o. 'Eye Color p. Gender you have a c�rrr^+n^+�s cense/JD? 1f so, ,give number and state. 5 11 1 w �N� [�jLJQ.,q. Race ILP - Yes ONO 'tate 60 14. Financial Information. a. Total purchase 57 gr "nvestlnert being made by the epp!#g sr�ty, corporation, partnership, I'urfded liability company, other. Q1.q b. 'list the total amount of the personal :investment , made by the person 'tisted on .question #2, in this business including arty notes, Joan, cash, services or equipment, operating .capital, stock purchases or flees paid_ � b ' if corporate investment only plaease skip to andcomplete section (d) •' Section b should ;reflect the :total of .sections c and e c. Provide ds&ls of the persond hvestmeant described in 14b. You must accoLmt for.all of the sources of this investment (Attach a separate .sheet _d needed) Type: Cash, Services or EV -4 -men! I-Accou- jt Type 1 Bark Name 1 Aamnnt d. Provide details ofithe co=rporate inv:str ien', des ;abed rn 14 b. Ybu :rnL st account ,for �a'I of the sourc�-_s .of this ynvesta t (Attach a separate sheet iff needed) Type: Gash, Serwi ',s Or SgUI P -Ont `{ Loans A=attnt Type _� If e_ Loan lnfomtatiun (Attach ,copies cif ;l nom or leans.) MAIM of t ier—des Address Term i I,I Bank Nam A.rriount Ser --an.- ! Amour: nt I dr^,.I� fz Lsn=fir r eri='ty of pen1ry tl sl lbiS aPfAC�t6P. ertd ail a`�a :ori _nls are tnw ,r:orrer EvA cc�r??�i8t8 L ul?e to-st 0 mr l nrnut2G`�e. ¢ed Sign- i(Print Strm2Sure �Tr[le I Date �' ��--��- it -T'►�'^ O�`'�ti.►-tom � MP�Pq�,� � Q, �'1,1�� -Powe,( 11 -19 -IC q d l.,L-a 1241 a (t 1p I.t.R.- Applicunl slmnld bring Ills shed AND 1`110110SLD I'REMISR. DIAMIA,NI encstpl3•l11g nhh OLA Itule Section 7-3 e1 seq. in Licensing Clerk for the use ar0outdcr Plnunlug and Zoning at 1719 riranlsmy-fork Centt•al Unllding, 3' Roar, 383-441-IRSO to nddress the ruur below questions. Nr7Tf•:: Thls review Is for z,.uning po}uuses unly and is tial approval rormry ehonge oroccupaucy ur use perinlnlug to the bulldlug Bode. A cepa, me building perrolt Is required rarbullding madlnentlans, Including a elinnge or use fir occupancy. Planning and Zoning Dcpnrtmcnu Cumpicics lionaun Portion: VC.) Is the Use at the Site Allorwed-v'! Yr-.S/NO Comments/L(Initatlons: '--FLU, —t'C ter• .t�7 L (aC- Z� L eN Uoes the Usc Itcquire a Use Itcview o - Site Rcvicty/ YE81N0 Comments: r t5 I(Usasitc Review is required has a Use Rcvicw/SitcRevicty bccu np ro��qq��� YCS/ NO Comnlenls (such as Cese Number/ Dnte crApprovul): 40,e Zo/5- go,, N ° Are there any zoning restrictions or conditions or approval an tic property YESMO that would prcvcnl this property From being upon from the hours or7:00 am to 2:00 nal! Comm plii nerrslSignau,rc J Planners Printed Name pinnnc,'s'I' ll. Plmusr's Slgnalurc Dale Rev. 09/11 c1'rl, ov nom.u1:R III-WERACC. LICI(NSINC AUTHORITY ZON INC / PLANNING CONVIRMATIUN I'll IOlt '1'U I,1C:CNSI: AI'Pl.1rA'I ION 1.i(Iuu,icrnsc Anhlicanl l:nmt tics Tan I':irtinn: is Ckq's ►tl xA& O -pe a1-i(:o—p01,), L4.0 Appliu,ml:'_ —`-._ •-_ I. ,, t/, T,nrlc Nahle: Lucky's Market Applie,un I'hnac: _30ss3n.rnan Applicunl Entail:.wene'Y @Iuckysmadcet.ccm I'ncmisc Addretis 695 S ©roadway, Bu6cler. CO 8035 luclour 11rcndsu Sclmu'e Fooingc: 37557_ Umdum Pi liu S,pmrc I'nul:tgc none Approved Iudnnr llrotuisu: s0 and QutLluur I'nliu: none. Occupancy LundlSualiug Cupucity. S: to G I• Inutcnl'Opc,nlinn: M*,e-m•to10:00p.m ) 1atliRcn; nn; I iqu0r Llucnsc•1'ytn: 3.2 �:.r n,s te.V11, r Appli.unt's Signature: -94 —. Applicant's Prinlad Nunte: Andy T Plllari / Re pun;ive to CKS. 12-47-313(l)and (I)c which ctm es In perti uml parl, "(1) No npplfcaliun rur the itisrnncc o7 uuy Iiectuse... shull be recelvud or ncled upon ...(c) Fur a IncTlinn In Nr nren wheru tilt sale urnhrot,ol beven,ges us conlemplalcd is hot panniacd under the nlrplicablc zonim Inn's ur the muldcipalily, c(ry and cmnny, or cuunty..." and r:evwup Liecits(ng Aalhority Itules Orproccdure.Subsedinn 5-1-1 (c)nvailnblcal: blur/;n•tir w.huuldc,cnlmatla.unt•/fi14GCacrklLircnsin,dRntcs4u3da1'li.'UI'muctlurc.ndr Applicunl slmnld bring Ills shed AND 1`110110SLD I'REMISR. DIAMIA,NI encstpl3•l11g nhh OLA Itule Section 7-3 e1 seq. in Licensing Clerk for the use ar0outdcr Plnunlug and Zoning at 1719 riranlsmy-fork Centt•al Unllding, 3' Roar, 383-441-IRSO to nddress the ruur below questions. Nr7Tf•:: Thls review Is for z,.uning po}uuses unly and is tial approval rormry ehonge oroccupaucy ur use perinlnlug to the bulldlug Bode. A cepa, me building perrolt Is required rarbullding madlnentlans, Including a elinnge or use fir occupancy. Planning and Zoning Dcpnrtmcnu Cumpicics lionaun Portion: VC.) Is the Use at the Site Allorwed-v'! Yr-.S/NO Comments/L(Initatlons: '--FLU, —t'C ter• .t�7 L (aC- Z� L eN Uoes the Usc Itcquire a Use Itcview o - Site Rcvicty/ YE81N0 Comments: r t5 I(Usasitc Review is required has a Use Rcvicw/SitcRevicty bccu np ro��qq��� YCS/ NO Comnlenls (such as Cese Number/ Dnte crApprovul): 40,e Zo/5- go,, N ° Are there any zoning restrictions or conditions or approval an tic property YESMO that would prcvcnl this property From being upon from the hours or7:00 am to 2:00 nal! Comm plii nerrslSignau,rc J Planners Printed Name pinnnc,'s'I' ll. Plmusr's Slgnalurc Dale Rev. 09/11 , August 5, 2016 CITY OF BOULDER 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 BAUEN STUDIOS LLC 2 W DRY CREEK C1R #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 Leifer of Completion for your records. Sincerely, Pnning a efo me Services Staff 0 0 . � • gCAj Ul ta4a� fly Z y P a e E®° i 15 E.a Rif =eUl oil re �sE MIR �41 74 if p.E8.is�,�3�i�s� INS :dz �5a�:EE € a e 1F Atp wtr a -1 [i now 19R-9. TV r 1 I 1 r hI -- No Z 0 o LL I@ spyin Him � ��"; IUMma nSSB u 41 i1i It tits s� IM w i g °��oene6 O Z:: qU� w. F= : N l s §a _ �7- s 8\0 \ Wendy IP�etrillo-Ru, ndle Lux ko 1 aflf , J ©pa n .. . 11"... "1,,',., „.,1. -j Subject FW: SBO Occupancy ffcmpari� L (IN se P -T) EJP-wl-n,fw,m i U I - iAl vl--4 I /AT.3l—T-- i vim. L/F.T-4-- ml T6$ F4XLOU9M C CoODE ANALYSIS VEPART�W PR1 A. ,A! TERATf03+19 NO CH4*E FROM EXISTING CONDITION- S. MATERIAL VM TAREA AME ADDED AND USE REMAINS OCCUPANCY TYPE GROUP M, RETAIL / IUNOLESALE ] CONSTRUCTION TYPE TlEt TYPE I1-13, FULLY SPRINKLERED BOi AREA 30,112 SF PLUS EXIST. 1,156 SF MEZZANINE T O M OCCUPANT LOAD I EGRESS f 2124 PALO A OCCUPANT LOAD CALCULATION GROCERY ! RETAIL SALES AF EA 2OA31 / 30 = 694 UVW AREAS: 2,410 1300 = S OFFICES W / i00 = 10 STOR .sE ! I-ECK 1,549 / 300 = 25 TOTAL OCCUPANT LOAD 138 EGRESS WIDTH CALCULATIaN 138 X.20 -- 148" OR 12'-4" LF REQUIRED 21 LF. PROVIDED AT 4 POMTS OF EGFE66 (MR 3 EXITS REQUIRED FOR OCC. LOAD EXCEEDNG 500) 1 of C y TNOMA,; * GEN1 306; �F 0. c sfio A CITY OF BOULDER BEVERAGES LICENSING AUTHORITY STAB' OF TRAINING The applicant hereby states that helshe 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 otheremployees who will have any connection or involvement with liquor or fermented malt beverages on the subject premises of this application, the applicants) state(s) the following: All employees involved in the service of alcohol, including, without limitation, managers, clerks, bartenders, and waitpersons, shallattend astate-certified Responsible Vendoralcohol serviceclass within threemonths from the approval ofthis license. New employees shalltakeaclasswithin three months oftheirhire. Any empioyeeparticipating in aTasdngsmusthave already completed astate- certifiedResponsibieVendoralcoholserviceclass.Trainingcmtificaiionmust remain current for employees involved in the service of alcohol. The applicant agrees thatthe above mentioned training shallbe a continuing condition of the license if the Authority approves this application. Oath of Applicant I declare underpenalty of perjury inthe seconddegree that i acknowledge that itis 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. Applicant — ')Q K "�. A thori ed Signature Luckv's Market Trade Name Jason B Sharon CEO, Manager PrintName,Title& Date Oedipus, Inc. Empirical Data Services 9 January 2017 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: Re: Enclosures: Package Via: Date Delivered: Time Delivered: Signed: Printed Name: Title/Position: Ms. Beata Mazurkiewicz, Licensing Specialist City Clerk's Office, Boulder 1777 Broadway Blvd., Boulder, CO 80306 Lucky's Market of South Boulder, LLC, dba Lucky's Market 695 S. Broadway, Boulder, CO 80305 Retail 3.2% FMB License, ON Premises Consumption Only Three (3) Petition Packets (2) + 2 Copies Original Report + 1 Copy Summary Letter Affidavit of Posting with Photographs HAND DELIVERY @Oedipus,TM Inc., P.O. Box 1012, Lafayette, CO 80026 Tel. (303) 661-0638; Fax. (303) 604-2862 exleg@comcast.net TM Oedipus, Inc. Empirical Data Services 9 January 2017 Ms. Beata Mazurkiewicz, Licensing Specialist City Clerk's Office, Boulder 1777 Broadway Blvd. Boulder, CO 80306 Lucky's Market of South Boulder, LLC, dba Lucky's Market 695 S. Broadway, Boulder, CO 80305 Retail 3.2% FMB License, ON Premises Consumption Only 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 three (3) 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 Premises Consumption Only 169 Signatures Favoring Issuance / 4 Deleted Businesses: 26; Residences: 143 19 Signatures Opposing Issuance / 2 Deleted Businesses: 5; Residences: 14 188 Total Signatures / 6 Deleted Max Scott will be attending the upcoming hearing scheduled for the 18" of January 2017 at 3:00 p.m. to testify on the survey methodology and results. Should you have any questions in the meantime, please call. Res ectfully, Tina L. Scott Oedipus, Inc. Encl: Three (3) 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. Neighborhood Needs & Desires Petition Summary Applicant: Luc4,'s Market Operating Company. LLC Trade Name: Lucky's Market Business Location: 695 S Broadway. Boulder. CO 80305 Occupancy: 60 Square Footage: 37557 Business Description: Lucky's Market is a grocery store that is applying for a 3.2% On Premise, type liauor license that will allow customers to purchase 3.2% beer for consumption on premises, allowing them to purchase a beer while they shop for groceries Operating Hours: 8:00 AM —10:00 PM Monday thru Sunday. 7 days a week License Type: Nev 3.2% On Premisevpe ligy.or license Same # of Licenses in area: 0 Date(s) of Petitioning: JANUARY 4, 6, & 7, 2017 Defined Neighborhood: North: Dartmouth to Broadway to 27th to Hwy 36, South: QV Limits East: Hwy 36 to Moorhead Circle Extended, West: City Limits Total Contacts: DELETED SIGNATURES Not at Home: Not Qualified: Refuse to Sign: Needs & Desires Already Met MISCELLANEOUS OBJECTIONS Reli'ous Objection: NEEDS f DESIRES NOT YET MET Remained Neutral: Alcohol Usage Objections: No Reason Given: 349 6 111 2 41 II 6 0 169 1 TOTAL # IN FAVOR 169 TOTAL # OPPOSED 19 4 Neighborhood Needs & Desires Petition Summary Applicant: Lucky's Market OperatinZ Company. LLC Trade Name: Lucky's Market Business Location: 695 S Broadway, Boulder. CO 80305 Occupancy: 60 Square Footage: 37557 Business Description: Lucky's Market is a grocer�v store that is applying for a 3.2% On Premise. VVe kgpor license that will allow customers to purchase 3.2% beer for consumption on premises,, allowin? them to purchase a beer while they shop for erroceties Operating Hours: 8:00 AM —10:00 PM Monday thru Sunday. 7 days a week License Type: New 3.2% On Premise type kgpor license. Same # of Licenses in area: 0 Date(s) of Petitioning: JANUARY 4, 6, & 7, 2017 Defined Neighborhood: North: Dartmouth to Broadway to 27th to Hwy 36, South: Civ Limits East: Hwy 36 to Moorhead Circle Extended, West: City Limits Total Contacts: 349 DELETED SIGNATURES 6 Not at Home: 111 Not Qualified: 2 Refuse to Sign: 41 Needs & Desires Already Met: 7 MISCELLANEOUS OBJECTIONS 6 Religious Objection: 0 NEEDS & DESIRES NOT YET MET 169 Remained Neutral: 1 Alcohol Usage Objections: 4 No Reason Given: 2 TOTAL # IN FAVOR 169 TOTAL # OPPOSED 19 AFFIDAVIT OF POSTING Applicant: Lucky's Market of South Boulder, LLC Trade Name: Lucky's Market Address: 695 S. Broadway, Boulder, CO 80305 Type of License: Retail 3.2% FMB License, ON Premises Consumption Only 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 6 January 2017, as evidenced by the photographs of posting attached hereto. all : 1 Cl 'A I I I*l :BSI:► : lind-anwrow STATE OF COLORADO ) ss. COUNTY OF BOULDER ) Subscribed and sworn to before me this F AX J SCOTT otary Public te of Colorado ID 19904013814 on Expires Oep 16, 2018 TINL. -COTT 6`'' d of JANUARY .2017. NOTARY PUBLIC Max J. Scott P.O. Box 1012, Lafayette, CO 80026 Wedipus, Inc., P.O. Box 1012, Lafayette, CO 80026 �u� -T (XLO c RAD6 I lei 1t LI "r; .-. ON NOW.'' -lu ""'Ii' q. I "Oil IYM'12157 �yltlh i. WT LIT jFJAPdNGaN pT COUNI ILU r1NIE AND DA, CtATEOFAPF B��L L W;mm�w . AppucATIoN I U o1; "-JBEF69 MUNIOR NT 18�50AI 777 ., 4 p v C 9; -L�l TM Oedipus; Inc. Empirical Data Services Lud y's Market 695 S. Broadway Boulder, CO 80305 Retail 3.2% FMB License ON Premises Consumption Only TM Oedipus, InC. Empirical Data Services 18 January 2017 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, LLC, dba Lucky's Market 695 S. Broadway, Boulder, CO 80305 Retail 3.2% FMB License, ON Premises Consumption Only 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. employees were briefed on the application. The employees 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 Wednesday and Friday, 4 and 6 January 2017 (businesses), and Wednesday, Friday and Saturday, 4,6 and 7 January 2017 (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. Three (3) petition packets, one packet representing businesses and two packets representing residences, together with a Summary Letter, this Report and an Affidavit of Posting with photographs were prefiled via hand -delivery on 9 January 2017 with the office of Ms. Beata Mazurkiewicz, Licensing Specialist, to comply with the prefiling deadline. ©Oedipus, Inc. Local Licensing Authority, Boulder, Colorado Re: Lucky's Market — 3.2% FMB License, ON Premises Consumption Only 18 January 2017 PETITION/OPINION POLL RESULTS 1. Total Doorknocks: Not -at -Homes and/or Business Owners/Managers Not Available 111 Not Qualified to Sign 2 Preferred to Not Participate 42 Parties in Interest that Participated 188 Deleted Signatures 6 Total Base Figure 349 2. Oualified Contacts: A. Sianatures and Those Not Signing Signatures Favoring Issuance 169 Businesses 26 Residences 143 Not Signing/Favoring Issuance 0 Signatures Opposing Issuance 19 Businesses 5 Residences 14 Not Signing/Opposing Issuance 0 Total Contacts 188 B. Breakdown of Reasons of Signatures in Opposition: No Need 7 Abhorrence of Alcohol 4 Religious Objections 0 Usage Objections 0 Miscellaneous Reasons 6 No Reason Given 2 Total Signatures 19 Page 2 Oedipus; Inc. 303 6610638 • FAX 303 604 2862 • P.O. BOX 1012 • LAFAYETTE • CO 80026 • www.oedipusinc.com Local Licensing Authority, Boulder, Colorado Re: Lucky's Market — 3.2% FMB License, ON Premises Consumption Only 18 January 2017 C. Breakdown of Signatures Favoring and ODDOsing: Page 3 Favoring Issuance (Based on Needs/Desires) 169 = 89.89% Signatures 169 Not Signing 0 Opposing Issuance (Based on Needs/Desires) 7 = 3.73% Signatures 7 Not Signing 0 Abhorrence of Alcohol 4 = 2.13% Signatures 4 Not Signing 0 Religious Objections 0 = 0.00% Signatures 0 Not Signing 0 Usage Objections (Commercial, Traffic, Parking, Crime) 0 = 0.00% Signatures 0 Not Signing 0 Other Miscellaneous Reasons 6 = 3.19% Signatures 6 Not Signing 0 No Reason Given 2 = 1.06% Signatures 2 Not Signing 0 Total Base Figure 188 = 100.00% 3. Needs and Desires Signatures: Signatures Favoring Issuance (Based on Needs/Desires) 169 Favoring Issuance/Not Signing (Based on Needs/Desires) 0 } 169 = 96.02% Signatures Opposing Issuance (Based on Needs/Desires) 7 Opposing Issuance/Not Signing (Based on Needs/Desires) 0 } 7 = 3.98% Total Base Figure 176 = 100.00% The petition packets are presented as follows: Cover maps, petitions, list of other licenses, affidavit. #1 / Sondra Blanchard / Residences #2 & #3 / Mark Steffek / Businesses & Residences Oedipus; Inc. 303 6610638 • FAX 303 604 2862 • P.O. BOX 1012 • LAFAYETTE 9 CO 80026 • www.oedipusinc.com Local Licensing Authority, Boulder, Colorado Page 4 Re: Lucky's Market — 3.2% FMB License, ON Premises Consumption Only 18 January 2017 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. BOX 1012 • LAFAYETTE 9 CO 80026 • www.oedipusinc.com j 1 Fleming1j ICg BW NIS ❑Low Center iS igh 12 � I u R / FD20 ❑ [�°°�`"ASE Mae - %non s . ifaUian�rYll�e ❑SCI S.C. !E @raad•„z7lh Wa 36 r Z' . 1 •.n -Ride F u j d r o n NIST - NOA � o I ( Green Mtn. \ 0� , �yF• Cemetery -National I'n�s Itu e �afS andardscy �r M a _ � NIST - NOAA Cre Ch � Main Pa f pElel.ti o � . J \ weS� ti '•� 8Tt17 r cq / �rP co S Mui M� �.¢. •an or or-, Alt.'K_ Liter 1 ool z H1gh .... + 5 P - ° J �f "rPark ° i. S ; Mir Ta a Ales �� 4 �antra Dr X N O 'Yil Benno iummi s IPar, National N. F \k -narte[ lont,- ' Q� T 1Vessor ch ga Qf Elem. ® 93 )o -Aldev Center Gbp Av antra Ho D•;. E v• ark National for C, Bear ` I► G �u 1 t reek m. D44 A� - ter Atmospheric t,reekg, yc R �� R s Research +i areek o "a ak n .�.. IR Atmospheric ��' WILD �Q 9 YA(C Research ������yyy°� °D W arc CIR ^ PT f 9 1OR il. O V ar Oa3 �mz a 't i 4 Pla is L a.+.. i7 -aAnO r 1 .:r`ii ±��I Ate JCr.FO�I 1 \ ¢ Mesa g � w Elem.®AFalrvlew High S of oo School xl^' R wn on !V DR�r \ 1 r ma LN V SCR4gqQQ\'�\¢ofy CI L1+. O - BUSINESSES O - 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 PREMISES CONSUMPTION To sell 3.2% beer /or consumption ON the licensed premises only — NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES] PUBLICHEARING: WEDNESDAY, 18 JANUARY 2017,3:00PM.,COUNCIL CHAMBERS, 2NOFLOOR, 1777 BROADWAY BLVD., BOULDER, CO 80306 Neighborhood Map for a New 3.2% On Premise Liquor License Lucky's Market - 695 S Broadway Applicant: Lucky's Market Operating Company, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On Premise Cih'Of "%`i�" \Y414 - % Boulder N0 RT H The information depzW on this map is provided as graphical representation only The City of Boulder provides no warranty mcpressed or implied as to 1 inch =1,750 feet the acaaacy andfor completeness of the Information contaned hereon BUSINESS PETITIONS p W t C 5J� F/emmg I 00 jj D ew vis ❑ Law Center / TP I igh C`_tuumr-r I I (" t 72 L .I `i J12 `. .FD2O� n`—1 + kb �Jc� co lS S x r 4ggE�'�_ N �a ❑ �j Base _ Wlllllama I 0 Mar Williams Yl/,Ze Meat 0 / '>� S.C. Vlllaga S O Me ❑ ❑ �7 Broad 27th Wa 36 I. tlaL.Q_�1 B" IF + Z 4 -n-Ride e e l d e r oJf�. J T t: I r Z� Z= 4! ma of o / ° u NIST - NOA c 0- `- - Hat o - Alt. K 8 � � .py fe F 'ter ! Green Mtn. �� j00 Cemetery -National Ian -Itu Hae andi aidsr cd f SFS NIST -NOAA ant ethnology n r, o� l at Cres k 'M Ch r C a in Pa a ■ i EI �Q t t \ �W,est� P FI i1Fgb1aIIC1 5 `� O �rY Pa �k o t i 0 51 Q� gX j M To a qr es t t - 4� T ... �.. ... F - air+-rt�.�•.rhe.-n-.R-t-d- x[�p�.!'" -� �� 9RTf1111 Q • Libra � ev/ l,IfrO L(bri Tabl- Masa 1 ummi »\ a � honer - National �� �' rqE ante .hool° 9av1 4 %Q Elem. - 93 l CoA d e r antra Center o°gyp �� nv� � or u NO W" 13L National for n 6B r m Q D4 PAA Atmospheric res. Y�» rt"` ter �o N R8S88rCh n ar tmeK CR R S' a `F- -1 or v e :ark [•+ac�r GQry4\ 1 "� Atmosphericrt` a, Mt%, vC0"06?1'\_ ILD O q C $IiYN � Researchcl W K a� DR" rlo O.�j 3 z y t V P'l''a to El Me e� Fairview High S of oo \ i School �y t1\J� Be DR / a, 4LQkt ii�tll(i3R/g�c� y� to i 1 zr �► �� KI v M �� BR(A OR�, b ram LN tpjCl .� 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 PREMISES CONSUMPTION To sell 3.2% beer for consumption ON the licensed premises only — NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES] PUBLIC HEARING: WEDNESDAY, 18 JANUARY 2017,3:OOPM., COUNCIL CHAMBERS, 2NoFLOOR, 1777BROADWAY BLVD., BOULDER, CO 80306 Neighborhood Map for a New 3.2% On Premise Liquor License Lucky's Market - 695 S Broadway . J �+ m m m Mtn - r l� w_ NO MT-P-44-CEOF w - id eline' N W M1 w !st- rn �•- .- ••_•- �, Bas Baseline Rd •• •• CIA tillFUFA URRA F� \ meati L�q-Pin on Dr .0 3 Raylel9h Sal %rie Gt Table Ws Applicant: Lucky"s Market Operating Company, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On Premise r� i 0 r L�.iL �^.• r 11 0 Illlrllrititi , Cr :Held b cg Dr C f °. -L-Gree Y u`tlla' d SAle.D r aYette Dr cn9`N°�a P 1441 f,� 3 Cityof V �. 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O p a)A C,u 6 A p v N w a� o A W �, -7Z' ,fl u PA o G u u A G t A �o �u �A a a 0. A V S� �c�o� 000 A � O �A o W � v T C u P �i1 V �A „a ,fl u PA o G u u A G t A �o �u �A a a 0. A V S� �c�o� 000 a Iva �- •a �'o 0 F Q+ v v T C u P �i1 V �A `� 1- A �.a rA µ ,fl u PA o G u u A G t A �o �u �A a a 0. A V S� �c�o� 000 a Iva � A •� �n F Q+ v ,fl u PA o G u u A G t A �o �u �A a a 0. A V S� �c�o� 000 a O O A V O ., m O a�-��J 0) f6� J V M eA N c"' u CA G \,n /" d fG s O 4 O Gid N V d W AC4ut lz o o� G° W r U r+ 7 d� ✓ � --mss•-" Q ' � oa � -� N 4? W tWA ay. 'a'S 4 f d S:% 0 O 0bz W OQA U � �E 6i G N NO Com-, Ow p a O W y y, y o V o °A OV ul c W cl IU 0 y� o y u v O ' p, t�l� V r� en y W �e vs lz v In 'UO cs tj lu cn W o W o U P. cs O •op U ^ o0 o u v Q ra L1) d " o`ni a o c� y D e� Cy :i p i' ' Y o a o a N? W�� o 10 y o 0 �0y ti°o � Q- a .A o T a Ngo A tp cn LUCKY' MARKET OF SOUTH BOULDER CO, LLC, dba ) LUCKY' S MARKET ) RETAIL 3.2% FMB ON PREMISES LICENSE ) AFFIDAVIT 695 S. BROADWAY BOULDER, CO 80305 I, MARK STEFFEK , an employee of Oedipus, Inc., circulated petition(s) in the above matter; THAT I explained to potential signers of the petition the type of license being applied for, the proposed license location, the applicant's name and tradename (if applicable), the survey issue and the qualifications for signing the petition; THAT I gave signers of the petition the opportunity to read, or have read to them, the petition in its entirety and understand its meaning; THAT I personally witnessed each signature appearing on the attached petition(s); THAT to the best of my knowledge, the information (name, address, age) written on the petition by the individual signing same is true and valid; THAT no promises, threats, or inducements were made on my part in the presentation of this petition; THAT each signature was voluntarily given; and THAT I personally have no financial interest or equity in the establishment named in this application (pursuant to Section 12-470308, C.R.S. [recodified], of the Colorado Liquor Code, and/or Section 12-46-104(3), C.R.S. [recodified], of the Colorado Beer Code. FURTHER THE AFFIANT SAYETH t STATE OF COLORADO ) ss. COUNTY OF BOULDER ) Subscribed and sworn to before me this �? day of JANUARY , 2017. IGS �yS� rj TINA LATINA SCOTT NO PUBLIC Notary Public - State of Colorado Tina Latina Scott Notary ID 20004035761 My Commission Expires Dec 5, 2020 P.O. Box 1012, Lafayette, CO 80026 @Oedipus, Inc., P.O. Box 1012, Lafayette, CO 80026 RESIDENTIAL PETITIONS R N. C 1 F/emmg i O ;�$jC:�,Q ew Vis ❑ Law Center / r ❑ ❑ ...,r+c -q:..:' n 'dgD B'404' tom. tray" p o:i7 t F�7UBase willliam Mai s, irllialnT1111 ge memo Village Me ❑ ❑ I Broad- 27th Way 36 ^t►�P z _ \-n-Ride / fn ,• 0u Ider fid I Xv"N" 0166 NIST Green Mtn. Cemetery :Nat andaf rds � NIST - NOAA � � \\ an echnology i i r ■ YYleSt� High'�lanii - d� Q �� 9,n �9 National tJ,�NE o Ada a Re Center WV� HO National for so r Atmospheric g ter 90 Research c c,.8 k reed �� or AtmosphericILD 000 q� t' A Research rin 9%ti-W Mesa Elem. School* BR�B i Fter -� a0l, .oey R}lnoid-f *Br pL,�[bryir� — Table Mae �- \ syk.uli,tTeur„ � I F'ontessor E Qf—Y,]E Elem. p 93 �� Tabl�Mes--i i Tanlra Or o ummi , A S rtartel._- ---�� chool antra Park �a Jr PAr 7 g \K C� arlow Plais r1 o k -ts �(vli�dle Scf�o�o� Er e+i - &Fairvlew High S�t of oa y \ 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 PREMISES CONSUMPTION To sell 3.2% beer for consumption ON the licensed premises only — NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES] PUBLIC HEARING: WEDNESDAY, 18 JANUARY 2017,3:00PM.,COUNCIL CHAMBERS, 2"o FLOOR, 1777 BROADWAY BLVD., BOULDER, CO 80306 Neighborhood Map for a New 3.2% On Premise Liquor License Lucky's Market - 695 S Broadway w:w- � ;y �rcv� ......a:.� U� 0'1,•i. albot Dr .. r r tit /d �DHSIJUU _ ®Baseline Rd V LETT7%i,=1 I II Q-11.cn.UuMariposalAvtc`atlllllill\ MOR iB�ebeljl ' ?Awng-Av- ffd King�AvKing Av l l %rie t _ i Table Me s a O Applicant: Lucky's Market Operating Company, LLC Trade Name: Lucky's Market Location: 696 S Broadway License Type: New 3.2% On Premise 0 Cr O,. d� �y cityO °' oj�4 f Boulder NORTHThe information depicted on this map is provided as graphmud representation only The City of Boulder provides no warr" expressed or implied as to 1 inch = 1,750 feet the acuracyandfor completeness of the nformats+n contained hereon Z O P u O LIL LU CL w a w O a AL L v a w z H H m w m i t` LQ NLn 1\ U M A u 44 to ;cy O v �+ M fplN to 41 44 1 L4 0 2 N fin M � .� z � G� A, U rn F, a V v O a a z u `M H N cl r b C�1 b O 8P4- -4 0 0 O 66 q O bA 4J O L, 0 M O 00 Q 4) O Cd 10 CdLn v 41 .n <11 K1 4J N r Q u CL M o Cd 44 ' q G W u u o 44 1°, a Yl �� i7 -N J J cd`U C; by H U u z ti la 0 J C lu to O 4J to % a QJ 1 N s �� i7 -N J J cd`U C; by H U u z ti la 0 J C lu to O 4J to % a QJ en O v s 000 O id y �� i7 -N N s S J J cd`U C; by H U u z ti la 0 j� Y C lu to O 4J to % a QJ en O v v 000 O id y O c- U o N s S J J 0 N q 9 "- q ❑.Sa 0 u 'O �V o.ace,W "a oo Q .z S v•3 a•N c q �.N u y aw v L %uC M O 0 uo 4.400aaa$� o A Q 0. ~ C ap vi 0. 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N Q c [� qj v v C W r. v o b3 p ""•1 •y •� v O p O 0 C L u qj cis v CS V O O cl U 'Zi 0 `n 1.2 P4 y V .0 Ei0 q� 4 ow P4 U V o0 u o wM F't'1 y~• 16 U v p ba0v9 W >0 b��� aP- �aa�r �14 o� " a W y 3 , fi Qj —0-6 9�4 w V W •7 N ^ 1�"� Q0 z O : a to e o y O C N W 1 V P. 1] u Kj z o a,z :a n U q 0°- WU- a Zy' Payy a q W y�Q •�, w 6G1 ..~.. cl v v' %-o t Z ggt-o w a. r. . aC,O o� z , b-qo oAC 0Cbha 'v ^ A m X T, 0.4 HFW" oo M H v cn O �ox cn C -o '0 rU U0;o; tz .0 0qj w 7 \ v a,'0 � v-0 ?l > �', -4.1 0` `Q W FW,b o c 3 �$� a LUCKY' MARKET OF SOUTH BOULDER CO, LLC, dba LUCKY' S MARKET RETAIL 3.2% FMB ON PREMISES LICENSE ) AFFIDAVIT 695 S. BROADWAY BOULDER, CO 80305 I, MARK STEFFEK , an employee of Oedipus, Inc., circulated petition(s) in the above matter; THAT I explained to potential signers of the petition the type of license being applied for, the proposed license location, the applicant's name and tradename (if applicable), the survey issue and the qualifications for signing the petition; THAT I gave signers of the petition the opportunity to read, or have read to them, the petition in its entirety and understand its meaning; THAT I personally witnessed each signature appearing on the attached petition(s); THAT to the best of my knowledge, the information (name, address, age) written on the petition by the individual signing same is true and valid; THAT no promises, threats, or inducements were made on my part in the presentation of this petition; THAT each signature was voluntarily given; and THAT I personally have no financial interest or equity in the establishment named in this application (pursuant to Section 12-470308, C.R.S. [recodified], of the Colorado Liquor Code, and/or Section 12-46-104(3), C.R.S. [recodified], of the Colorado Beer Code. FURTHER THE AFFIANT SAYETH NOT. qCIRr STATE OF COLORADO ) ss. COUNTY OF BOULDER ) Subscribed and sworn to before me this FNotary LATINA SCOTT lic - State of Colorado ID 20004035761 ion Expires Dec 5, 2020 day of JANUARY , 2017. <Ucr-,= es�� NOTXRY_PUBLIC Tina Latina Scott P.O. Box 1012, Lafayette, CO 80026 @Oedipus, Inc., P.O. Box 1012, Lafayette, CO 80026 RESIDENTIAL PETITIONS Fleming jC eW Vis ❑ Law ".'er I f igh �ruu�•NNN / I ' 1 FD2_0 u door---- r``j ❑ Bass Mor M•r ❑ El D S.C. --02 t. —� SIAf ma oy• W4 � �a ; NIS A / Green Mtn. Da Cemetery NatlonalIn i C ,S andards Q' NIST - NOAA �y an echnology West. - •_ Highland` 1 ga�ary v 9 q National oi l d e as Center GobpVV P Wu� HD National for n, Bear Atmospheric reek ter Research S. ar Ocee cr o Park Atmospheric WILD D F Research CR �"c+19�yW0 K 1 B�r a rti Mesa ✓ .—.� � � School0 � e�J1- BE OR 1' ` ��r �I � o BRf9 r'"' DR\tel C' Waal•_■ 1�AianLs loll• e Vile s.. S 36 Boulder I\ �i Cre k 5 -armTTan Meas j� Q Tants Or ,s_--._P.ack.n.Rid -. o� x�T,�a �u; i;S" k=? fleynold� m R Br■nhT.61. M••■ uX mmi L ^ � rla RBl ,Montessor 6ChO0I .�.7 // Elam.0 93 A y� • ^ antra V • ark � m c, 0 D4 PA.: CIR CR i c,9 F ri Clu DR�\� . ar N Platte* FF Nil -0ho. I eor AFairvlew High S of oo �— `c 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 PREMISES CONSUMPTION To sell 3.2% beer for consumption ON the licensed premises only — NO OPEN CONTAINERS MAY BE TAKEN OFF THE LICENSED PREMISES] PUBLIC HEARING: WEDNESDAY, 18 JANUARY 2017,3:00 PM., COUNCIL CHAMBERS, 2ND FLOOR, 1777 BROADWAY BLVD., BOULDER, CO 80306 Neighborhood Map for a New 3.2% On Premise Liquor License Lucky's Market - 695 S Broadway N� 1111- Bil rLT' u'� Ny�"Nibot Dr t t lin@" a N P1 N��. �, Base _ ©seline Rd •� •� Terr��rm cmmrmr,__i �-s--rte rz HIS 11 .92 tin 11 s � �i • ° - ii inti - _ . _ .i u�ii ► ++�; � s ���� • • iiVftdff ME a I - • . C OO:e' ♦ � ��1�_ :� � ♦• ' a � .yS� i4* r ■ � fly.■ ntt ,�� jPs•�+s.+:• �� �� IN _► ►* As ��i S .wad �� ���� as�1■ _ 4.- - - � �.+_'�%.• t�i`'�D�I Table Mesa N - - amu-' r , l } Applicant: Lucky's Market Operating Company, LLC Trade Name: Lucky's Market Location: 695 S Broadway License Type: New 3.2% On Premise a Cr O,. a .pq City of VW\ Boulder N0 RT H The information dep=W on this map t5 provided as graphrml representation only The Cdy of Bouldcq provides no warranty expressed or snplied as to 1 inch = 1,750 feet the acarracy andror completeness of the infonnat on contained hereon o o ti � a �vwD l o en en pa ca a W 1� J �o is u (U.S y O X C O W '4) Q 1 0 i OU ^O O td CL. u W o' N is u o v v a M" en v v z v u W e �• 0" O t u b O :: o ^^ r .A .4 .100H C� C ~ v c 0 r C .. y V ai u u� h x z a /' 'b o o u G 'S . zi >p G �h ~ a+ y '� a w C7 m i 'b w v v v p �77 o ca ° n oc°i ti 61 a �° °- C Z o �Vu ' a ..i if 1 4 C u a 'p O M r tn�• 'd v v 6a o H W 0U,z ros y' 4 o a C A4 Jic a, O �� dd a �.. a 5 0 •- 'ti o O v a� a C u (u W fn V w a .o lYi�•� ti u u o. c c Op" J :� a uu a '� cO�� �,��ooa0 �Wa' H 0 y v P-4 im r ' O F4 W w s°Je wo U w x q p- V. o G c po H6� v fiW $o u v 0 N v pw a o w C+ a �.� W Dz q v c° a �O �o a O y r ti O in ^ z '� � o N qjba u H o� a r V M y tj CIF) Z 'D oj o o fry N 00 cd U UE I O A .� G J y cn .fl r. 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BROADWAY BOULDER, CO 80305 I, SONDRA BLANCHARD . an employee of Oedipus, Inc., circulated petition(s) in the above matter; THAT I explained to potential signers of the petition the type of license being applied for, the proposed license location, the applicant's name and tradename (if applicable), the survey issue and the qualifications for signing the petition; THAT I gave signers of the petition the opportunity to read, or have read to them, the petition in its entirety and understand its meaning; THAT I personally witnessed each signature appearing on the attached petition(s); THAT to the best of my knowledge, the information (name, address, age) written on the petition by the individual signing same is true and valid; THAT no promises, threats, or inducements were made on my part in the presentation of this petition; THAT each signature was voluntarily given; and THAT I personally have no financial interest or equity in the establishment named in this application (pursuant to Section 12-470308, C.R.S. [recodified], of the Colorado Liquor Code, and/or Section 12-46-104(3), C.R.S. [recodified], of the Colorado Beer Code. FURTHER THE AFFIANT SAYETH N ?X-7-2, CIRCULATOR STATE OF COLORADO ) ss. COUNTY OF BOULDER ) A Subscribed and sworn to before me this day of JANUARY , 2017. TINA LATINA SCOTT NOTAR YIJYLIC Notary Public - State of Colorado Notary ID 20004035761 Tina Latina Scott My Commission Expires Dec 5, 2020 P.O. Box 1012, Lafayette, CO 80026 ©Oedipus, Inc., P.O. Box 1012, Lafayette, CO 80026 4y OF BO�,<O f�HAXGf Finance 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, January 9, 2017. P.O. Box 791 1 1777 Broadway, Boulder CO 80302 1 bouldercolorado.gov 10: 303-441-3040 Neighborhood Needs & Desires Petition Summary Applicant: Lucky's Market Operating Company. LLC Trade Name: Lucltv's Market Business Location: 695 S Broadway. Boulder. CO 80305 Occupancy: 60 Square Footage: 37557 Business Description: Lucky's Market is a grocery store that is applying for a 3.2% On Premise type liquor license that will allow customers to purchase 3.2% beer for consumption on premises., alloxvine- them to purchase a beer while they shop for groceries Operating Hours: 8:00 AM —10:00 PM Monday thru Sunday. 7 days a week License Type: New 3.2% On Premise type liquor license Same # of Licenses in area: 0 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 � r G� ct H F ori M Xl'r• c— cr, f., ¢ In lull -0 cn u W G Q eC � �. v G ac'i D N N v c ca oN G a U O � ✓ N o1 �� p Q y N y R '� � � tA O�p1 'Oca C� d 46 G F� < G aOlt, v ,Z � � o ✓' G '�0 �n O� °�' � � �" �Ll 'G � wN o r a d N ca o "A d U Pr+ �4 py TWO w m O F a) d �O {, „/, W a -nIAA � � Gq O V^ o r� op✓ W v� In O o ° ;64 ci �o C% �� � O �' y cn ? •�, 'k � O � �%p, cry � .� . � `�„ c- � ti � ''`° � �, ^ V fir/ � ,a • j '�°' �� 4 o ca PA c4 ? 9 Q N N a bA a° o a rA� �Q ooN�NTo rn CA' o O G� �,� ✓� Gn a Co 4 oPA PA +A o r 6 O N of YR GN O cl In ca O N �PA N o.�y�, ti. t m p o .� C y U �w W p O 0 c o R R L:O O•py� �� zO O Ol % ° W P a u Z o �' yW ... p u W G cet 0 U O a zo o� W'o u 6W bo U u o � � -04 L1 N O ire t6,bp y u u 0 aiW °'a \ rj� W � rJy Q �" �` d • � u ✓ w chi � F� .y. O a H.�a N G° G O NW ON �- tA i �� r,- 0 ,o � o 4. _C Z aC O P 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: Agenda Item 10 CITY OF BOULDER BEVERAGES LICENSING AUTHORITY PRELIMINARY FINDINGS AND REPORT IN THE MATTER OF THE APPLICATION FROM Ali Baba Boulder, Inc. Ali Baba Grill 3033 28th Street Boulder CO 80301 Attention: Mahmoud Dukmak Re: Ali Baba Boulder Inc. d/b/a Ali Baba Grill Premise Location: 3033 28th Street, Boulder, CO 80301 FOR A Transfer of Ownership of a Beer and Wine 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 Transfer of Ownership of a Beer and Wine 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 November 10, 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- 1-2, this topic was intentionally omitted from investigation by Licensing Clerk. 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 April 30, 2021. 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- 1-2, this topic was intentionally omitted from investigation by Licensing Clerk. 6. EXISTING OUTLETS IN DESIGNATED NEIGHBORHOOD Responsive to C.R.S. §12-47-312 (2) and BLA Rules of Procedure Subsection 5-1-2, 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): Mahmoud Dukmak, Owner; Fayad Aoutabachi, Owner; Aswad Fadi, Owner Mahmoud Dukmak No record of arrest per CBI background check. Fayad Aoutobachi No record of arrest per CBI background check. Aswad Fadi No record of arrest per CBI background check. Source of information: Individual History Report (IHR) self -disclosure, and CBI results. FBI results pending as of January 7, 2017. Prior Administration and Operational Characteristics: Mahmoud Dukmak and Fayad Aoutabachi as Owners/Partners in Ali Baba Grill located in the Denver Tech Center, Greenwood Village, Colorado held a liquor license from October 2010 to October 2015. Deputy City Clerk of Greenwood Village reported no adverse information or licensing violations. 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 purposes of local licensing authority deliberations. 9. 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, January 18 2017, at 3:00 pm, 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: httr)s://www-static.bouldercolorado.eov/docs/BLA Rules of Procedure-1- 201505081442.pdf or a public copy is made available for review at the Licensing Clerk's Office. January 10, 2017 BEVERAGE LICENSING AUTHORITY CITY OF BOULDER, COLORADO Mishawn J. Cook, Tax and License Manager and Board Secretary N., 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 of Applicant(s): A I P, A Trade Name: Phone No: n Z- i1 N o- 3 9 Z Vxc 0416A Aa CA Contact Person: m a �q wt a . , L7Y Business Address: '� * u I l ,S i'_ 8 b Q (d f,,/ - � , 9 0 3 v 1 _ Mailing address: 3 0 3 3 2-1? � S o u1 tot fn `0 , R© 3 0 Property Owner: Pi� U Pfb f ah C-1 Phone Number (local): .?03-44_7-8326 Property Manager: 3a VA f-5 I K n N Phone Number (local): 3o s - 4 -t 7 - cy i 2- Property Property Manager's Mailing Address: .3 i n 7-v ON S 6bu0[&, 12,0 - YO -3 p i General Manager: Phone Number (local): 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): 0 New License ($1,000.00) Change in Location ($750.00) E] Change in Class ($750.00) Type of License (fee): Hotel -Restaurant ($75.00) Hotel -Restaurant w/Optional Premises ($75.00) t/ Beer and Wine ($48.75) 3.2% Beer On & Off Premises ($3.75) Club ($41.25) Race Track ($75.00) 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, 20 10] $ -1ci�' �7 5 -- APPLICANTS DO NOT FILL THIS AREA OUT **kk*********k**k**kk***********k***k****kk*k**k**#*****************kkk****k******** 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) b) 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. 1 S) 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. vltoll 6 Authorized Signature Date (A (1,4 W�,b J b /PAfAeA_ Print Name & Title G' ty (�uesfi Dn+r�tte Avk swCV-1 '6 ( L s,6 avi �s-y Mee 4 '�enrcw• cow--� �i'crS i ct.� vc� } Z_ (laws -9-Pw �.� PO 5- ye'' 6 - Cook, Q„ep d i'Sl, uraJl�ra. �. Pari �+nne w�� t�+�sia Ff,-g JY - ceq,,; i eL 5,. �-Ce,��;�+e�. 5e�-e. S�r�e. [7��'�� �,.,�t�e,���� fe5�.�•���- hoc �ye�.c�, .� . C.a,�•l� tneded` ave.i Seyv�. L,`1b � o � evQfl Ov^e• �$\n h . •�{'o J�c.L. ; / ` - ae,�er s��� dv e(' ^fix, C,�.etk� 1b5 0�- Co��u��h`o� CAv%oJh �I��.y� a �e� �- C,�b ol0ocheck i.c�•) lu V41 c -16 1�- No, 1 b - S�4- �q I _ ,t 9 P IA . — IVO ks � �! i l! b � StY v ea'� 7 Pdi�e part�a t q„ l har•c w l b -e- no &o f ENTREES Includes a house salad and Italian dressing, serving of hummus, and a side of rice ALI BABA FAVORITES °GYRO MEAT Rotisserie broiled, spiced beef and lamb fillet, served with tzatzlki sauce $11.95 CHICKEN SHAWARMA MEAT Tender chicken fillets marinated in a savory garlic sauce $11.95 FALAFEL PLATE Six fried veggie patties, served with hummus and a choice of salad.'feffoush, 'tabbouleh, and rice. Greek or house salad. Add rice upon request $11.95 HUMMUS BE-SHAWARMA A generous portion of hummus, topped with your choice of gyro meat, chicken shawarma meat or a combination of both. Add rice upon request $11.95 °VEGETARIAN LOVERS A combination plate of hummus, baba ghonouj, grape leaves, falafel, 'feffoush,'tabbouleh and rice. Served with pita bread $11.95 MEAT LOVERS COMBO A three kabob combination plate of chicken, Iamb and kobideh $14.95 oK1NG COMBO Mediterranean combination plate of the Vegetarian Lovers and Meal tovers $15.95 ALI BABA KABOBS CHICKEN KOBIEDEH KABOB Two ground chicken skewers mixed with parsley, garlic, lemon and red pepper $12.95 KOBIDEH KABOB Two ground beef skewers mixed with onion, paprika and black pepper $12.95 KAFTA KABOB Three skewers of ground lamb mixed with parsley, black pepper and red pepper $12.95 CHICKEN KABOB Two skewers of tender chicken pieces marinated in lemon pepper, olive oil, spices with grilled anions and green bell peppers $13.95 LAMB KABOB Two skewers of lamb pieces marinated in olive oil and spices with grilled onions and green bell peppers $13.95 BEEF- KABOB Two skewers of beef tenderloin pieces marinated in olive of and spices with grilled onions and green bell peppers $1195 0 Menu item contains gluten Raw meat may contain harmful bacteria ENTREES Includes a house salad and Italian dressing, a serving of hummus, and a side of rice ALI BABA SPECIALTIES BAMYA (OKRA) Stewed baby okra slowly cooked with lamb, dlantro, garlic, pomegranate and tomatoes. Seasoned to perfection $12.95 LAMB CURRY Tender pieces of lamb cooked in a tomato sauce with potatoes, carrots, green peppers, onions and curry spices $14.95 CHICKEN CURRY (hicken breasts cooked *n a tomato sauce with potatoes, onions, green peppers and curry spices $14.95 LAMB SHANK Tender bone -in lamb shank baked in a tomato sauce with carrots, potatoes and spices $15.95 CHICKEN BARG Two chicken breasts marinated in lemon juice, olive oil, garlic, saffron and spices. Grilled and served with one skewer of chicken kobideh kabob $15.95 SOLTANI Tender beef loin filet seasoned and grilled with one skewer of kobideh kabob $1195 LEBANESE & MEDITERRANEAN CUISINE 3033 28th St. • Boulder, CO 80401 303440-1393 DINE IN * TAKEOUT * CATERING Visit us at alibabagrill.com DESSERT LAMB CHOPS 0BAKLAVA $3.50 CHEESE KANAFE Rack of lamb chops marinated and grilled to perfection $19.95 Crispy baked layers of honey $3.95 LEBANESE MEAT COMBO FOR TWO A combination platter with two lamb kabobs, two chicken kabobs and three kafta kabobs. Includes house salads, hummus and rice $29.95 ALI BABA SEAFOOD SHRIMP CURRY Shrimp simmered in a tomato sauce with onions, green peppers garlic and curry spices $15.95 SHRIMP SCAMPI Shrimp simmered in a tomato sauce with butter, garlic, onions and green peppers $15.95 DEEP FRIED SALMON Salmon steak marinated with olive oil and spices. Served with garlic paste $15.95 GRILLED SEAFOOD KABOB 112 Pound of grilled salmon steak with a skewer of shrimp, scallops and veggies. Grilled to perfection and marinated with olive oil, lemon juice, saffron and spices `75.95 RED SNAPPER FISH A whole red snapper fish spiced and deep-fried to perfection served with white rice and a special sauce (tahini, parsley and lemon juice). It comes with hummus and salad. $18.95 SHRIMP BERIANI Shrimp cooked with Beriani sauce served with white rice, salad and hummus $1195 sweetened filo dough. Filled and topped with walnuts A LA CARTE SIDES KABOBS FRENCH FRIES $200 CHICKEN KOBIDEH .35,00 FETA CHEESE . . .. $2.50 KAFTA .............54.50 HOUSE SALAD . ..... $2.50 KAETA(2 SKE\YERS) ... $6.00 RICE . . 52.50 KOBIDEH ............ S450 GARI IC PASTE .. $395 CHICKEN . .... .. $5.00 T7ATZIKI SAUCE .... .. .53.95 LAA1B. ...... $500 0G)'RO MEAT ...........$5.00 BEEF .......... 300 CHICKEN SHAWAIUM MEAT .$5.00 PIZZA $S.95 1. MEAT PIZZA WITH VEGGIES 2. MEAT PIZZA With Pomegranate sauce and One nuts 3. SPINACH PIZZA Vegetarian&vegan 4. CHEESE PIZZA Vegetarian S. MOHAMARA PIZZA Spiry vegetarian piva&vegan 6. ZATTAR (THYME) PIZZA Vegetarian&vegan 7. ZATTAR PIZZA withlabne S. GREEK GYRO PIZZA WithFetacheese 9. SPINACH & CHEESE PIZZA 10. SPINACH & MEAT PIZZA 11. MOZZARELLA SESAME SEEDS PIZZA 12. VEGGIE COMBO Green& red peppers, sliced mushrooms, onion, tomatoes, topped with optional mouarella cheese or without cheese 13. CHICKEN SHAWARMA PIZZA 14. VEGGIE COMBO Toppedwithslximp APPETIZERS Fl UMMUS A puree of chickpeas, sesame lemon Nice, and salt. Topped with paprika and olive oil. Served with pita bread $5.95 BABA GHANOUJ Baked eggplant puree with pomegranate, garlic, sesame, and lemon juice. Topped with sumac and olive oil. Served with pita bread $5 95 oSAMBUSEK WITH CHEESE (5) Fetta cheese, eggs, parsley, red pepper and olive oil with spices wrapped in wanton skin and lightly fried in soybean oil $5.95 °SAMBUSEK WITH SPINACH (5) A blend of spinach, onion, pomegranate, walnut, and olive oil wrapped in wanton skin. tightly fried in soybean oil $5.95 GRILLED MUSHROOMS Grilled mushroom skewers marinated with olive oil, butter, saffron, lemon Nice, and spices $5.95 FAVA BEANS Fava beans marinated with garlic, lemon Nice and olive oil topped with tomatoes $5.95 oMUHAMARA A puree of walnut, red bell peppers, cracked wheat, onion, and lemon juice. Topped with olive oil and served with pita bread $5.95 CHICKEN WINGS (8) Deep hied with spices $5.95 VEGGIE KABOBS Two grilled skewers of onions, tomatoes, green bell peppers, and mushrooms $5.95 FALAFEL (6) Fried veggie patties created with a combination of chickpeas, vegetables and spices. Served with sesame sauce for dipping $6.25 GRAPE LEAVES (6) Fresh chopped parsley, diced tomatoes, rice, and onions wrapped in seasoned grape leaves $6.25 °FRIED KIBBEH (3) Seasoned sidoin and ground beef combined with walnuts, cracked wheat, and spices $6.25 QUAIL Grilled quail marinated in saffron, olive oil, and spices $6.25 GRILLED SHRIMP (6) Jumbo shrimp marinated with (ajun seasoning, saffron, olive oil, and lemon juice. $9.95 LEBNEH Kefir cheese topped with dried mint and live oil and served with pita bread $4.95 KESHKI Kefir cheese, bulgar, onion, dried mint topped with olive oil and served with Pita bread $4.95 SOUPS & SALADS LENTIL SOUL' Red lentils simmered with diced carrots, onions, cumin and parsley $4.25 °NOODLE SOUL' Angel hair pasta simmered in a tomato broth with onion and green bell peppers $4.25 CUCUMBER YOGURT Fresh yogurt blended with diced cucumber, dry mint, garlic, and lemon juice $4.25 oTABBOULEH Finely chopped parsley, onion, tomatoes, and cracked wheat topped with lemon juice and olive oil $5.95 oFETTOUSH SALAD Fresh romaine lettuce tossed with diced tomatoes, cucumbers, olives, chopped parsley, seasoned pita chips and topped with a lemon vinaigrette dressing $4.95 Add Chicken Shawarma Meat $3 Add Gyro Meat $3 Add Shrimp $5 GREEK SALAD Fresh romaine lettuce tossed with diced tomatoes, cucumbers, olives, feta cheese and topped with a vinaigrette dressing $5.95 Add Chicken Shawarma Meat $3 Add Gyro Meat $3 Add Shrimp $5 FRESH BAKED PIES Made with fresh white dough and a filling of your choice oCI-IEESE Feta cheese, olive oil, parsley, and spices $2 °SPINACH Spinach, onion, pomegranate, lemon juice, walnut, and olive oil $2 o M U HAMARA Walnut, red bell pepper, cracked what, onion, olive oil $2 °MEAT Ground Iamb, onion, tomatoes, pomegranate, pine nuts, and spices $3 oVEGG1E PIE COMBO 2 spinach, 2 cheese and 2 muhamara $10 °MEAT PIE COMBO 2 spinach, 2 cheese, 2 meat $12 LUNCH SPECIALS $8.95 Includes choice of meat, house salad with Italian dressing and a side of rice GYRO MEAT Rotisserie broiled spiced beef and lamb fillet served with tzatziki sauce CHICKEN SHAWARMA MEAT Tender chicken fillets marinated in a savory gadic sauce CHICKEN KABOB (hicken pieces marinated in lemon pepper, olive oil and spices with onions and green bell peppers LAMB KABOB Lamb pieces marinated in olive oil and spices with grilled onions and green bell peppers BEEF KABOB Beef tenderloin pieces marinated in olive oil and spices with grilled onions and green bell peppers CHICKEN KOBIDEH KABOB Ground chicken skewer mixed with parsley, lemon pepper, red pepper and garlik KAFTA KABOB Ground lamb skewer mixed with parsley, onion, black pepper and red pepper KOBIDEH KABOB Ground beef skewer mixed with onion, paprika and black pepper SANDWICHES $5.95 ADD FRENCH FRIES $2 Sandwiches are wrapped in pita bread with lettuce, diced tomatoes and sesame sauce oGYRO Rotisserie broiled, spiced beef and lamb fillet on a bed of tzattiki sauce CHICKEN SHAWARMA Tender chicken fillets marinated in a savory garlic sauce BEEF SHAWARMA Tender beef marinated in a savory sauce with parsley, onion, tomato, pickles and tahina sauce FALAFEL Fried veggie patties on a bed of hummus CHICKEN KOBIDEH KABOB Ground (hicken skewer on a bed of hummus KOBIDEH KABOB Ground beef skewer on a bed of hummus KAFTA KABOB Ground Iamb skewer on a bed of hummus HUMMUS A puree of chickpeas, sesame, lemon juice and salt BABA GHANOUJ Baked eggplant puree with pomegranate, garlic, sesame and lemon C I TI -f C �t,CeS 1 I D Y1 dol i( e jC �J C�3 I , C L e,� cvi" m ee t(f&vz, cow—, �Fe/Y-s ,`Ct^ ) tnS�Zle 3 — '10 y` �o 5- Hes' _ Con I-- P. , d c, l w-6.3Ltn., I Qar � +'n,ie 5 e4 x �.� se�oe, � ��� ��� ���;� �ce5��c��- nor �y��• eve icp— "r . C.�e��-s vreger y. 10-P pve(` r� x���. � (���.�('0�1• o�� l�o.y) v��e� c` C.ab l(- N�,Je•� sed'J� ex-u,1� I ,�- CA,check i.c� 15- No, J b - 5�4 pio UJ 10-e- Sty go 0 �9 �hQcc no CITY OF BOULDER BEVERAGE LICENSING AUTHORITY ACKNOWLEDGEMENT OF TRANFER OF LICENSE SUBJECT TO PAST, PENDING, OR POSSIBLE FUTURE DISCIPLINARY ACTION j - Iw( Aw'►� erson's Name) on behalf of �,, r3 L�c� go V-UtNl (Business Applicant Name) am the applicant for transfer of the liquor license currently issued to zoi7 LL c— at the licensed premise location ofJ -.30-36 I understand and agree that if the transfer of the license is approved, the license may continue to be subject to any restrictions and conditions currently on the license. I understand that if there are any days of suspension currently held in abeyance against the license, the license may continue to be subject to those days in abeyance even after the transfer. I f irther understand that if any incidents, which could subject the license to disciplinary action, have either occurred or will occur on the licensed premise prior to approval of the transfer, the license may still be subject to possible disciplinary actions that could affect the license, even after the transfer, only where myself, my agents(s) and/or my employees either knew or should have Iatown of the incidents. I understand that it is my sole responsibility to inquire and investigate all possible sources of information to learn of any past, ongoing or possible future disciplinary actions that could result in any revocation, suspension, or fines being imposed. These sources include, but are not limited to the inquiry and investigation of the current licensee, manager(s), employees of the licensed premise, and the review of the public records of the Colorado Department of Revenue, the Boulder City Licensing Division, the Boulder Police Department, the Boulder District Court, the Boulder Municipal Court, and/or the Boulder County Court Criminal Divisions. I also understand that I have the option to withdraw the application for the transfer of the license and file an application for the issuance of a new liquor license. Should a new liquor license be issued, that license would NOT be subject to any disciplinary action based upon incidents prior to the issuance of the new license. A I 6 6-62Gc�. , Z►�- A ) 1, e Cts 61-a 11 Applicant Trade Name <---_\\ 1,, Makwk4 'I �)L Authorized Signature c/ Print Name, Title, and Date COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division 1375 Sherman St, Denver CO 80261 September, 2005 AFFIDAVIT OF TRANSFER AND STATEMENT OF COMPLIANCE Pursuant to the requirements of 12-47-303(3)(b), Colorado Revised Statutes, Licensee hereby states that all accounts for alcohol beverages sold to the Applicant are: ® Paid in full. There are no outstanding accounts with any Colorado Wholesalers. p Licensee hereby certifies that the following is a complete list of accounts for alcohol beverages that are unpaid: Licensee and Applicant agree that all accounts will be paid for from the proceeds at closing by the: ❑Licensee OApplicant p Licensee unavailable to certify disposition of accounts for alcohol beverages - Inventory list attached. Transfer by operation of law - Regulation 47-304. M Applicant will assume full responsibility for payment of the outstanding accounts as listed above. p No alcohol beverage inventory transferred or sold. Licensee hereby authorizes the transfer of its Colorado Retail Liquor License to the Applicant, its agent, or a company, corporation, partnership or other business entity to be formed by the Applicant. Dated this ,ZG day of Oc;� -"&� 20 t 6 Seller: 20/7, LLC �7-06�.�0-000 Licensee & License Number 2vt� !,Lc— Trade name Signature /'P em, b e r M� .m ,-, r Position dkep�fn I-e6a Print Name Buyer: AL/ BABA BouLDxK . T-vAc. Applicant Y I 1 i &aLe, Trade name t Signature 0 Position (M a,,1A Vw o itA Print Name DR 8404 (08/10/16) COLORADO DEPARTMENT OF REVENUE Colorado Liquor Liquor Enforcement Division (303)205-2300 Retail License Application ❑ New License ❑ New -Concurrent ✓❑ Transfer of Ownership ❑ State Property Only • 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.colorado.gov/enforcement4iquor • 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 ALI BABA BOULDER J -j(- , 81-2399069 2a.Trade Name of Establishment (DBA)State Ali- 1' h 9,A � >rl i + Sales Tax Number Business Telephone I 303-440-1393 3. Address of Premises (specify exact location of premises, include suite/unit numbers) 3033 28TH ST City County State ZIP Code BOULDER BOULDER CO 80304 4. Mailing Address (Number and Street) City or Town State ZIP Code 3033 28TH ST BOULDER CO 80304 5. Email Address MAHMOUD.ALIBABA@GMAIL.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 Number Present Class of License Present Expiration Date 2017, LLC 147 06450 000 1 BEERIWINE LIQUOR 105/18/2017 Section A Nonrefundable Application Fees Section B (Cont.) Liquor License Fees ❑ Application Fee for New License ............................................... $920.00 ❑ Lodging & Entertainment - L&E (City) ................................................ $500.00 ❑ Application Fee for New License w/Concurrent Review ............. $1020.00 ❑ Lodging & Entertainment - L&E (County) .......................................... $500.00 ❑r Application Fee for Transfer ......................................................$920.00 ❑ Manager Registration - H & R ............................................................... $75.00 Section B Liquor License Fees ❑ Manager Registration -Tavern.............................................................. $75.00 ❑ Add Optional Premises to H & R......... $100.00 X Total ❑ Manager Registration - Lodging & Entertainment................................$75.00 ❑ Add Related Facility to Resort Complex $75.00 X Total ❑ Master File Location Fee ........................$25.00 X Total ❑ Arts License (City)................................................................................ $308.75 ❑ Master File Background ...................... $250.00 X Total El Arts License (County).......................................................................... $308.75 ❑ Manager Permit - LLDS/RLS.............................................................. $100.00 21 Beer and Wine License (City).............................................................. $351.25 ❑ Optional Premises License (City)........................................................ $500.00 ❑ Beer and Wine License (County)........................................................ $436.25 ❑ Optional Premises License (County) .................................................. $500.00 ❑ Brew Pub License (City).................................................................... $750.00 ❑ Racetrack License (City)...................................................................... $500.00 ❑ Brew Pub License (County)................................................................. $750.00 ❑ Racetrack License (County)................................................................ $500.00 ❑ Club License (City)............................................................................... $308.75 ❑ Resort Complex License (City)............................................................ $500.00 ❑ Club License (County)........................................................................ $308.75 ❑ Resort Complex License (County)...................................................... $500.00 ❑ Distillery Pub License (City)................................................................. $750.00 ❑ Retail Gaming Tavern License (City) .................................................. $500.00 ❑ Distillery Pub License (County)........................................................... $750.00 ❑ Retail Gaming Tavern License (County)............................................. $500.00 ❑ Hotel and Restaurant License (City .................................................... $500.00 ❑ Retail Liquor Store License (City)........................................................ $227.50 ❑ Hotel and Restaurant License (County) ............................................ $500.00 ❑ Retail Liquor Store License (County) .................................................. $312.50 ❑ Hotel and Restaurant License w/one opt premises (City) ................. $600.00 ❑ Tavern License (City)........................................................................... $500.00 ❑ Hotel and Restaurant License w/one opt premises (County)............ $600.00 ❑ Tavern License (County)...................................................................... $500.00 ❑ Liquor Licensed Drugstore (City)......................................................... $227.50 ❑ Vintners Restaurant License (City) ..................................................... $750.00 ❑ Liquor Licensed Drugstore (County) .................................................. $312.50 ❑ Vintners Restaurant License (County)................................................ $750.00 Questions? Visit: www.colorado.gov/enforcementAiquorfor more information Do not write in this space - For Department of Revenue use only Liability Information License Account Number1 Liability Date License Issued Through (Expiration Date) 1 Total 1 1 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/enforce men Miquorfor more information Items submitted, please check all appropriate boxes completed or documents submitted I. Applicant information A. Applicant/Licensee identified 0 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 IV ❑ 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 Vl. 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) VIII. 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 and Lodging & Entertainment 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 X. Manager Permit for Liquor License Drug Store and Retail Liquor Store when included with this application 2 A. $100.00 Permit Fee ❑ B. Individual History Record (DR 8404-1) 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? n n 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? ❑ 0 (c) Had interest in another entity that had an alcohol beverage license suspended or revoked? ❑ ❑1 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 ❑ 0 preceding two years? If "yes", explain in detail. _ 10. Are the premises to be licensed within 500 feetjof any public or private school that meets compulsory education requirements of Colorado law, or the principal campus of any college, university or seminary? ❑ R1 Waiver by local ordinance? or ❑ ❑ Other: 11. Is your Liquor Licensed Drug Store (LLDS) or Retail Liquor Store (RLS) within 1500 feet of another retail liquor license for off-premises sales in a jurisdiction with a population of > 10,0000? NOTE The distance shall be determined by a radius measurement that begins at the principal ❑ doorway of the LLDS/RLS premises for which the application is being made and ends at the principal doorway of the Licensed LLDS/RLS. 12. Is your Liquor Licensed Drug Store(LLDS) or Retail Liquor Store (RLS) within 3000 feet of another retail liquor license for off-premises sales in a jurisdiction with a population of < 10,0000? NOTE—The distance shall be determined by a radius measurement that begins at the principal ❑ 0 doorway of the LLDS/RLS premises for which the application is being made and ends at the principal doorway of the Licensed LLDS/RLS. 13. 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, id ntify the name of the busine sand list any curren financial interest in said business including loans to from �,�j/r any or a licensee. f Icer 14. Does the Applicant, as listed on line 2 of this application, have legal possession of the pr6mises by virtue of ownership, lease or other ❑ ❑ arrangement? ❑ Ownership 0 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 fll i j3 �clo a /v zt(cl / Tvt r . Za j b. Is a percentage of alcohol sales included as compensation to the landlord? If yes, complete question 13. ❑ M 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". 15. 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 �I 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. 16. Optional Premises or Hotel and Restaurant Licenses with Optional Premises: ❑ ❑ Has a local ordinance or resolution authorizing optional premises been adopted? Number of additional Optional Premise areas requested. (See license fee chart) 17. Liquor Licensed Drug Store applicants, answer the following: (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. 18. 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 ❑ ❑ object of a patriotic or fraternal organization or society, but not for pecuniary gain? (c) How long has the club been incorporated? (d) Has applicant occupied an establishment for three years (three years required) that was operated solely for the reasons stated above? ❑ ❑ 19. Brew -Pub, Distillery Pub or Vintner's Restaurant applicants answer the following: El El(a) Has the applicant received or applied for a Federal Permit? (Copy of permit or application must be attached) 19a. 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 8404-1) 19b. For all Liquor Licensed Drug Stores (LLDS) and Retail Liquor Stores (RLS) the manager must also submit an Individual History Record- DR 8404-1, Fingerprints, and obtain a Manager Permit. Last Name of Manager . (� First Name of Manager Date of Birth ] 1 (.) lbeca t I H—CL S CuL, 19c. 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. Name IType of License I Account Number 20. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers, directors, Yes No 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. 21. 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, Citv & State I DOP I Position %Owned 9Jc DUKMAK MAHMOUD AY O 0'-1 � ' OFFICER/OWNER 33,33 3 }3 Name Home Address, City &,State I DOB I Position %Owned 1 AOUTABACHI FAYAD OFFICER/OWNER s�ol2 V Name Home Address, City & Stalq_ D �p,� DOB Posit' n %Owned T 6 �� A- UJ r� °C gozly ll�v3�1� D ► �v���t�. 33��33 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: '❑ 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 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 SignaturePrinted Name and Title Date 14--- IDUKMAK,MAHMOUD /rPa�t- /G to �' 1,311811t, Report and Approval of Local Licensing Authority (City/County) Date application filed with local authority Date of local authority hearing (for new license applicants; cannot be less than 30 days from date of 1 t �' I application 12-47-311 (1) C.R.S.) 1 _ , The Local Licensing Authority Hereby Affirms that each person required to file DR 8404-1 (Individual History Record) 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 ❑ Will conduct inspection upon approval of state licensing authority ❑ Is the Liquor Licensed Drug Store (LLDS) or Retail Liquor Store (RLS) within 1500 feet of another retail liquor license for off -premises Yes No sales in a jurisdiction with a population of > 10,0000? El ❑ ❑ Is the Liquor Licensed Drug Store(LLDS) or Retail Liquor Store (RLS) within 3000 feet of another retail liquor license for off -premises sales in a jurisdiction with a population of < 10,0000? NOTE—The distance shall be determined by a radius measurement that begins a ❑ at the principal doorway of the LLDS/RLS premises for which the application is being made and ends at the principal doorway of the Licensed LLDS/RLS. 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 I Telephone Number I EJ R1 Town, City County Signature Print Title Date Signature Print Title Date 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 for the suspension or revocation of the license applied for. Name ofApplicant(s): . ��.1 . !'� PS'A %Sc; t.�C�iL't , 11A - �- - Trade Name: ... _ _ - _ C _ Gi Ina A i i` (3 ato& Ori O 1 Business Address: l7 3 3 Z-8 t� S f• 13 o u l eA-v\- (t)• h' U 3o i Phone No: 303- L N U -- i 3 g 3 Contact Person: Mu lI vlftglrj Mailing address: 3 0 3 3 OR I %n' 5 r - D d u 6o- $ n .3 o f Other Liquor Licensed Establishments that principals or managers of Applicants) now holds: p 1 A If applicant is a corporation or LP or LLC, names of persons purchasing stock or membership units: M A wt aLd b c,l k v s-rL lC / FL, A, �.� u Jt A -s w -v-4 Is this a new or existing business: /,i etJ If new business, state approximate investment amount: $ 14 U, o vo Where will these funds come from? M ct k"u1j av--d ja-if Gill -5 t,,J, ",j. If existing business, state purchase price including inventory: $ 1 , Where will these fimds come from? If cash is to be invested, please complete the following: (If you need additional space, please attach additional pages) Person or business investing Mel timoij I6 L&Vv�ai(LC2 n J a ,(On c�i Address of Investor: ?to 2 k 0 LL tri Amount of Investment o " &00 0 Source of Investment C N ecjr-% &j . , (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: �/ / A 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?( 14 AS r -- What What name will the account be under? M a 1% M 0 u rpt / +1 t.A ,/ r --A-0( Who will be authorized to sign on the account? M ct h m u Q ��i�a i�ct�� A S "-zL). iI i 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. i i 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 lmowledge. 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. ' gI16 Authorized Signature ./ Date M&1n,nW- auk , t�wv �n Print Name & Title DR 8404-1 (03113/15) 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 "NIA". 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 Businessp ) Home Phone Number Cellular Number IA1- /JQba CY` l X03-`�2 0-"j"2 �t I . - 2. Your Full Name (last, first, middle) 3. List any other names you have used Mq hYA P U -d bK1-C YA6d< YM 4. Mailing address (if different from residence) Email Address 13Niu W.6zi1d PL. A,cvugu Co-kotgoy Mah>nnnu-d,A1;babe, P-,gWL0 n 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 Current �,,rud.N g 000 y znoH Prem.J- Previous 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 A 1, AA13A 66 t I 10q fit/, Z Doo Wek.,� 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 Al I A S. Have you ever applied for, held, or had an intgrest in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory to any licensee? (If yes, answer in detail.) f)1,- r3Ag N 6611 1 _f - G atm tv-m f' V 0 6,TC ( b t' S r e SS C 10 SeJ ) . 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.) 21 s ❑ No El Yes E o 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.) l] Yes M No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a 0 Yes M9No deferred sentence? (If yes, explain in detail.) 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 bylaw, 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 fib. Social Security Number c. Place of Birth [,' Q U h a1* f yit / s tf { Q I d. IJ.S. Citizen L�Yes [:IN. e. If Naturalized, state where f. When g. Name of District Court t^I�rado I Iqq� 7 I (-1 palno_e h. Natura i a ion Certificate Number i. Date of Certification 1. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number 2 19gI I Nig I w I. Height m. Weight n. Hair Calor o. Eye Color p. Gender q. Race r. Do you have a current Driver's License/0 License/0If so, give number and state. 5,3 1 Iyp IScalf kPqV,-- B"w,(, 1 Male I Wki-Fe IMKes ❑No #_ _State (c�lornrl� 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ Up I Ooo,cp_ b. List the total amount of the personal investment, made by the person listed on question #2, in this businee-z i -1 --ding any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ , r3 133 3 ` 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 CA11_1V Account Type Bank Name C OAS L— Amount /3j 333 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 r L edc Loans Account Type e. Loan Information (Attach copies of all notes or loans) Name of Lender r� L) 1,S" f's S Bank Name CH RSL Address Term Security Amount Amount Oath of Applicant I declare under penalty of eriury that this an 1' o� and all attachments are true. correct and complete to the best of my knowledge. Authorized Signature �.—. Prints nature Title Date �a.hv✓t�r�`:t�u�y, - � vw ��/Pu��v\� 1�1,�p6 DR 8404-t (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 Gass 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 questlon is not applicable, please indicate so by "NIA". 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 yj business � �t � � Home Phone Number _ Cellular Number _ 2. Your Full Namelasst, (first, middle i r n ( ) 3. List any other names you have use 4. Mailing address (if di event from resi ence) Email Address 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 Current _ n r Previous - 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 I : Q� Z S, +� rz, t #wj,44 iI I+n �►-e� P 0— 0 C i 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` T as — hr. c+"?+RSHJT Y 4 �._ .... :-: r _ _ ter-- _ _. x 1r�''+TIf4 � �YY+.rs�� lrfi :. # �TO� _ .. «..�y.y......�..-..., r -v... rye...-�..rr1� ....•T_rw'r-'w.' . YY.weu. rrx���...�r vn.��..Y.l+r'r� inY. fi, A Y B. 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.) s _- _ El Yes R9_0 . ;C Cax J[1 3t=' cw,,�r li a�rxe, ..jk uric�A at3si�,�`r .rT°Yd 1 1 „ 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 o T. t . Vyh i 1,sL�? e_ Y '' ?rw? ' .i� ri . _: � t4AKI rad l _P'�*�1+�t e4 • 44 • 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.) Oyes 2<0 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a ff 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 required in uuestion #13 is solely for identificatiop purposes. 13a. Date of Birth I b. Social SPrllr�y Number c. Place of Birth _ f r�,,L`,,� S t{ f � (t—a - I 1 d. U.S. Citizen 3'Yes [:IN, e. If Naturalized, slate where f. When g. Name District Court -J h. Naturalization Certificate Number i. Date of Certification 1. If an Alien, Give Alien's ilegistration Canumber k.$ermanent Residence Card Number I. Height Im. Weight n. Hair Color o. Eye Color p. Gender q. Race ff o you have a current Driver's License ID? If so, give number and state. I r;JI,1 fe Ule. [:)No _State n (Or-z�-Z) 14. Financial Information. a. Total purchase 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 thisbusinessincluding any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e 'Lr" 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) _i ari�prrerdld.a { a ; Type: Cash, /Services or Equipment Account Type t7"'� �'`�' ` Bank Name Amount"* -~I �. �. �:-.-.. � "".'.1#.7Es�. a �r ...-� �.+1..:,I...w.Sw.Y1 0{: : �r�.iwY �i,aR,.�,y ��~ , ,�,y.,.+.� �r�A..; �a.....t.�..a: ��.lzi►4i1] r ` 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 r I .:r 'o �'.•.[. 3Cq�Si�' 0�.� i7r!a.? bG + - b'k r..3 Wive e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount W+M %*-1 Ih1L�;r:i�3('"1E�t trc� easy idOiaalx ml fua� ■ x�t !#3 iari+pg ;lrir�, _ tyi ►! OA6rA;& sam-- l iJ :i4 icurll a - Oath of Applicant I declare VAder nalty ofieriury that this asy )kation and all attachmeq s are true. correctandcomplete to the best of my knowledoe. Authorized Sign ure Print S natu� Date 4Ilt Z LI�+(�1 01.Evv-k ) LL � J, �-�`' of ��., . � '� j tw/16 DR 8404-1 (03113/15) 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 WK. 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/ Home Phone Number I Cellular Number ti 'A 12'A '! ,f � -7 2x - 142-1-b�53 2. Your FUII ame (last, first, middle) 3. List any other names you have used A o dab) c,%1 i Ie'["q Gt_o1 /dl A 4. Mailing address flidifferent from residences ` Email Address S a. Com, pellet �>cl s F. Li C! I, C -A tc . 12 f, 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 current Previous 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 f- 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name "o�f/Relative Relationship to You Position Held Name of Licensee All P1 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.) /q)/- I;M A Grp ll 1 ( C (o sed ) 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.) (�es ❑ No ❑ Yes Pf4o 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited ❑ Yes (A- 10 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 El Yes J�o deferred sentence? (If yes, explain in detail.) 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes 0 -go Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal info tmation re�uired in question #13 is solely for idepItificakjjq purposes. Aa. ale of Birt Ib. Social Security Number Ic. Place o i 'D 0, CCL S J S yY % G ` d. U.S. Citizen M res ❑ No e. If Naturalized, state where� f. When g. Name of Di trict Court CC 10 r7cct-c? I Z v u( I ; rap6M o -c- h. eh. Naturalization Certificate Number i. Date of Certification 1. if an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number I ill I � A I. Height Aight n. Hair Color o. Eye Color p. Gender r. Do you have a current Driver's LicensellD? If so, give number and state. 1 �?V I s4� ` ���� I male jq.Race L,) IEKes [:1 No # _State Ct) )oY aAc) 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ Q(I 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. $ 1 '� 11 Z 2 2 I j 3 " 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 Co-%\, r � eCLc i V-,, Bank Name 04 l -s & Amount 13r��3.73 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 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Oath of Applicant Bank Name Amount Term Security Amount I declare under penalty of aeriury that this a Qlication and all attachments are true, correct and complete to the best of my knowledge. Authorized Signature Print ignature �tle Date v CITY of: BOULDER BEVERAGE LICI.NSINC AUl'l101ti'i Y ZONING/ PLANNING CONFIRMATION PRIOR -I'0 LIC:I:NSIi AI PLIC'Al ION hictuor LimuskAnnilcant Cotnnlctes Ton Portion: Applicant' IJ_ Rr�JGI gGr.2ir�G1� vtC, 'fradeNnme: 411(1( Applicant Phouc: 72—,(s —ef UJ0 AppiicatilEntail: _M4AWLa kt �g gtaiut(•�t��`'! Treatise Addrem 3 r i; Z Indoor Ptrmisc Squnre 1'ooinge: Outdoor Palin Syuarc Foutnge jeam q ! 0 Approved Indnor Piumise: M �, and Outdoor Patio; UcL7g)ancy 1,040auing ('upuril). 1 -Inns nrOperarlan: _,___M L_j New ( Jl-rmunsrcr (`1 Muddincattiou; I lrIuor I.Jue-use "Type: /J �- /1 WI ✓l �_ Applicant's Signature: Applicant's Printed Nm�_stj nc: as _bWC*WdC Ite.Vonsive to MLS. 1247-313(1) and (I)c which stoles in perlincul part, "(I) No nppiicnliun fur the issuance or any licaise... shall be received or acted upon ...(e) Pur a localicrr In all arca where the sale uralcohol bevarago ua contemplated is not permitted utalcr the applicable zoning Inws of the municipality, city and caunty, or Lvunty..." xnd lievemge Licenshtg Authority Rules or Procedure. Subsectlnu 3-1-1 (c) available al: (lyp:!/m�w.lwuld�hcoloiuditham/file-A lxrl;lt jyg j ItuksyalltulB:�Uhraccduro.ndf Appltcani should bring this sheet AND PitOPOSED PREAIISE DIAGRAM eompl)ing with 1111.A Rule Section 3-3 at seq. to Ltearaing Clerk Gtr the use or Boulder Planning and Zoning at 1739 Brooduwy-Park Cenind Building, 3rd Floor, 303-441-1880 to address The roar helaw questions. NOTI{: This revinv is for zoning purposes only and is not approval for tiny change or otcupaacy or use pertaining to the building code. A separate building perntlt Is required ror building modifications, Including n change of use or occupancy. Planning and Zoning Dcparimcal Complcics Holtont Portion: ' S_ !n J / Q 1 Is ilia Use at the Silo Allowed'!// I O e�r4 jor, r YGS/NO CoinlnCnts/l.innilalions: '�l �-ht KI 4T) C�+�.., �.�,�, 1 (13 C Ar�p• C"o Docs the Use Require a Use Review or Site Rcvicw? ?9 - Z/ YES 0 Continents: r >"x Pc m- , c-. c3 F f CIL. �, C1 t .Mter` (/�s e Q,� ✓ �c� OJ %n+ IrUsc/Sitc Review is rcquu•ed has a Use Review/Site Review been npproved7 YES! NO Continents (such as Case Number! Date or Approval): X16 I Arc then: tiny zoning mstrictious or conditions of npproval on the property YES/NO that would prevent this property from buing open from the hour's af7:00 ata to Z:OD nun'! Comments! Limitations: Planner's Signature 1 1 Planners Pnntccd' Na me 1 �r-c�, c� t•- C C 1 J� co j �"Y� � U- l '"1 1 (•o PlanncrKn itic Plunncr's Signature (late Rev. 09/11 m m CITY OF BOULDER Planning Department P.O. Box 791 Boulder, Colorado 80306 Phone(303)441-3270 FAX (303)441-3241 NOTICE FINDINGS AND DECISION OF THE CITY OF BOULDER BOARD OF ZONING ADJUSTMENT DISPOSITION OF ZONING CASE DOCKET NUMBER 99-21 CONCERNING THE APPLICATION FOR A VARIANCE OF THE SETBACK REQUlRWAFN'TS OF SECTION 9-3.2-1, B.R.C. 1981 AT 3033 28TH STREET OF TEBO DEVELOPMENT, WHOSE MAILING ADDRESS IS 1301 WALNUT. On October 14, 1999, the City of Boulder Board of Zoning Adjustment, a quorum being present, held a public hearing, after giving notice as required by law, on the application of the applicant for the following variance: a reduction of the major street setback for an outdoor dining area. The patio will be setback from the centerline of 28th Street 80 feet, where 90 feet is required. Section of the Land Use Regulations to be varied: Section 9-3.2-1. Based on our field investigation and the relevant testimony, exhibits, and other evidence introduced at the hearing, and in accordance with the applicable provisions of the Boulder Revised Code, 1981, we 5nd by a preponderance of the evidence that the criteria for granting a variance have been met, and grant the variance as requested. This variance is limited to the use and structure for which it was requested, including the location on the lot and maximum height, as shown on the request. This variance was approved by the vote of 3-1. EXECUTED this 14th day of October, 1999, effective as of October 14, 1999. Kent Stutsman/, Presiding Officer of the Board at the Meeting By: l"7 Gary Kretsc , Secretary to the Board f Zoning Adjustment This decision constitutes a final decision as of the date of the hearing at which it was trached. If a variance was granted, the variance expires within 180 (one hundred eighty) days after the date it was granted if no building permit is issued for such variance within that period Amended Diagram 0 fL-,r-09 PL,,6•klf 3033 261' �r _ No �pu�l✓aj _ ______�_._�_ .._ - ok.� .� -t5FM4:;,E L APCHITi5cTS, Alm A c�Rb aF Uftv►"Er..Mp�►�tr�lj f�- ,��j 1 PROPOSED FLOOR PLAN �,Q 1/1611= 1'-0" Ali Baba Grill MINOR TENANT FINISH 3033 28TH STREET BOULDER, COLORADO 80301 J LQ DIAGRAM 06.27.16 ` REVISED CONTACT: Peter Carey 720-636-6371 5305 spine road suite f, peter@uparch.net boulder CO 80301 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 ofthis license. New employees shall take aclass within three months of theirhire. Any employee participating in aTastings must have already completed a state - certified Responsible Vendor alcohol serviceclass. 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. et Applicant ✓ �\ __t7_ Authorized Signature J A h''gabs. Grill Trade Name PrintName, Title & Date CITY OF BOULDER BEVERAGES LICENSING AUTHORITY STATEMENT OF FOOD SERVICE Pursuant to Section. 12-47-411, C.RS., as amended, the applicant hereby certifies that they have read and fully understand the following excerpts: Hotel -Restaurant license "Restaurants shall sell malt, vinous, and spirituous liquors as provided in this section only to customers of such restaurant and only if meals are actually and regularly served and provide not less than twenty-five percent (25%) of the gross income from sales of food and drink of the business of the licensed premises. It is the intent of this section to require hotel and restaurant licensees to maintain a bona fide restaurant business and not a mere pretext of such for obtaining a hotel and restaurant license." Brew -Pub license "A brew pub licensee shall sell malt, vinous, and spirituous liquors for on -premises consumption only if at least fifteen percent (15%) of the gross on -premises food and drink income of the business of the licensed premises is from the sale of food." Pursuant to Regulation 47-418, the applicant certifies that he/she shall at all times, when meals are required to be served, maintain on the premises adequate personnel, foodstuffs and other necessary facilities, equipment and supplies for the preparation and serving of meals as defined by 12-47- 103(20) C.R.S., as amended. Oath of Analicant I declare under penalty of pequry 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 Liquorand Beer Code and all City of Boulder rules, regulations and codes which affect my license. A �i . P),_ab�, P5 `tVLC• A�, (-kA h Applicant Trade Name Authorized Signature ✓ Print Name, Title & Date Agenda Item 11 CITY OF BOULDER BEVERAGES LICENSING AUTHORITY PRELIMINARY FINDINGS AND REPORT IN THE MATTER OF THE APPLICATION FROM Bittersweet Cafe LLC d/b/a Bittersweet Cafe 5385 Gunbarrel Center Court Boulder, CO 80301 RE: Bittersweet Cafe LLC d/b/a Bittersweet Cafe Proposed Premise Location: 5385 Gunbarrel Center Court, Boulder, CO 80301 FOR A New Hotel -Restaurant 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 Hotel -Restaurant 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 November 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. 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 with a stated maximum term of August 2031. 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) 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): Bittersweet Cafe LLC d/b/a Bittersweet Cafe: Michael Boselli, Member and Registered Manager; Patrick Walsh, Member; Don Anthony Boselli, Member; Michael Boselli, Member and Registered Manager: No record of arrest per FBI/CBI background check. Patrick Walsh, Member: 1- Arrested April 19, 1994 by University of Colorado Boulder Police Department: Charge 1— Marijuana - Possession Charge 2 — Drug Paraphernalia — Possession — 2 Counts Charge 3 — Fail to Appear, 3rd Degree Assault 2 - Arrested June 30, 1994 by Boulder County Sheriff Office: Charge 1— Probation Violation 3rd Degree Assault, Guilty, Sentence - 4 Days 3 - Arrested July 4, 1994 by Boulder Police Department: Charge 1— Damage Property Mischief Over $100 Under $399, Misdemeanor Charge 2 —Crimes Against Person Harassment, Misdemeanor 4 - Arrested September 27, 1994 by Boulder County Sheriff Office: Charge 1— Driving Under the Influence Charge 2 — Fail to Appear Liquor Underage Charge 3 — Fail to Appear Tress Public Property 5 - Arrested January 3, 1995 by Boulder Police Department: Charge 1— Fail to Appear Poss Liquor Underage Charge 2 — Damage Property Mischief, Misdemeanor Charge 3—Trespassing 15Y Degree, Felony 6 - Arrested February 4, 1996 by Lafayette Police Department: Charge 1— Fail to Appear Mischief/Harassment 7 - Arrested July 24, 1996 by Boulder Police Department: Charge 1— Public Peace Brawling Charge 2 — Public Peace Fighting Charge 3 — Resisting Arrest, Misdemeanor 8 - Arrested November 5, 1996 by Boulder County Sheriff Office: Charge 1— Public Peace Brawling, Guilty, Sentence - 2 Days Charge 2 — Public Peace Fighting Words, Guilty, Sentence - 2 Days Charge 3 — Resisting Arrest, Misdemeanor, Guilty, Sentence - 2 Days 9 - Arrested May 11, 1997 by Boulder Police Department: Charge 1— Fail to Appear Brawling/Fighting Words/Resisting 10 - Arrested August 23, 1997 by Boulder Police Department: Charge 1— Trespassing 3rd Degree Charge 2 — Crimes Against Person Harassment, Misdemeanor 11- Arrested November 7, 1997 by Boulder Police Department: Charge 1— Damage Property — Private Charge 2 —Assault Threats Charge 3 — Fail to Appear Brawling/Fighting Words/Resisting, Misdemeanor 12 - Arrested June 12, 1998 by Boulder Police Department: Charge 1— Driving Under the Influence, Misdemeanor Charge 2 —Traffic Offense, Misdemeanor Charge 3 — Contempt of Court Fail to Comply Charge 4 — Fail to Appear Damage Property 13 - Arrested October 5, 1998 by Boulder County Sheriff Office: Charge 1— Fail to Appear FTA: MITT SENT (Harassment) 14 - Arrested August 24, 1999 by Boulder County Sheriff Office: Charge 1— Driving Under the Influence, MIT: D.U.I. — 2"d Off in 5 Years, Misdemeanor, Guilty, Sentence - 30 Days 15 - Arrested or Received August 11, 2000, Sheriff's Office San Diego, CA Charge 1 — Counts of Inflict CRPL INJ SP/COHAB, Charge -273 5 PC -Inflict Corporal INJ On Spouse COHAB, Released/Detention Only 16 - Arrested or Received June 5, 2009, Sheriff's Office San Diego, CA Charge 1— Counts of BATT PO/EMERG PRSNL/ETC Charge 2 - Counts of Fight In Public Place Mr. Walsh has provided both a cover letter and individual explanation sheets for each incident listed as well as court dispositions for charges that were available to him as of January 7, 2017. Don Anthony Boselli, Member: No record of arrest per FBI/CBI background check. Prior Operational Characteristics and Enforcement History Michael Boselli is also a co-owner of Press Play, a Boulder Tavern liquor licensee. Press Play has an enforcement record for a violation for two counts of sale to a visibly intoxicated person with a BLA on October 30, 2014 and with a penalty of 6 suspension days served and 12 days held in abeyance for a 1 year period. 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, January 18, 2017 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: httos://www- static.bouldercolora do.Rov/docs/BLA Rules of Procedure-1-201505081442.Ddf or a public copy is made available for review at the Licensing Clerk's Office. January 10, 2017 BEVERAGE LICENSING AUTHORITY CITY OF BOULDER, COLORADO Mishawn J. Cook, Tax and License Manager And Board Secretary 0 Neighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Cafe - 5385 Gunbarrel Center Court Monarch Rd Monarc d- .. n Ln Rd Bittersweet Cafe time •�•���� dtiabitat O. qr �h White R /80 O� II0q� Applicant: Bittersweet Cafe, LLC Trade Name: Bittersweet Cafe Location: 5385 Gunbarrel Center Court License Type: New Hotel -Restaurant pry Cree*V1 Mineral Rd 4a 1 3 ____� — y 4� Qat � `or 1, �11%% Meeker Rd Rdi F°,;° io, 'FTryy/✓ ,, �. �Dr c/4�house Rd ` Old Post es Rd `m Jev �Ra Bugle Ct W avo 0 V O moo, r a Q -a Par rC a Park Pl City of n:..*� '. Boulder NORTHa 1► 1 H The infamatlon depicted an this map is provided as graphical representation only The Qty of Boulder provides no warranty expressed or implied, as to 1 inch = 2,000 feet the accuracy andlorcompleteness ofthe :dormation contained hereon 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 of Applicant(s):_ ► , e4-5( Cie,e-i Trade Name: Phone No: _J 3 ' 76 9 - Z ? Contact Person: Business Address: 7ZS- 6ct/1 Mailing address: 5r3 V ,�- 6-A Property Owner: 1 h L� Cit, �/ �, L Phone Number (local): 101 ' Property Manager: Phone Number (local):(_�3) Property Manager's Mailing Address: S -3-L40 �I�j I � General Manager: 1 'Ii Ae. Phone Number (local):(3�rl) '576 - y66<,,j 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) 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] 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 Boundani East Boundani 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? 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. 0 Authorized Signature Date Ma,'q Qo5rjf- cxuh,.q,- Print Name & Title City of Boulder Liquor License Application City Questionnaire Answers: 1. Bittersweet Cafe LLC is a coffee shop/wine bar that will sell coffee and specialty espresso drinks, as well as sandwiches, salads, and small plates. Wine and specialty craft cocktails and local craft beers will be sold on site as well. 2. Our proposed hours will bel as follows: Sunday through Saturday, 6:OOam until l .c0 PM l 4. Occupant load has not yet been applied for. 5. Yes, we have an emergency plan in place consisting of 3 exit doors. 6. We plan on having 38 employees. 4 managers/assistant managers; 6 full time employees and 28 part time employees. 7. 2 of the 3 owners currently own establishments that sell beer/liquor. Those two owners have completed TIPS certification and one of the owners has had sommelier training. 8. The owner, Michael Boselli, is the General Manager and is TIPS certified and owns a separate establishment in Boulder County that sells liquor. 9. All employees will be TIPS certified with ongoing, weekly trainings. We have a detailed employee handbook outlining proper procedures for selling alcohol to patrons. 10. We reserve the right to refuse service to anyone demonstrating alcohol or drug intoxication. 11. We will refuse service to anyone without proper identification or anyone showing visible signs of alcohol/drug intoxication. We reserve the right to refuse service on anyone demonstrating verbal or visual cues of intoxication. All employees (bartenders, waitstaff and managers) are expected to abide by the guidelines outlined in the TIPS certification handbook. 12. All employees of Bittersweet Cafe LLC are expected and trained to follow the policies and procedures outlined in the employee handbook. Policies and procedures will be upheld through daily supervision and weekly trainings. 13. All patrons will be carded upon ordering of any alcoholic beverage. We will use visual verification of identification to ensure everyone is 21 and over. 14. Live music will be offered on certain days of the week. 15. There will be speakers on all patios providing proper ambiance for our guests, taking into consideration all noise ordinances. 16. N/A 17. Kitchen will close 30 minutes prior to closing of the actual establishment. 18. 50/50 on food to alcohol sales. 19. Private events will be held to the same standards as daily operations. 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N Z Q1 `u 7 N ro O C) ? rn Z Q + O in rp + aj O Lj U W o i' C 00 g ro � W T � O ai w W - +-� v1 a— w w W _ Lu Qj Lu N rd N 4J J m N J x '� 01 L M SQj N L7 E 15 � V r0 4- t7 V CT N u d V u 3 to z U m rn ti DR 8404 (06/28/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 Colorado Liquor Retail License Application ❑ New License Xr 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.colorado.gov/enforcement/liquor • Local License Fee $ 1. Applicant is applying as a/an ❑ Individual ❑ Corporation D< Limited Liability Company Partnership (includes Limited Liability and Husband and Wife Partnerships) ❑ Association or Other 2. Ap I' ant If an LLC, name of LLC; if artnership, at least 2 partner's names; if corporation, name of corooration I FEIN Number �i t t �C �-�� 2a.Trade at a of Esta ishment (DBA) State Sa;__ ... 3. Address of Premises (specify exact location of premises, include suite/unit numbers) G&,g- 4-4'. City County State ZIP Code -ula'e-C r co Ci�� 4. Mailing A dress (Number and Street) g C' or To n State ZIP Code �s 3 I u O& 5. Email Address Pyr; 1 -/*t@ &���.� 6. If the premises currently has a liquor or beer license, you must answer the following questions Present Trade Name of Establishment (DBA) I Present State License Number I Present Class of License I Present Expiration Date Section A Nonrefundable Application Fees Section B (Cont) Liquor License Fees ❑ Application Fee for New License...............................................$920.00 ❑ Liquor Licensed Drugstore (City)......................................................... $227.50 CK 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 Section B Liquor License Fees ❑ Manager Registration -Tavem.............................................................. $75.00 ❑ Add Optional Premises to H & R......... $100.00 X Total ❑ Master File Location Fee ........................$25.00 X Total ❑ Add Related Facility to Resort Complex $75.00 X Total ❑ Arts License (City)................................................................................ $308.75 ❑ Arts License (County).......................................................................... $308.75 ❑ Beer and Wine License (City).............................................................. $351.25 ❑ Beer and Wine License (County)........................................................ $436.25 ❑ Brew Pub License (City).................................................................... $750.00 ❑ Brew Pub License (County)................................................................. $750.00 ❑ Club License (City)............................................................................... $308.75 ❑ Club License (County)........................................................................ $308.75 ❑ Distillery Pub License (City)................................................................. $750.00 ❑ Distillery Pub License (County)........................................................... $750.00 X Hotel and Restaurant License (City .................................................... $500.00 ❑ Hotel and Restaurant License (County) ............................................ $500.00 ❑ Hotel and Restaurant License w/one opt premises (City) ................. $600.00 ❑ Hotel and Restaurant License Wone opt premises (County)............ $600.00 ❑ Master File Background ...................... $250.00 X Total ❑ Optional Premises License (City)........................................................ $500.00 ❑ Optional Premises License (County) .................................................. $500.00 ❑ Racetrack License (City)...................................................................... $500.00 ❑ Racetrack License (County)................................................................ $500.00 ❑ Resort Complex License (City)............................................................ $500.00 ❑ Resort Complex License (County)...................................................... $500.00 ❑ Retail Gaming Tavern License (City) .................................................. $500.00 ❑ Retail Gaming Tavem License (County) ............................................. $500.00 ❑ Retail Liquor Store License (City)........................................................ $227.50 ❑ Retail Liquor Store License (County) .................................................. $312.50 ❑ Tavern License (City)........................................................................... $500.00 ❑ Tavern License (County)...................................................................... $500.00 ❑ Vintners Restaurant License (City) ..................................................... $750.00 ❑ 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 NumberI Liability Date I License Issued Through (Expiration Date) I 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 applicantxe actlX. 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 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 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) VIII. 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? ❑ V (b) Had an alcohol beverage license suspended or revoked? and any ❑ (c) Had interest in another entity that had an alcohol beverage license suspended or revoked? El 1:1Has ❑ If you answered yes to 8a, b or c, explain in detail on a separate sheet. Number of additional Optional Premise areas requested. (See license fee chart) �. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the "yes", ❑ (a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of Pharmacy? preceding two years? If explain in detail. If "yes" a copy of license must be attached. 10. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of Colorado ❑ ❑ (a) Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and not for pecuniary gain? or the principal campus of any college, university or seminary? EJlaw, ❑ ❑ Waiver by local ordinance? or (c) How long has the club been incorporated? 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 &es 'dentify the ami q 1tFy� b Ine s a list any p� ;� current financial interest in said business including any loans to or from a licensee. �c�4� i i'- eYt ce- ,,��77 12. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownKI)ership, leas'or other` arrangement? ® ❑ ❑ Ownership 0� 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 �_ Te nt q Expire (.tx:�l(o2r�- ��d3 � b. Is a percentage of alcohol sales Abluded 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 1l2" 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 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: El 1:1Has 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: (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 ❑ ❑ object of a patriotic or fraternal organization or society, but not for pecuniary gain? (c) How long has the club been incorporated? (d) Has applicant occupied an establishment for three years (three years required) that was operated solely for the reasons stated above? ❑ ❑ 17. Brew -Pub, Distillery Pub or Vintner's Restaurant applicants answer the following: (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 8404-1) Last Na aof Manager First Name Qf Manager n.ro . f aThr; fill C (J� 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? If yes, provide name, type of license and account number. Namj� j l / Type of License Account Number /'1 LAS'1`rL► -' ' /�'m O ('d5C L.`, I T&J ,(� i Sr. 1 417 - Cc. 71D V ^ 600c'� 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. #8 — press play bars liquor license was suspended by the city of boulder for 5 day in the violation of over service to a customer. This is the only violation the bar has had. 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. N�& I N -ma Address. City & State Name M 'law Name ii 2 I Hnma Hnnress. L nv a Mate D� /4rlk � I _'bel r Name Name Home Address, City & State L 1 nnR I Position " %Owned 1, , e 4 Signature (attest) Print Title 'osition % Owned Position % Owned .'osition % Owned 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: 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 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 cgm"ith the provisions of the Colorado Liquor or Beer Code which affect my license. ���,� � Printed e and Till � � to Auth/ o � I ! r I Nil 1 I � I �(O Report and Approval of Local Licensing Authority (City/County) Date application filed with local authority `Date of local authority hearing (for new license applicants; cannot be less than 30 days from date of i n �� I application 12117-311 (1) C.R.S.) The LoJ licensi�lAuthority Hefeby Affirms that each person required to file DR 8404-1 (Individual istory Record) has: ❑ Been fingerprinted ❑ Been subject to background investigation, including NCICICCIC 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 I Telephone Number ❑ Town, City ❑County Signature Print Title Date Signature (attest) Print Title Date 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 for the suspension or revocation of the license applied fo Name of 4hcint(s): 1 tJ�Q C�3� C Trade Name:�'c-- e--S-c Business Address: "��ti (' ,-�-�• c Phone No. 3- Z�-`� Contact Person: Mailing address: 5✓ � � t pre -1 P �-.C� t -�-' Other Liquor Licensed Establishments that princi aI or managers of A�� licint(s) now holds: 666(10's St �e� S� L -LC. 1, �, -� � /e4M < Crc If applicant is a corporation or LP or LLC, names of persons purchasing stock or membership units: Is this a new or existing business: rV C C-0 Ifnew business, state approximate investment amount: S LkYo I Where will these funds come from? P—r6u r .( (&,n k co�,,4-.c, If existing business, state purchase price including inventory: $ Where will these funds come from? If cash is to be invested, please complete the following: (If you need additional space, please attach additional pages) � n Person or business investing Cjh'N/ Ike - &157 10-P, Address of Investo. Amount of Investment Source of Investment: (Chec g, Savings, Bo , 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. Term of Obligation: Business Bank Account Information iWhat bank will the business account be maintained at? What name will the account be under? RAV-e4 -- Who will be authorized to sign on the account? All ot,, s / qj- i i 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. i i 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. i Authorized Signature Date Print Name & Title DR 84D4-1 (03113115) 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 100/6 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 R-staurant 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 "NIA". Any deliberate misrepresentation or material omission may jeopardize the license api plication. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name91fBiness I Home Phnne NutnhPr yellglar Number CJ� 1, c ?i3) 2S7 F15S- �me (last, first middle) ttC� ��i.v1 4. Mailing adtlddddress (ii Ifferent from residence) Email Addjess L' 1 Q 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number 1 ') City, State, Zip From To CURPnt lA l�'�,f/T` & CD gooZP 1 Pr 1281 W141N C;, DU1Svt42 Co 16 o01--2 ��% 1S— 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 H411d From To 13I-H-dAlc,We-ef C!&t . 9'3& MWK Srt („ouisvi`lf- W%6o27 OLA-7kt,4 2-0-10 pr'orS�yl:, r. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beveragIndustry. Name of Relative Relationship to You Position He Name of Licensee 4VOLe'k WaaiSto :W I T e, LO - &A'VK t'- t3i3o55""f-s biI CCC. 8. Have you ever applied for, held, or had an Interest in a Colorado Liquor or Beer License, or loaned rroney, furniture, fixtures, equipment or inventory to any licensee? (If yes, answer In detail.) (Yes ❑ No evrreL4 t�,crn, Ltgvor Lur-i ce to Lovtsv't1La C -o UK o8f3o ` S Pifil" S Ino: U,G. I}L�o i�ao� cx (t�lvor Ltt✓c¢ t T3Yoo,.��Q t�, Co IJ S I' c;L+ Lake Sew r2 >4',-Lz+t C C-Lu6 v trxA--Ar '�3 �' -G.rS w e.>="�' L.c-�C� ,� r2 LL c- 9. 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or hav ; you U(es ❑ No applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in Jetail.) (JOE V -'P- kvea 0' W oilc-e ver U vl.at iovt v. 'Z �2 1 W'a v► et w e'-' Gi%,,pLH,,s Fo-de4 aL �.o �.,,�l�a�ceJ�(�ec!� • we In.�,ve sa��sFt�r11 1 55 v a 1 �a tcl - "t -e t, ve ClAck %,1 rc L w, V% l 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or iorfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain 'n detail.) / Yes El No 'LOA � I ?ULA` l c.D1--A 1P`"Dctx&" . � lG'WI-1 A ,. C.t7( Wrc.S J< i a 11. Are you currently under probation (supervised or unsupervisbd), parole; or completing the requireme its of a deferred sentence? (If yes, explain in detail.) ❑YestVo 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detai'.) ❑ Yes M No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal I[�fo[matio jj ��uiree in question #13 is solely for idle �cat''o purposes. a 7a Date o6rfh (b. Social Security Number i C.ce of B�rtfi I X Y" 011d C A I d. U.S. Citizen Wes ❑ No n I Ig. Name of District Court I h. Naturalization Certificate Number i. Date of Certification I j. If an Alen, GiveAlen's Registration Cana Number I k. Petinanent Residence Card Number I. Heigpt I m. Weight I n. Hair Color o. Eye Colorp. Gender ace Do you have a current Driver i5 UcemeAD? If so, give//numb r and state. Soo 5 i Uvetz g ��,{ I q. Rc WA I w I�Yes El No # State �DI�L 14. Financial Information. a. Tota[ -purchase priee..Qr in—Omenl beino made by the applying entity, corporation, partnership, li nited 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 , o 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 o'' this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount (P/anv) �e-,I, ?10,000 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 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Tenn Security Amount Oath of Applicant I declare neermalty of oedury that this plication and all attachments are true. correct and comoletl to the best of my knowledge. print Signature tittle Date Patrick Sean Walsh I Bittersweet Cafe LLC. 5385 Gunbarrel center court 1303.257.8955 1 patrick@bittersweetcafes.com 1/4/2017 Beata Mazurldewicz Licensing Specialist II O: (3031441-3091 mazurkiewlczBObouldercolorado.e_ ov Finance Department 1777 Broadway, Boulder, CO 80302 Bouldercolorado.gov Dear Licensing Board: I feel that it is important that I explain the many incidents resulting in arrests in my early years. At that time, I was a confused and angry young man, due to family issues and poverty, many of these arrests are due to not following though and violating probation because of my unstable home life. I'm am in no way making excuses, but I can't change my behavior decades ago. With the support of my loving wife and family I've matured and become a productive member of my community. I currently own three successful businesses that I have built from the ground up, with no money and a lot of hard work and sacrifice. I'm happily married with two beautiful children, l am on the board for the Downtown Business Association in Louisville, CO, and a member of a great charity organization; Guys Who Give. I have been able to purchase my own home and a rental property as well, because of my change in lifestyle. Please allow me to continue to grow, both as a business and an individual so that I can provide a stable life for my children by considering this when deciding about this license. I have had a liquor license in good standing for my businesses in Louisville for the past six years and I have also held a license in good standing in Broomfield, CO as well. Sincerely, Patrick Walsh Owner, Bittersweet - Cafe & Confections 303.317.5522 1303.257.8955 1 www.bittersweetcafes.com 1 836 Main St Louisville, CO 80027 4t CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: I o assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will he scheduled, please complete the following worksheet: Person's Name: _041 i CL S C & 1A Name of Liquor Licensee or Applicant: Description of Charge and Date: �oSSQSS ioh v F vticl r hua�a I �,cra_a►-h1?0s5 Date of Final Court Resolution: 10 I200 1 l) I �- Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: I A ► S c Lo -;A +ke. Clna rj&-,, -IA ha-cA oY r,,,, re -co LQ_ r4u.�, � �I1, 6-41 4, he -CL 26 � Z -M-S ctclo Court documents showing dismissal attached? Please Explain: Vl 2c,C P_ cz2 GAA o_c-" �- ❑ Yes IKLJVo Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please Explain: I � o� � c ttc Vc, I L(_tA,5e. In LoV1<,fj(2 I ow- SeL"4j- l -u< maA5" anA Ixcve Lv,vvld c..jre&4 A&,pl S"v e 4-ki< *I,nti2. �� p (e as_e-, sZ-c— cover pa- e_ PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARREST OR CHARGE. PLEASE SUBMITTHIS S,AIAOVCLICCT AMR /111 I1TT A.1^I�{11`_`I�.T� ATL r/1P_T 3n AI/r r+Rli+f�Tr114^1 In 7,I A Iy ARLjk nATr n r. �,t►i rrr ccrr rr _^I -. crvll ry rvvIF vnn I Ii-rualrvcf rurcl_ CiVON IIIL DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. COUNTY COURT, BOULDER COUNTY, COLORADO Court Address: Boulder Justice Center 1777 Sixth St. P.O. Box 4249 Boulder, CO 80306-4249 Phone Number: 303-441-3750 RID:C0071994F 000669 COURT USE ONLY " Case Number: 1994F 000669 The People of the State of Colorado vs. WALSH, PATRICK SEAN Division: SENTENCE ORDER Defendant: WALSH, PATRICK SEAN Date of Birth: Count Class 1-iea 1 18-18-406(1) - Possession of 1 oz or less of Marihuana P02 Plea of Guilty 2 18-18-428(1) - Controlled Substance: Paraphernalia Poss P02 3 18-18-428(1) - Controlled Substance: Paraphernalia Poss P02 ASSESSED FINES & COSTS TOTAL $0.00 MACDONALD. DIANE RIDER Judge/Magistrate WALSH. PATRICK SEAN Defendant [3 Finding Guilty 01/04/2017 Date 01 04/2017 Date ..,*.....*.,.,..,,...*.............**,..,*.,..*.,***......NOT ICE........,#„*,.,.,,.#.**........,�...........,,.....*.,.., Following this hearing you are to present this form to the Clerk's Office for payment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. I N T E G R A T E D C O L O R A D O O N L I N E N E T W O R K (I C 0 N) Status: CLSD County Court, Boulder County Case #: 1994 F 000669 Div/Room: 8 Type: Drugs The People of the State of Colorado vs. WALSH, PATRICK SEAN DV STATUS: Case File Date: 4/19/1994 Case Close Date: 10/28/1995 Appealed: N Confidential Intermediary .............. Bar # Name Judicial Off...: 012391 DIANE RIDER MACDONALD Alt Jud Officer: 000000 Description Stat Date Time Rm/D Trial........... 0:00 Next Schd Event: 0:00 Last Schd Event: Further Proceedings HELD 10 28/1994 2:00 P Last Event.....: Closed after post jdg activi n/a 10/28/1995 Attorney(s)..... N Agency: Univ of CO Police Ticket/Summons Number(s): Warrant.......... Warrant Date: Party on Warrant: Change of Venue.: Agency: Bond(s)................... Y Agency Case #: Arrest#: Sentence Date ............. SCRT 5/11/1994 Detention Location.......: Supervising Agency.......: Probation Officer......... Expired Date: ----- PARTIES ----- PARTY ROL STS NAME ATTORNEY DEF 1 WALSH, PATRICK SEAN Date of Birth............ Sex...................... Male Race..................... Caucasian Height ................... 511 Weight ................... 155 Hair Color ............... Blonde Eye Color ................ Bliip- Home Address ............. : BOULDER, CO 00000-0000 ----- OTHER PEOPLE ----- ROL ROLE NAME SRT 1 STEINMAN, ARTHUR M CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS 1 ( ) 18-18-406(1) Possession of 1 oz or less of Marihuana P02 Offense Date: From: 4/19/1994 To: 4/19/1994 Time: 01:50 AM BAC: .000 Arrest Date........ 4/19/1994`Time: Ticket #: Plea ............... Pie-6--ot Guilty Date: 5/11/1994 Disposition........ Guilty Date: 5/11/1994 CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS 1 (A) 18-18-406 (8) (b) (I) Manufacture/Distrib./ Sale of Marihuana F4 investigation Offense Date: From: 4/19/1994 To: Arrest Date........ 4/19/1994 Time: SNT DATE SENTENCE DESCRIPTION 5/11/1994 Sentence by Court Judicial Officer......... SNT DATE SENTENCE DESCRIPTION Court Costs .............. Community Service........ 2 ( ) 18-18-428(1) Controlled investigation Offense Date: From: 4/19/1994 To: Arrest Date........ 4/19/1994 Time: 3 ( ) 18-18-428(1) Controlled investigation Offense Date: From: 4/19/1994 To: Arrest Date........ 4/19/1994 Time: FILE DATE EVENT DESCRIPTION 4/19/1994 Arrest Report Filed FILE DATE SCHEDULED EVENT DESCRIPTION 4/19/1994 First Appearance Officer: DIANE RIDER MACDONALD Status.: CONT -Continued by Parties IN CUSTODY 4/19/1994 Further Proceedings Officer: DIANE RIDER MACDONALD Status.: HELD -Hearing Held 4/21/1994 Preliminary Hearing Officer: DIANE RIDER MACDONALD Status.: HELD -Hearing Held 5/11/1994 Case Closed 9/29/1994 Further Proceedings Officer: DIANE RIDER MACDONALD Status.: HELD -Hearing Held 10/24/1994 Letter FROM DEFENDANT REQUESTING EXTENSION 10/25/1994 Reopened DEF/ WALSH, PATRICK SEAN 10/28/1994 Order 4/19/1994 Time: 01:50 AM BAC: .000 Ticket #: STATUS .: DIANE RIDER MACDONALD STATUS .. $18.00 .. 24.00 HOUR(S) Substance: Paraphernalia Poss P02 4/19/1994 Time: 01:50 AM BAC: .000 Ticket #. Substance: Paraphernalia Poss P02 4/19/1994 Time: 01:50 AM BAC: .000 Ticket #: Event ID: 000001 SCHD DATE TIME ROOM PRI 4/19/1994 02:00 PM CJ 01 Length: 1.00 Hour(s) Note..: IN CUSTODY /MM 4/21/1994 03:00 PM CJ 08 Length: 1.00 Hour(s) Note..: FLG CHARGE 5/11/1994 09:00 AM 8 01 Length: 1.00 Hour(s) Event ID: 000010 10/28/1994 02:00 PM 8 Length: 1.00 Hour(s) Note..: P J MOTN Event ID: 000012 Event ID: 000013 Event ID: 000014 RE-REFERRAL TO CS-24HRS.CS TO BE COMPLETED. 8/14/1995 Motion Event ID: 000015 BY DA -TO REVOKE PROBATION 10/28/1995 Closed after post jdg activity Event ID: 000016 BOND INFORMATION Bond Id Number...... 1 Bond Status..... Set Date............ Set Amount...... $100.00 Post Date........... 4/20/1994 Post Amount..... $100.00 Prof Surety Power #: 2-188846 Bond Instructions: May use for Fines and Costs: May be released to Defendant: End of Case: 1994 F 000669 / KAG /DV /MM Type: Type: SUR CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: To assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: _Fa+1( GL &Q~ weA C"k— Name k - Name of Liquor Licensee or Applicant: CaPi-c- Uc Description of Charge and Date: -F,-,,74, A i o h Vt kc -A i nv` Date of Final Court Resolution: PConvicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual Histo Record Form: `` p rtoc.P_- 0M, P.�Aw-lq a/( �h [ N C,T Po.�tn oma? =W it LO ►�I,,P.v� rC R�,o . -a a, -A t e,- wt, a w, o r Al F -'F -Pry a-lk 1>P_' S,o a►. now- Court ow-Court documents showing dismissal attached? ❑ Yes PP No Please Explain: Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please Explain: JP Ar S -0 ✓1 PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARREST OR CHARGE. PLEASE SUBMITTHIS WGJfCI'C�rfCC f KI�C� KLC K f (!i(.I`fIV�CfV.r3 f LCRS f Y �f/ TS F�tfUK f Cf TUUIS' Ef C.F>i Fftfilifi�fC� �IK �E QK �11�1 I -HL DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: I o assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: FGL_ � I Ck SeU. v1 (/� S �A Name of Liquor Licensee or Applicant: (,(_, (,\ Description of Charge and Date: Cri ri I AO -C IM i < rl -IJ i�,,raS Date of FinarCourt Resolution: 2 2 1 I I °l Ci (, Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: f r C k ct r cl �' r f- (� S C 1 D 5 +�b` t e wa4 ZZ-1Q_-IrS a0)0 aJ � kavC gv-ovo UC, VL, 00 0U o� +MI5 ��?e- 0� ,ter. 1 c Court documents showing dismissal attached? ❑ Yes �PNo Please Explain: CoUv4 Ao c5 e, t cc( _e l Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please Explain: 1 CkV'I au VT,�u A�A l w.o w o SoC, e I ow�v,,o4, ?tz i ie45 C(o,d G\uje SNP, „Jo GJGr lic�vte� (� iblo,rado, PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARREST OR CHARGE. PLEASE SUBMIT THIS �AIADVGLlCCT AAIJ1 All ATTA!`I,#J\A r-KMC AT 1 t•ACT �nANC nr��.n rx,rn \ri1)!n nt :-L""14-2- JJ-A n,1AlC nA r� n r.• ►� r rrr.ri\'i—EiFfiruJ J{r'r'. iiT r'lia.rr�rr'r. rr.. PTY L LAS.J1lPT1..Irt\IVI\rVfVV1\YLlT11Lr'\I'ill't�i'UJYIV V7\`VlY 11 DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. COUNTY COURT, BOULDER COUNTY, COLORADO Court Address: Boulder Justice Center 1777 Sixth St. P.O. Box 4249 Boulder, CO 80306-4249 Phone Number: 303-441-3750 The People of the State of Colorado vs. WALSH, PATRICK SEAN Defendant: WALSH, PATRICK SEAN Count 1 18-4-501 - Criminal Mischief 2 18-9-111 -Harassment ASSESSED FINES & COSTS TOTAL F' RID:C0071994M 002666 COURT USE ONLY " Case Number: 1994M 002666 Division: 7 SENTENCE ORDER Date of Birth: Class Plea Finding M2 Plea of Guilty Guilty M3 Plea of Guilty Guilty $0.00 CLERK OF CURT. 01/04/2017 Judge/Magistrate rate Date WALSH. PATRICK SEAN 01/04/2017 Defendant Date ......,...�....,,,..,,,,*..,#*....t*....,,*,..,,......*.....#.NOTICE..,,**..,.,..**..,,*...............*...*,.,«.,.,,.,,....�.,�* Following this hearing you are to present this form to the Clerk's Office for payment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. I N T E G R A T E D C O L O R A D O O N L I N E N E T W O R K (I C O N) Status: CLSD County Court, Boulder County Case #: 1994 M 002666 Div/Room: 7 Type: Criminal Mischief The People of the State of Colorado vs. WALSH, PATRICK SEAN DV STATUS: Case File Date: 7/05/1994 Case Close Date: 2/21/1996 Appealed: N Confidential Intermediary .............. Bar # Name Judicial Off...: 015054 CARE HOYE ENICHEN Alt Jud Officer: 000000 Description Stat Date Time Rm/D Trial........... 0:00 Next Schd Event: 0:00 Last Schd Event: Review VACT 4/30/1997 7:00 A Last Event.....: Closed after post jdg activi n/a 2/21/1996 Attorney(s)..... N Agency: Boulder Police Dept Agency Case #: Ticket/Summons Number(s) : 61670 + Arrest#: Warrant.........: RSWT Warrant Date: 2/05/1996 Expired Date: Party on Warrant: WALSH, PATRICK SEAN Change of Venue.: Agency: BOCS Boulder County Sheriff Dept Bond(s)................... Y Sentence Date ............. SPLE 7/14/1994 + Detention Location.......: Supervising Agency.......: Probation Officer......... ----- PARTIES ----- PARTY ROL STS NAME ATTORNEY ROL DEF 1 WALSH, PATRICK SEAN Date of Birth............ Sex...................... Male Race..................... Caucasian Height ................... 511 Weight ................... 155 Hair Color ............... Brown Eye Color ................ Blue Home Address ............. : BOULDER, CO 80301-0000 PPL 1 THE PEOPLE OF THE STATE OF C ----- OTHER PEOPLE ----- ROLE NAME SRT293 RADATUS, ANDRE CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS 1 ( ) 18-4-501 Criminal Mischief M2 $100-399 Offense Date: From: /_0A./_1.9.94�To: 7/04/1994 Time: 11:20 PM BAC: .000 Arrest Date....... 7/04/1994 Time: Ticket #: 61670 (• _ CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS Plea ............... Plea of Guilty Date: 7/14/1994 Disposition........ Guilty Date: 7/14/1994 SNT DATE SENTENCE DESCRIPTION STATUS 7/14/1994 Sentence Resulting fm Plea Judicial Officer..........: MARSHA BAER YEAGER Jail. .................. 10.00 DAY(S) Probation .................: 12.00 MONTHS) SUPERVISED PROBATION: MH TX W/PROOF QUARTERLY TO DAIS OFFICE; RESTITUTION SNT DATE SENTENCE DESCRIPTION STATUS ORDERED; NO CONTACT. REVOKE 93M5149 AND TERMINATE. /DM 2 ( ) 18-9-111 Harassment M3 domestic violence Offense Date: From: 7/04/1994 To: 7/04/1994 Time: 11:20 PM BAC: .000 Arrest Date........ 7/04/1994 Time: Ticket #: 61671 Plea ............... Plea of Guilty Date: 7/14/1994 Disposition........ Guilty Date: 7/14/1994 SNT DATE SENTENCE DESCRIPTION STATUS 7/14/1994 Sentence Resulting fm Plea Judicial Officer..........: MARSHA BAER YEAGER FILE DATE EVENT DESCRIPTION 7/05/1994 Misdemeanor Complaint Filed Event ID: 000001 E -Filed: FILE DATE SCHEDULED EVENT DESCRIPTION SCHD DATE TIME ROOM PRI 7/05/1994 First Appearance 7/05/1994 02:00 PM CJ Officer: MARSHA BAER YEAGER Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: IN CUSTODY IN CUSTODY /KG SEE SENTENCE TO COUNT 1 /DM 7/05/1994 Pre -Trial Conference 7/22/1994 11:00 AM 107 Officer: MARSHA BAER YEAGER Length: 1.00 Hour(s) Status.: VACT-Vacated Note..: DA OFFICE 7/14/1994 Disposition Hearing 7/14/1994 02:15 PM CJ 04 Officer: MARSHA BAER YEAGER Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: IN CUST 7/14/1994 Case Closed Event ID: 000008 E -Filed: 8/21/1995 Motion Event ID: 000010 E -Filed: BY DA -MOTION TO REVOKE PROBATION /KAG 9/01/1995 Hearing on Probation 10/13/1995 02:30 PM 7 Officer: CARE HOYE ENICHEN Length: 1.00 Hour(s) Status.: PFTA-Party Failed to Appear Note..: COMPLAINT 10/13/1995 Warrant Failur to Appear Event ID: 000012 E -Filed: DEF/ WALSH, PATRICK SEAN BOND SET AT 1000.00 WARRANT EXPIRES 4/30/97 DEF FTA'D PROB REVOC HEARING /,JM Related Event RSWT Return of Service on Warrant 2/05/1996 12/20/1995 Review 4/30/1997 07.00 AM Q •1.00 Officer: CLERK OF COURT Length: Hour(s) Status.: VACT-Vacated Note..: WARR EXP 2/05/1996 Further Proceedings 2/14/1996 09:00 AM F Officer: KRISTINA B HANSSON Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: ON BOND 7 ON BOND /KAG 2/05/1996 Return of Service on Warrant Event ID: 000017 E -Filed: DEF/ WALSH, PATRICK SEAN FILE DATE SCHEDULED EVENT DESCRIPTION SCHD DATE TIME ROOM PRI Related Event WFTA Warrant Failur to Appear 10/13/1995 2/05/1996 Reopened Event ID: 000018 E -Filed: 2/14/1996 Hearing on Probation 2/21/1996 03:00 PM 7 Officer: CARE HOYE ENICHEN Length: 1.00 Hour(s) Status.: VACT-Vacated Note..: CONTESTED 2/21/1996 Order Event ID: 000022 E -Filed: DA WITHDRAWS COMP; PROB TERMINATED /JM 2/21/1996 Closed after post jdg activity Event ID: 000023 E -Filed: BOND INFORMATION Bond Id Number...... 1 Bond Status..... Set Date............ 10/13/1995 Set Amount...... $1,000.00 Type: Post Date........... 2/05/1996 Post Amount..... $1,000.00 Type: SUR Prof Surety Power #: 10-244030 Bond Instructions: May use for Fines and Costs: May be released to Defendant: End of Case: 1994 M 002666 CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: 10 assist you In the preparation for your uptoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: ��7L)-1 GK_ (pow //I)a6-4 J� /ff�S ���� Name of Liquor Licensee or Applicant: oaL- C . Description of Charge and Date: �✓I l//h Gi 1�1,1� i �? �[ I /Da i,'�c( Date of Final Court Resolution: (-'2 ( I G j I g S q Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual Histtoryy Record Form: '(� l IJ � I �� �QN r k rA r o? r? Court documents showing dismissal attached? Please Explain: ❑ Yes "o Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please Explain: II ^^ �► Cb�l.1A Ci A LSD J e_� �\ Ac p OPV ��� 1 o in a,"j PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARREST OR CHARGE. PLEASE SUBMITTHIS ! QMCUCCT AKIM At 1 A'T'T'A /'yIR4.:_%j Ar 1 C.r Cr 2n AIS n�Jr l],ray Irnl IR'f! �. �1�RRI ��� Ar.� nn .... �i ,. _� % �i%�✓r:t:. .ti: Pr.i. r.r-1 tory. J✓tet r,r r"'rrcnl ry rv=', DLAI I�rcrcrvrcl C vIY vIY I17C DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. RID:C0071994T 007226 COUNTY COURT, BOULDER COUNTY, COLORADO Court Address: Boulder Justice Center 1777 Sixth St. P.O. Box 4249 Boulder, CO 80306-4249 Phone Number: 303-441-3750 The People of the State of Colorado vs. WALSH, PATRICK SEAN Defendant: WALSH, PATRICK SEAN Count 1 42-4-1202(1)(b) - Driving while Ability Impaired ASSESSED FINES & COSTS Outstanding JudgmentMarrant Fee TOTAL GLOWINSKY CAROL Judge/Magistrate WALSH. PATRICK SEAN Defendant " COURT USE ONLY " Case Number: 1994T 007226 Division: 9 SENTENCE ORDER Date of Birth: Class Plea Finding M Plea to Lesser Charge Guilty $30.00 PAID $0.00 01/04/2017 Date 01/04/2017 Date .....,.,*.............*.*......*...,..*..,....,,,,,.......,,.,NOTICE..,,..,....,,*,,,,**.....,..*,...**.....,*,.,,,,.,,.*.......... Following this hearing you are to present this form to the Clerk's Office for_ pa ment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. I N T E G R A T E D C O L O R A D O O N L I N E N E T W O R K (I C O N) Status: CLSD County Court, Boulder County Case #: 1994 T 007226 Div/Room: 9 Type: Driving Under the Influenc The People of the State of Colorado vs. WALSH, PATRICK SEAN DV STATUS: Case File Date: 9/28/1994 Case Close Date: 12/16/1994 Appealed: N Confidential Intermediary .............. Bar # Name Judicial Off...: 001078 DAVID R TORKE Alt Jud Officer: 000000 Description Trial........... Court Trial Next Schd Event: Last Schd Event: Hearing Last Event.....: Notice Filed Attorney(s)..... N Stat Date Time Rm/D HELD 12/30/1994 2:00 P 0:00 HELD 2/02/1995 2:00 P n/a 6/15/1995 Agency: Boulder County Sheriff Dept Agency Case #: Ticket/Summons Number(s): 19847 Arrest#: Warrant.........: Warrant Date: Expired Date: Party on Warrant: Change of Venue.: Agency: Bond(s)................... Y Sentence Date ............. SCRT 12/16/1994 Detention Location.......: Supervising Agency.......: Probation Officer......... ----- PARTIES ----- PARTY ROL STS NAME ATTORNEY DEF 1 WALSH, PATRICK SEAN P WALSH, PATRICK SEAN Date of Birth............ Sex...................... Male Race ..................... Caucasian Home Phone ............... (303) 581-0405 Height ................... 510 Weight ................... 140 Hair Color ............... Brown Eye Color ................ Blue Marital Status........... Separated Home Address ............. : BOULDER, CO 80302-0000 PPL 1 THE PEOPLE OF THE STATE OF C ----- OTHER PEOPLE ----- ROLE NAME IMP 1 OTH MULLER, TAREE CNT STS STATUTE NUMBER CHARGE DESCRIPTION 1 ( ) 42-4-1202(1)(b) Driving while Ability Impaired 0601 CLASS M CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS Offense Date: From: 9/27/1994 To: 9/27/1994 Time: 09:15 PM BAC: .000 Arrest Date)......: 9/27/1994 Time: Ticket #: 19847 Plea. ......... : Plea to Lesser Charge Date: 12/16/1994 Disposition.......: Guilty Date: 12/16/1994 1 (A) 42-4-1202(1)(a) Driving under the Influence M Offense Date: From: 9/27/1994 To: 9/27/1994 Time: 09:15 PM BAC: .000 Arrest Date........ 9/27/1994 Time: Ticket #: 19847 SNT DATE SENTENCE DESCRIPTION STATUS 12/16/1994 Sentence by Court Judicial Officer........... DAVID R TORKE Community Service.......... 24.00 HOUR(S) Probation .................. 12.00 MONTH(S) Victim Compensation Fund..: $25.00 Victims Assistance Fund...: $60.00 LEAF Assessment............ $90.60 Alcohol Eval Fee........... $149.00 Court Costs ................ $18.00 $60 COMM CORR /CL FILE DATE EVENT DESCRIPTION 2/02/1994 Order Event ID: 000014 E -Filed: 9/28/1994 Summons and Complaint Filed Event ID: 000001 E -Filed: FILE DATE SCHEDULED EVENT DESCRIPTION SCHD DATE TIME ROOM PRI 9/28/1994 First Appearance 9/28/1994 02:00 PM CJ Officer: DAVID R TORKE Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: IN CUSTODY IN CUSTODY /KG 9/29/1994 Pre -Trial Conference 10/20/1994 10:00 AM 109 Officer: DAVID R TORKE Length: 1.00 Hour(s) Status.: HELD -Hearing Held 10/12/1994 Pre -Trial Conference 10/13/1994 08:30 AM 109 Officer: DAVID R TORKE Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: DAIS OFC 10/13/1994 Certificate Filed Event ID: 000006 E -Filed: TRIAL DATA /MM 10/14/1994 Court Trial 12/30/1994 02:00 PM 9 Officer: DAVID R TORKE Length: 1.00 Hour(s) Status.: HELD -Hearing Held 12/16/1994 Case Closed Event ID: 000011 E -Filed: 2/02/1995 Order Event ID: 000013 E -Filed: DEF APPEARED, WAS ORDERED TO COMPLETE LEVEL II EDUCATION AND THERAPY, AND ALCOHOL UNIT IS TO DISCONTINUE UA'S /CL IF THERAPIST BELIEVES THERAPY IS NOT NEEDED TO EXTENT ORDERED, CAN SEND REPORT TO COURT TO THAT EFFECT /CL 6/15/1995 Notice Filed Event ID: 000015 E -Filed: COMMUNITY CORRECTIONS NOTICE OF NONCOMPLIANCE /KAG 11/25/2014 Hearing 2/02/1995 02:00 PM 9 Officer: CAROL GLOWINSKY Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: ALC DISP BOND INFORMATION Bond Id Number...... 1 Bond Status..... Post Date........... 9/30/1994 Post Amount..... $500.00 Type: PRC Bond Instructions: May use for Fines and Costs: May be released to Defendant: BOND INFORMATION Conditions: MONITORED ANTABUSE End of Case: 1994 T 007226 4S CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: 1 o assist you In the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: /-I. "/ CK rS,o_a n �it4,/at t Name of Liquor Licensee or Applicant: Description of Charge and Date: CC" M -od IMS S Ck►Q t Date of Final Court Resolution: (D 1 1 ci I aq l0 1 ❑ Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: / 4/- r (; LCge UJe rP Gi'� 1 oged +o �a -.s f of m/i.4 re-roLeGi to ✓ DA rr r 4V_ (i/ r �l 10 VI �� DF4V_k15`�0; ti feCor'9C �vt . _MZCL4rq.a-S go Cll5vL,c55ta G-4e,f 0. 0( -P -4e, Q_9 to VX . Court documents showing dismissal attached? yes ❑ No Please Explain: �' LQ c k. fern r c� S a-{ a, c_ Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? PYes ❑ No Please Explain: 3 -'Se TISM's5cs PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARREST OR CHARGE. PLEASE SUBMIT THIS iii YilVCL.ICCT Ah1-1 1111 ATPA/`�J1f r..1�fT[` AT 1 I'll fT± MAVf` l.rffno_T %I^) on. RI A I �rA/�IJ.Ir ATP � � r. r�i "i7iZ t�J iiic.r n�r�r�r.l Rr C4/F/1 VIS Y\T,4i, PV'rV tv wr-m 1'ILP *1'VV"f0)'V1 VlVr 1,14L DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. COUNTY COURT, BOULDER COUNTY, COLORADO Court Address: Boulder Justice Center 1777 Sixth St. P.O. Box 4249 Boulder, CO 80306-4249 Phone Number: 303-441-3750 The People of the State of Colorado vs. WALSH, PATRICK SEAN Defendant: WALSH, PATRICK SEAN Count 1 18-4-501 - Criminal Mischief 2 18-4-502 - First Degree Criminal Trespass ASaeaseu riNt5 & COSTS TOTAL GLOWINSKY CAROL Judge/Magistrate WALSH. PATRICK SEAN Defendant SENTENCE ORDER RID:C0071995F 000013 " COURT USE ONLY " Case Number: 1995F 000013 Division: 9 Date of Birth: Class Plea Finding M2 F5 $0.00 01(04/2017 Date 01/04/2017 Date .....****..,...,.«...............,.,**..*....,..,,*.*..,.......NOTICE*..*.....*.�,,.*.**........*.......,...,...*.*.,*,*„*....... Following this hearing you are to present this form to the Clerk's Office for payment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. I N T E G R A T E D C O L O R A D O O N L I N E N E T W O R K (I C O N) Status: CLSD County Court, Boulder County Case #: 1995 F 000013 Div/Room: 9 Type: Trespass The People of the State of Colorado vs. WALSH, PATRICK SEAN DV STATUS: Case File Date: 1/04/1995 Case Close Date: 10/15/1996 Appealed: N Confidential Intermediary .............. Bar # Name Judicial Off...: 009407 CAROL GLOWINSKY Alt Jud Officer: 000000 Description Stat Date Time Rm/D Trial........... 0:00 Next Schd Event: 0:00 Last Schd Event: End Deferred Plea/Prosec Hrg VACT 2/01/1996 7:00 A Last Event.....: Motion n/a 10/16/1996 Attorney(s)..... Y Agency: Boulder Police Dept Agency Case #: Ticket/Summons Number(s): 64866 Arrest#: Warrant.........: Warrant Date: Expired Date: Party on Warrant: Change of Venue.: Agency: Bond(s)................... Y Sentence Date ............. SCRT 2/21/1995 Detention Location.......: Supervising Agency.......: Probation Officer......... ----- PARTIES ----- PARTY ROL STS NAME ATTORNEY ROL DEF 1 WALSH, PATRICK SEAN JACOBSON, STEVEN KEITH DPU Date of Birth............ Sex ...................... Male Race ..................... Caucasian Height ................... 511 Weight ................... 155 Hair Color ............... Brown Eye Color ................ Blue Home Address ............. : BOULDER, CO 00000-0000 CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS 1 ( ) 18-4-501 Criminal Mischief M2 investigation -under $100 Offense Date: From: 1/03/1995 To: 1/03/1995 Time: 02:20 PM BAC: .000 Arrest Date........ 1/03/1995 Time: Ticket #: 64866 SNT DATE SENTENCE DESCRIPTION STATUS 2/21/1995 Sentence by Court Judicial Officer........... DAVID R TORKE Deferred Prosecution......: 12.00 MONTH(S) CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS NO ALC OR DRUGS, COMPLETE DRUG TX, ALC TX, CONCURRENT TO TX ALREADY ORDERED IN PREVIOUS CASE /KG 2 ( ) 18-4-502 First Degree Criminal Trespass F5 investigation Offense Date: From: 1/03/1995 To: 1/03/1995 Time: 02:20 PM BAC: .000 Arrest Date........ 1/03/1995 Time: Ticket #: FILE DATE EVENT DESCRIPTION 1/04/1995 Arrest Report Filed FILE DATE SCHEDULED EVENT DESCRIPTION 1/04/1995 First Appearance Officer: DAVID R TORKE Status.: HELD -Hearing Held IN CUSTODY 1/04/1995 Rtrn Filing of Charges Officer: DAVID R TORKE Status.: HELD -Hearing Held 1/09/1995 Preliminary Hearing Officer: CAROL GLOWINSKY Status.: VACT-Vacated 1/09/1995 Motion FOR PRELIMINARY HEARING 2/02/1995 Further Proceedings Officer: CAROL GLOWINSKY Status.: HELD -Hearing Held 2/15/1995 Disposition Hearing Officer: CAROL GLOWINSKY Status.: HELD -Hearing Held 2/21/1995 End Deferred Plea/Prosec Hrg Officer: CAROL GLOWINSKY Status.: VACT-Vacated 2/21/1995 Converted -Deferred Pros Grant 10/09/1996 Miscellaneous FILE TO DA FOR ACTION 10/15/1996 Motion BY DA TO DISMISS DEFERRED PROSECUTION 10/15/1996 Dism after Successful Completi 10/15/1996 Case Closed 10/16/1996 Motion BY DA TO DISMISS Event ID: 000001 SCHD DATE TIME ROOM PRI 1/04/1995 02:00 PM CJ Length: 1.00 Hour(s) Note..: IN CUSTODY /KAG 1/06/1995 02:00 PM CJ 03 Length: 1.00 Hour(s) 1/30/1995 09:00 AM 9 Length: 1.00 Hour(s) Event ID: 000007 2/15/1995 09:00 AM 9 Length: 1.00 Hour(s) 2/21/1995 09:00 AM 9 Length: 1.00 Hour(s) 2/01/1996 07:00 AM 9 Length: 1.00 Hour(s) Event ID: 000010 Event ID: 000013 Event ID: 000014 Event ID: 000015 Event ID: 000016 Event ID: 000017 BOND INFORMATION /MM / JF /DLC /DLC Bond Id Number...... 1 Bond Status..... Set Date............ 1/04/1995 Set Amount...... $500.00 Type: Post Date........... 1/05/1995 Post Amount..... $500.00 Type: PR Bond Instructions: May use for Fines and Costs: May be released to Defendant: Conditions: PR IF VERIFIABLE ADDRESS, NO CONTACT End of Case: 1995 F 000013 CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: To assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: Taut'k 5 ✓vl W G S Name of Liquor Licensee or Applicant:I 'CN S u-��Ze�T a'A'.- LL' Description of Charge and Date: ! a,J vP ryz_ Ao A pPe-o—r- Date of Final Court Resolution: P) Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record For�: C n I 0 t5CLZ' o`` of2S Tc)��S�oV O.X� -b Ilt�v. Court documents showing dismissal attached? ❑ Yes F9 No Please Explain: Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please Explain: a, Ss' t-0 N S a a o , PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARRESTOR CHARGE. PLEASE SUBMIT THIS inivi�i�Sncc r AND ALL A77ACHivtEi' fS AT LEAS -r Y UA" ef(VOK 1 U 9UCIK CLA HEAKfNG 1JAf . oil url I hik DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK -WORKSHEET: I o assist you In the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: ?Gtij t o W otL S\A Name of Liquor Licensee or Applimnt: tkkP�S 2 2 C ('tt� `� L_ Description of Charge and Date: _N k,4 A ex( r r- t rA tv, �r, i WC4ra Sc, Date of Final Court Resolution: 10 f ( (a 1. C1 Q, Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: r t �^�� r,. ow9a,C w�Q AI Sc LoSEu4-okA--,f- \w -s 09-"rncoLeC4 0v1 PCe(,kQNc:rlaC aD-jP&u&T 011ow Sf iioy S acn r�i Q�IwLp )vl IA, . —Lice 1 �I J W a 4' r - A / Court documents showing dismissal attached? ❑ Yes M No Please Explain: Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please (Explain: f r I N,G J e U _0.,r w D. n^ I S -� zk i J a Vk ct Vvn a ✓l Vy-;SAV dtn.c tm,e.,.A,i-tV 0� ;bu.p/t� hvVj, I (91A)& wt-- - 1-,'�-w 6uslae--3s Ct,,d �o�d 0- Li, �Vas (IUA/192 tVt LovL5atk�R_Go 1h gooa S-t-.wtofI I PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARRESTOR CHARGE. PLEASE SUBMIT THIS to/ADVCUCCT A/11'1 All ATTAC,X_AZ_1/TC AT 11• AR $nAVrn IrIATrL�+t � n "r4QIN VTrn r;:.r rr.r� r. r.7. -r r cors r� .r vrs r ri�irc,n r r v =:nficnJvT r r,rcrrr lYi ui-c l C vi c vio' T; -f� DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. COUNTY COURT, BOULDER COUNTY, COLORADO Court Address: Boulder Justice Center 1777 Sixth St. P.O. Box 4249 Boulder, CO 80306-4249 Phone Number: 303-441-3750 The People of the State of Colorado VS. WALSH, PATRICK SEAN Defendant: WALSH, PATRICK SEAN Count 1 18-4-504(1) -Third Degree Criminal Trespass 2 18-9-111(1)(g) -Harassment: Inconvenient Hours ASSESSED FINES & COSTS Count # 2 Victim Compensation Fund Victims Assistance Fund Court Costs Probation REVOKED: 24 Months Jail: 10 Days Probation Reinstated: 24 Months Jail: 20 Days TOTAL SENTENCE ORDER -�tl 0 RID:C0071997M 003451 COURT USE ONLY " Case Number: 1997M 003451 Division: 10 Date of Birth: Class Plea Finding P01 Plea Not Guilty Dism by DA M3 Plea of Guilty Guilty $60.00 $60.00 $18.00 $138.00 Other Conditions of Sentence: PROS REVOKED & REINSTATED, ALL ORIG T'S & C'S PLUS 20 DAYS JAIL ON WORKENDERS WITH START DATE OF 06/26/98. DEF RE-REFERRED TO INTERVENTIONS /CL MONTGOMERY LAEL ELISABETH Judge/Magistrate WALSH. PATRICK SEAN Defendant 10/29/1997 Date 10/29/1997 Date .�*.....�...,,*.,,.«....,.**.*..,,....,.***......,,.,*.,,*....,.,.NOTICE...........................,,,.,,,,.,,..,....***.**....«......, Following this hearing you are to present this form to the Clerk's Office for pa ment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. I N T E G R A T E D C O L O R A D O O N L I N E N E T W O R K (I C O N) Status: CLSD County Court, Boulder County Case #: 1997 M 003451 Div/Room: 10 Type: Public Peace And Order The People of the State of Colorado vs. WALSH, PATRICK SEAN DV STATUS: Case File Date: 8/25/1997 .,,.Ga-ffe Close Date: 10/16/1998 4pealed: N Confidential Intermediary. ............ : Bar # Name Judicial Off...: 009193 JOHN F STAVELY Alt Jud Officer: 000000 Description Stat Date Trial........... Next Schd Event: Last Schd Event: Review VACT 2/28/2000 Last Event.....: Return of Service n/a 10/26/1998 Attorney(s)..... N Agency: Boulder Police Dept Agency Case #: Ticket/Summons Number(s): 5555 Arrest#: Time Rm/D 0:00 0:00 7:00 A Warrant.........: WRQU Warrant Date: 10/08/1998 Expired Date: Party on Warrant: WALSH, PATRICK SEAN Change of Venue.: Agency: BOCS Boulder County Sheriff Dept Bond(s)................... Y + Sentence Date ............. SPLE 10/29/1997 + Detention Location.......: Supervising Agency.......: Probation Officer......... ----- PARTIES ----- PARTY ROL STS NAME ATTORNEY DEF 1 WALSH, PATRICK SEAN Date of Birth............ Sex ...................... Male Race ..................... Caucasian Height ................... 511 Weight ................... 170 Hair Color ............... Brown Eye Color ................ Blue Home Address ............. : buuLDER, CO 80301-0000 PPL 1 THE PEOPLE OF THE STATE OF C ----- OTHER PEOPLE ----- ROL ROLE NAME IMP 1 SUR GULLETTE, TODD CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS 1 (D) 18-4-504(1) egree Criminal Trespass P01 Offense Date: Fro $/23/19 8/23/1997 Time: 02:15 AM BAC: .000 Arrest Date........ 8/2-3/1997 Time: Ticket #: 5555 Plea ............... Plea Not Guilty Date: 9/17/1997 CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS Disposition........ Dism by DA Date: 10/29/1997 2 ( ) 18-9-111(1)(g) Harassment: Inconvenient Hours M3 domestic violence Offense Date: From: 8/23/199 To: 8/23/1997 Time: 02:15 AM BAC: .000 Arrest Date........ � 23/199.7= Time: Ticket #: 5555 Plea............... Plea Not Guilty Date: 9/17/1997 Plea............... Plea of Guilty Date: 10/29/1997 Disposition........ Guilty Date: 10/29/1997 SNT DATE SENTENCE DESCRIPTION STATUS 10/29/1997 Sentence Resulting fm Plea Void Judicial Officer..........: THOMAS JEFFERSON REED Modified Date.............. 6/12/1998 Victim Compensation Fund..: $60.00 Victims Assistance Fund...: $60.00 Court Costs................ $18.00 Probation.................. 24.00 MONTH(S) Jail....................... 10.00 DAY(S) HOME DETENTION; DV TX; SUPV THRU ADULT PROB; NO CONTACT W/JESSICA BRUNNER; MON SOBR /LAG 10/29/1997 Sentence Resulting fm Plea Active Judicial Officer..........: LAEL ELISABETH MONTGOMERY Victim Compensation Fund..: $60.00 Victims Assistance Fund...: $60.00 Court Costs................ $18.00 SNT DATE SENTENCE DESCRIPTION STATUS Probation.................. 24.00 MONTH(S) RK Jail.. : ................... : 10.00 DAY(S) Probation Reinstated......: 24.00 MONTH(S) Jail....................... 20.00 DAY(S) PROB REVOKED & REINSTATED, ALL ORIG T'S & C'S PLUS 20 DAYS JAIL ON WORKENDERS WITH START DATE OF 06/26/98. DEF RE-REFERRED TO INTERVENTIONS /CL FILE DATE EVENT DESCRIPTION 8/25/1997 Misdemeanor Complaint Filed Event ID: 000001 E-Filed: FILE DATE SCHEDULED EVENT DESCRIPTION SCHD DATE TIME ROOM PRI 8/25/1997 Arraignment 9/17/1997 09:00 AM F Officer: KRISTINA B HANSSON Length: 1.00 Hour(s) Status.: HELD-Hearing Held Note..: TO DIV 10 ON BOND /VAR 9/18/1997 Pre-Trial Conference 10/23/1997 10:45 AM 110 Officer: THOMAS JEFFERSON REED Length: 1.00 Hour(s) Status.: HELD-Hearing Held Note..: DAS OFFICE 10/24/1997 Disposition Hearing 10/29/1997 02:00 PM 10 Officer: THOMAS JEFFERSON REED Length: 1.00 Hour(s) Status.: HELD-Hearing Held 10/29/1997 Case Closed Event ID: 000011 E-Filed: 10/29/1997 Case Closed Event ID: 000018 E-Filed: 12/24/1997 Notice Filed Event ID: 000012 E-Filed: OF COMPLETION OF IN HOME DETENTION /WES 4/02/1998 Report Event ID: 000013 E-Filed: FROM BLDR ALCOHOL EDUCATION CENTER /DLC 4/08/1998 Complaint Event ID: 000014 E-Filed: DEF/ WALSH, PATRICK SEAN FROM INTERVENTION- FOR REVOCATION OF SUPERVISION AND REQUEST FOR NOTICE OF HEARING. /LAD FILE DATE SCHEDULED EVENT DESCRIPTION SCHD DATE TIME ROOM PRI 4/08/1998 Reopened Event ID: 000015 E -Filed: DEF/ WALSH, PATRICK SEAN 4/16/1998 Warrant Failure To Comply Event ID: 000016 E -Filed: DEF/ WALSH, PATRICK SEAN BOND AMOUNT $500 WARRANT EXPIRES: 10/31/99 FAILURE TO COMPLY W/ INTERVENTION /LAD Related Event WRQU Warrant Quashed 6/12/1998 4/17/1998 Review 10/31/1999 07:00 AM Q Officer: CLERK OF COURT Length: 1.00 Hour(s) Status.: VACT-Vacated Note..: WARR EXP 6/12/1998 Further Proceedings 6/12/1998 02:00 PM CJ 02 Officer: LAEL ELISABETH MONTGOMERY Length: 1.00 minute(s) Status.: HELD -Hearing Held Note..: IN CUSTODY 6/12/1998 Warrant Quashed Event ID: 000017 E -Filed: BSO S986360; BLDR P988919 /LEJ Related Event WFTC Warrant Failure To Comply 4/16/1998 8/18/1998 Filing Other Event ID: 000019 E -Filed: BY BSO - DEF FTA TO SERVE SENTENCE; 8 OF 20 DAYS SERVED /LEJ 8/19/1998 Order Event ID: 000020 E -Filed: WARRANT ORDERED, NO BOND, SERVE 12 DAYS STRAIGHT /CL 8/19/1998 Reopened Event ID: 000021 E -Filed: 8/19/1998 Warrant Failure To Comply Event ID: 000022 E -Filed: DEF/ WALSH, PATRICK SEAN DEFT FTC W\MITT SENTENCE NO BOND, NO EXP DEFT MUST SERVE 12 DAYS STRAIGHT /MM Related Event WRQU Warrant Quashed 10/08/1998 8/24/1998 Review 2/28/2000 07:00 AM Q Officer: CLERK OF COURT Length: 1.00 Hour(s) Status.: VACT-Vacated Note..: NO EXP 10/02/1998 Complaint Event ID: 000023 E -Filed: FOR REVOCATION OF SPRVSN AND RQST FOR NOTICE OF HRG BY INTERVENTION /CJN 10/08/1998 Warrant Quashed Event ID: 000024 E -Filed: Related Event WFTC Warrant Failure To Comply 8/19/1998 10/08/1998 Mittimus Issued Event ID: 000025 E -Filed: AMENDED MITTIMUS ISSUED FOR DEF. /CT 10/08/1998 Further Proceedings 10/16/1998 09:00 AM 10 Officer: THOMAS JEFFERSON REED Length: 1.00 Hour(s) Status.: HELD -Hearing Held 10/16/1998 Order Event ID: 000026 E -Filed: DEF IN CUSTODY; MANINGO PD; DEF ADMITS VIOLATION; PROBATION REVOKED AND TERMINATED; 30 DAYS JAIL GIVEN, CTS. 10/16/1998 Closed after post jdg activity Event ID: 000027 10/26/1998 Return of Service Event ID: 000028 BY BSO - MITT SENTENCE COMPLETED 10-25-98 BOND INFORMATION Bond Id Number...... 1 Bond Status..... Post Date........... 8/25/1997 Post Amount..... $500.00 Bond Instructions: May use for Fines and Costs: May be released to Defendant: Conditions: CS; NO CONTACT; INTERIM SUPV; MONITORED SOBRIETY /CT E -Filed: E -Filed: /LEJ Type: CS BOND INFORMATION Bond Id Number...... 2 Bond Status..... Set Date............ 4/16/1998 Set Amount...... $500.00 Type: Post Date........... Post Amount..... Type: Bond Instructions: May use for Fines and Costs: May be released to Defendant: End of Case: 1997 M 003451 # , --C bel levc., ,z 8' 9 v VI -Caste prrobcz iov% V , 0 l ce'10V--, ad d cA -b CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK -WORKSHEET: p�.r res fS � To assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: , a1r'c U)akk_ Name of Liquor Licensee or Applicant: 5 Ckrswee Gf� LLC Description of Charge and Date: j m y Zq I g R b J, I L p(Xe. bra j l� Ve C�ecicec� wikl�-{-I�e.&)VhGor�-a-►Iv( Date of Final Court Resolution: YA L) vl.i ct Co J r+ are,( -r-�y Ao not ve.a, r&D1_0( ❑ Convicted of Charge? ❑ Charge Dismissed? O Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: L Old, r I Ott'sC�O (-i��e c�lGirg25 -i-0 I G\e_ be -sl of hely reCaIeCf I ru S WQ S VLe-Ar l y2 U y o ar5 a 01 Court documents showing dismissal attached? ❑ Yes ❑ No Please Explain: I I •2G c,{-vl d Gt Va Gam` ' VC CLtIfl GLGVlLI CO�i e S� J VL I -Mat was nDvle.-PoThtS ct_"2li'�w+In.-e_G0' 0fV&OeilGt��2 Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ,(Yes ❑ No Please Explain: SLe, CDVe.0 page_ PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARRESTOR CHARGE. PLEASE SUBMIT THIS Wt RKSHEE r Ardu ALL A77AC.l"(I{%EWS AT LtASf :J UMTS AvOk O TUCK ULA FiEAFtfi G IjAI E at? ON I Fit DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. /- ** iq CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: To assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: ���, � C�_ IN R t S Name of Liquor licensee or Applicant: AA -e/, S u-, a e k Cc�,4 LL,c. Description of Charge and Date: �0 1 h So oot/ri ct I 'QW A 1 Date of Final Court Resolution: 2(P °lel `Convicted of Charge? ❑ Charge Dismissed? Explanation of Omisslon/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual Historyecord Form: '%.x(p� �lC_ �oSeAAP ren rjOli. ah VA/11 4,ii�rNn, x' 't,; wal.,v_,grq I 0p j 0190 14 A IM2 ` IA v%Am th2 oiL tn� l q.S LX�e�.Ll) Itiicrly t Court documents showing dismissal attached? ❑ Yes i Mo Please Explain: S e,e a4c' C'"_cL Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? ❑ Yes ❑ No Please Explain:t- IOft A w, ✓ C�1 (x i j' l�!„/`a�,., 1 P ie r S'o ✓A 40 uJ. � � 4 V.0 /,-At r n moo( 9 1o/ t?6ov/ l / ea SIn ,'/fine, l4ou qf�t���� nvyn tvI fA 2/rr�s� e� ��sa eta k,Lae he.Lvl�n goo�� s'f-qtw.'� fro CJgzet� C�� qes« / �l��eGvriJ�_ PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARRESTOR CHARGE. PLEASE SUBMIT THIS ir`v R.13Hci"r AiiiDFAZ: Ar-rgcHiZitiv' i i A LLEAs r y"IIIKTS FKIUIS i u 1W K bLFt; FItAKfNU UAI t UK UN I Flt DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. COUNTY COURT, BOULDER COUNTY, COLORADO Court Address: Boulder Justice Center 1777 Sixth St. P.O. Box 4249 Boulder, CO 80306-4249 Phone Number: 303-441-3750 /2 ol/�/ RID:C0071998T 005210 COURT USE ONLY " Other Conditions of Sentence: CASE TERMINATES WITH 30 DAYS HOME DETENTION AND PAYMENT OF COSTS OF $444 MONTGOMERY LAEL ELISABETH Judge/Magistrate WALSH. PATRICK SEAN Defendant 06/12/1998 Date Q6/12/1998 ate .*....,..,.,.,,,,........,,,**.,.........,**...............,,,�.NOTICE..,..,.,,..,....,,.....,,.,,,,..,**,,,,,..,,*.,,,.**.**,,......,. Following this hearing you are to present this form to the Clerk's Office for pa ment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. Case Number: 1998T 005210 The People of the State of Colorado vs. WALSH, PATRICK SEAN Division: 9 aeN i tnCE ORDER Defendant: WALSH, PATRICK SEAN Date of Birth: Count Class Plea Finding 1 42-4-1409(2) - Vehicle Operator w/o Insurance MT1 Dlsm by DA 2 42-4-1301(1)(b) - DRIVING WHILE ABILITY IMP -2ND OFF M Plea of Guilty Guilty ASSESSED FINES & COSTS Count # 2 Probation Alcohol Eval & Supry REVOKED: 24 Mo Jail: 20 Days Community Service: 48 Hours Victim Compensation Fund $25.00 Victims Assistance Fund $60.00 LEAF Assessment $90.00 Alcohol Eval Fee $156.00 Court Costs $18.00 Jail: 30 Days Outstanding Judgment/Warrant Fee $60.00 PAID TOTAL $349.00 Other Conditions of Sentence: CASE TERMINATES WITH 30 DAYS HOME DETENTION AND PAYMENT OF COSTS OF $444 MONTGOMERY LAEL ELISABETH Judge/Magistrate WALSH. PATRICK SEAN Defendant 06/12/1998 Date Q6/12/1998 ate .*....,..,.,.,,,,........,,,**.,.........,**...............,,,�.NOTICE..,..,.,,..,....,,.....,,.,,,,..,**,,,,,..,,*.,,,.**.**,,......,. Following this hearing you are to present this form to the Clerk's Office for pa ment. Payment is due by the end of business on your Court Date. Pursuant to §16-11-101.6, C.R.S., if the Defendant does not pay all amounts assessed at the time of order, the Defendant shall pay an additional time payment fee. In addition, the Defendant may be assessed a late penalty fee each time payment is not received on or before the due date. I N T E G R A T E D C O L O R A D O O N L I N E N E T W O R K (I C O N) Status: CLSD County Court, Boulder County Case #: 1998 T 005210 Div/Room: 9 Type: Driving Under the Influenc The People of the State of Colorado vs. WALSH, PATRICK SEAN DV STATUS: Case File Date: 6/12/1998 Case Cloag nate; 7/26/1999 Appealed: N Confidential Intermediary .............. Bar # Name Judicial Off...: 012563 LAEL ELISABETH MONTGOMERY Alt Jud Officer: 000000 Description Stat Date Time Rm/D Trial........... 0:00 Next Schd Event: 0:00 Last Schd Event: Review VACT 8/31/2000 7:00 A Last Event.....: Amended Mittimus Issued n/a 8/19/1999 Attorney(s)..... Y Agency: Boulder Police Dept Agency Case #: P988919 Ticket/Summons Number(s): 93064 Arrest#: Warrant.........: WCAN Warrant Date: 6/21/1999 Expired Date: Party on Warrant: WALSH, PATRICK SEAN Change of Venue.: Agency: BOCS Boulder County Sheriff Dept Bond(s)................... Y Sentence Date ............. SPLE 6/12/1998 + Detention Location.......: Supervising Agency.......: Probation Officer......... ----- PARTIES ----- PARTY ROL STS NAME ATTORNEY ROL DEF 1 WALSH, PATRICK SEAN BENJAMIN, NICOLE MORBACH DPU P WALSH, PATRICK SEAN Date of Birth............ Sex...................... Male Race ..................... Caucasian Home Phone ............... Height ................... 511 Weight ................... 170 Hair Color ............... Brown Eye Color ................ Blue Home Address ............. : BOULDER, CO 80301 PPL 1 THE PEOPLE OF THE STATE OF C CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS 1 (D) 42-4-1409(2) Vehicle Operator w/o Insurance MT1 Offense Date: From: 6/12/1998 To: Time: 03:25 AM BAC: .000 Arrest Date.......Ticket #: 93064 Disposition........ Dism by DA Date: 6/12/1998 2 ( ) 42-4-1301(1)(b) DRIVING WHILE ABILITY IMP -2ND OFF M CNT STS STATUTE NUMBER CHARGE DESCRIPTION CLASS Offense Date: From: 6/12/1998 To: Time: 03:25 AM BAC: .000 Arrest Date........ 6/12/1998 Time: Ticket #: 93064 Plea ............... Plea of Guilty Date: 6/12/1998 Disposition........ Guilty Date: 6/12/1998 2 (A) 42-4-1301(1)(a) DRIVING UNDER THE INFLUENCE M Offense Date: From: 6/12/1998 To: Time: 03:25 AM BAC: .000 Arrest Date........ 6/12/1998 Time: Ticket #: 93064 SNT DATE SENTENCE DESCRIPTION STATUS 6/12/1998 Sentence Resulting fm Plea Void Judicial Officer..........: LAEL ELISABETH MONTGOMERY SNT DATE SENTENCE DESCRIPTION STATUS Modified Date .............. 7/26/1999 Probation Alcohol Eval & S: 24.00 MONTH(S) Jail ....................... 20.00 DAY(S) Community Service.......... 48.00 HOUR(S) Victim Compensation Fund..: $25.00 Victims Assistance Fund.... $60.00 LEAF Assessment............ $90.00 Alcohol Eval Fee........... $156.00 Court Costs ................ $18.00 $60 COM SERV FEE /CL 6/12/1998 Sentence Resulting fm Plea Active Judicial Officer..........: LAEL ELISABETH MONTGOMERY Probation Alcohol Eval & S: 24.00 MONTH(S) RK Jail ....................... 20.00 DAY(S) Community Service.......... 48.00 HOURS) SNT DATE SENTENCE DESCRIPTION STATUS Victim Compensation Fund..: $25.00 Victims Assistance Fund...: $60.00 LEAF Assessment............ $90.00 Alcohol Eval Fee........... $156.00 Court Costs ................ $18.00 ... .. . Jai 1. ........... '; 0_._0.0_-DAY.(_S ) CASE TERMINATES WITH 30 DAYS IONAND PAYMENT OF COSTS OF $444 DRI -E rVENT ESCRIPTI i 6/12/1998 Summons and Complaint Filed Event ID: 000001 E -Filed: ARREST REPORT /LEJ _F�L�B---, 6/12/1998 ase Closed Event ID: 000002 E -Filed: FILE DATE SCHE D EVENT DESCRIPTION SCHD DATE TIME ROOM PRI 6/12/1998 Arraignment 6/12/1998 02:00 PM CJ Officer: LAEL ELISABETH MONTGOMERY Length: 1.00 minute(s) Status.: HELD -Hearing Held Note..: IN CUSTODY IN CUSTODY /LEJ 6/15/1998 Disposition Hearing 6/12/1998 02:30 PM CJ Officer: LAEL ELISABETH MONTGOMERY Length: 1.00 Hour(s) Status.: HELD -Hearing Held Note..: IN CUSTODY 6/15/1998 Mittimus Issued Event ID: 000003 E -Filed: DEF/ WALSH, PATRICK SEAN 12/10/1998 Reopened Event ID: 000004 E -Filed: 12/10/1998 Filing Other Event ID: 000005 E -Filed: BY PROBATION - COMPLAINT AND REQUEST FOR ORDER AND SUMMONS /LEJ 12/29/1998 Hearing on Probation 2/22/1999 01:30 PM 9 Officer: LAEL ELISABETH MONTGOMERY Length: 1.00 Hour(s) Status.: PFTA-Party Failed to Appear FILE DATE SCHEDULED EVENT DESCRIPTION SCHD DATE TIME ROOM PRI 2/22/1999 Warrant Failur to Appear Event ID: 000006 E -Filed: DEF/ WALSH, PATRICK SEAN FOR COURT HEARING 2/22/99 - BOULDER /CRS Related Event WCAN Warrant Cancelled 6/21/1999 2/23/1999 Review 8/31/2000 07:00 AM Q Officer: CLERK OF COURT Length: 1.00 Hour(s) Status.: VACT-Vacated Note..: WARR EXP 6/14/1999 Further Proceedings 6/21/1999 02:00 PM 9 Officer: LAEL ELISABETH MONTGOMERY Length: 1.00 Hour(s) Status.: CONT -Continued by Parties 6/21/1999 Hearing on Probation 7/26/1999 09:00 AM 9 Officer: LAEL ELISABETH MONTGOMERY Length: 1.00 Hour(s) Status.: HELD -Hearing Held 6/21/1999 Warrant Cancelled Event ID: 000007 E -Filed: Related Event WFTA Warrant Failur to Appear 2/22/1999 6/23/Entry of Appearance Event ID: 000008 E -Filed: 1 '7/2_6/1999 Order _.Ev_ent_ID_: -000-009 E-Filed: _ _ _ ADMITS VIO, DEF WILL ZOMPLETE 30 DAYS HOME DETENTION IN LIEU OF PROB AND COMM SERVICE, DEF STILL OWES $444, WHEN PAID CASE WILL TERMINATE —" /CL 7/2.6/1959 Closed aYf6r post jdg activity Event­�[I7-""'00`0"010"'-" --E - iled: 8/19/1999 Amended Mittimus Issued Event ID: 000011 E -Filed: DEF/ WALSH, PATRICK SEAN BOND INFORMATION Bond Id Number...... 1 Bond Status..... Set Date............ 2/22/1999 Set Amount...... $1,000.00 Type: Post Date........... Post Amount..... Type: Bond Instructions: May use fox Fines and Coster -- May be released to Defendant: End of Case: 1998 T 005210 415 - CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: To assist you in the preparation for your upcoming testimony before the Beverage licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: /A7Y/riC f,4 h WG Name of Liquor Licensee or Applicant: 14ev'r W� Description of Charge and Date: /h4/c� Cr�1 in i Date of Final Court Resolution: ❑ Convicted of Charge? Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: / Gly S c /_-j <7 o ,W C �,,.r� 2 7 752s t o h -c �, r2 co tee 7/ran Court documents showing dismissal attached? ❑ Yes WNo Please Explain: Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? R Yes ❑ No Please Explain: Pe2-' f P See- PLEASE em PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARREST OR CHARGE. PLEASE SUBMITTHIS WORKSHEET AND ALL ATTACHMENTS AT LEAST 9 DAYS PRIOR TO YOUR BLA HEARING DATE OR ON THE DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. ,4�- %l, CRIMINAL CHARGE FOUND ON LIQUOR LICENSE APPLICANT BACKGROUND CHECK - WORKSHEET: To assist you in the preparation for your upcoming testimony before the Beverage Licensing Authority (BLA) or to help you provide more information to the City Licensing division to determine whether a BLA hearing will be scheduled, please complete the following worksheet: Person's Name: Pa+-, t Gk xeao (tea (c m Name of Liquor Licensee or Applicant: Description of Charge and Date: 7::Il 11 h 4 i h Date of Final Court Resolution: ❑ Convicted of Charge? ❑ Charge Dismissed? Explanation of Omission/ Non -disclosure of Charge on questions 10, 11, and 12 of State Individual History Record Form: Court documents showing dismissal attached? ❑ Yes ADNo Please Explain: p�11a14 Evidence of Rehabilitation (other licenses successfully held, education completed, businesses operated, changes in life experience, treatment completed, passage of time since last offense) attached? �@qes ❑ No Please Explain: seC, -0G_,47Z � PLEASE COMPLETE A WORKSHEET FOR EACH LISTED ARRESTOR CHARGE. PLEASE SUBMIT THIS WORKSHEET AND ALL ATTACHMENTS AT LEAST 9 DAYS PRIOR TO YOUR BLA HEARING DATE OR ON THE DEADLINE ESTABLISHED BY CITY LICENSING IF NO BLA HEARING HAS YET BEEN SCHEDULED. OR 8404-1 (03113115) 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. N me`qf Business I Homp Pnnno ti,,.. k— Cellular Number LLC, {3-7o�i-Z77� 2 Your Full N/amen(laUtfirs/ t, mid le) used 52I1i !'(�(�Y1G�G ("--o cit 4. Mailing address (if ifferen from residence) Email Address ftl /A& : 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 CUrrAnt F A077 ` -,1JA, ► Pec�u,'� u �Coc� 7-) q 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 In li'Am'ok L4 IoAo 119 L Folz 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, Wes ❑ No furniture, fixtures, a uipment or invento to any licensee? (If yes, answer in detail.) �-� P16q fir- ev, s1� �� s�; �� Lo, �o�0Z 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you LJYes ❑ No applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) m.l L i Lbvi5c t,0,5 3"sP -,--J � 6- ca�/-5 ek.4 Prc,,,S P1 --�/ �X 7 -L -c- 0�-(- , 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.) YesNo 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) ❑Yes NNo 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes 9 No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal II[p�fo[mati�n required in question #13 is solely for identification purposes. 13a. Date of Birth I b. Social Securitv Number I c PINe of Bi h C0fUr fd. U.S. Citizen OYes ❑No Wen g. Name of District Court f I h. Naturalization Certificate Number i. Date of Certification Ij. If an Alien, Give Alien's Registration Card Number Ik. Permanent Residence Card Number I. Height m. Weight Hair Color o.,, fE'"ye''Color p. Gender q. Race r..�IDo you have a current Driver's License/ID? If so, give npmber an state. `IZzd In. �a, '>, ueI I m I � I[oYes ❑No # ' State C6la3Y 14. Financial Information. a. Total urchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $_ IZD,6zc�-7 b. List the total amount of the personal investment, made by the person listed on question #2, int ' business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ ^ q6-1000 • 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 C6-0, k � ) 5" A— /4 q5t 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 e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Bank Name Amount Tetra Security Amount Oath of Applicant I declare under Pena v of that this ao IISaIgn and all attachments are true, corre and complete to the best of my knowledge. Auth ed Sj@fiaf - % Print Si nature �� , title Date 6989 Green willow ct. Boulder co. 80301 8-12/7-14 2733 Sunset st. Erie co. 80516 12-04/8-12 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 Cellular Number 2. Your u Name last, fi t, m�i d ejrl^P l� 1 s�?q 3 4q Ar �[ li l�o/ R�7hon y �(j,� riifferent from rest ence) Email Address �o ) clirai 1. Cor, 5. List current residence address. Include any previous addresses within the last five years. (Attad sepatite sheet if necessary) Street and Number City, State, Zip From To Current Allwd , Cc X050,3 /M 201& 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 ,,/ A � e,4Men4s LW- 10V60 kfer S�. �P`' ou)w 19�1� C':UXfei�l1322,/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 I Name of Licensee t on 01J3 alJ I 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 XNo 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.) ElYes 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 X No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) ❑ Yes TZ No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal info[m tion required in question #13 is solely for identification purposes. 13a nate of Birth I b. Social Security Number c. Place of Birth 64A Francisco 'co, I d_ U.S. Citizen AYes ❑ No e. If Naturalized, state where f. When g. Name of District Court N/A �� �A �. Naturalization C rtificate Number i. Date of Certification j. IfanAien,(�rveAlien's egistration Card Number k. Permanent Residence Card Number N�A /V IA I I I. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race r. Do you have a curWnt Drive'-' icensellD7 Ifgo� a number and state. �' 11816 Drow n flue I MQje le"MS r ,y NYes ❑ No # � to 14. Financial Information. a. Total pyjrchase price or inv stinent be,*ng made by the applying entity, corporation, partnership, limited liability company, other. $_ r) 71 b. List the total amuunt of the personal investment, made by the person listed on question #2, in tis business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ _S,-,660 t 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 Cus V, Sav 1 rLq* Vep-�Y Ia hk 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 NIA e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount N. I r , Oath of Applicant I d re yn�f�ry of ry that this a Wlication and all attachments are true. correct and complete to the best of my knowledge. rued na u rint Signature 11C19 Title IDate CITY OI? 1101Ji•llls'It BEVERAGE LICENSING AU'1'IRMITY ZONING / PLANNING CONFIRMATION 1'111011 TO LIC UNSE APPLIC'A'110t` l.iquurj:iccose Amilicam Completes Too Portion:: , -• I Applicant �� �%'.X-lite C11�c 2LC ''Inde Nume: Applicant ?'hone: 3c>3— Z$'7-05 Altpliciml Email. P&rljz(3)b��cc,TC IhcmiseAddreNs zS Gun b -m -e I C-eP4-is-r c - SCJ. '&J 3�v) Inclooi Treatise Stluare l,'anlabc:_ r1ZX, Ouidum Pulio Square Foulage Y7 Approval Indnoi Pru►nise: D7 and Outduor Patin: Occupancy Laid/Sealiul; Capacity. How's ofopelalton — �.9��r'►Z —� 1 PPP _�_-- I J New [_I Tionsi'cr ( j Mudd- ,Hoow II iquouor License Type: NrJT�� �Ke.S 4-�-7L Applicant's lcnt's Primed Name: Aaz.,j 6, Responsive to C.R.S. I2-47-313(1) and (I )e which slates in Itcnineol part, "(1) No npplicaliun for the issu;mee of any license... shall be received or tided upon ...(e) Fur a locodon in mi nren where the sale of:dcohol beverages It,; contempliled is not pen nitted ander the applicable zoning lnws of lite unuricipnlhy, city and county, or cuunly..." and licventge Licensing Authority Rules of Procedure. Subsection 5-1-1 (c) available at. htpri: u•uw.lauuIdoleulal2du.eut/fil�srCaerkiLi�cnrinc'ltulcz%2tl�tl';621t1'ioretluru.ndI' Applicanl should bring this sheet AND I'llOPOSED PREMISE DIAGRAM complying with OLA Rule Section 3-3 m seq. 1n Licensing Clerk for tits use of Boulder Platnoing and Zoning of 1739 llrundway-Pa rk Central Millding, 3"t Floor, 303-441-1880 to address file four heluw questions. NOTE: This review Is for zoning purposes only and is not approval for any change of occupmtcy or use perinhdng to the bollding coda:. A sepnrnte bulldhtg permlt is required for building modilientions, including it change of use or occupancy. l� Planning turd Zoning Depirlment Completes Bottom Portion: is the Use ut the Site Allowed'? YFS/NO CommcnLOUrnitations: e y Docs the Use Rcgnirc n Use Review or Site Rev'cw7 YESINO Comments: /Y74>- S -/ L/ -1 3 If Use/Sitc Review is required has a Use Revic%v/Site ltevicw been npprovcd? YES/ NO Comments (such as Case Number/ Date of Approval): .,41),e z-Gi6 - 00 2-83 -Zd - /6 /"-/0 Arc there any zoning restrictions or conditions of approval on the property YES/NO that would prevent this property ft•om being open from [lie hours of 7:00 int to 2:00 nm7 Cam7" lations: _„• _ s Planner's Signature I'lannct'sjPrinted Name / 1'Innncr's Title Planner's Signature Dale Rev. 09/11 CITY OF BOULDER Planning and Development Services 1739 Broadway, Third Floor • P.O. Box 791, Boulder, CO 80306-0791 phone 303-441-1880 • fax 303-441-3241 • email plandevelop(a bouldercolcrado.gov v4m.bouldernlandevelop.net ADMINISTRATIVE REVIEW NOTICE OF DISPOSITION You are hereby advised that the following action was taken by the Planning Department: DECISION: Approved DATE: November 28, 2016 REQUEST TYPE: Minor Modification ADDRESS: 5385 Gunbarrel Center Ct APPLICANT: Bittersweet Cafe LLC CASE #: ADR2016-00283 LEGAL DESCRIPTION: Lot 1, Gunbarrel Square Subdivision Replat B, City of Boulder, County of Boulder, Colorado DESCRIPTION: STANDARD MINOR MODIFICATION to the LUR2011-00059 to permit a 24 seat outdoor patio area on the south side of the Bittersweet Cafe tenant space in Building 14. Scope of work includes installation of a patio railing. FINAL DECISION STANDARDS: This application is approved per the criteria as set forth in Boulder Revised Code 1981. This approval is subject to the following standards. These standards must be met in order for the administrative review approval to be valid. 1. No portion of the patio or railing may encroach into the public right-of0way without approval of a revocable lease and reconsideration of a minor modification. 2. A building permit required for installation of the patio and railing. Approved as submitted. This application is approved per the criteria for Minor Modifications to Approved Site Plans as set forth in section 9-2-14(k), B.R.C. 1981. This approval does not constitute building permit approval. Building permit review and approval shall be required prior to the initiation of any construction. The Applicant shall be responsible for ensuring that all construction is compliant with the approved plan set dated November 28, 2016. This decision is final and may not be appealed. A new request may be considered only as a new application. INFORMATIONAL COMMENTS 1. Based on the supplied parking data at Gunbarrel Center the approved Site Review (which included a parking reduction) permitted a total of 174 indoor seats and 80 outdoor seats (also see application ADR2015-00163 & ADR2016-00045 for seating information). With this application, 54 indoor seats and 24 outdoor seats may be approved for the subject space leaving 65 indoor seats and 40 indoor seats for future uses as of the date of this approval 2. Please note the proposed patio may not encroach into the existing adjacent planter. Clarify the planter location in relationship to the proposed railing at the time of permit submittal. 3. Per 2012 IBC Sections 1015 and 1021, due to the increased occupant load, a second exit is required. Approved By: CAJ'y1&J Caeli Hill, Planning Department LU LLLn LL ��pp O O C7 W NN W J O w 2 U U) Q z� L ��Q cc z Q a � 1 id ww2za: a 8 U LL z Fco W 208 LLZ iW A a: @0 d 80d / iMMS83"e 10908 00 'lUOMBUO-1 101 88nS •eny PSE EOL °Maa 9000180®®go G { `l ���--��----�--'''''^j]] u I V 0 - WON WON T"tJ 0 99 Jr auk 4¢�i .I -z6 c LLI f aw r ' I C\1 ° 1♦iY ■w �i r T I /Im T jx� -M -77 wr w Nw N f cc Q _ lNcl Lzii I Q _ — •� d r... � W LU .L •,ZC "� Wd LSES:ZI 9lOZl9l/l l E 3 a rn LL E R E W cofD Q q t0 co LL co CD ry Ld O O a co U c 0 tm J O r 0 7 V U O CL rn LL IL � D a fiz, u, Zy Q G W J 80d / iMMS83"e 10908 00 'lUOMBUO-1 101 88nS •eny PSE EOL °Maa 9000180®®go G { `l ���--��----�--'''''^j]] u I V 0 - WON WON T"tJ 0 99 Jr auk 4¢�i .I -z6 c LLI f aw r ' I C\1 ° 1♦iY ■w �i r T I /Im T jx� -M -77 wr w Nw N f cc Q _ lNcl Lzii I Q _ — •� d r... � W LU .L •,ZC "� Wd LSES:ZI 9lOZl9l/l l E 3 a rn LL E R E W cofD Q q t0 co LL co CD ry Ld O O a co U c 0 tm J O r 0 7 V U O CL rn LL IL � D N ® O fiz, A?5 0� s z U LL 80d / iMMS83"e 10908 00 'lUOMBUO-1 101 88nS •eny PSE EOL °Maa 9000180®®go G { `l ���--��----�--'''''^j]] u I V 0 - WON WON T"tJ 0 99 Jr auk 4¢�i .I -z6 c LLI f aw r ' I C\1 ° 1♦iY ■w �i r T I /Im T jx� -M -77 wr w Nw N f cc Q _ lNcl Lzii I Q _ — •� d r... � W LU .L •,ZC "� Wd LSES:ZI 9lOZl9l/l l E 3 a rn LL E R E W cofD Q q t0 co LL co CD ry Ld O O a co U c 0 tm J O r 0 7 V U O CL rn LL HOd / 133MSH31118 .21MIN+ tosoe 00 'woweuo-1 lot apS *GAH PIE 60L 'Song WMAMOM 61 k 0 Ne .g and :. j04� f +r a z U. z a S 7 CC ad f t J W � . O Z W Wd Z9565Z t 91t1m w t ee= E 8 C B a LL E W v rn �i of O LL n f\ n M co X A 00 0 0 C O E 0 _ a M O n ZZ O U 7 D 1 i LL Q U) LLqp �tpp� pLL U) c t0 EOy of W.J 7 p W Q ¢ ¢ a W ,� a ¢ Q aTLULs p U— W G F LL Hod 133MSU3.uis '-1311M tosoo oo'woWBuo-1 99 G ICIV SANo ISSUnS ovsa sm®IlaAaalld 61 o ❑ � I MN 0ST9 018 {0719111 11/15/2016 1053 50 AM 7� 32 1' -" D br � 4�6 -6 V cc ]D M Z j J L �r m •• m m XI u y r�1 I.1 E N i � 1 O� � 06 CN) (LL) F9 PRODUCTIONS INC. 2540 Sunset Drive Apt. 166 Longmont, CO 80501 r PROJECT: BITTERSWEET / POR X 4 N ? -• W 1 M p-4 W tC i OD a� n--nTcom-n -n n M D cn n m v c r m D D �J r�1 I.1 E N i � 1 O� � 06 CN) (LL) F9 PRODUCTIONS INC. 2540 Sunset Drive Apt. 166 Longmont, CO 80501 r PROJECT: BITTERSWEET / POR X 4 N ? -• W 1 M p-4 W tC i OD a� n--nTcom-n -n n M D cn n m v c r m D D 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 a state -certified Responsible Vendor alcohol service class within three months from the approval of this license. New employees shall take a class within three months of theirhire. 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. Applicant Authorized Signature ►`. � W_F' cW c r + Trade Name PrintName, Title & Date CITY OF BOULDER BEVERAGES LICENSING AUTHORITY STATEMENT OF FOOD SERVICE Pursuant to Section. 12-47-411, C.R.S., as amended, the applicant hereby certifies that they have read and fully understand the following excerpts: Hotel -Restaurant license "Restaurants shall sell malt, vinous, and spirituous liquors as provided in this section only to customers of such restaurant and only if meals are actually and regularly served and provide not less than twenty-five percent (259/6) of the gross income from sales of food and drink of the business of the licensed premises. It is the intent of this section to require hotel and restaurant licensees to maintain a bona fide restaurant business and not a mere pretext of such for obtaining a hotel and restaurant license." Brew -Pub license "A brew pub licensee shall sell malt, vinous, and spirituous liquors for on -premises consumption only if at least fifteen percent (15%) of the gross on -premises food and drink income of the business of the licensed premises is from the sale of food." Pursuant to Regulation 47-418, the applicant certifies that he/she shall at all times, when meals are required to be served, maintain on the premises adequate personnel, foodstuffs and other necessary facilities, equipment and supplies for the preparation and serving of meals as defined by 1247- 103(20) C.R.S., as amended. Oath of Aaalicant 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 Liquorand Beer Code and all City of Boulder rules, regulations and codes which affect my license. (�l 4­�, � �F ��� cne,-P—r Applicant Trade Name ., L,//,' ,k, `7 - Authorized Si tore Print Name, Title & Date ESQUIRE PETITIONING SERVICES, LLC Liquor Licensing Specialists 2792 South Race Street Denver, Colorado 80210 Telephone: (303)331-8600 Facsimile: (303)331-9048 Email: kvietrs@comcast.net January 9, 2017 To: City of Boulder Liquor Licensing Authority Re: Summary report of petition circulation methods and results in the application for A Hotel -Restaurant Liquor License Applicant: Trade Name: Proposed Location: Methods: Bittersweet Caf66, LLC. Bittersweet Cafe 5385 Gunbarrel Center Court Boulder, Colorado 80301 1. The petition circulation was conducted under the control of Esquire Petitioning Services, L.L.C. ("Esquire"). 2. Circulators were driven to the proposed site and became familiar with the Applicant's proposed location. 3. Petitions were pre -filed according to the Licensing Authority's local rules. 4. Esquire prepared all of the petition circulation materials. Each circulator carried a clipboard and petition packet consisting of the following: a. a map of the designated neighborhood with neighborhood boundaries outlined and the proposed location of the outlet denoted by an "X"; b. a petition cover sheet stating: the Applicant's name, the trade name, the proposed location, the type of license application, the qualifications for signing the petition and the information concerning the public hearing; c. signature sheets that provided eligible persons the opportunity to sign the petition in support of, or in opposition to, the application; and d. data sheets on which to record all responses by address. 5. The circulators were instructed as follows: a. to state the petition being circulated concerned an application for a new Hotel - Restaurant Liquor License for Bittersweet Caf66, LLC., dba Bittersweet Caf6; b. to present the map of the designated neighborhood, state the Applicant's name, trade name and to describe the Applicant's location, c. to review the qualifications for signing the petition and the petition issue; d. to provide eligible persons the opportunity to sign the petition in support of, or in opposition of the application; e. to witness all signatures; and f. to record, by address, all responses on the data sheet. RESULTS: 1. 2. Overview of Petition Results: Total door knocks: Persons who signed the petition: Persons who declined to sign the petition: Ineligible contacts: (Younger than 21; non-resident; non-English speaking; Not a business owner or manager) No answer to the door knock: Response of Eligible Contacts: a. Signatures supporting issuance: Residents: Business Owners/ Managers: TOTAL: b. Signatures opposing issuance: Residents: Business Owners/ Managers: TOTAL: TOTAL SIGNATURES 2 Totals: 109 21 130 1 0 1 131 407 131 27 12 250 Percentages 83.2 16.0 99,2% 0.8 0.0% 0.8% 100% C. d. 0 Reasons Stated for Signing In Opposition to the License: Totals % of people signing: Does not drink alcohol: 1 0.8 Neutral: 0 0.0% Sufficient number of outlets: 0 0.0% No reason stated/Other: 0 0.0% TOTAL: 1 0.8 Results analyzed on a needs and desires basis: Signatures supporting the issuance of the 130 100% license because the eligible contacts desired the license to issue because the existing outlets are not sufficient to meet the needs of the neighborhood. Signatures opposing the issuance of the license because the eligible contacts did not desire the license to issue because the existing outlets are sufficient to meet the needs of the neighborhood. Total: Reasons stated for declining to sign the petition Preferred to remain neutral 2 No interest in application: 15 Does not drink alcohol: 1 Too busy to sign: 8 Against corporate policy: 0 Does not sign Petitions 0 Other: 1 TOTAL: 27 3 0 0.0% 130 100% Neighborhood Needs & Desires Petition Summary Applicant: Bittersweet Cafe LLC Trade Name: Bittersweet Cafe Business Location: 5385 Gunbarrel Center Court. Boulder. CO 80301 Occupancy: 78 Square Footage: 3565 Business Description: Bittersweet Cafe is a coffee shoo /wine bar that will sell coffee and specialty egnresso drinks. as well as sandwiches. salads. and small plates. Wine and specialty craft cocktails and local craft beers will be sold on site as well. Operating Hours: Sunday throue-h Saturday. from 6:00 AM to 11:00 PM. 7 days a week License Type: New Hotel -Restaurant type liouor license. Same # of Licenses in area: A— Date(s) of Petitioning: 14/1 r 0 U 5 i H ess 1/8/11 veS I C(CA 'S Defined Neighborhood: North: &OT Limits South: Tay Road East: 75th Street West: 55th Street 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 3 *0 TOTAL # OPPOSED _"4 0 -i S0 �a aI Q) 0 Neighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Caf6 - 5385 Gunbarrel Center Court 1 Monarch Rd OD ERN .0 w i+ in I Bittersweet Caf6 N Rd �1 Meeker Rd pry Cres P`1 Mineral Rd I L� I ,KCaE U- CLOS OA Spine Rd 1 /$ .` hr %house Rd l; Longbow �Drf-� — _ � Old Post time r_4an�rc�49v.m'.V , G- 4 ` Habitat D' _ `a`lt " ,�i an_ h to Rc #70,180 C t we s Rd v601 *a + a O Bugle Ct Q- Q°$ 't v Oda Gi°, °O 40 d Par,. X11 w I1114 to E 2 a° Park PI Applicant: Bittersweet Caf6, LLC Trade Name: Bittersweet Cafe Location: 5385 Gunbanrel Center Court License Type: New Hotel -Restaurant Cityof V!A Boulder N0 RT H The information depicted on this mop is provided IS graphical represematlon Only The CK y of Boulder provides no warranty, expressed or Implied, as to 1 inch = 2,000 feet the accuracy andforcompleteness orthe infonnaban contained hereon Rd I la P: U 61 u z .t M H sI w a 4 m u 9 0 M r N a G R c� H u x O qvq F' o O 00 40 0 u u 0 c CL 9 a L °rL a R d ` Q H v i V^ .� w � 'v 4l Y •a0 u q° v to o u u ul n c u a u, a ro k M w 4 OV u O bz v o C G I:j U Q c) O N O~ ,.-.5 ., d F..] r. fi a W '.���w w •arx a0 o o b O G 4 N•1 Nlu to En M v �° H a, 4 'O 'R- y N �• c u T z . • �y 0. 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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. 1 Circulator's Name: r U f Circulator's Signature: L't (- Circulator's Address: r JC State of Colorado County of Atv �CV\n�6h 0 u LCt Of� Cent-e,nt7)(rj C ss. ) Subscribe and sworn to before me this 1 da of (� I�- ANASTASIA CIRRICIONE NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20164024997 + W COIL ASSION EXPIRES JUNE 30;, 2020 Notary bli MM My Commission Expires: �- .3() 0)0 In Neighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Cafe - 5385 Gunbarrel Center Court Monarch Rd onarc N 7rn E Dry Creed Mineral ted Bittersweet Cafe Qa o . 0° t_ +� h Meeker Rd f Mgr r -•�L k�"ut _ ,�,T,,,; , r4. kout Rd, us Ir Rd ni C4 I W Roa,\ no Rot, �'�� p• rrWlhdB �'� ,.. Spine Rd O ~ ! FoC+,46 house Rd Longbow Dr I � Old Post � Q�nb tlme dMabitat DY �,.. ;1 r ��y`dG 4 ,0�ac W to RIO 01190 Ct es Rd Bugle Ct Q \a o O za Par,F O �W�illr� *EP "a3a Park PI Jay'ARd y r Applicant: Bittersweet Cafe, LLC fl) 041-U" (n(L-p— �,,�,�, P� _ c91�ii City of *✓�✓� Trade Name: Bittersweet Cafe d -t- Boulder Location: 5385 Gunbarrel Center Court u 4 , ,� NORTH The nrormelreprepctedonlhsmapis Chyof ou ase informal ion a p, on onfy The CNy of Boulder provides no warranty expressed or inpl ad, as to License Type: New Hotel -Restaurant i inch = 2,000 feet the accuracy andforeompbtenessorthe information contained hereon Neighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Cafi - 5385 Gunbarrel Center Court Monarch Rd Applicant: Bittersweet Caft, LLC Trade Name: Bittersweet Caf6 Location: 5385 Gunbarrel Center C u NORTH License Type: New Hotel-Restaura t 1 inch = 2,000 feet City Of f ,OP Boulder The information dap.cted on th.s map is provided as graph eai representation on!y The Chy of Boulder provides no wmraMy expressed or implied as to the accuracy and/or completeness or the information contained hereon Rd' 4 W i.7 ZIE cc v v 4 Ln 110 Ln 4i P•1 M tr Ch .1 0 z O w 0 0 v MMO 1Q U Q 61 V Ln 00 M Ln Im O 0 14 M a.i cd r; N 00 cc x 0 IF c 00 A V 0.4 0;9�ON y UO u N.u Sd O bry O > " i 1 Q N Vu y rr ' Nu s ] 0 aa',O�G u to a u e o O U •� •9 .a � u 00 ~a o Z0Q.,a o oafs e pcn R „w piJ a &=0) a �o cF-� 4 /\ 1-4 5 H c°a n ISI AA! 1 1•`., �[ YC .o �" o � t�7 �, Q l '1 `vU7v5 •q W .`uu.. u .A zooms cl 131 a ..pp V w v. 9`` z as ''•�.�� z 0 H a IT 0 F H A 4 u Lno en O a W N r Im.5 I � 1.1 a R Ru 'a 4,Q 1� �'� to a O =a, w° Av N u. 4 tr Nac v° w a u " d r r • O \ ul z ���JJJ s� -O oO V3 P-4 « C O a ° ee� to a a � E C1, V a O R�ir.l �L •a gym" ° O o B PG A O oG W �d ae ti � ° c Oa �� a�w w w O wH °vzzWi� a4 O -d eta $ H c UO3 O M _ .� 'Fe a °4u z PQ ° oawvx ho r" V v0 1-14 to o C tea° ~ G �. 0 c urn a , Q w U 41 Ln 14 49 w Ctf 'DPCIy GIAI 'wT cZ g4 a ti �J' -yi C7 �+ O Q M C5 V4v o o v 00 ►•+ 4 �� a 0. !� W si C3 , /1 W y O f� CO A x on IV$ 44 v L' N a0 ~ O �ry 0 �J a.+ L W Q # ed td 4w(t] o q e , H y J G a q C4 O u U y d C u o'a x o p z c a b 4 0° a ad x z a V y „� f/� �Ly �'etic ac - 0 O a oj oo v, v GA O z i4 .: 2 d H �p " yo W y o °91. ho y� a 04 o Chi `�' • O• v .a CG N u O 40 �a PG Q'�O �a D o �. o a, r a4 a ° O � A vw uQ co ' H B ,u c U �x ° vWi aa' �O In" o D w v fi U .21 a u � Q y U U w O0. p a+Qa �Wi aM P. o Fq S FA P. 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V] p d W .. o►j 3 � p a '° c�U. U 'fib '� �3£ �wbbg; �woa1-4 x a A fou Ga (l� Go Is ks u O v ti av �Wp w5I a W, of F .� 00 ' O tn ea ; W a+ u ^ A '' d 0 f� CO y A U �.^ E a, b �. v N *� a. A x Ln Ln M w M Q� 00 o. O P U 4. Q B f-4 w Q d z O a B w o a u C \ O = P� O U ou i to 0. O a b I 'no O R W , •7 o C -0 'b H .4 ° q 0 a . N b o o, s h o a o C C , O Ca u v n 0iL0 � cacd� .y 4 L -o E Y as OAC tea, w Ln Q -4a 3 O R cl. � cn 10 ° „en RU� 4 vv til 0 b � ai ; z u TT b °a REi -2� 4 o V b WF o 3 G 9 � .0 . 0 7 a4v a Q u r4 x o�Z r u 'q ^I "o 'A a7 m q .J' h ^O a r••� +I '.7�►+ za C),� 0 �w C 00 ra a -o 0 o •d so u -90U ``� 0 o U Z C 42.�•�°�, fur c .d >,.5 H O �l ►•rh � T fn Affidavit of Circulator t do hereby certify that I was the Circulator of the 1 h v v attached petitiofs 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. 1 / Circulator's Signature: � lq6q- Circulator's Address: r �XZ3 State of Colorado ss. County ofr ) pmpahi� Subscribe and sworn to before me this day of Notary Public SEM J(3L N L) t -7 GAROLJOHNSON r �] STATE P DO My Commission Expires: 1 NOTARY ID 205-CMIR MY COMt4M*N W1M AMY 14, Mss Neighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Caf6 - 5385 Gunbarrel Center Court Monarch Rd a Rd I Bittersweet Cafe U) _. CO) 1 F 4 Spine Rd Q'�4 - Ro 4 Longbow Dr ttme r_C.Un_ rML&v, dHabitat�D Wh to Roo �halgo Ct Ir O� W�Ilir�� � eS Applicant: Bittersweet Cafe, LLC Trade Name: Bittersweet Cafe Location: 5385 Gunbarrel Canter Court License Type: New Hotel -Restaurant Meeker Rd Dry CreOw" Mineral Rd Roa�ng �°r���Wlr o� A �,es Rd � Bugle Ct so�Dr"' C, 4d4ouse Rd Old Post c,. u Ora OVa P �Par* C /1 � r d Park PI City of NORTH O Boulder RTH The information dep cted on th s map is providod as graphical represerttalton only The City of Boulder provides no warranty, expressed or onpl,ed as to I inch = 2,000 feet the accuracy and/ar completeness or the lnformet r contained hereon MV Re U aj Ln ,10 M 4 V 4.40 w u w M N e� i3 H cq a� Qj U3 z x yN z 00 . d! O Q C a u oj aj aj cd Q a w M u uCd uI v cl � U � y U 8 w u co R u'1 U Ono M +' v •� u u a rA Q. .d u p a w d d m y v w Y N u b y u e a a0W)0 I z0 o •9 O 0 ys, o ;>. H MV a C B J. v C u 0 v 49 x z v V W 4 Ln Ln M W M Qy cn Oo a a 0 a C7 O d 0 P4 V 14v a Q1 V_ Ln 0 M0 Q O •a to a a ey v x 9 U) cis ul c� U) c v .0 b co v w 0 U cl .a u O x N aj w u ca .4 ZIWU U a+ v QjccV A cc .9 Q. 8 M N 06 b x H ✓y1 ^ -" za Gw b g Qv00 O0 o .� m M. a M. sr _ dJ AcI� K �j 3 loll �_�� (�✓ rV In � +n ✓y1 ^ -" za Gw b g Qv00 O0 o .� m M. a M. sr _ dJ AcI� K �j 3 loll �_�� (�✓ </ ' �• ►� In ` +n � 0.5 V c Gw b g Qv00 O0 o .� m M. a M. sr _ dJ 2 P ` V y o bio to � � v bw M 4 c 0 •� �a r b 4 0 O H OR W R y o ts o -N W '* v V � ti O Q Lr b;� Nab a �b c O u°a .•OyOr�u�a � .Q l�j W �N.. y •a r z 4�w.E�a n V .p � ea x •� b 0 ° ' a 0.th o w _�>a�0 �o°�- V . 1% 4 w ro v B v i� z !: w .1 O z O a 10 L" N M U; .s� W Cd T W N ul u Cd liw u Cd u O N 0 u Cq w U u 3 i� CI v Ga wi u 0 9Q 440 4 w N .o V U Cd Cd 104x 0 0 .may I I M a+ ti N 00 �1 H u oj f tv x 0 O M W A V W O to '� a c 0 0 J d " O u a V a 5 Ylu cn � 19 A Q O 0 x � u D . c �� as Y °o '' 0 u Ln x c�W U zEv H Q CL o- 'aw c o �O O 'd > V N N n =o �°• O �a 4 v a lu O dcl gn vep v a cc Jud N to Y « .btr td v e -4t" rp0 tl1 .G N H cd V Iti O (� t0 ►�' y $ qj z�a vat°�„x o IA gn to u a� 4 �" b °�br a_ u M 0000 -.0 C v a ul Cd Cd N V v 4. x V °dxi o C4o C3 q h Oo J y` O R 0 W a a m 96 a a, O .4; v 0Qj a u Z 6J ti L� O 00 �1 M f. p Ci b Q• .. u 10, p•� Cl 4w v v (j a V P4 x 00IW W ON LRS' v1 �, o � z. w C, 0. CL u � (.� •b C7 o o a s o, q�q $ uj ig��u.� IOU c O y 'R ea C +� Z •qb C ,u c � ' •fj Z�" .. 0 Ocq i 41 j a WL� Ty 0t�,•_�•+ , vqu I 0 m I: 4 M Ln M W M 00 C, O x .1 O N5 b h b vi v .o N gna gn I 0 N v uV .ti Cd QjW O u �Cj N X v 0 N aui w O u C3 w U 11 Qj QjQj a vi W d' a rA O. wwN Iv � W Y N d C � b V H / 0Oy�ry '� O a O C (4 a 04 z0a Oa� �b U 'aya'dx E O a0 O / 0Oy�ry '� O a O C (4 m a c.� z0a Oa� U 'aya'dx 0 wH Y E O jl 472 P4 v .2 o '� O a O E jl 472 S x Ln In M w M Q" rA z 0 a a U; b U) Z !/J CO U2 1 O v :� lua W O u cd .a u O N 1.124O u w Ual cc v i� a u 4 vim a rA i u u W rA a a �0 u � v o u p o •a -p°d I C7 � yv 1-4 ca. -u -:S Ew bn tu $ o o� CO � OOC �•° u 4 a o� N N � v� �w u 2 �j x � O � F" o a H C/1 • V W C n° d • '0 0 u u x L f" wto�� z5u N Q ti �5 ga0-0 0 0� p o b >v O ld R O Y��1 a.� �'u W 0119 a o H Ci i u u W rA a a �0 u � v o u p o •a -p°d I C7 � yv 1-4 ca. -u -:S Ew bn tu $ o o� CO � OOC �•° u 4 a o� N N � v� �w u 2 �j x � O � F" o a H C/1 • V W C n° d • '0 0 u u x L f" wto�� z5u N Q ti �5 ga0-0 0 0� p o b >v O ld R O Y��1 a.� �'u W 0119 a o H x \ 1` , i Q ` b aj Lr) M ea ° a k.' w 4.)cq cc .00 S cd a � z ,.. v c •may V u e� E'IU' Q a� 41 Qj u �` '+�� CZ7 0= X -868 U3 to 3 u�.� ac L z 91 130 V3 a0-00 0rn � it a r� V.° u E PW, A 't7 3 u o •� Oai� ayw U , O�� a gam' a vx 6 W a, CG W al w clji toNO ZO ai o B a VQQyJJ ^+ 00 M �J M �'o 'Id 14 rcd cd Aa �z .. Cd N7 UP) Ln U'Ono uaCd dd i.., > , ...c 'a CVw ea , o O a x �'M. O 'ctv 'v p �p pO� n z P. ? �'' `p o; U W O Iu C o o G4 td In p o o ° e a0. v ;,b �..5 0. y °° u .d t'' w O m oa A V ..s E a4 •a �' A z u O Ow ..�0rA 04 a o O 0 y >,wH =' ---I J o q c a J R �= o .a C tC v o v ob s o S. C c N M �. ��'C,0 u o S L a C u C' BpQ� aXto P, � cn a � O �� y M 0 t4 y O v� c�Wa� xx b ?' o zbo. �th CA P; a � $�G0 o'" IIop 0 o F. 0 vWi y�x= g 79 v' C4 Z0. c� a0ccw g0. TO bCc: >v O o :•:� H b0 ow CO W m v �O H �.�s � �U w Z o�:0,� o.u�.:, w Pio >,s Affidavit of Circulator I, M ` 1 (P C�Ct!Z�+�a do hereby certify that I was the Circulator of the attached petiti ns and further, that I personally witnessed each signature appearing on the petitions. To the best of my knowledge, each signature thereon is the signature of the person whose name it purports to be, each address given opposite each name is the true address of the person that signed, that each person who signed the petition had the opportunity to read, or have read to them, the petition in its entirety and understood its meaning. All of the undersigned were shown the map and list provided by the City of Boulder's licensing department. I also affirm that no premises, threats or inducements were employed whatsoever in connection with the presentation of this petition and that every signature appearing hereon was given freely and voluntarily. Circulator's Name: Circulator's Signature: Circulator's Address: ITEt2�7 �2�T�j C— State of Colorado ss. County o�8awlder. PCU(36&VP Q �,1 Subscribe and sworn to before me this V day of I (it _ l� L 7 Cil. ri L, n f Notary Public 8M CAMX JOHNSON NOTARY PUBLJC STATE OF COtSRADO My Commission Expires: NOTARY ID 20M"157 W COWASSKMI ENM JLLY AMS Neighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Will - 5385 Gunbarrel Center Court Monarch Rd onarch- d N N i. Dry creO\"" Mineral Rd Bittersweet Cafe Qa } mal Meeker Rd �LWk-uu d kout Rd N Dpral Dr'jj- Re J s Ir Rd M 1° slooNIn ��C.'e Spine Rd /!$m8 Ro �.�`'� C/11 '46 r 4 - -- - �� A house Rd Longbow Dr ttme t4ar,/�v� G� /s/Old Post d tHabitat P c a0,. h to R°c, �nq►I8o C t �M.a s Rd -JIt �a Bugle ct w t a v 0 01 ,17 p �W91flr vJ �/ 3 r d Park PI JayARd y Applicant: Bittersweet Caf6, LLC City Of*►'"�i'� Trade Name: Bittersweet Cafe Boulder Location: 5385 Gunbarrel Center Curt NORTH The nformation depicted on th s map is providad as graphical representation only The City of Boulder provides no wamenly expressed or implied, as to License Type: New Hotel -Restauran 1 inch = 2,000 feet the accuracy andfor completeness or the information contained hereon K 110 Ln M w w On N a l H v I H R v W Q+ v u a R QjM I u R .a u 0. y v W 0 u ec .4 w U 4) v I� a cA n, GO 1+.1 R Q a v 0 Pel O w N A U U cd b aOs x w 0 O •n R 3 0 0 00 i � i o. 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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: l C, r,( —1 (-) r\ r rt Circulator's Signature: 0 OA (1� C rWW rA Circulator's Address: I -(g5 C • S � L(\ l C, Cf .. Cf� n IGtV State of Colorado ) Ass. o County of der ) Subscribe and sworn to before me this "l day of ,( U I ! ANASTASIA CIRRICIONE NOTARY PUBLIC M1p STATE OF COLORADO NOTARY ID 20164024997 Not lic W COMMISSION EXPIRES JUNE 30,202D SE70 My Commission Expires: W - 9X) -0"kAQn ``{y of eo��of4City o Boulder . il'147 *00F 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, January 9, 2017. P.O. Box 791 1 1777 Broadway, Boulder CO 80302 1 bouldercolorado.gov 10: 303-441-3040 Neighborhood Needs & Desires Petition Summary Applicant: Bittersweet Cafe LLC Trade Name: Bittersweet Cafe Business Location: 5385 Gunbarrel Center Court. Boulder. CO 80301 Occupancy: 78 Square Footage: 3565 Business Description: Bittersweet Cafe is a coffee shop/wine bar that will sell coffee and specialty espresso drinks. as well as sandwiches. salads. and small plates. Wine and specialty craft cocktails and. local craft beers will be sold on site as well. Operating Hours: Sunday through Saturday. from 6:00 AM to 11:00 PM. 7 days a week License Type: New Hotel -Restaurant type liquor license Date(s) of Petitioning: Defined Neighborhood: North: City Limits South: Tay Road East: 75th Street West: 55th Street Total Contacts: Not at Home: Not Qualified: Refuse to Sign: Same # of Licenses in area: 4 Needs & Desires Already Met: Religious Objection: Remained Neutral: Alcohol Usage Objections: No Reason Given: TOTAL # IN FAVOR TOTAL # OPPOSED 5 w m U v v a z v b e� a w �a 00 U U 0 Lal Io O M 0 00 0 v b 0 pq 4-10 U s.i 4-1 C v 4 4-4 C7 N 00 M a GJ v t� U �i a m •ch A 3-4 N y � w � y v � C CC❑t� •- v G o a cy .d 0 q v v 4v R, 0 °J `d U0 v (0 0 E vv rp v b rlt 0 0.ai r4 I:s 44 C rr C D (~n LLb O y u zi0 U O Sr -G u C V. % � a c° a v N H v ed _ 1 U N N O �.- .�° �Wz °� °' ao �y v O ffj O y^ .N� ca u A O 0 a°£ o o� v.fi v v ub.0o •� 61 "� O w "4 L �' 'b •� }moi_ O -0 fi�� u vx o w �-, 0 4 Z 0 O w �n L M O o c vWi bz o o� O 0 W P -4 E >, O b v'E H Io a o�a,� o v E b'�Wb o enM 4� p B b vH , H U N o° fi v u cn °r° .dcWn pA O c u {Z ° v� A 5 o (U f:4 cOa C •� •� V � p, x � •a W cd u LTA C N W= u ^ ..N -d o �. 0�. 0 G v Zu vti' "C fi cV x v Z' w z v yz 0 7 N Q exp Q'•' fs1 p N v cr U)W a Qty 4 4� ou N a 0 p 'o v h? �° a o O 'ti b to >' C v W o bn°1 v C Ow m a�J cn ccn cNi . o O 0 No .ti WW �' > -db u a0� _y M a. z 2, w 1 o =0 O v z 00 rl O4 -i N N Fy c3 A U as w v~bp v* oOO a b o cd �. H U 5 a w �a 00 U U L u m u v B O b 0 a� �n v u U u O b Q cd u O u w u u v or b O v v� a Hca �'. O v 0 u O bA C7 °C v v O w w C v cna 0 o 0 o 4. v � N; o � °' ° a E CJ 0 U N u ca '� z GL 'b °' N -0 0 0. 4m rA b\ o w U c U � A. 1 41 a 1 14 'O a w c% li v % � b C. h •y Q1 O N m O 10 u Cd " C ate„ .N. v ND C4 O C � c o �q Q .7 W z .. q '„ 0 �° as pc'"O0O " aFao v O O a o o �• fi q 0 a s '� o a W v W °z u v o A Oa� cn0 a� a.yd c� ��w � �w O wH y� (n �" r� O OO v v 4Z� U �' o0 M C4b p� C W a°o v cr ui v z v O a N v �w z �O �x -d °� H 0 x u N h u W uv 06 'd qJ 45 O c/1 c a. O A. vv i 1 v cn D, IQ I". Q v (' v v x H U w c C4�xQjCo a° NdQ c . 4n m Czoo�aa-°p° x N N C H w �. o °O q rz, v v u ° C o ° C O v v v W^ v,b tia O" o >.�� 'O C> U x bt v b z z� ��o..p� wa A�°o v v ;O viov zRa C"o oU 4w rA Z Q cN a v 0 wt p v °�°.d � CQ C) ��C`��L..yo �v7 FNeighborhood Map for a New Hotel -Restaurant type Liquor License Bittersweet Cafe - 5385 Gunbarrel Center Court Monarch Rd - - - - - - -Monarch=Rd - - - - - e U u� in U Rd Bittersweet Cafe oca�� Spine -Rd--' ,L=ongbow=Dr prGunbar,re_l, - timedHabitat D I ~ I Meeker Rd PI E Dry Cree\ Mineral Rd R C*, it White RO/h0740 Ct , `.awes Rd L6. Bugle Ct v SP T 'WellIV4 y a� ----- I L M �O Applicant: Bittersweet Cafe, LLC Trade Name: Bittersweet Cafe Location: 5385 Gunbarrel Center Court License Type: New Hotel -Restaurant C/ 46house Rd Old Post s�dhQ' 5<\° Q,a �av o 0 O� zr Parr ��� Ls Park PI /�/ 64f City of -��� a Boulder NORTH The information depicted on this map is provided as graphical representation only The City of Boulder 1 inch = 2,000 feet provides no warranty, expressed or implied, as to the accuracy and/or completeness of the information contained hereon u c u ♦+ J Y J �+ lL fL0 Z o u D UQ m m d u LL Qv �uix� 0 0 M m Mo aa) .°-1 c Ln L L L L L L m m m Z C •c > F- C7 v0i C7 C7 U N 000 N W OJ W Ln ZD ZD 4141 L L L L O O O O Q Q Q Q C C C C LL 7 7 7 7 41 m m m m lA V1 lA lA 0) OJ O1 O1 x 0 0 0 0 to to 1n un r -I r -I r -I r -I W Q O o 0 0 } N N N N W tD tD tD r -I r -I r -I r -I Lu O O O O f \ \ n � Q M W� M W Ln to to to W H H r•1 H F- O O O O Q \ \ N LU U C Ln N O {A r -I 0000 Coco 00 cc 0 0 99 CO M M �* M r1 Lu 0 N O O M O O 4V1 1� 1\ Z H N a a .- N m v Ln 'a c � m oiS � l7 IY m a+ � N O) Q m OJ cc Z w m C IL >• m m L Ol N -C Y C' O m > H m U >- (D L L L L O O O O Q Q Q Q C C C C LL 7 7 7 7 41 m m m m lA V1 lA lA 0) OJ O1 O1 x 0 0 0 0 to to 1n un r -I r -I r -I r -I W Q O o 0 0 } N N N N W tD tD tD r -I r -I r -I r -I Lu O O O O f \ \ n � Q M W� M W Ln to to to W H H r•1 H F- O O O O Q \ \ N LU U C Ln N O {A r -I 0000 Coco 00 cc 0 0 99 CO M M �* M r1 Lu 0 N O O M O O 4V1 1� 1\ Z H N a a .- N m v Ln 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: Agenda Item 12 Change to BLA Rule of Procedure Section 2-8 (see underlined change): "Pursuant to Section 2-3-1 (b)(3), BRC 1981, the Authority shall appoint amongst its membership a Chair and Vice-Chair. If both the appointed Chair and Vice-Chair are absent from an Authoritv hearing, the Chair may appoint an alternate Chair from the members for such hearing" or similar text. Chapter 2 - Beverages LicenseM 4-2-1. - Legislative Intent. The purpose of this chapter is to protect the public health, safety, and welfare by requiring all persons to be licensed by the city to sell or offer for sale any liqueralcohol beverage ^r- 3v�✓ weer. The city council intends that the city issue local licenses for sale of such beverages, as authorized by state law, and that the city's licensing requirements be consistent with those for state licenses under state law. 4-2-2. - City License to Sell Required. (a) No person shall sell or offer for sale any malt, vinous, or spirituous liquor LM in the city without first having obtained a city license therefor under the provisions of this chapter and laws of the State of Colorado, in addition to any other license required by the state. (b) No person shall sell or offer for sale any fermented malt beverages u without first having obtained a city license therefor under the provisions of this chapter and the laws of the State of Colorado, in addition to any other license required by the state. (c) Nothing in this code shall be deemed to require a person to obtain a separate city license in order to sell or offer for sale any malt, vinous, or spirituous liquor or fermented malt beverage pursuant to a special event permit issued by the State of Colorado. M Ordinance No. 5187 (1989) 4-2-3. - Authority to Issue City Licenses. (a) An applicant for a city license under this chapter shall apply therefor to the Beverage Licensing Authority established by Section 2-3-3, "Beverage Licensing Authority," B.R.C. 1981, on forms provided by the authority. (b) The authority may issue the following types of city licenses: (1) Retail liquor store; (2) Liquor -licensed drugstore; (3) Beer and wine; (4) Hotel and restaurant; (5) Tavern; (6) Club; (7) Arts; (8) Racetrack; (9) Brew pub; (10) Fermented malt beverage on -premises; (11) Fermented malt beverage off -premises; (12) Fermented malt beverage on premises and off premises; (13) Hotel and restaurant with optional premises in accordance with local allowance; aPA (14) Tastings of alcoholic beverages conducted on licensed retail liquor stores and liquor -licensed drugstore premisesi- (15) Bed and Breakfast Permits; (16) Art Gallery Permits; (17) Vintner's Restaurant; (18) Distillery Pubs; and (19) Lod2ina and Entertainment Facility; (20) Resort Comulex- (c) In order to qualify for a city license under this chapter, an applicant must meet all conditions for the issuance of the parallel state license prescribed by the Colorado Liquor Code, L�J for malt, vinous, and spirituous liquors, and the Colorado Beer Code, for fermented malt beverages, except that the fees for a city license are those prescribed by Section 4-20-2, "Alcohol and Fermented Malt Beverage License and Application Fees," B.R.C. 1981. Ordinance Nos. 5347 (1990); 5835 (1996); 7043 (2000); 7380 (2004) 4-2-4. - State Law Procedures Apply. (a) Provisions of the Colorado Liquor Code and the Colorado Beer Code governing procedures for applications, hearing, and decisions for state liquor or fermented malt beverages apply for city licenses. The principal campus of the University of Colorado is eliminated from the application of the five hundred -foot distance restriction of § 12-47- 313(1)(d)(I), C.R.S., for hotel -restaurant and beer and wine liquor licenses only. For the purposes of this section, the principal campus is defined as the area generally circumscribed by Broadway Street on the west; Baseline Road on the south; 28th Street, Colorado Avenue, and Folsom Street on the east; and Boulder Creek, 17th Street, and University Avenue on the north. (b) Provisions of the Colorado Liquor Code and the Colorado Beer Code governing procedures for applications, hearing, and decisions for state liquor or fermented malt beverages apply for city licenses. The principal campus of the Naropa University is eliminated from the application of the five hundred -foot distance restriction of § 12-47- 313(1)(d)(I), C.R.S., for beer and wine liquor licenses only. For the purposes of this section, the principal campus is defined as the area generally circumscribed by Arapahoe Avenue on the north; Marine Street and the University of Colorado on the south; a business at 2034 Arapahoe and University of Colorado residences on the west; and a multi -use bike path on the east. (c) The optional procedures m set forth in §§ 12-47-601(3) to (6), C.R.S., are accepted and adopted for application by the Beverage Licensing Authority. Ordinance Nos. 5069 (1987); 5317 (1990); 5347 (1990); 5348 (1991); 7276 (2003); 7939 (2013); 8084 (2015) 4-2-5. - Obligations of Licensee. No person licensed under this chapter shall fail to comply with all applicable provisions of state law and applicable requirements of this code and any ordinances of the city regulating the conduct of the licensed business. 4-2-6. - Revocation and Suspension of City License. The authority may suspend or revoke the license of any licensee who has had its corresponding state license suspended or revoked. 4-2-7. - Term and Renewal of City Licenses. (a) The term of the city license issued under this chapter is twelve months from the date of issuance. (b) Applicants for renewal of city licenses shall apply to the Beverage Licensing Authority on or before the forty-fifth day prior to the date of expiration of the license. Ordinance No. 5347 (1990) 4-2-8. - Transfer of License. No person licensed under this chapter shall transfer the city license to another person or to another location without the prior approval of the Beverage Licensing Authority. Standards for transfer of a city license are those applicable to transfers of state licenses under state law. Ordinance No. 5347 (1990) 4-2-9. - License Fees. The city manager shall issue all licenses granted by the authority upon receipt of the license fee prescribed by Subsection 4-20-2(d), B.R.C. 1981. 4-2-10. - Hotel and Restaurant Optional Premises License. (a) The authority may allow hotel and restaurant licenses to include an optional premises authorization as part of a hotel and restaurant license in accordance with the provisions of § 12-47-310, C.R.S., the provisions of this section, and all other standards applicable to the issuance of licenses under the Colorado Liquor Code and this chapter. (b) Such authorization may only be considered when the premises to be licensed is: (1) A golf course located upon an outdoor sports and recreation facility as defined in §§ 12-47-103(22)(a)(I 1) and (22)(b), C.R.S.; or (2) Chautauqua Park. (c) There shall be no minimum size requirement for Chautauqua Park or for the golf course facilities which may be eligible for the approval of an optional premises authorization as part of a hotel and restaurant license. However, the authority may consider the size of the particular outdoor sports and recreational facility in relation to the number of optional premises requested for the facility. (d) There shall be no restrictions on the number of optional premises which any one hotel and restaurant license may have at Chautauqua Park or on a golf course facility. However, any applicant requesting approval of more than one optional premises shall demonstrate the need for each optional premises. (e) When submitting an application for the approval of authorization of optional premises as part of a hotel and restaurant license, an applicant shall also submit the following information: (1) A map or other drawing illustrating the facility boundaries and the approximate location or locations where alcoholic beverages will be sold and consumed; (2) A description of the method which shall be used to identify the boundaries of the optional premises when in use; (3) A description of the provisions to ensure the applicant's control over each area designated as an optional premises; and (4) A description of the provisions which have been made for storing malt, vinous, and spirituous liquors in a secured area on or off the optional premises for future use on the optional premises. (f) An application for a new hotel and restaurant license which includes a request for authorization of optional premises, shall be processed in the same manner as any other new license application. An application for an optional premises authorization filed in connection with an existing hotel and restaurant license shall be processed in the same manner as an application to change, alter, or modify the licensed premises. Ordinance Nos. 7043 (2000); 7276 (2003) 4-2-11. - Tastings. No retail liquor store or liquor -licensed drugstore licensee shall conduct alcoholic beverage tastings unless a license has been obtained in accordance with this section and pursuant to the requirements and limitations set forth in § 12-47-301(10), C.R.S. The beverage licensing authority is authorized to issue tasting licenses in accordance with the requirements and limitations of § 12-47-301 (10), C.R.S. At its discretion, the authority may authorize the city clerk to issue those tasting licenses. Ordinance No. 7380 (2004) 4-20-2. - Alcohol and Fermented Malt Beverage License and Application Fees. (a) The applicant for a malt, vinous or spirituous liquor license shall pay the appropriate application fee, as follows: Application Fee (1) New license $1,000.00 l (2) Transfer of feeatien eF ownership or Change of Location of license 750.00 (3) License renewal 100.00 (4) Late application fee for expired license 500.00 (5) Special event: Under 250 persons 50.00 Over 250 persons 1 100.00 (6) (Temporary permit for transfer of ownership 100.00 (7) Bed and breakfast permit 25.00 (8) Duplicate license �4 50.00 (9) Trade name/corporation name change 50.00 (10) Temporary modification of premises 50.00 (11) Permanent modification of premises 100.00 i (12) Five -hundred -foot measurement for liquor license application 50.00 (13) Tasting permit 50.00 14 License Conversion for Tavern licenses (valid until August 10. 2017) i 75.00 Page 1 (b) Each applicant for a hotel and restaurant, tavern, and lodaina and entertainment license shall pay a manager registration fee of $75.00 to the City. (c) Each applicant for a fermented malt beverage license shall pay the appropriate application fee, as follows: Application Fee (1) New license (2) Transfer of feeatien OF ownership or Change of Location of license (3) License renewal (4) Late applications fee for expired license (5) Special event: Under 250 persons Over 250 persons (6) Temporary permit for transfer of ownership --i $1,000.00 J 750.00 100.00 500.00 100.00 100.00 (d) Each licensee licensed under Chapter 4-2, "Beverages License," B.R.C. 1981, shall also pay the following applicable annual license fee at the time of applying for the license, which is refundable if the license is denied: Application Fee F,�IJ)Retail liquor store $22.50 I(2) Liquor -licensed drugstore 22.50 I�(3) Beer and wine 48.75 1(4) Hotel and restaurant 75.00 .1 I (5) Tavern 75.00 Page 2 (6) Club I 41.25 (7) Arts 41.25 (8) Racetrack 75.00 (9) Brew pub 75.00 (10) Fermented malt beverage: ! (A) On -premises 3.75 (B) Off -premises 3.75 I _ _ (C) On- and off -premises 3.75 11 Bed and Breakfast Permits 7F 25.00 12 Art Gallery Permits 3.75 13 Vintner's Restaurant 75.00 14 Distillery Pub 75.00 15 Lodging and Entertainment 75.00 16 Resort Comblex 75.00 (e) Statutory administrative fee per person for background checks caused by changes in structure of entity: $100.00 (f) Special event—;:,iacr: $2j.Q0/day.$38-5g oer person reimbursement for backaround checks obtained. (9) Ordinance Nos. 4838 (1984); 5081 (1987); 5150 (1988); 5347 (1990); 5425 (1991); 5599 (1993); 5676 (1994); 5835 (1996); 5899 (1997); 7380 (2004); 7528 (2007); 7564 (2007); 7629 (2008); 7697 (2009); 7767 (2010); 7874 (2012) Page 3 Agenda Item 13 MATTERS FROM THE LICENSING CLERK NEIGHBORHOOD BOUNDARIES HEARING ON JANUARY 18, 2017 TO DESIGNATE NEEDS AND DESIRES BOUNDARIES FOR BEVERAGE LICENSING AUTHORITY PUBLIC HEARING ON FEBRUARY 15, 2017 FOR SUBJECT APPLICATION. January 9, 2017 SENT VIA FIRST CLASS MAIL You may attend the above neighborhood boundary hearing on January 18, 2017 at 3:00 pm and/or provide written neighborhood boundary recommendations to Boulder Beverages Licensing Authority by Monday, January 16, 2017 if you wish, but you are not required to do so. Pursuant to BLA Rules of Procedure Section 4.1 available at: httos://www- static. bouldercolorado.Qov/docs/BLA Rules of Procedure- 1-201505081442.ndf, the boundaries typically include an area of not less than a one-half (1/2) mile radius around the proposed establishment. In addition, factors including, but not limited to, zoning boundaries, land use designations, traffic flow, access roads, demographics, size of establishment, natural and human - made barriers, and consideration of other similar licenses in the area proposed may also be considered by the BLA. After the boundary hearing, our office will prepare and provide you with your petition materials, including the BLA's North, South, East and West designated neighborhood boundaries, usually within 6 calendar days. As a reminder, Needs and Desires Evidence, such as petitions, are due in our office by Monday, February 6, 2017. Mailinc Address: Kbc Cycling LLC Full Cycle 1795 Pearl Street Boulder, CO 80302 Attn: Russell Chandler Application Details: Applicant: Kbc Cycling LLC Trade Name: Full Cycle Location: 1795 Pearl Street, Boulder, CO 80302 License Type: A Beer & Wine Liquor type liquor license N O + J Application: Kbc Cycling LLC d/b/a Full Cycle, 1795 Pearl Street, Boulder, CO 80302 Total Indoor Sq. Ft.: 5716 Patio Sq. Ft.: 311 Total Premise Sq. Ft.: 6027 Max. Indoor Seating: 42 Max. Patio Seating: 16 I Total Premise Seating: 58 Hours of Operation: Sunday—Thursday: 7:00 AM -10:00 PM; Friday—Saturday: 7:00 AM -11:00 PM; Patio to close by 10 PM all days SPECIAL EVENT LIQUOR LICENSES AND TEMPORARY MODIFICATIONS —JANUARY 2017 Name of Event Name of Applicant Location of Event Date of Event Time of Event Type of Permit Gallery Reception Open Studios Celtic New Year Irish Step Dancers of Recital Colorado Rembrandt Yard Thursday, 1301 Spruce Street January 19, Boulder, CO 80302 2017 Boulder Jewish Sunday, Community Center, January 22, 6007 Oreg Ave, 2017 Boulder, CO 80303 5:00 PM - 8:00 Special Event PM Application 3:30 PM -7:30 Special Event PM Application 12/22/2016 License Database Page 1 of 2 Liquor License Notices Sent Notices were sent to these licensees Trade Name/Applicant. Location/Mailing Address: Number: License Type: Expires: Deadline: ADO'S 114313th Street, Unit 101 47-06241-0000 Hotel -Restaurant Liquor 04/21/2017 03/07/2017 Ado's LLC 114313th Street, Unit 101 BYS RESTAURANT & BREWHOUSE 1690 28th St 47-01141-0000 Brew Pub Liquor 04/16/2017 03/02/2017 Chicago America Holding LLC 7755 CENTER AVENUE, Suite 300 BOTTLES 2520 Arapahoe Ave 47-01022-0000 Retail Liquor Store 04/11/2017 02/25/2017 Kimi Corp 6873 Fairview Dr BOULDER WINE MERCHANT 2690 Broadway 10-35806-0000 Retail Liquor Store 04/15/2017 03/01/2017 Boulder Wine Merchants, Ltd 2690 Broadway BUFF 2600 CANYON BLVD. 23-57253-0000 Hotel -Restaurant Liquor 04/15/2017 03/01/2017 The Angel Tree, Co 2600 CANYON BLVD CHEBA HUT TOASTED SUBS -BOULDER 1315 College Ave 47-01243-0000 Hotel -Restaurant Liquor 04/19/2017 03/05/2017 Makin Moves LLC 1315 College Ave CURED WINES 1825 Pearl St Suite B 28-70777-0000 Retail Liquor Store 04/21/2017 03/07/2017 Cured Wines LLC 1825 Pearl St Suite B FUJI CAFE 2018 Broadway Street 47-06239-0000 Beer & Wine Liquor 04/24/2017 03/10/2017 Sherpa Holdings 2015 LLC 2018 Broadway GUNBARREL LIQUOR 6566 Lookout Rd 47-02789-0000 Retail Liquor Store 04/13/2017 02/27/2017 Battambang Inc 6566 Lookout Rd HOTEL BOULDERADO 211513th St 10-52819-0003 Hotel -Restaurant Liquor 04/29/2017 03/15/2017 Boulderado Restaurants, Inc 2475 Broadway, Unit 305 HYATT PLACE BOULDER 2230-2224 30th Street, Boulder, CO 47-04055-0000 Hotel -Restaurant Liquor 04/02/2017 02/16/2017 Noble -Interstate Management Group, LLC 4501 N. Fairfax Drive, Suite 500 JUST HIT IT INC 5706 Arapahoe Ave 40-27995-0000 Hotel -Restaurant w/Opt 04/20/2017 03/06/2017 JUST HIT IT, INC 1290 Edinboro Dr KASA 1468 Pearl St, Suite 110 42-29645-0000 Hotel -Restaurant Liquor 04/30/2017 03/16/2017 Kasa, LLC 1468 Pearl St, Suite 110 KING SOOPERS 33 3600 Table Mesa Dr 01-10779-0044 3.2% Beer Off Premise 04/30/2017 03/16/2017 Dillon Companies, Inc PO Box 305103 MOTOMAKI 1600 28th Street #1216, Boulder, CO 47-02878-0000 Hotel -Restaurant Liquor 04/22/2017 03/08/2017 Hapa Franchise Group Inc. 948 North Street, Suite One RIVER AND WOODS 2328 Pearl Street 47-06248-0000 Hotel -Restaurant Liquor 04/28/2017 03/14/2017 Eat at Home, LLC 2075 Oak Ave SHINE RESTAURANT AND GATHERING PLAC 202713th St 14-71491-0000 Brew Pub Liquor 04/03/2017 02/17/2017 Shine Community LLC 202713th St TACO JUNKY 114913th St 47-04578-0000 Hotel -Restaurant Liquor 04/07/2017 02/21/2017 13th Street The Hill, LLC 114913th Street TURLEY'S KITCHEN 2805 Pearl St 41-63052-0000 Hotel -Restaurant Liquor 04/05/2017 02/19/2017 P.G.T., Inc 2805 Pearl St WORLD OF BEER 921 Pearl St 47-04906-0000 Hotel -Restaurant Liquor 04/05/2017 02/19/2017 JTR Boulder LLC 660 S. Colorado Blvd 20 licensees receiving notices Notices were NOT sent to these licensees as they are set for non -automatic renewal Trade Name/Applicant: Location/Mailing Address: Number: License Type: Expires: Deadline: BOGEY'S EATERY & SPIRITS 6525 Gunpark Dr Unit 380 31-38238-0000 Hotel -Restaurant Liquor 04/18/2017 03/04/2017 DNMK Enterprise Inc. TRANSFER 85 Kolar Court REDS LIQUOR 4481 N Broadway 30-47175-7000 Retail Liquor Store 04/12/2017 02/26/2017 Opaque Dragon LLC TRANSFER 4481 N. Broadway Expiring Between 4/1/2017 and 4/30/2017 12/22/2016 License Database Page 2 of 2 Liquor License Notices Sent Notices were NOT sent to these licensees as they are set for non -automatic renewal Trade Name/Applicant Location/Mailing Address: Number. License Type: Expires: Deadline: 2 non -automatic renewal licensees Expiring Between 4/1/2017 and 4/30/2017 City of Boulder City Council members: The below quoted questions were posed to the Beverage Licensing Authority (BLA) and the BLA discussed these questions at their monthly hearing on Wednesday December 14, 2016. The below text includes both a restatement of the questions and a summary of the BLA's discussion and comments. Council's Questions: 1. How do you think the City can improve its public engagement process? How would you recommend that Council engage with the community? 2. What do you think the City's top three priorities should be in 2017? 3. What do you think will be the City's three biggest challenges over the next five years, and how should we address them? Summary of BLA's discussion: The BLA finds that the city newsletter is just a PR tool now, but feel that instead it should be used to provide more important information and perspective on community issues. The BLA would like periodic updates on community issues, such as the progress toward municipalization and goals achieved in affordable housing. The BLA thinks that there should be no excuse to defer city maintenance at this time for city assets and buildings, in that, there should be enough funds from other sources of tax revenue so that all items are current on maintenance and fully updated. The BLA also thinks that maintenance and improvement of softscapes (flowers and plants) in Transportation areas should occur, given the tax revenues from a variety of sources. The BLA wonders why the affordable housing list is not made public. The BLA discussed that there should be a requirement to improve the quality of the as- built environment so as to improve the architecture aesthetic in the City of Boulder. The BLA pointed to the City of Seattle's planning website as an example where citizens can view every building project in that city and submit public input via web entry that will be incorporated. The BLA commented that the public input process is almost farcical, in that, input is solicited and collected, but that said public input is not incorporated into the finished product of development and other projects, because inclusion of it is not mandatory and legally required. It should not be the case that residents express what they want, and then projects proceed as they will. This has lead, the BLA stated, in the most divisive environment that many long term Boulder resident members have ever seen. Neighborhoods residents and neighborhood associations do not feel heard because their input is not incorporated into the resulting development. An example of the Hogan- Pancost Property was offered. The BLA wonders why city planning and zoning codes are not written to require some retail spaces to offer services and shopping to residents of very dense residential areas. A change to code is required to enforce this because residential housing units are more profitable for developers, so there is not an incentive for this to occur without a legal requirement for it. An example was given of the Aurora neighborhood. Further, the BLA wonders why, when the City of Boulder is so dependent on local sales tax remittance that such a code change has not already been made to require retail options in dense residential settings. The BLA gave the example of the City and County of Denver as a municipality that requires retail in residential dense projects. The BLA commented that more community resident units and more jobs in the Boulder community does not necessarily result in balanced growth. Bigger is not better. The BLA provided an example of University of Wisconsin -Madison, related to projects. The BLA also commented that an increase in population in and of itself will not result in adequate affordable housing, without mandates which will add those units to the resulting housing in Boulder. The BLA feels that there should be a community wide conversation about if the existing residents and the already present businesses in Boulder want and desire more growth. The BLA also comments that City Ordinances when drafted should be written so that they can be enforced, and then they should be actively enforced. Further, it should not be possible to pick and choose what enforcement will be done and the results of enforcement should not change. It should not be the case that there is a refusal to enforce certain ordinances, for example, jaywalking and texting while driving on 28th street. Agenda Item 14