HomeMy WebLinkAbout20111289RESOLUTION
RE: APPROVAL OF RENEWAL APPLICATION FOR 3.2 PERCENT BEER RETAIL
LICENSE ISSUED TO CIRCLE K STORES, INC., DBA CIRCLE K STORE #2709846
AND AUTHORIZE CHAIR TO SIGN - EXPIRES MAY 29, 2012
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, Circle K Stores, Inc., dba Circle K Store #2709846, presented to the Board
of County Commissioners of Weld County, Colorado, an application for the renewal of a 3.2
Percent Beer Retail License for the sale of fermented malt beverages, containing not more than
3.2 percent of alcohol by weight, in sealed containers not for consumption at the place where
sold, and
WHEREAS, pursuant to Exhibit 5-H of the Weld County Code, said applicant has paid
the sum of $107.50 to the County of Weld for the renewal of the existing license, and
WHEREAS, said applicant has exhibited a State License for the sale of fermented malt
beverages containing not more than 3.2 percent of alcohol by weight in sealed containers not
for consumption at the place where sold, outside the corporate limits of any town or city in the
County of Weld at the location described as follows:
10963 West 1-25 Access Road, Longmont, Colorado 80501
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 License Number 2011-09 for applicant to sell fermented malt
beverages, containing not more than 3.2 percent of alcohol by weight, in sealed containers not
for consumption at the place where sold, 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 May 29, 2012, providing that said place where the licensee is authorized
to sell fermented malt beverages containing not more than 3.2 percent of alcohol by weight, in
sealed containers not for consumption at the place where sold, 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.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said application.
Le, - So AEA'
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2011-1289
LC0013
RENEW 3.2 PERCENT BEER RETAIL LICENSE - CIRCLE K STORE #2709846
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 23rd day of May, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: EXCUSED
Barbara Kirkmeyer, Chair
Weld County Clerk to the
XCUSED
can P. C�enlway, Pro-Tem
BY:
Deputy Clerk to the Boa
Garda
y Attorney
ugl- Rade =cher
Date of signature:
Tern
2011-1289
LC0013
tre:_Mr..CMC-rrr-Crr..C.C.C.CCM
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License Fee $107.50
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FOR A 3.2 PERCENT BEER RETAIL LIQUOR LICENSE
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THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
DR 8402 (10/29/07)
STATE OF COLORADO
DEPARTMENT OF REVENUE
Liquor Enforcement Division
1881 Pierce Street, Suite 108
Lakewood, Colorado 80214
CIRCLE K STORES INC
CIRCLE K STORE
#2709846
10963 W 1-25 ACCESS RD
LONGMONT CO 80504
ALCOHOLIC
BEVERAGE LICENSE
Liability Information
Account Number
County City Indust. Type Liability Date
LICENSE EXPIRES AT MIDNIGHT
21-65089-0120
03 206 445120 C 053007
MAY 29, 2012
Type
Name and Description of License
Fee
2125
3.2 PERCENT BEER RETAIL
$ 75.00
LICENSE (OFF PREMISES)
2190
COUNTY 85 PERCENT OAP FEE
$ 42.50
TOTAL FEE(S)
$ 117.50
This license is issued subject to the laws of the State of Colorado and especially
under the provision
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. Questions concerning this license should be addressed to the Department of
Revenue, Liquor Enforcement Division, 1375 Sherman Street, Denver, CO 80261.
In testimony whereof, I have hereunto set my hand.
�,'t_ 'v/(/� l' , UIJN 23 2011 �/, �•,
(2)Dat � AJA zt) RLE WV -a
lVV/ 111 11J:.
Division Director Executive Director
DR 8400 (11/09/06) LIQUOR OR 3.2 BEER LICENSE
COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION
DENVER, COLORADO 80261
II,,,I.LI,IIuuIL,,,II,uI,I.I'IAA III r.I.Irrlrlulrlr,I
CIRCLE K STORE #2709846
SHELLEY HUFF
3001 GATEWAY DRIVE STE 130
IRVING TX 75063-2640
This renewal reflects no changes from the last ap-
plication. Complete page 2 and file now!
El 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
21-65089-0120
License Type
2125
Liability Information
03 206 445120 C 053007
Business Location
10963 W 1-25 ACCESS
LONGMONT CO
Current License Expires
MAY 29, 2011
DEPARTMENTAL USE ONLY
Total Amount Due
Total 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 of this renewal
and 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
G^^'
III
D•a�te
?site,
Busin Ph
�ihm5-4768
OY 1'1�
Title
Licensing Repr s nta
Sales Tax Number
Z j - lg c ck R — I0 (2G
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
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.
are satisfactory, and we
11
tt,e, N®A DETACH
Local Licensing Authority for
County, ColoradoSignature
flDM4Weld
Title Acting Chair Pro—TieDavid
Board of Commissioners r1
-\r
E. Long e._1` �e
DO NOT DFTA
NOT DE
DR 8400 (11/09/06) LIQUOR OF4,3.2 BEER LICENSE
COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION
DENVER, COLORADO 80261
Business Name
CIRCLE K STORE
LICENSE NUMBER (Use for all reference)
21-65089-0120
PERIOD
05-12
TYPE OF LICENSE ISSUED
3.2 PERCENT BEER RETAIL
LICENSE (OFF PREMISES)
CASH FUND
2330-100(999)
$ 50.00
STATE FEE
2125-750(999)
$ 25.00
COUNTY 85% OAP
2190-100(999)
$ 42.50
Make check payab
check to a one time e
early as the same day r "!S1/""' "e.'rt�• v
If your check is rejected due to in . or uncollected funds, the Depadment of Rev-
enue may collect the payment amount directly from your banking account electronically
ue.The State may convert your
ur bank account may be deeded as
erred, your check will not be returned. 21
2011-1289
DR 8401 (02/19/09)
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 stabli hme t
tvci& &%tC 3111 �-12
State License Number
'LI-- Uc 4 - 012O
1. Operating Manager
1 Iw,41/2\) 1 lociSCv1
Home Address Ft -Co I1in
23x0 VJ •Courl-1j 9,3 .$ 1S2gl g0c n.1
Date of Birth
2. Do you have legal possession of th�'.pqreAm'i.sees for which this application for license is made?
Are the premises owned or rented: . V V 1 1 If rented, expiration date of lease:
Ye No
3. Has there been any change in financial interest (new notes, loans, owners, etc.) since the last annual application? If yes, explain in
detail and attach a listing of all liquor businesses in which these new lenders or owners, (other than licensed financial institutions) are
materially interested.
Yes No,
I`vAy'(I
�
4. 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 convicted of a crime? If yes, attach a detailed explanation.
Yes No
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
revoked, or had interest in any entity that had an alcoholic beverage license denied, suspended or revoked? If yes, attach a detailed
explanation.
sNp
Yes s
6. Does the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), have a
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.
Yes Nq
❑ µIZI
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:
(a) Are there, or have there been: any officers or directors; or managing members; or general partners added to or deleted from
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
10% or more membership interest in the LLC; or any partners with 10% or more interest in the partnership added to or deleted14
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.
Yes Nq
/u -(/\-f,
Yes No
8. Sole proprietorships, Husband -Wife Partnerships or Partners in General Partnerships: N I/r1`. ^
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
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
i CI'l 1 \ L
Printed name
Shelley Huff
Date
C' /6/1k
MEMORANDUM
Wilk
COLORADO
TO: CHRISTIE PETERS, CTB
FROM: DAN JOSEPH
ENVIRONMENTAL HEALTH SERVICE
SUBJECT: LIQUOR LICENSE INQUIRY
DATE: April 19, 2011
CC: CINDY SALAZAR; DEBRA ADAMSON
In response to your request, Environmental Health Services has reviewed the Retail Food
Service Establishment file for the Circle K Store #2709846, located at 10963 West I-25
Access Road, 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 III
j({/a MEMORANDUM
f To: Christie Peters, Clerk to the Board
WIFrom: Bethany Salzman, Zoning Compliance Officer II
COLORADO Date: April 22, 2011
Subject: Liquor License Referral ((LC0013))
Review of the following liquor license renewal by the Department of Planning Services shows the following:
21-65089-0120
Circle K Stores, Inc.
Dba: Circle K Store # 2709846
10963 1-25 Access Road
Longmont, CO 80504
Zone District: C-3
This use is allowed through the zone district and the Site Plan Review (SPR-241) Permit.
No violations are occurring on the property at this time.
SERVICE, TEAMWORK, INTEGRITY, QUALITY
To: Weld County Board of Commissioners
From: Deputy Lisa Carpenter
Date: May 9, 2011
RE: Ruben Guardiola
Dear Commissioners,
I have researched and found no reported calls for service to Circle K Store #2709846,
located at 40963 I-25 Access Road West, Longmont, CO 80504 for the Calendar year of 2010 to
present day.
I find no grounds for disapproval for the renewal of the liquor license.
Respectfully Sub ed,
Deputy Lisa Carpenter
Community Resource Officer
Weld County Sheriff's Office
1950 "O" Street
Greeley, CO 80631
LIQUOR/BEER RENEWAL REVIEW FORM
Date: May 5, 2011
TO: Lisa Carpenter
FROM: CTB
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 of the license.
PLEASE RESPOND NO LATER THAN: MAY 2, 2011
ESTABLISHMENT: CIRCLE K STORES, INC.
DBA CIRCLE K STORE #2709846
10963 1-25 ACCESS ROAD WEST
LONGMONT, CO 80504
Current license expires: May 29, 2011
No concerns
Depute nitials
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)
:.****.*****...,...************.*************.......,..:****..,<.<..***..:a:..*........«...*.......*****
Please notify at Extension
Board of Commissioner's Transfer of Ownership hearing.
of the date and time of the
Liquor/Beer License Worksheet
The following concerns are noted:
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)
Nud5(y-,
Establishment Owner, Please Print Date
L.,Theb m
Establishment Signature Deputy's Si nature
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 ENFORCEMENT WORKSHEET
1950 ()'Street
Greeley, Colorado 80631
Voice (970) 356-4015 • Fax (970) 304-6467
i Inspection Report
Li Incident Report
CR#:
License Tiade Name : )1eiL 4 4 w <--( Li
Licensee Name: el( (Le-- �`, -* o� 7613 `t �P
i—fcs-
License If/Type:
061 UrFr1('1 S �/�
Date of Report / Incident: t
Os 0�1 -
` to
Address: /) 9 s �-S,/kte ess
,` ,
Person Contacted: 1. t M Futics.)
mil/
City, State, IP: 1 o AO/Yld , (16 b GS6 /
Telephone # 7�/ 3 - 67,I - (}�5-.�9'
Yes No NIA
Yes No NIA
State Liquor License Posted
✓
Manager Registered
State Sales Tax License Posted
✓
License in Control of Premises
E. --
County Liquor License Posted
✓
Trade Name Property Registered
✓
Federal Form 11* Call (800) 398-2822
✓
Premises Physical Control Adequate
✓
Food Service License Posted
V
Acceptable Dispensing System
:✓
Minor Warning Sign Posted
1.
Off Premise Storage Licensed
(-
Meals and Snacks Available
✓
Only Permitted Items Sold
Cleanliness Adequate
✓
Alcohol From Permitted Source
`—
Books & Invoices Available
Discuss Sales of Liquor to Minors
/
Alcohol Beverage Stock Acceptable
L
Discuss Sales to Intoxicated Persons
[Warning [Follow -Up Inspection
Ovevanyvt7 / A 5 kRk(
Licensee / Representative
Signature
Violation:
I
Date:
I Time:
Subject:
DOB:
I Hgt:
Wgt: I Eyes: I Hair
Cbthing:
DL / ID#'
State:
Address:
City:
State:
Zip:
Evidence; Yes NO
H/W Phone
Summons #:
Court Date:
Photos: Yes NO
CLL.� , /Sorb-OIIao
arra ive:
Deputy! it: a -v Z0 -CU Date: S -_ 9- (f
SA ef}2PEN
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DATE
RECEIPT DATE -"'$ I
RECEIVED FROM (Owed; K 5twrees
ADDRESS PO.QOx 5 s -c Pho-, ix AZ -
HOW PAID
CASH
CHECK
10 7
50
HONEY
ORDER
RECEIPT
RECEIVER FROM
ADDRESS / 'ox
FOR
KO10 / NO 85847
(109(03 Z- S e- �� i`�)
sciog-?ASS cipay4s7
7.50
CCU rily)
BY Chig:ft; p-(55
NO.
85848
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U.S. Postal Service.'
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
l t Q vor__ L te. n,o.e_
SENDER: COMPLETE THIS SECTION
• Complete items 1, 2, and 3. Also complete
Hem 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 mailplece,
or on the front if space permits.
1. Article Addressed to:
DAcle K St0Res, .nC.
Postmark
Here
COMPLETE THIS SECTION ON DELIVERY
D. Is delvery address different from item 1? O Yes
H YES, enter delivery address below: ❑ No
&9cle K Si -DR-. kc27Inewo
/09403 Wyes/1- 1-2G5 /jars! Rand
Lvr r7 C7 CO jvc /- 3 ,Sarylce Type
i/ 11tcCertified Mail
O Registered
O Insured Mail
❑ Express Mall
O Return Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery! (Extra Fee) O Yes
2. Article Number
(Transfer from seMce label)
PS Form 3811, February 2004 Domestic Return Receipt 102505-02-M-1540
7005 1820 0003 5225 0662
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