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Home My WebLink About20131566.tiffRESOLUTION RE: APPROVAL OF RENEWAL APPLICATION AND REPORT OF CHANGES FOR HOTEL AND RESTAURANT LIQUOR LICENSE FROM JENSEN ENTERTAINMENT, LLC, DBA T-BONES RESTAURANT AND LOUNGE, AND AUTHORIZE CHAIR TO SIGN - EXPIRES JULY 17, 2014 WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, Jensen Entertainment, LLC, dba T -Bones Restaurant and Lounge, presented to the Board of County Commissioners of Weld County, Colorado, an application for the renewal of a Hotel and Restaurant Liquor License, for the sale of malt, vinous and spirituous liquors, and Donald Hines is the sole owner, and WHEREAS, the applicant has also presented the Board with a Corporate Report of Changes as follows: Fred Schlegel replaces Tony Jensen, as Manager, and WHEREAS, pursuant to Exhibit 5-H of the Weld County Code, said applicant has paid the sum of $175.00 to the County of Weld for the renewal of the existing license, and $100.00 for the Report of Changes, and WHEREAS, said applicant has exhibited a State Liquor License for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, outside the corporate limits of any town or city in the County of Weld at the location described as follows: 3815 Highway 119 Longmont, Colorado 80504 WHEREAS, the Licensee shall host "responsible vendor" training every six (6) months as agreeable to the Colorado Department of Revenue Liquor Enforcement Division, and this training shall be open to other area licensees. Each employee shall be "responsible vendor" trained, and the Licensee shall provide documentary evidence that each employee has been "responsible vendor" trained to the Weld County Sheriff's Office within thirty (30) days of the first available "responsible vendor" class after hiring. Evidence of such shall be included in the referral report submitted by the Sheriff's Office at the time of annual renewal. NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld County, Colorado, having examined said application and the other qualifications of the applicant, does hereby grant 2013-11 to said applicant to sell malt, vinous and spirituous liquors for consumption by the drink on the premises only, only at retail at said location; and the Board does hereby authorize and direct the issuance of said license by the Chair of the Board of County Commissioners, attested to by the Clerk to the Board of Weld County, Colorado, which license shall be in effect until July 17, 2014, providing that said place where the licensee is authorized to sell malt, vinous, and spirituous liquors for consumption by the drink on the premises only, shall be conducted in strict conformity to all of the laws of the State of Colorado and the rules and regulations relating thereto, heretofore passed by the Board of County Commissioners of Weld County, Colorado, and any violations thereof shall be cause for revocation of the license. uc,.cts 70ff-C- Via) cc Sat in 2013-1566 LC0014 RENEW LIQUOR LICENSE - T-BONES RESTAURANT AND LOUNGE PAGE 2 BE IT FURTHER RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Corporate Report of Changes submitted by Jensen Entertainment, LLC, dba T -Bones Restaurant and Lounge, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said Renewal Application and Report of Changes. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 24th day of June, A.D., 2013. BOARD ONTY COMMISSIONERS WELD U COLORADO ATTEST: Weld County Clerk to the Board BY: Deputy Cle A to the Board ED AORM' ounty Attorney Date of signatureJAUO 2 3 2013 at -Sara Kirkmeyer William F. Garcia, air b.ug a Ra.emac er, Pro -Tern can P. Conway MIL -4 fie 0, ike Freeman 2013-1566 LC0014 THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402 (07/01/2012) STATE OF COLORADO DEPARTMENT OF REVENUE LIQUOR 1881 Lakewood, ENFORCEMENT Pierce Street, Colorado Suite 80214 DIVISION 108 JENSEN ENTERTAINMENT LLC dba T-BONES RESTAURANT AND LOUNGE 3815 HWY 119 LONGMONT CO 80504 ALCOHOL BEVERAGE LICENSE Liquor License Number 42570830000 License July Expires 17, at Midnight 2014 License Type HOTEL & RESTAURANT (COUNTY) Authorized MALT, Beverages VINOUS, AND SPIRITUOUS This license is issued subject to the laws of the State of Colorado and especially under the provisions of Title 12, Articles 46 or 47, CRS 1973, as amended. This license is nontransferable and shall be conspicuously posted in the place above described. This license is only valid through the expiration date shown above. Any questions concerning this license should be addressed to: Colorado Liquor Enforcement Division, 1881 Pierce Street, Suite 108, Lakewood, CO 80214. In testimony whereof, I have hereunto set my hand. 7/5/2013 sp 57-3M444a4Ack botAnta,..5,64ALL Division Director Executive Director tiscJJJ� JJ� JJ� J��.�J� J' JJ1 JJ1 kt Ct O-4 r O a . r. U9-4 cc Ct • C I. E ▪ CU 4-O ) ^d U C U U . � V U Ct C cc U a cc U 0 .D cc N antanlis CC.5,7-5snanii20G THIS LICENSE EXPIRES JULY 17, 2014 NON -TRANSFERABLE. TO BE POSTED IN A CONSPICUOUS PLACE. DR e400 (Revised 09/01/12) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION SUBMIT TO LOCAL LICENSING AUTHORITY LIQUOR OR 3.2 BEER LICENSE RENEWAL APPLICATION T-BONES RESTAURANT AND LOUNGE 3815 HWY 119 REGEIVED LONGMONT CO 80504 JUN 062013 WELD COU, Fees Due Renewal Fee Storage Permit $100 x $500.00 Optional Premise $100 x Amount DuelPaid COO 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 as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department may collect the payment amount directly from your banking account electronically. PLEASE VERIFY & UPDATE ALL INFORMATION BELOW 01 RETURN TO CITY OR COUNTY LICENSING AUTHORITY BY DUE DATE DBA - T-BONES RESTAURANT AND LOUNGE Licensee Name JENSEN ENTERTAINMENT LLC Liquor License # 42570830000 License Type - Hotel & Restaurant (county) Sales Tax License # 42570830000 Expiration Date 7/17/2013 Due Date 6/2/2013 Street Address 3815 HWY 119 LONGMONT CO 80504 Phone Number (303) 915 3165 Mailing Address 3815 HWY 119 LONGMONT CO 80504 Operating Mane a ,- t 11 - e/gr Date of Birth Home Address pro t, 502-9 ��dtk /i6 ,: M C4, Phone Num ^ 3©3- 1. Do you have legal possession of the premises at the Is the premises owned or rented? ❑ Owned ®. 2. Since the date of filing of the last annual application, or organizational structure (addition or deletion of officers, and attach a listing of all liquor businesses in which directors, managing members, or general partners NOTE TO CORPORATION, LIMITED LIABILITY officers, directors, managing members, general partners and return immediately to your Local Licensing Report of Changes, along with all supporting documentation 3. Since the date of filing of the last annual application, (other than licensed financial institutions) been convicted 4. Since the date of filing of the last annual application, (other than licensed financial institutions) been denied revoked, or had interest in any entity that had an explanation. LI YES aNO 5. Does the applicant or any of its agents, owners, managers, or indirect interest in any other Colorado liquor license, yes, attach a detailed explanation. ❑ YES 0 6. SOLE PROPRIETORSHIPS, HUSBAND -WIFE PARTNERSHIPS must complete and sign the DR 4679: Affidavit — attach a copy of their driver's license, state -issued street address above? a YES ❑ Rented` `If rented, expiration date has there been any change in financial directors, managing members these new lenders, owners (other than are materially interested. LI YES 1. COMPANY AND PARTNERSHIP APPLICANTS: or persons with 10% or more interest Authority, Form DR 8177: Corporation, and fees. has the applicant or any of its agents, of a crime? If yes, attach a detailed has the applicant or any of its agents, an alcohol beverage license, had alcohol beverage license denied, suspended partners or lenders (other than including loans to or from any licensee NO AND PARTNERS IN Restriction on Public Benefits (available ID or valid passport. NO of lease 1I- /% interest (new notes, loans, owners, etc.) or general partners)? If yes, explain in detail licensed financial institutions), officers, NO If you have added or deleted any in your business, you must complete Limited Liability Company or Partnership owners, managers, partners or lenders explanation. ❑ YES la NO owners, managers, partners or lenders an alcohol beverage license suspended or or revoked? If yes, attach a detailed licensed financial institutions) have a direct or interest in a loan to any licensee? If GENERAL PARTNERSHIPS: Each person online or by calling 303-205-2300) and AFFIRMATION & CONSENT I declare under penalty of perjury in the second degree that this application and all attachments are true correct and complete to the best of my knowledge. Type or Print Name of Applicant/Authorized Agent of Business Do Al Ai Title Nam( Signature ill Date reR1—/O9 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, that such license, if granted, will comply with the provisions of Title 12, Articles 46 and 47, C.R.S. THEREFORE THIS APPLICATION,.. ' '-/ Z4 an. t i. • rt f• a Local Lic ng Authority For - Weld County, Colorado Date JUN 2 4 !,' a` Signature Willi m f. Garcia Title Chair, Board of Weld Count Commissioners Attest B�;la y; s1,„/ ""f ' To: Weld County Board of Commissioners From: Deputy Lisa Carpenter Date: June 13, 2013 RE: Jensen Entertainment LLC., DBA T -Bones Rest and Lounge Dear Commissioners, I have researched and found several reported calls for service to Jensen Entertainment LLC., DBA T -Bones Rest and Lounge, located at 3815 Hwy 119, Longmont, CO 80504 for the Calendar year of 2012 to present day. These calls consist of three Disturbances, a suspicious person, 1 fraud report, 1 Assault report, a fight and an unwanted party. There were also 17 bar checks done by Deputies on duty in District Two. I find no grounds for disapproval for the renewal of the liquor license. Respectfully Submitte Deputy Lisa Carpe Community Resource Officer Weld County Sheriffs Office 1950 "O" Street Greeley, CO 80631 LIQUOR/BEER RENEWAL REVIEW FORM Date: June 11, 2013 TO: Lisa Carpenter/Mark Mellon FROM: CTB — Tammy Waters SUBJECT: Liquor License Check In accordance with the procedure for Liquor and/or beer license checks, please review all records on the following establishment for any associated reports during the last year and return your report to the Weld County Clerk to the Board's Office within two weeks. Your report will be used by the Board of County Commissioners in considering the renewal request for a Hotel and Restaurant Liquor License. PLEASE RESPOND NO LATER THAN: June 21, 2013 ESTABLISHMENT: JENSEN ENTERTAINMENT, LLC DBA T-BONES REST AND LOUNGE 3815 HIGHWAY 119 LONGMONT, CO 80504 Current license expires: July 17, 2013 C No concerns � Deputy's Initials The Sheriffs Office had a concern and the deputy has mutually worked with the licensee to correct the concern. (Complete Attached Worksheet) Unresolved concerns exist requiring a Probable Cause Hearing scheduled by the Board of County Commissioners. (Complete Attached Worksheet) •***********************++«*************************************************************************** Please notify at Extension Board of Commissioner's renewal hearing. of the date and time of the Liquor/Beer License Worksheet The following concerns are noted: 111 The Licensee and the Sheriffs Office have collectively agreed to implement the following to correct concerns noted above: (A time line and corrective action should be listed for each concern) 3ar \` owt o Establishmrt Owner, Please Print shment Signature Date p s Signature Use another sheet of paper or attach separate proposal to this packet if needed. Attach copies of all reports associated with this establishment for the last year. Both the Deputy and the Owner of the establishment will be required to attend the Liquor Hearing to testify to the above agreement. WELD COUNTY SHERIFF'S OFFICE CommunityResource Office LIQUOR EN ENT WORKSHEET 1950 O'Stieot • Greeley, Colorado 80631 Voice (970) 356-4015 • Fax (970) 304-6467 Inspection Report u Incident Report CR#: t.icau.traae>ram L (1 e'Vtpy4t tIjccrtsee /1 Name:1\ — T ( luv�e-S &ST i , TLicense*/ {C t k �..\iLl.c-l_/a.. /4 Date of Report / Incident i i _ 13 - Address. . 1 s !- Li { L Person Ccnlactea_4, ((OA._ OA- \ -15-WS r c ii. City. State, Zip:U.: (LC1 (1/16 1,3--, ?ij 8 6SU l TeiePhcoe t: 30 . 10 I$ •- I Oa Yes No WA Yes No NIA State Liquor License Posted V Manager Registered ✓f Sales Tax License Posted VState License in Control d Premises ' County Liquor License Posted ✓' Trade Name Properly Registered -- Federal Form 11 ' Call (800) 398-2822 ✓ Premises Physical Control Adequate Food Service License Posted ✓ Acceptable Dispensing System '.- Minor Warning Sign Posted tz Off Premise Storage Licensed Meals and Snacks Available Only Permitted Items Sold Cleanliness Adequate 17_4 Alcohol From Permitted Source Books & Invoices AvailableDiscuss Sales of Liquor to Minors Alcohol Beverage Stock Acceptable Discuss Sales to Intoxicated Persons ✓ ❑Warning OFollow-Up Inspection L LLA� :JF( ce /Representative Signature Date Violation: I Date: I Time' Subject: I DOB L I HI: I W'gi: I Eyes' i Hair. Cbthing: DL ! IN: State: Address: City. State: Zip: Evidence: Yes NO HAM Phone Pi Summors It: Court Date Phclas: Yes NO Narrative: ti 5-71 Deputy: �� #: b-)0,01 S Date: 6-, - (3.13 MEMORANDUM To: Tammy Waters, Deputy Clerk to the Board June 14, 2013 From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services Subject: LC0014 Review of the following liquor license renewal by the Department of Planning Services shows the following: 42-57083-0000 Jensen Entertainment, LLC dba T -Bones Restaurant and Lounge 3815 Highway 119 Longmont, Colorado 80504 Zone District: Three Lot Minor Subdivision (C-3) - Commercial This use is permitted through a Site Plan Review (SPR-364) permit. Currently there are no active violations noted on the above mentioned property SERVICE, TEAMWORK, INTEGRITY, QUALITY Weld County Referral Department of Planning Services 1555 N 17th Ave Greeley, CO 80631 (970) 353-6100 Date: June 17, 2013 Application: JENSEN ENTERTAINMENT, LLC DBAT-BONES REST AND LOUNGE 3815 HIGHWAY 119 LONGMONT, CO 80504 Project: Liquor Renewal and Change of Corp Structure Liquor License # 4257083000C The Weld County Building Inspection Department finds one building permit for repair work to exterior of building, BCR13-00419; work is in progress, the one code violation complaint for this property has been closed, BCV13-00007. The Building Inspection department has no concerns. Frank Piacentino Department of Building Inspection Tammy Waters From: Sent: To: Subject: Follow Up Flag: Flag Status: Janet Carter Friday, June 07, 2013 12:51 PM Tammy Waters Re: T -Bones - Jensen Entertainment - Liquor Renewal and Change of Corp Structure Follow up Flagged Public works doesn't have any comments at this time. Sent from my iPhone On Jun 7, 2013, at 9:32 AM, "Tammy Waters" <twaters@co.weld.co.us> wrote: In accordance with the procedure for Liquor and/or beer license checks, please review all records on the following establishment for any associated reports / concerns during the last year and return your report to the Weld County Clerk to the Board's Office within two weeks. Your report will be used by the Board of County Commissioners in considering the renewal request and change of corporate structure for a Hotel and Restaurant Liquor License. PLEASE RESPOND NO LATER THAN: June 21, 2013 ESTABLISHMENT: JENSEN ENTERTAINMENT, LLC DBA T-BONES REST AND LOUNGE 3815 HIGHWAY 119 LONGMONT, CO 80504 Current license expires: File Location: July 17, 2013 LC0014 Tammy Waters Deputy Clerk to the Board 1150 0 Street(P.O. Box 758(Greeley, CO 80632 tel: (970) 336-7215 X5226 <image001.jpg> Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. <T -Bones Renewal.pdfl CT -Bones Change of Corp Structure.pdfl 1 Tammy Waters From: Sent: To: Cc: Subject: Roy Rudisill Wednesday, June 19, 2013 4:02 PM Tammy Waters Deb Adamson Re: T -Bones - Jensen Entertainment - Liquor Renewal and Change of Corp Structure No concerns for this renewal from OEM Roy Director Roy Rudisill Weld County Office of Emergency Management 1150 0 Street Greeley Co. 80632 970-304-6540 W 970-381-0417 C On Jun 19, 2013, at 3:51 PM, "Tammy Waters" <twaters(dco.weld.co.us> wrote: > Hi, > The deputy that needs to attend the hearing for this has requested that we put this on the agenda for Monday, June 24, 2013. I'm still waiting for referrals from you and I know I am bugging you early but do you have information that you would like to have included in the information presented to the Board? > Thanks > From: Tammy Waters > Sent: Friday, June 07, 2013 9:33 AM > To: Bethany Salzman; Brad Yatabe; Dan Joseph; David Clarke; Deb Adamson; Frank Piacentino; Janet Carter; Roy Rudisill > Subject: T -Bones - Jensen Entertainment - Liquor Renewal and Change of Corp Structure > In accordance with the procedure for Liquor and/or beer license checks, please review all records on the following establishment for any associated reports / concerns during the last year and return your report to the Weld County Clerk to the Board's Office within two weeks. Your report will be used by the Board of County Commissioners in considering the renewal request and change of corporate structure for a Hotel and Restaurant Liquor License. > PLEASE RESPOND NO LATER THAN: June 21, 2013 > ESTABLISHMENT: JENSEN ENTERTAINMENT, LLC DBA T-BONES REST AND LOUNGE > 3815 HIGHWAY 119 LONGMONT, CO 80504 > Current license expires: July 17, 2013 > File Location: LCOO14 > Tammy Waters 1 O CO O -0 C U (d 0 O CO c a, o0 E ti U0 ° x (I) pima, 5)00°) UU d RECEIPT DATE we-- tr. NO. 87009 QA0-(tirkoka4/4 RECEIVED FRO ADDRESS R HOW CASH GeD (50 CHECK MONEY ORDER Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) BY „/A onv o RECEIPT DATE LI-(H3 N°. 87010 kunvY\ft4"-4" TbtswS RECEIVED FROMCJ S%'. ADDRESS FOR UG9uw re~ixt CASH CHECK MONEY HOW PAID rtc 1/V Ceu.": •SENDER: COMPLETE THIS SECTION Street, Apt. No.; or PO Box No. —Ecyles City, State, ZIP+4 BY ■ Complete items 1, 2, and 3. Also compt®te item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: 1 3V[5. ij 1I 9 i'Yl flyl j W ?05614 6/b5b$vise. \./d: tw B. Received by (Printed Name) D. Is delivery address different from. item 1? 0 Yes if YES, enter delivery address below: , ❑ No Total Postage & Fees 3. Service Type Certified Mail. 0 Express Mail ❑ Registered 0 Return' Receipt for Merchandise ❑ Insured Mall ❑ 0.0.0. 4. Restricted Delivery'? (Extra Fee) ❑ Yes' 2. Article Number (Transfer from service label) 7004 2890 0003 5709 9027 PS Form 3811, February. 2004 Domestic Return Receipt 102595.02-M-1540 Memorandum TO: Tammy Waters FROM: Dan Joseph SUBJECT: Liquor license inquiry T -Bones DATE: June 21, 2013 CC: Cindy Salazar; Debra Adamson In response to your request, Environmental Health Services has reviewed the Retail Food Service Establishment file for T -Bones Restaurant and Lounge, located at 3815 Highway 119, in Longmont, Colorado. At this time, there are no problems or concerns regarding this establishment. Should you have any questions regarding this matter, please contact me via e-mail at djoseph@co.weld.co.us or by phone at 970-304-6415 extension 2206. Thank you. Dan Joseph Environmental Specialist 111 Tammy Waters From: Sent: To: Subject: Tammy Waters Wednesday, August 28, 2013 8:56 AM 'Eaton - DOR, Robin' RE: T -Bones Restaurant Mgr That's the one that is now transferring to another owner and is selling the business as of tomorrow. We are having the hearing for the temporary license today. So they are not sending in the $75.00 now, it's a bit of a mess. Tammy Waters Deputy Clerk to the Board 1150 O Street'P.O. Box 758IGreeley, CO 80632 tel: (970) 336-7215 X5226 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Eaton - DOR, Robin[mailto:robin.eaton@state.co.us] Sent: Wednesday, August 28, 2013 8:50 AM To: Tammy Waters Subject: T -Bones Restaurant Mgr Hi Tammy, I have found in my stack of applications a manager change and DR 8177 for dba T -Bones restaurant and I am showing that the manager fees were not collected for this H&R. On the 8177 it shows that F. Schlegal is the manager but not a Member of that company and as such, they need to submit the $75. I think this was sent in an email on 7-5 or 7-16 and I can't seem to remember the reply. Could you please refresh my memory on this Mgr. Change application Thank you Robin Eaton Liquor Enforcement Colorado Department of Revenue 1 Tammy Waters From: Sent: To: Subject: Attachments: Hi Robin, Tammy Waters Tuesday, July 16, 2013 9:42 AM 'Eaton - DOR, Robin' FW: T -Bones application Jensen Entertainment Report of Changes.pdf lc IAaci 4 -7S V ,ptt„`0.An—k Can you please check this and see if we have it correct now? I also attached the letter for Don Hines, he really doesn't have any supporting documentation. According to him the other partner skipped town so I'm not really sure if this letter will work or not. Thanks, Tammy Waters Deputy Clerk to the Board 1150 O Street)P.O. Box 758/Greeley, CO 80632 tel: (970) 336-7215 X5226 V°— NW_ Y2f6"+ Ob ems � takaeAr Net 'SP Srv1/46 lnru st LoAnA"`tailsgS Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Tonya Johnson Sent: Monday, July 08, 2013 8:20 AM To: Eaton - DOR, Robin Cc: Tammy Waters; Esther Gesick Subject: RE: T -Bones application Robin, Good morning. I see you have sent this to Esther as well, I wanted to let you know that I am no longer in the Clerk to the Boards office. If you could please send future Liquor emails to Esther and Tammy Waters (twaters@co.weld.co.us) that would be great. I will forward this to Tammy as well. I hope you have a wonderful weekend. Tonya Johnson Weld County Department of Planning Services 1555 N 17th AvenuelGreeley, Colorado 80631 tel: 970-353-6100 x 3529 trjohnson@co.weld.co.us Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Eaton - DOR, Robin [mailto:robin.eaton@state.co.us] Sent: Friday, July 05, 2013 11:52 AM To: Esther Gesick Cc: Tonya Johnson Subject: T -Bones application Hi Ladies, I hope that the 4th was a restful and comfortable time off for you. Upon review of the DR 8177 and 8442 applications I will need some additional information and odcuments, they are as follows: 1. As per the instructions I will need supporting documents, such might be a signed minutes of the meeting, resignation letters, purchase agreement. This could also need an amend IHR for any fees/funds that were used. 2. Need to amend the DR 8177 to show Don Hines on the right side of question #8 being replaced and then Fred should be on the left side, along with his information. 3. Also, Fred should be in question #9..left side of the question and D. Hines on the right as the "replaces." That way it show Fred Schlegel replaces Don Hines as I believe has taken place. Thank you Robin Eaton Liquor Enforcement Colorado Department of Revenue 2 DR 8442 (09/24/09) Page 1 COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION DENVER, COLORADO 80261 (303)-205-2300 PERMIT APPLICATION AND REPORT OF CHANGES FOR DEPARTMENT USE ONLY CURRENT LICENSE ALL ANSWERS LOCAL LICENSE APPLICANT SHOULD NUMBER MUST BE PRINTED FEE $ 100.00 42-57083-0000 TO ORDER CALL (303) 370-2165 IN BLACK INK OR TYPEWRITTEN OBTAIN A COLORADO LIQUOR & BEER CODE BOOK 1. Applicant is a . Company (iii-S.R., ., n • Corporation • Individual 42-57083.0000 [ Limited Liability • Partnership 2. Name of Licensee Jensen Entertainment LLC 3. Trade Name T -Bones Restaurant and Lounge 4.Location Address 3815 HWY 119 City Longmont SELECT THE APPROPRIATE SECTION BELOW JFrA SF Pi IY s ii l.' L' _A I(lLk • o �- 4, Mb a °er a ≥G�r`rYn 'ICS � ' a . r. ti County Weld AND elf � PROCEED TO THE INSTRUCTIONS fill -L.Y i'2 iS li , se I � , .x� ''�3"a'i�� ZIP 80504 ON PAGE 2. �3 y L)�Y nyl.l frllll! � , � - License Account No. 42-57083-0000 Warehouse Branch Corp. or Location Alter or x Storage House Trade Permit Modify Total Fee Premises Total Fee Facility Fee Permit (ea) $100.00 Permit (ea).... 100.00 Name Permit (ea).50.00 (ea) 150.00 Premises 2210-100 (999) • Retail (Hotel & Restk)..$75.00 (Tavern) $75.00 (Other Licenses) NO FEE 2200-100 (999) ■ Wholesale 1983-750 (999) ■ Manager's Registration 2012-750 (999) 9 Manager's Registration II Change of Manager 2260-100 (999) ■ Change 2230-100 (999) N Change 2280.100 (999) • Change, $150.00 •o I r i(�J gliO® =nfA of Optional to Existing H/R • Liquor License 2270-100 (999) No. 2220-100 (999) • Addition $100.00x of Related Total to Resort Complex $50.00 1988.100 (999) II Addition • Duplicate License $75.00 x DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY DATE LICENSE ISSUED LICENSE ACCOUNT NUMBER PERIOD -750 (999) -100 (999) The State mayconvertyourcheckto a one time electronic banidng transaction. Your bank account may be debited as early es the same day received by the State. if converted, your check wit not he returned. If your check is rejected TOTAL Viepaysmentamoun d ec0lyttrromyour kar ountelearfraiicaii pem AMOUNT DUE $ .00 DR 8442 (09/24/09) Page 2 INSTRUCTION SHEET FOR ALL SECTIONS, COMPLETE QUESTIONS 1-4 LOCATED ON PAGE 1 Q Section A To Register or Change Managers, check the appropriate box in section A and compiete question 8 on page 4. Proceed to the Oath of Applicant for signature (Please note: Hotel, Restaurant, and Tavern licensees are required to register their managers). El Section B For a Duplicate license, be sure to include the liquor license number in section B on page 1 and proceed to page 4 for Oath of Applicant signature. El Section C Check the appropriate box in section C and proceed below. 1) For a Retail Warehouse Storage Permit, go to page 3 complete question 5 (be sure to check the appropriate box). Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 2) For a Wholesale Branch House Permit, go to page 3 and complete question 5 (be sure to check the appropriate box). Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 3) To Change Trade Name or Corporation Name, go to page 3 and complete question 6 (be sure to check the appropriate box). Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 4) To modify Premise, go to page 4 and complete question 9. Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 5) For Optional Premises or Related Facilities go to page 4 and complete question 9. Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 6) To Change Location, go to page 3 and complete question 7. Submit the necessary information and proceed to page 4 for Oath of Applicant signature. DR 8442 (09124109) Page 3 y+ !("+fPa:l S t) N+ ° ' It © j ly. + � n _ 5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit etc.) • Retail Warehouse Permit for: in On —Premises Licensee (Taverns, Restaurants • Off —Premises Licensee (Liquor stores) • Wholesalers Branch House Permit Address of storage premise: City , County Zip Attach a deed/ lease or rental agreement for the storage premises. Attach a detailed diagram of the storage premises. • „ . ≤_ o in 6. Change of Trade Name or Corporation Name supporting documents) of State, or of State, and • Change of Trade name / DBA only ■ Corporate Name Change (Attach the following 1. Certificate of Amendment filed with the Secretary 2. Statement of Change filed with the Secretary 3. Minutes of Corporate meeting, Limited Liabil'ty Members meeting, Partnership agreement. - _ 2 Old Trade Name New Trade Name Old Corporate Name New Corporate Name ,,.,�5� ad, i1 r9 e ® " r 4'L`rc ;ti s 6ti�`g ee , 7. Change of Location NOTE TO RETAIL LICENSEES: An application to change location has a local application fee of $750 payable to your local licensing authority. You may only change location within the same jurisdiction as the original license that was issued. Pursuant to 1247 - 311 (1) C.R.S. Your application must be on file with the local authority thirty (30) days before a public hearing can be held. Date filed with Local Authority Date of Hearing (a) Address of current premises City County Zip (b) Address of proposed New Premises (Attach copy of the deed or lease that establishes possession of the premises by the licensee) Address City County Zip (c) New mailing address if applicable. Address City County State Zip (d) Attach detailed diagram of the premises showing where the alcohol beverages will be stored, served, possessed or consumed. Include kitchen area(s) for hotel and restaurants. DR 8442 (09/24/09) Page 4 1 A% ty,fnx l © , : v F: I 8. Change of Manager or to Register the Manager of a Tavern or a Hotel and Restaurant liquor license. (a) Change of Manager (attach Individual History DR 8404-I H/R and Tavern only) Former manager's name Tony Jensen New manager's name Fred Sehsdf � i te,0' (b) Date of Employment 01/01/2011 establishment? any other liquor licensed establishment? Has manager ever managed a liquor licensed Does manager have a financial interest in If yes, give name and location of establishment ' Yes ■ Nog Yes ■ No f 0 I'03 O .A 0 p - r'{ 0 -rr;5 31�y Y.f, 4. ` Ilyh'x' ( r ,A,ahf E;tw�1:�6j ri�Irr,s� ; ,3: ' .; gH, 9. Modification of Premises, Addition of an Optional Premises, or Addition of Related Facility NOTE: Licensees may not modify or add to their licensed premises until approved by state and local authorities. (a) Describe change proposed (b) If the modification is temporary, when will the proposed change: Start (mo/day/year) End (mo/day/year) of any public or campus of any NOTE: THE TOTAL STATE FEE FOR TEMPORARY MODIFICATION IS $300.00 (c) Will the proposed change result in the licensed premises now being located within 500 feet private school that meets compulsory education requirements of Colorado law, or the principal college, university or seminary? (If yes, explain in detail and describe any exemptions that apply) (d) Is the proposed change in compliance with local building and zoning laws? (e) If this modification is for an additional Hotel and Restaurant Optional Premises or Resort Facility, has the local authority authorized by resolution or ordinance the issuance of optional (f) Attach a diagram of the current licensed premises and a diagram of the proposed changes licensed premises. (g) Attach any existing lease that is revised due to the modification. Yes ❑ No ■ Yes ■ No IN Complex Related premises? Yes No❑ for the FI i++ r erg, i . i ji uei C.F '�, G ,` 2 m a 1 rA �i + if t''=- '{+.+ ✓ 1r © e I G �f fi -.r W;�, S.I) A d 5,'�P4 f��{R�:h�li a�� 9(rAyBl'�` dla. un 0� v r- cs,i'ss�d a x bjii a { P I b° e or aeldla P it aR' �t I ', item t r A. . Q' �°l ! r rc s= h �1itt�� ra / .. �. h �BGfll to y4�f�?,�,��Co ra �° � ®�h, e ta�('4k °citinil Signature ( )4,,,,r /t, JJJ�+rrJ✓✓✓11tNYN��////��lll- Me Owner Date 1118/13 ,�JjY i'5.:(I i o© njlll,�, ® '. L"oFr O yi d�C�' Y�Yr;: e)1T I!I'�' 5xry iJ " £-+p � }P{,�9f, t f n,, A+n h ✓ �d { .J I, f �n ooA°K°, o tL �o Ld10 o 'ti x "hr ed a�du ins,,,,r+oteloU®C a'Y �Et Yf o(r 9` ^001 0 )Z©qua a - G "-Itc0"i ° ' Eo rG1P Y LU�ih�d o o 1rr=o 0 0,�1 `T71lSs ({d" IS I 1 « n $aka A.�� M uysf° slti�a„n'" `` S a m�n© °LTli. , >o E THISA -.LIe to ';[ A a VEs rM vI Local Licensing Authority (City or County) Weld County Date filed with Local Authority 01/18/2013 signature Wi am F. Garcia vVn✓�AA Title Chair, Board of Weld County Commissioners Date JUN 2 42013 Ir it 6a 1] V f t 3SFlt�' ¢Y�} [ i tuk E a T 0 ,. LI E �S` ti� ,n ` ari „ t rt+wu _ ° °I ° sa n an®ce,,®I{ sw _ �r°1' nk:° !tasV�E rtr 1 ii NN, 1 n° fl i Signature Title Date O'l0/ a/54%ems DR 8177 Page 2 INSTRUCTIONS CORPORATION, LIMITED LIABILITY COMPANY OR PARTNERSHIP REPORT of CHANGES NOTE: ENCLOSE A CHECK PAYABLE TO THE AUTHORITY WHERE THIS APPLICATION WILL BE FILED FOR $100.00 FOR EACH PERSON LISTED IN SECTIONS 8 AND 9 ON THE APPLICATION. MASTERFILE APPLICANTS MUST INCLUDE A FEE OF $250.00 FOR EACH PERSON LISTED PAYABLE TO THE COLORADO DEPARTMENT OF REVENUE. (Application filed directly to the state) NOTE: If you are a Limited Liability Company (LLC), or a Partnership (Limited, General, or Husband and Wife) check box 2355. For Corporations check box 2350. Attach the following supporting documents to the Report of Changes Application: • Certificate of Incorporation (or) Date stamped Articles or, Partnership Agreement (Limited and General Partnerships) • Certificate of Good Standing dated within the last two years • Certificate of Authority (only if a foreign corporation) • Copies of minutes of meetings by the Corporation, Limited Liability Company or Partnership supporting the changes reflected on the front of this application. This includes letters of resignation, or appointment of any officers, or directors of a Corporation, or any managing member or members of a Limited Liability Company, or any general or limited partner in a Partnership (including husband and wife partnerships). • NOTE: If the Licensee as listed on Line 1 has a sole stockholder that is a Corporation, or LLC, or Partnership, attach a letter designating one officer, or managing member or the general partner to be the "principal person" for the applicant. This person MUST ALSO fill out a DR8404-I (Individual History Record) and submit fingerprints for background investigation. This application and all supporting documents must FIRST BE FILED WITH, AND APPROVED BY, THE LOCAL LICENSING AUTHORITY (CITY, TOWN, COUNTY). Applications will not be accepted unless all applicable questions are fully answered, all supporting documents correspond exactly with the name of the applicant. 1. List the name of the Corporation or Limited Liability Company or Partnership 2. List the State Sales Tax Number. 3. List the Applicant's State Liquor License Number. 4. List the Trade name of the business. 5. List the area code and telephone number of the business. 6. List the complete address, City, State and Zip Code, of the licensed premises. 7. List your mailing address if different than number 6 above. 8. List all officers, directors of a corporation, or all managing members of the LLC, or General Partners of Limited or General Partnerships. List the person's Position, Home Address, Date of Birth and the name of the person being replaced (if applicable). 9. List all 10% (or more) stockholders or members or Partners, and indicate ownership percentage, Home Address, Date of Birth, and the name of the person they purchased ownership interest from (if applicable). 10. List the name and address for service of the Registered Agent. 11. A person authorized to sign on behalf of the Applicant must sign the application, list their title, and the date the application was signed. 12. To be filled out by the local licensing authority only. List the name of the authority and indicate if the authority is a county, town/city. Then sign the application, list your title and attest the city! county officials signature and date the application. DR 8177 (05/09/08) PAGE 1 COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER CO 80281 (303) 205-2300 REPORT OF CHANGES 21 CORPORATION, LIMITED LIABILITY COMPANY AND PARTNERSHIP Liquor and 3.2 Beer Licenses (2355) 7 LLC/PARTNERSHIP SEE INSTRUCTIONS AND (2350) El CORPORATION FEE SCHEDULE ON PAGE 2 DO NOT WRITE IN THIS SPACE 1. Corporate/L.L.C./Partnership Name Jensen Entertainment LW 2. State Tax Account Number L4257083 3. State Liquor License Number 42-57083-0000 4. Trade Name T -Bones Restaurant and Lounge 5. Telephone Number 303-678-9100 6. Address of Licensed Premises 3815 HWY 119 City Longmont State CO ZIP Code 80504 7. Mailing Address if different than above City State ZIP Code 8. LIST ALL officers, directors (corporation) or Managing Members (L.L.C.) or General Partner(s). Each Officer, Director, Managing Member or Partner MUST FILL OUT a DR 8404-I (Individual History Record). PositionHeld Names Home Address DOB Replaces owner Donald R Hines 1049 Monaco Pkw Denver CO 80220 on 9. LIST ALL 10% (or more) Stockholders or 10% (or more) Members or 10% (or more) Limited Partners. Each person listed Must Fill out a DR 8404-I (Individual History Record) Stockholders/Members/Partners owning 10% (or more) of business Owned Home Address DOB Replaces Donald R Hines 100 1049 Monaco Pky Denver CO 80220 j rmc ;1 S, 10, Registered Agent Address For Service OATH OF APPLICANT / 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. 11, Authorized Stgnatu Void( r (Owner O Date 11/1$/13 REPORT OF LOCAL LICENSING AUTHORITY The foregoing changes hay-. : - - -wed and examined by the Local Licensing Authority. 12. Local Licensing Authority Far m, Weld County � `.._,„ 1County Town/City Signature 1111 F. Garcia i % A .gtgq rte.. 1 air, Board o ne • ijal Commissioners Date JUN 2 42013 Anent �V,, , t �` 1,411 ^t'>t!� to the Board BY ` a �/ nir r 2,,• Clerk to the Board Date JUN 2 42013 r. DO NOT WRITE I flc �. l�l r DEPARTMENT OF REVENUE USE ONLY � .�� ii. Y INFORMATION License Account Number Period Cash Fund -100 (999) TOTAL A 0.70'/3 --/S Jensen Entertainment LLC 3815 State Highway 119 Longmont, CO 80504 To Whom It may Concern: 07.12.13 TonyJensen was a part owner in Jensen Entertainment LLC, but is no longer a part of, or employed by Jensen Entertainment LLC. He abandoned the business and fled the state of Colorado. His whereabouts are unknown. I am now the sole owner of Jensen Entertainment LLC, and Fred Schlegal is the manager. If you need further information from me, let me know. Sincerely, Don Hines 303.579.1941 DR 8404-I (07/25/11) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1881 PIERCE STREET RM 108A DENVER CO 80261 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 thy, 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. 1. Name of Business •Itx.}'-E' A r iA-r ct, h, p �.i- & L c A K din f. s R° .Q.j "7.s r cs...,' 2. Your Full Name (last, first, middle) r G1 e ;u14; V ' P I �c �e�� ( 0r 3. List any other names you have used. 4. Mailing address (if different from residence) 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 5bq 9 G(5r)d f 110110-v i7(tky L O ,,t„ -1 CO roc 09 g O --C-7'10 Previous 6. List all employment within the last five years. Include any se f employment. (Attach separate sheet if necessary) NAME OF EMPLOYER OR BUSINESS ADDRESS (STREET, NUMBER, CITY, STATE, ZIP) HELD FROM TO - Ali? •QWstow �VIJ-67/ ktcf r.a ' i CJ vk # /PO/SITION / C�Kf j.e" -��1J l--.2e►3 /lu4 SKy 40,-/-1)...4-5 /05 65) XP- Fr i a r Odor ac7/0 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 /14 NI - NA AIA 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. ce ❑ Yes I!� No 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer license anywhere in the United States? If yes, explain in detail. ❑ Yes No 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited 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 fcurrently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (if yes, explain in detail.) ❑ Yes U^ No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) Yes N.No PERSONAL AND FINANCIAL INFORMATION Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a. Date of Birth c. Place of Birth C ct w. c 14 .") �.0 t-4.., J rs -Q /-1-€ \r d. U.S. Citizen? 2sYes No e. If Naturalized, State where f. When g. Name of District /Court h. Naturalization Certificate Number i. Date of Certification j. If an Alien, Give Alien's Registration Card Number k. Permanent Residence Card Number I. Height �r *) m. /Weight go n. ,Hair Color $$ou o. +Eyre Color 1�ti'7a ( p. Sex /41 ( q. Race q. C r. Do you have a current Driver's License? If so, give number and state l .Yes � No ` f 14. Financial Information. a. Total purchase price $ Al / (if buying an existing business) or investment being made by the applying entity, corporation, (i limited liability company, other $ /V% partnership, b. List the total amount of your investment in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid $ c. Provide details of the 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 Source Amount 4.11:<4 41/1"-- A/A d. Loan Information (attach copies of all notes or loans) Name of Lender Address Term Security Amount M r 4/4 AIA- /1/4 /4///1 Oath of Applicant I declare under penalty of perjury that this application and all attachments are true, correct, and complete to the best of my knowledge. Au ed Si natyle 4 The Date Air 7-51 t-cC.7 4�C- v�� C� `✓ pG��JC /7Q , Q7� /n/� /9O�-r✓ /J o C'-7-2ev z=5 -Le %c Q'1,u�7/o J xJ c 2fl � -cam CePC� 53_ 503— 962-0 %D Gt/h oil l7 17--Jcedi GO-) f a2J-( J e r S s� v /G✓)ocAhi 72-7,c) S'% %P p 1 (�y q . S her -r w n - S �� d tes a te- (7.7z4,-, an d /s /ice U C_2 tj)10 co-) c i xn c t i0 Ss- Letters of Reference: The Weld County Board of Commissioners require three (3) letters of reference from each applicant. These letters can be from past and current business associates, employers, employees, and coworkers, or personal friends. 1') Ng r/ cdiuceril ' /"reGl .$c/%y/ve/ 4-gi 4/ww 6iec/✓ 4,v / AM/r 71/1// � i {fro 11 fi epr/-`Jyv, f/ej Li- i9 Mee c`6' Aix tire p7 l /NUEi hiiu 0-:Y�? rHy /Ha- //tieCr 3( 9) 20130520-01271 DATE 05/16/2013 SO WELD COUNTY RECORDS GREELEY 1950 "0" STREET GREELEY, CO 80631 RE: SCHLEGEL,FREDERICK D JR DATE OF BIRTH: soc: xxx-xx- The Colorado arrest record for the person noted to follow. The Colorado Bureau of Investigation's database contains detailed information of arrest records based upon fingerprints provided by Colorado law enforcement agencies. Arrests which are not supported by fingerprints will not be included in this database. On occasion the Colorado criminal history will contain disposition information provided by the colorado Judicial system. Additionally, warrant information, sealed records, and juvenile records are not available to the public. Since a record may be established after the time a report was requested, the data is only valid as of the date issued. Therefore, if there is a subsequent need for the record, it is recommended another check be made. Falsifying or altering this document with the intent to misrepresent the contents of the record is prohibited by law and may be punishable as a felony when done with intent to injure or defraud any person. sincerely, Ronald c. Sloan, Director colorado Bureau of Investigation ATTN: SO WELD COUNTY RECORDS GREELEY COLORADO BUREAU OF INVESTIGATION - IDENTIFICATION UNIT 690 KIPLING STREET,SUITE #3000, DENVER, COLORADO 80215 (303)239-4208 THIS IDENTIFICATION RECORD IS FOR LAWFUL USE ONLY AND SUMMARIZES INFORMATION SENT TO THE COLORADO BUREAU OF INVESTIGATION FROM FINGERPRINT CONTRIBUTORS IN THE STATE OF COLORADO. UNLESS FINGERPRINTS ACCOMPANIED YOUR INQUIRY, THE COLORADO BUREAU OF INVESTIGATION CAN NOT GUARANTEE THIS RECORD RELATES TO THE PERSON IN WHOM YOU HAVE AN INTEREST. IF THE DISPOSITION IS NOT SHOWN OR FURTHER EXPLANATION OF AN ARREST CHARGE OR DISPOSITION IS DESIRED, THAT INFORMATION MAY BE OBTAINED FROM THE AGENCY WHO FURNISHED THE ARREST INFORMATION. Page 1 20130520-01271 ONLY THE COURT OF JURISDICTION OR THE RESPECTIVE DISTRICT ATTORNEY'S OFFICE WHEREIN THE FINAL DISPOSITION OCCURRED CAN PROVIDE A CERTIFIED COPY TO ANY SPECIFIC DISPOSITION. STATE LAW GOVERNS ACCESS TO SEALED RECORDS. BECAUSE ADDITIONS AND DELETIONS TO A CRIMINAL HISTORY RECORD MAY BE MADE AT ANY GIVEN TIME, A NEW INQUIRY SHOULD BE REQUESTED WHEN NEEDED FOR SUBSEQUENT USE. ******************* ****** IDENTIFICATION ** NAME(S) USED: PHYSICAL: DATE(S) OF BIRTH: PLACE(S) OF BIRTH: SCARS/MARKS: SCHLEGEL, FREDERICK DURRELL JR SCHLEGEL, FRED D JR SCHLEGEL, FREDERICK D JR SCHLEGEL, FRED SCHLEGEL, FREDERICK D JR *.....ate.,.*..aa..4 **** SEX: M RACE: W HGT: 507 WGT: 157 EYE: HAZ HAIR: BRO SKN: NJ SC CHIN ************************** CRIMINAL HISTORY Cycle 001 ARREST DATE ARRESTED AGENCY ARREST NUMBER NAME USED CHARGE CHARGE LITERAL ************************* 10/30/1969 BOULDER POLICE DEPARTMENT 20019 SCHLEGEL, FREDERICK D JR 01 FAIL TO APPEAR *CRIMINAL JUSTICE AGENCIES MAY NOT HAVE PROVIDED ALL ARRESTS, *CHARGES OR DISPOSITIONS TO THE CBI. THIS RECORD SHOWS ALL *ARRESTS, CHARGES & DISPOSITIONS THAT WERE PROVIDED, UNLESS *ACCESS TO THEM HAS BEEN LIMITED BY COURT ORDER. *FALSIFYING OR ALTERING THIS RECORD WITH THE INTENT TO MISREPRESENT* *THE CONTENTS OF THE RECORD IS PROHIBITED BY LAW, AND MAY BE * *PUNISHABLE AS A FELONY WHEN DONE WITH THE INTENT TO INJURE OR *DEFRAUD ANY PERSON. * ---- END OF RECORD MEETING DISSEMINATION CRITERIA ---- 05/16/2013 07:35MT Page 2 a RECEIPT o -a No RECEIVED FROMo _ U o 0 ADDRESS U o o ,T -a Y m N N O DATE ten Sn1e1/40-1-V:\ NO. 86784 DR 8442 (09/24/09) Page 1 COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION DENVER, COLORADO 80261 (303)-205-2300 PERMIT APPLICATION AND REPORT OF CHANGES FOR DEPARTMENT USE ONLY CURRENT LICENSE ALL ANSWERS LOCAL LICENSE APPLICANT SHOULD NUMBER MUST BE PRINTED FEE $ 150.00 42570830000 TO ORDER CALL (303) 370-2165 IN BLACK INK OR TYPEWRITTEN OBTAIN A COLORADO LIQUOR & BEER CODE BOOK 1. Applicant isa ❑ Corporation ❑ Individual El Limited Liability Company �,`� ,.. '>5E ,._ �< UM 42570830000 • Partnership 2. Name of Licensee Jensen Entertainment, LLC 3. Trade Name T -Bones Restaurant and Lounge 4.Location Address 3815 HWY 119 City Longmont SELECT THE APPROPRIATE SECTION BELOW '. 0' l ry .' i•Ns�� 9 oiot•�Mna L'a � `; � + County Weld AND F PROCEED TO THE INSTRUCTIONS . 1 S M1 h. i !��rwtlan,�:` ZIP 80504 ON PAGE 2. Y l V p .,, YPo I id r' `:�St,.�.�'.�,t,u • License Account 1983-750 (999) 0 2012-750 (999) 0 0 No. Warehouse Branch Corp. or Location Alter or 1 Storage House Trade Permit Modify Total Fee Premises Total Fee Facility Fee Permit (ea) $100.00 Permit (ea).... 100.00 Name Permit (ea).50.00 (ea) 150.00 Premises 150.00 2210-100 (999) • Retail Managers Registration (Hotel & Restr.)..$75.00 Managers Registration (Tavern) $75.00 Change of Manager (Other Licenses) NO FEE 2200400 (999) • Wholesale 2260-100 (999) ■ Change 2230-100 (999) • Change 2280-100 (999) 17 Change, $150.00x .� of Optional x to Existing FUR Liquor License 2270-100 (999) No. 2220-100 (999) ■ Addition $100.00 1988-100 (999) 0 Addition $75.00 of Related x Total to Resort Complex 0 Duplicate License $50.00 DO NOT WRITE IN THIS SPACE — FOR DEPARTMENT OF REVENUE USE ONLY DATE LICENSE ISSUED LICENSE ACCOUNT NUMBER PERIOD -750 (999) -100 (999) The State may convertyour check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected TOTAL dueto insuttiuenloruncollticSo nds, the Depadmentof Revenue maycolle the payment amountdirectyfrom your bank accountelectmnically AMOUNT DUE $ .00 DR 8442 (09/24/09) Page 3 hl -, -,' 5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit etc.) • Retail Warehouse Permit for: ❑ On -Premises Licensee (Taverns, Restaurants ❑ Off -Premises Licensee (Liquor stores) • Wholesalers Branch House Permit Address of storage premise: City , County , Zip Attach a deed/ lease or rental agreement for the storage premises. Attach a detailed diagram of the storage premises. * a ; 6. Change of Trade Name or Corporation Name supporting documents) of State, or of State and • Change of Trade name / DBA only • Corporate Name Change (Attach the following 1. Certificate of Amendment filed with the Secretary 2. Statement of Change filed with the Secretary 3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement. o Old Trade Name New Trade Name y Old Corporate Name New Corporate Name k`"i,,F Ali yn#�,;,, z r, © ® fi {r h ;�. r �a. 7. Change of Location NOTE TO RETAIL LICENSEES: An application to change location has a local application fee of $750 payable to your local licensing authority. You may only change location within the same jurisdiction as the original license that was issued. Pursuant to 12-47- 311 (1) C.R.S. Your application must be on file with the local authority thirty (30) days before a public hearing can be held. Date filed with Local Authority Date of Hearing (a) Address of current premises City County Zip (b) Address of proposed New Premises (Attach copy of the deed or lease that establishes possession of the premises by the licensee) Address City County Zip (c) New mailing address if applicable. Address City County State Zip (d) Attach detailed diagram of the premises showing where the alcohol beverages will be stored, served, possessed or consumed. Include kitchen area(s) for hotel and restaurants. DR 8442 (09/24/09) Page 4 a r 8. Change of Manager or to Register the Manager of a Tavern or a Hotel and Restaurant liquor license. (a) Change of Manager (attach Individual History DR 8404-I H/R and Tavern only) Former manager's name New manager's name (b) Date of Employment Has manager ever managed a liquor licensed establishment? Yes ■ No ❑ Does manager have a financial interest in any other liquor licensed establishment? Yes ■ No ❑ If yes, give name and location of establishment l:.x © m . fl,� Lail LL+ ; a © (flI nrz ₹ia�n 9. Modification of Premises, Addition of an Optional Premises, or Addition of Related Facility NOTE: Licensees may not modify or add to their licensedpremises until approved by state and local authorities. PP (a) Describe change proposed Include kitchen in licensed premise so that walk in beer cooler may be used to store beer. (b) If the modification is temporary, when will the proposed change: Start (mo/day/year) End (mo/day/year) NOTE: THE TOTAL STATE FEE FOR TEMPORARY MODIFICATION IS $300.00 (c) Will the proposed change result in the licensed premises now being located within 500 feet of any public or private school that meets compulsory education requirements of Colorado law, or the principal campus of any college, university or seminary? (If yes, explain in detail and describe any exemptions that apply) Yes ■ No Cd (d) Is the proposed change in compliance with local building and zoning laws? Yes E No ❑ (e) If this modification is for an additional Hotel and Restaurant Optional Premises or Resort Complex Related Facility, has the local authority authorized by resolution or ordinance the issuance of optional premises? Yes ■ No ■ (f) Attach a diagram of the current licensed premises and a diagram of the proposed changes for the licensed premises. (g) Attach any existing lease that is revised due to the modification. lro 3r3" .�, I . e....s ° Y 41- 4t TMx'2 P lvr Fs Y ''c ' �` "S a �rr�F;t t �ll� ae, F`�5"rf i Zt 4 rn �r'K xn'^3 r / �� LI rm a3' 3 s s f P - - G ik Hai;lx 7S a el : um® r�° •riflthe.e ofio ° o �h ��o °orn° °�®Ito horn n°� ohs l r eYoti.a ° t 1 f° U® �; §fie°r et � © h ° st G e °°s Signature Title Date OCApL(E 4r h or °®lno oo: o ®be n ml 0 oremis tui o ory n® volt °° kh s haver 'it or� o�fi® 'M 7 gr3" " ° 7 rS. -s fin° ©r. E e E THISA" .,��fi A�>,r.mi ,r... �R.. Ui G ItTYGITY oqS z�onotct °ly '-� o° oLICA C®UNTYtj o. of ofdh ° °r°*Son ofT',1tP 42 to .l ®V o rs>i �}n., a 61/2 ooli 1als Attics �' a'rL. Local Licensing Authority (City or County) Date filed with Local Authority Signature Title Date y g[d ma' 6 F'' I"t e iqF foreoo{n,o h ® tr ® no r ® ®F StTr/Ca cornou S ltlltm° E LICE; Title SIN teo e UTH® ItTY e s ®fTifl �. gn 2' rtlrvl � �r� �, f' s nT n°oaf Date Signature N(mj nActsoe Uctr\stct aprena,isC r1ccfrh crvf oil Tre rn i sc i\( tnitv , h a (Asaprow( se Yvicddth cOis/t OLD NW - Cairo/14 c>aoL Hello