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LA Packet 08-10-2010P TOWN OF AVON, COLORADO AVON AVON LIQUOR LICENSING AUTHORITY MEETING FOR TUESDAY, AUGUST 10, 2010 . t MEETING BEGINS AT 5 PM AVON TOWN HALL, ONE LAKE STREET PRESIDING OFFICIALS CHAIRMAN RON WOLFE VICE CHAIRMAN BRIAN SIPES BOARD MEMBERS RICHARD CARROLL, DAVE DANTAS, KRISTI FERRARO AMY PHILLIPS, ALBERT "Buz" REYNOLDS, JR. TOWN STAFF TOWN ATTORNEY: ERIC HEIL TOWN MANAGER: LARRY BROOKS TOWN CLERK: PATTY MCKENNY ALL LIQUOR BOARD MEETINGS ARE OPEN TO THE PUBLIC EXCEPT EXECUTIVE ,SESSIONS COMMENTS FROM THE PUBLIC ARE WELCOME DURING PUBLIC HEARINGS PLEASE VIEW AVON'S WEBSITE, HTTP : / /WWW.AVON.ORG, FOR MEETING AGENDAS AND MEETING MATERIALS AGENDAS ARE POSTED AT AVON TOWN HALL AND RECREATION CENTER, ALPINE BANK, AND AVON LIBRARY I. CALL TO ORDER/ ROLL CALL 2. INQUIRY OF THE PUBLIC FOR COMMENT AND APPROVAL OF AGENDA 3. RENEWAL OF LIQUOR LICENSES a. Applicant: Suncor Energy Sales, Inc., d /b /a Shell Address: 46 Nottingham Road Manager: Anakut Loya Type: Retail 3.2% Beer License (Off Premise) b. Applicant: Chair Four LLC, d /b /a Vin 48 Address: 48 E Beaver Creek Blvd Manager: Colin Baugh Type: Hotel and Restaurant Liquor License C. Applicant: Dillon Companies, Inc. d /b /a City Market #26 Address: 260 Beaver Creek Place Manger: Chuck Holcomb Type: Retail 3.2% Beer License (Off Premises) 4. CONSENT AGENDA a, Minutes from July 13, 2010 5. ADJOURNMENT Avon Council Meeting.10.08.10 Page 3 of 5 Memo To: Avon Liquor Licensing Authority Thru: Larry Brooks, Town Manager cc: Eric Heil, Town Attorney Prom: Debbie Hoppe, Court Clerk Date: August 06, 2010 Re: Renewal of Liquor Licenses Summary: The Town Council serving as the Avon Liquor Licensing Authority will consider the following liquor license application for renewal at its board meeting next week: a, Applicant: Suncor Energy Sales, Inc., d /b /a Shell Address: 46 Nottingham Road Manager: Anakut Loya Type: Retail 3.2% Beer License (Off Premise) b. Applicant: Chair Four LLC, d /b /a Vin 48 Address: 48 E Beaver Creek Blvd Manager: Colin Baugh Type: Hotel and Restaurant Liquor License c. Applicant: Dillon Companies, Inc. d /b /a City Market #26 Address: 260 Beaver Creek Place Manger. Chuck Holcomb Type: Retail 3.2% Beer License (Off Premises) Background & Discussion: Colorado Liquor Code, 12 -47 -302, provides for guidelines related to liquor licensing renewals; applications for the renewal of an existing license shall be made to the local licensing authority. The Town Clerk, Town Attorney, and Police Department have reviewed the applications submitted referenced above and the materials are in order. Police Report results are summarized below: There was one alcohol related call from Shell in the last year and it was Anakut reporting a drunk driver. There were no incidents related to the sale of liquor. Shell has a good record of reporting drunk drivers and people that enter the store that are drunk. There have been no alcohol related calls for service at Vin 48 during the past year. There were several alcohol related calls from Avon City Market but nothing concerning sales to minors or intoxicated parties. Financial Implications: There are local and state liquor licensing fees associated with renewal applications that have been submitted to the Town. Town Manager Comments: Attachments: r State of Colora rms for Liquor License Renewals Avon Police Department Background Memos DR 8400 (11109/06) LIQUOR OR 3.2 BEER LICENSE COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION DENVER, COLORADO 80261 SUNCOR ENERGY SALES INC SHELL 7800 E ORCHARD RD STE 300 GREENWOOD VILLAGE CO 80111-2583 This renewal reflects no changes from the last ap- plication. Complete page 2 and fife now! Yes there are changes from the last application. If applicant is a Corporation or Limited Liability coin - pany, use DR 8177 and send in with this renewal. Any other changes of ownership require a transfer of ownership. See your Local Licensing Authority immediately. License Number License Type 41- 44268 -0013 2122 Liability Information 44 003 447110 C 103003 Business Location 0046 NOTTINGHAM RD AVON CO Current Wcense Explres OCT 29, 2010 DEPARTMENTAL USE ONLY Total Amount Due To Paid Date Wholesaler, manufacturer, importer, and public transportation system license renewals do not need Local Licensing Author- ity approval and must be returned directly to the Colorado De- partment of Revenue at least 30 days prior to the current li- cense expiration date. This application for renewal must be returned 10 your CfTY OR COUNTY Licensing Authority at least 45 days prior to the expira- tion date of your current license. Failure to do so may result in your license not being renewed. include both pages of this renewal and payment. 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 ign ur / Date Business Phone Title� i Sales Tax Number REPORT AND 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 nn ( Q_F i}�AQ! -; rw q%.i0T QFTAC.}'? Make check payable to: Colorado Department of Revenue.The State may convert your DR 8400 (11108106) LIQUOR OR 3.2 BEER LICENSE COLORADO DEPARTMENT OF REVENUE check to a one time electronic banking transaction. Your hank account may be debited as RENEWAL APPLICATION early as the same day received by the Stale. If converted, your check will riot be retumed, DENVER, COLORADO 80261 If your check is rejected due to Insuffl6ent or uncollected funds, the Department of Rev. enue may collect the oavment amount directly from vour bartkl no acoo unl electranlcally. Business Name SHELL LICENSE NUMBER (Use for all reference) 41 -44268 -0013 PERIOD 10 -11 TYPE OF LICENSE ISSUED CASH'FUND STATE FEE 3.2 PERCENT BEER RETAIL CITY 85% OAP LICENSE (OFF PREMISES) 2330 - 100(999) 2122- 750(999) 2180 - 100(999) $ 50.00 $ 25.00 $ 21.25 TOTAL AMOUNT DUE $ 96.25 DR 8401 (02119109) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1881 PIERCE RECEIVED JUN ] 8 2010 LAKEWOOD, CO 80281 �+ (303) 205 -2300 ATTACHMENT TO LIQUOR OR 3.2 BEER LICENSE RENEWAL APPLICATION This page must be completed and attached to your signed renewal application form. Failure to include this page with the application may result in your license not being renewed. Trade Name of Establishment State License Number 2ruv%W 5 1 e . a. Skit 4t'P- Y�z.�Sr -bo13 1. Operating Manager Home Address Date of Birth 041Qt.V.� t 4 I20 DO Y X4,p 04 (d 2-Z) —77- 2. Do you have legal possession of the premises for which this application for license is made? Yes No Are the premises owned or rented: _ (SiAAVlW _ If rented, expiration date of lease; & ~11 3. Has there been any change in financial interest (new notes, loans, owners, etc.) since the last annual application? If yes, explain in Yes No detail and attach a listing of all liquor businesses in which these new lenders or owners, (other than licensed financial institutions) are El materially interested. 4. Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers, principals, or lenders Yes No (other than licensed financial institutions), been convicted of a crime? If yes, attach a detailed explanation. 1:1 Er 5. Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), been denied an alcoholic beverage license, had an alcoholic beverage license suspended or Yes No revoked, or had interest in any entity that had an alcoholic beverage license denied, suspended or revoked? If yes, attach a detailed explanation. 6. Does the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), have a Yes No direct or indirect interest in any other Colorado liquor license (include loans to or from any licensee, or interest in a loan to any licensee)? If yes, attach a detailed explanation. Sale ❑ 7. Corporation or Limited Liability Company (LLC) or Partnership applicants must answer these questions. Since the date of filing of the last annual license application: Yes No (a) Are there, or have there been: any officers or directors; or managing members; or general partners added to or deleted from 11 applicant for renewal of a 3.2 beer or liquor license? (b) Are there or have there been; any stockholders with 10% or more of the issued stock of the Corporation; or any members with Yes No 10% or more membership interest in the LLC; or any partners with 10% or more interest in the partnership added to or deleted from the applicant for renewal of a 3.2 beer or liquor license? (c) If Yes to (a) or (b), complete and attach Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes, and all supporting documentation, and fees your Local Licensing Authority immediately. 8. Sole proprietorships, Husband -Wife Partnerships or Partners In General Partnerships: EVIDENCE OF LAWFUL PRESENCE Each person identified above must complete and sign the following aff idavit. Please make additional copies if necessary. Each person must also provide a copy of their driver's license or state issued Identification card. In lieu of form DR 4679, the undersigned swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one): r] I am a United States Citizen I am not a United States Citizen but I am a Permanent Resident of the United States I am not a United States Citizen but I am lawfully present in the United States pursuant to Federal Law I am a foreign national not physically present in the United States I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, or fraudulent statement or misrepresentation in this sworn affidavit is punishable under the criminal laws of Colorado Revised Statute 18 -8 -503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. Signature Printed name Date i=i EXHIBIT A LIST OF LOCATIONS - COLORADO TRADE NAME SITE ADDRESS JURISDICTION SALES TAX EXTENSION 41- 44268- Phillips 66 2410 E. Arapahoe Rd; Centennial 80122 Arapahoe County -0001 Phillips 66 7273 E. Evans Ave.; Denver 80224 Arapahoe County -0002 Phillips 66 12401 W. 641h avenue; Arvada 80004 Arvada -0003 Phillips 66 6400 Sheridan Blvd.; Arvada 80003 Arvada -0004 Phillips 66 7970 Wadsworth Blvd.; Arvada 80003 Arvada -0005 Phillips 66 5360 N. Wadsworth Pkwy.; Arvada 80002 Arvada -0006 NO BEER Phillips 66 16820 E. 6th Avenue; Aurora 80011 Aurora -0007 Phillips 66 14491 E. Colfax Avenue; Aurora 80011 Aurora -0008 Phillips 66 16890 E. Iliff Avenue; Aurora 80011 Aurora -0009 Phillips 66 12098 E. Mississippi Ave; Aurora 80013 Aurora -0010 Phillips 66 3385 S. Tower Rd; aurora 80011 Aurora -0011 Phillips 66 13780 E. 6th Avenue; aurora 80013 Aurora -0012 NO BEER Phillips 66 0046 Nottingham Rd; Avon 81620 Avon -0013 Phillips 66 5195 W. 120th Ave; Broomfield 80020 Broomfield -0014 NO BEER Phillips 66 1760 W. Midway Blvd.; Broomfield 80020 Broomfield -0015 Phillips 66 699 S. 8'h Street; Colorado Springs 80905 Colorado Springs -0016 Phillips 66 1590 S. Academy Blvd.; Colo Spgs 80916 Colorado Springs -0017 Phillips 66 4075 Austin Bluffs Pkwy; Colo Spgs 80918 Colorado Springs -0018 Phillips 66 506 W. Garden /Gods Rd; Colo Spgs 80907 Colorado Springs -0019 Phillips 66 4270 E. Platte Ave; Colo Spgs 80909 Colorado Springs -0020 Phillips 66 7285 E. Hampden Ave.; Denver 80224 Denver -0021 TRADE NAME SITE ADDRESS JURISDICTION SALES TAX EXTENSION 41.44268 - Phillips 66 4650 Peoria Street; Denver 80239 Denver -0022 Phillips 66 1901 S. Sheridan Blvd.; Denver 80227 Denver -0023 Phillips 66 2715 S. Santa Fe Dr.; Englewood 80110 Englewood -0024 Phillips 66 9200 N. Federal Blvd.; Federal Hts 80221 Federal Heights -0025 Phillips 66 5901 S. University Blvd.; Grnwd Vllg 80121 Greenwood Village -0026 Phillips 66 8755 E. Arapahoe Rd; Grnwd Vllg 80112 Greenwood Village -0027 NO BEER Phillips 66 5860 S. Kipling St.; Littleton 80127 Jefferson County -0028 Phillips 66 5205 W. alameda Ave.; Lakewood 80226 Lakewood -0029 Phillips 66 11203 W. Colfax Ave.; Lakewood 80215 Lakewood -0030 Phillips 66 350 S. Union; Lakewood 80228 Lakewood -0031 Phillips 66 1850 S. Wadsworth Blvd.; Lakewood 80232 Lakewood -0032 Phillips 66 6515 S. Broadway; Littleton 80121 Littleton -0033 Phillips 66 6200 S. Santa Fe Dr.; Littleton 80120 Littleton -0034 Phillips 66 8020 S. Broadway; Littleton 80122 Littleton -0035 NO BEER Phillips 66 6556 S. Broadway; Littleton 80121 Littleton -0036 NO BEER Phillips 66 1201 Bonforte Blvd.; Pueblo 81001 Pueblo -0037 Phillips 66 1800 Highway 50 West; Pueblo 81008 Pueblo -0038 Phillips 66 190 US Highway 6; Silverthorne 80498 Silverthorne -0039 Phillips 66 2651 E. 120th Ave.; Thornton 80233 Thornton -0040 Phillips 66 10396 N. Washington; Thornton 80229 Thornton -0041 Phillips 66 9991 Wadsworth Pkwy; Westminster 80021 Westminster -0042 Phillips 66 9995 W. 44th Avenue; Wheat Ridge 80033 Wheat Ridge -0043 Phillips 66 9000 1 -76 Frontage Rd. Henderson 80640 Henderson -0044 Avon Police Department Liquor License Application Individual Name(s): Anakut Loya Name of Business: Type of License: Event Name: Date of Event: Suncor Energy Sales Inc ® Hotel & Restaurant ❑ Special Event Permit Location of Business: 46 Nottingham Rd Avon, Colorado 81620 Date Received: July 27, 2010 Photographs /Fingerprints: Z On File ❑ Special Event -- N/A Investigation lay: ❑ Detective Sergeant Jonathan Lovins Z Detective Aurion Hassinger Date: August 4, 2010 CBI Criminal Investigation (attached): Local Criminal Investigation: Local history revealed no felony or alcohol related arrest record for Anakut Loya. There was one alcohol related call from Shell in the last year and it was Anakut reporting a drunk driver. There were no incidents related to the sale of ligour. Shell has a good record of reporting drunk drivers and people that enter the store that are drunk. Comments: Liquor Code Violations in the past calendar year: ❑ Yes ® No If yes, explain: Smoking violation in the past calendar year: ❑ Yes ® No If yes, explain: ® Background investigation conducted with no problems and or areas of concern. N.C.I.C. database not accessed on this applicant. Investigation Time: 2 hours. Administration Time: 1 hour. Ole . ir�lr DR 8400(11/09106) LIQUOR OR 3.2 BEER LICENSE COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION DENVER, COLORADO 80261 CHAIR VIN 48 PO BOX AVON Iii ® This renewal reflects FOUR LLC 5490 July 2 1 2010 plication. Complete page 2 and file now! juN 17 '10 USINES8 - TAX CLEARING T2 ap- Yea there are changes from the last application. if appiicant is a Corporation c it Limited Liability co. i r- pany, use DR 8177 and send in with this renewal. Any other changes of ownership require a transfer of ownership. See your Local Licensing Authority immediately. License 5 � 1r9 0 7 - 00 0 0 11.1rensel 1910 Liability Information Title ry ,9 S 44 003 722110 B 101107 Business Location Locai Licensing Authority for D 48 E BEAVER CREEK BL AVON CO Attest Current-License Expires OCT 10, 2010 DEPARTMENTAL USE ONLY Total Amount Due Total Paid00 r Wholesaler, manufacturer, importer, and public transportation system license renewals do not need Local Licensing Author- ity approval and must be returned directly to the Colorado De- partment of Revenue at least 30 days prior to the current li- cense expiration date. This application for renewal must be returned to your CITY OR COUNTY Licensing Authority at least 45 days prior to the expira- tion date of your current license. Failure to do so may result In your license not being renewed. Include both pages of this renewal and payment. �ffl­i OF APPLICANT declare under penalty of perjury in the secondApgreet { his application and all attachments are true, correct, and complete to the best of my knowledge. Authorized Signature D Date BX 's Phone l i � 9 b3 Title ry ,9 S Sales Tax Number / �J REPORT AND 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. Locai Licensing Authority for D Date Signature T Title A Attest 1,I1:-�T FF'T4r`H �) -_TACH DR 9401 (02119109) COLORADO DEPARTMENT OF REVENUE Ll0UOR ENFORCEMENT DIVISION 1881 PIERCE LAKEWOOD, CO 80281 (303) 205 -2900 ATTACHMENT TO LIQUOR OR 3.2 BEER LICENSE RENEWAL APPLICATION This page must be completed and attached to your signed renewal application form. Failure to include this page with the application may result in your license not being renewed. Trade Name of Establishment �OS�Jtlrad i 6ars State License Number ._6V0 7 - X00 1. Operating Manager Nome Address k Ovi, Date of Birth ? o I� 0 E ally(L . 2. Do you have legal possession of tHd pre is s or which this application for license is made? Are the � If Yes premises owned or rented: rented, expiration date of lease: al 3. Has there been any change in financial interest (new notes, loans, owners, etc.) since the last annual application? If yes, explain in Yes No detail and attach a listing of all liquor businesses in which these new lenders or owners, (other than licensed financial institutions) are ❑ materially interested. 4. Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers, principals, or lenders Yes No (other than licensed financial institutions), been convicted of a crime? It yes, attach a detailed explanation, ❑ 5. Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), been denied an alcoholic beverage license, had an alcoholic beverage license suspended or Yes No revoked, or had interest in any entity that had an alcoholic beverage license denied, suspended or revoked? If yes, attach a detailed explanation. 6. Does the applicant, or any of Its agents, owners, managers, principals, or lenders (other than licensed financial institutions), have a Yes No direct or indirect interest in any other Colorado liquor license (include loans to or from any licensee, or interest in a loan to any licensee)? If yes, attach a detailed explanation. 7. Corporation or Limited Liability Company (LLC) or Partnership applicants must answer these questions. Since the date of tiling of the last annual license application: Yes No (a) Are there, or have there been, any officers or directors; or managing members; or general partners added to or deleted from E] applicant for renewal of a 3.2 beer or liquor license? (b) Are there or have there been: any stockholders with 10% or more of the issued stock of the Corporation: or any members with Yes No 10% or more membership interest in the LLC; or any partners with 10% or more interest in the partnership added to or deleted El from the applicant for renewal of a 3.2 beer or liquor license? (c) if Yes to (a) or (b), complete and attach Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes, and all supporting documentation, and fees your Local Licensing Authority immediately. Ia. 5d.e praprietorshtps, Husband -Wlre Partnerships or Partners In Geneval Farinersriips., EVIDENCE OF LAWFUL PRESENCE Each person identified above must complete and sign the following affidavit. Please make additional copies if necessary. Each person must also provide a copy of their driver's license or state Issued Identification card. In 11 of f nif DR 4579, the undersigned swears or affirms under penalty of perjury under the laws of the State of Colorado thaf ( k one): I am a United States Citizen ® I am not a United States Citizen but I am a Permanent Resident of the United States Q 1 am not a United States Citizen but I am lawfully present in the United States pursuant to Federal Law I am a foreign national not physically ,present in the United States I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law' requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, or fraudulent statement isrepresentation in this sworn affidavit is punishable under the criminal laws of Colorado Revised St to 18 -8 and i &I constitute a separate criminal offense each time a public benefit is fraudulently received. Signature Printed name Date Celli 0, MF Avon Police Department Liquor License Application Individual Name(s): Collin Baugh Name of Business: Type of License: Event Name: Date of Event: NMI Hotel & Restaurant ❑ Special Event Permit Location of Business: 48 East Beaver Creek Blvd Avon, Colorado 81620 Date Received: July 27,2010 Photographs /Fingerprints: M On File ❑ Special Event — N/A Investigation by: ❑ Detective Sergeant Jonathan Lovins Detective Aurion Hassinger Date: August 4, 2010 CBI Criminal Investigation (attached): Local Criminal Investigation: Local history revealed no felony arrests for Collin Baugh. There were no alcohol related calls to Vin 48 in the last year. Comments: Liquor Code Violations in the past calendar year: ❑ Yes ® No If yes, explain: Smoking violation in the past calendar year: ❑ Yes ® No If yes, explain: Z Background investigation conducted with no problems and or areas of concern. N.C.I.C. database not accessed on this applicant. Investigation Time: 2 hours. Administration Time: 1 hour. 60'C'V�u����� DR8400(11/09ro8) LIQUOR OR 3.2 BEER LICENSE COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION DENVER, COLORADO 80261 IIIIIIIII11111111goI III I III I II III III III INIIIIII11111ru1111111 CITY MARKET #26 LICENSING DEPT PO BOX 5567 TA DENVER CO 80217 -5567 ® This renewal reflects no changes from the last ap- plication. Complete page 2 and file now! 0 Yes there are changes from the last application. If applicant is a Corporation or Limited Liability com- pany, use DR 8177 and send in with this renewal. Any other changes of ownership require a transfer of ownership. See your Local Licensing Authority immediately. License Number License Type 01 -1 0779- 014{1 2122 Liability Information 44 003 445110 C 101100 Business Location a 07A 0-29—H BEAVER CREEK PL AVON CO Current License Expires OCT 10, 2010 DEPARTMENTAL USE ONLY Total Amount Due To Paid Date Wholesaler, manufacturer, importer, and public transportation system license renewals do not need Local Licensing Author- ity approval and must be returned directly to the Colorado De- partment of Revenue at least 30 days prior to the current li- cense expiration date. This application for renewal must be returned to your CITY OR COUNTY Licensing Authority at least 45 days prior to the expira- tion date of your current license. Failure to do so may result In your license not being renewed. Include both pages ofthis renewal end payment. OATH OF APPLICANT I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. Authorized Signature. Russ Dispense Date 7/26/10 Business Phone 303 -698 -3676 Title I &I Vice President Sales Tax Number 01- 10779 -0140 REPORT AND 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 e7r'..r•,e �. �,.4 -.1 BE =H '30 N'--)T DFrA177H n- 1 INnT D -- -i 4. DR 8400 (11109106) LIQUOR OR ,f,2 SEER LICENSE Make check payable to: Colorado department of Revenue.ThiState may conveil your COLORADO DEPARTMENT OF REVENUE check to a one time electronic banking transacllon Your bank account may be debited as DENVER, COLORADO 80261 RENEWAL APPLICATION early as the some day received by the state. If convened, your check will not be returnecl- 21 If your check is rejected due to insufficient or uncollected funds, the Department of Rev- enue may collect the oavmanr .mnunl rlir —tlu frnm vour hankinn Business Name CITY MARKET #26 LICENSE NUMBER (Use for all reference) 01- 10779 -0140 PERIOD 10 -11 TYPE OF LICENSE ISSUED CASH FUND S'T'ATE FEE 3.2 PERCENT BEER RETAIL CITY 85% OAP LICENSE (OFF PREMISES) 2330--100(939) 2122- 750(999) 2180- 100(999) 50.00 $ 25.00 $ 21.25 TOTAL AMOUNT DUE $ 96.25 DR 8401 (02119/09) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1881 PIERCE LAKEWOOD, CO 80261 (303) 205.2300 ATTACHMENT TO LIQUOR OR 3.2 BEER LICENSE RENEWAL APPLICATION This page must be completed and attached to your signed renewal application form. Failure to include this page with the application may result in your license not being renewed. Trade Name of Establishment State License Number City Market #26 01 -10779 -0140 1. Operating Manager Home Address Date of Birth Chuck Holcomb 1815 Brush Creek Court; Eagle, CO 10/5/57 2_ Do you have legal possession of the premises for which this application for license is made? Yes No Are the premises owned or rented: Owned If rented, expiration date of lease: R1 3. Has there been any change in financial interest (new notes, loans, owners, etc.) since the last annual application? It yes, explain in Yes No detail and attach a listing of all liquor businesses In which these new lenders or owners, (other than licensed financial institutions) are materially interested. 4. Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers, principals, or lenders Yes No (other than licensed financial institutions), been convicted of a crime? If yes, attach a detailed explanation. El 5. Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), been denied an alcoholic beverage license, had an alcoholic beverage license suspended or Yes No revoked, or had interest in any entity that had an alcoholic beverage license denied, suspended or revoked? If yes, attach a detailed explanation. 6. Does the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), have a Yes No direct or indirect interest in any other Colorado liquor license (include loans to or from any licensee, or interest in a loan to any ❑ licensee)? if yes, attach a detailed explanation. 7. Corporation or Limited Liability Company (LLC) or Partnership applicants must answer these questions. Since the date of filing of the last annual license application: Yes No (a) Are there, or have there been: any officers or directors; or managing members; or general partners added to or deleted from for applicant renewal of a 3.2 beer or liquor license? (b) Are there or have there been: any stockholders with 10% or more of the issued stock of the Corporation; or any members with Yes No 10% or more membership interest in the LLC; or any partners with 10% of more interest in the partnership added to or deleted from the applicant for renewal of a 3.2 beer or liquor license? (c) If Yes to (a) or (b), complete and attach Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes, and all supporting documentation, and fees your Local Licensing Authority immediately. 8. Sole proprietorships, Husband -Wife Partnerships or Partners in General Partnerships: EVIDENCE OF LAWFUL PRESENCE Each person identified above must complete and sign the following affidavit. Please make additional copies if necessary. Each person must also provide a copy of their driver's license or state issued Identification card. In lieu of form DR 4679, the undersigned swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one): ❑ I am a United States Citizen 0 I am not a United States Citizen but I am a Permanent Resident of the United States u I am not a United States Citizen but I am lawfully present in the United States pursuant to Federal Law 0 I am a foreign national not physically present in the United States I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, or fraudulent statement or misrepresentation in this sworn affidavit is punishable under the criminal laws of Colorado Revised Statute 18 -8 -503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. Signature Printed name Date Attachment to DR8401 for Icing Soopers or City Market 3.2% beer license renewal, Question 5. Several King Soopers /City Market store licenses were suspended in separate isolated incidents for a short period when a clerk unintentionally sold beer to a minor, after which precautions were taken so that it would not occur again. Question 6. Dillon Companies, Inc., a Kansas Corporation, also holds 3,2% beer licenses for the following stores located in Colorado: King Soo pers, City Market, Mini Mart, Inc & Loaf `N Jug Avon Police Department Liquor License Application Individual Name(s): Chuck Holcomb Name of Business: Type of License: City Market N Hotel & Restaurant Special Event Permit Location of Business: 260 Beaver Creek Place Avon, CO 81620 Avon, Colorado 81620 Date Received: July 27, 2010 Photographs /Fingerprints: On File ❑ Special Event — ,NIA Investigation by: ❑ Detective Sergeant Jonathan Lovins Z Detective Aurion Hassinger Date: August 3, 2010 CBI Criminal Investigation (attached): No history Local Criminal Investigation: No negative law enforcement contacts with Mr. Holcomb Comments: City Market: Local history revealed several calls for service for a one -year period at Avon City Market. There were several alcohol related calls but nothing concerning sales to minors or intoxicated parties. Liquor Code Violations in the past calendar year: ❑ Yes Z No If yes, explain: Smoking violation in the past calendar year: ❑ Yes 0 No If yes, explain: [I Background investigation conducted with no problems and or areas of concern. N.C.I.C. database not accessed on this applicant. Investigation Time: 2 hours. Administration Time: 1 hour.