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Home My WebLink About20112405.tiffRESOLUTION RE: APPROVAL OF RENEWAL APPLICATION FOR 3.2 PERCENT BEER RETAIL LICENSE ISSUED TO MARY JENSEN, DBA HIGHLANDLAKE, INC., AND AUTHORIZE CHAIR TO SIGN - EXPIRES NOVEMBER 9, 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, Mary Jensen, dba Highlandlake, Inc., presented to the Board of County Commissioners of Weld County, Colorado, an application for the renewal of a 3.2 Percent Beer Retail Liquor License for the sale of fermented malt beverages, containing not more than 3.2 percent of alcohol by weight, for consumption by the drink on the premises, and 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 for consumption by the drink on the premises, and 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: 16983 County Road 5 Mead, Colorado 80542 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 2011-19 to said applicant to sell fermented malt beverages, containing not more than 3.2 percent of alcohol by weight, for consumption by the drink on the premises, and 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 November 9, 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, for consumption by the drink on the premises, and 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. 2011-2405 (W. 50, Yppl. ID is -II LC0035 RENEW 3.2 PERCENT BEER RETAIL LICENSE - HIGHLANDLAKE, INC. PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 12th day of September, A.D., 2011. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST:. arbara Kirkmey r, Chair Weld County Clerk to the Board BY: Deputy CI k to the Boar OVER T ORM: orney �Y Date of signature: 10 -1g -I Sean P. Con , ay F. Garcia N David E. Long Pro-Tem Douglas ademacher 2011-2405 LC0035 eccrwaccrac rem= rr.rr..crrl 1 H • ..:, W N z 0 LU cn a a z 1/41 O w o v z glIJ N O U o tils8 C4 z 0 ciag O w O Pao -0 3.14° O1_, Q ~ c.14 O U a � o O ag a —I O 0 w IH O Pod H >-(I1 1 01 IS I - hi Ct FOR A 3.2 PERCENT BEER RETAIL LIQUOR LICENSE 3.2% OF ALCOHOL BY WEIGHT H O 0 z z H z O w 44 0 cu O .O M 0 b N rn Li).- w r -a r-: O 0 -,cu rt a) H C O L o o • co O 0 N T o co O ct in v - b UA ad 4-4 a U▪ di `n 7:1 cn N Ct M 04;) 4 rd U 0 t aC O, 0 at' w CU be ct N .U) d • O t 0 cE N 0 o 0 0-4 45 U " b b ci - �'° E o o .5 0 b o• U C C`o�- a ° o O 0 C • oct v) o bct 7) c C et 71 1 V 4.4 co o _ -0 4. ° o U CI 0 U .. es CU t "la CI• y bA cd ad cn b ��0 o 5 ,r; e� u v H -v �, ct : o b al o `� CI 174 V U) � ,� o cn ai E' �� u ..-tS y C) -5 x°cu�.cTs -4 0 E o CUM a) b a) b �;_ t C' 0 ..mr, �, O Z v . '� .E O O di - ct U) � t t' el otj U CC al v CU cli �,na Ct Zi3 � C -�.� -5 vC) I o t �,° '� �, ai . -d .., C) ci a� o 0 .5 •o .� U E v 0 C) cu t4_4 up cl Gi C101 X v-+ ;-+ ccs ,1,o H -d C U) ci w 0 a) • C) 0 ci 0 U name by its officers duly U) hereunto subscribed sioners has U 0 w .0 ci (24 a) 0 x z 0 H E cC 0 r--A;C-.;:t.Thp;:\ VVv - 0 .10 cse'''Gni�nJ G_l�G' G_I�GnJJsse5.4 ct z O z Ct O II ti z O U C/: C C THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402 (07/18/11) DEPARTMENT ALCOHOLIC STATE OF COLORADO OF REVENUE Liquor Enforcement Division 1881 Pierce Street, Suite 108 Lakewood, Colorado 80214 HIGHLANDLAKE INC HIGHLANDLAKE INC 16983 CR 5 MEAD CO 80542-9737 BEVERAGE LICENSE Liability Information Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT 14-27324-0000 03 206 451110 C 111087 NOV 09, 2012 Type Name and Description of License Fee 2126 2190 3.2 PERCENT BEER LICENSE (ON/OFF PREMISES) COUNTY 85 PERCENT OAP FEE $75.00 $42.50 TOTAL FEE(S) This license is issued subject to the laws of the State of Colorado and especially of Title 12, Articles 46 or 47, CRS 1973, astamended: This license is nontransferable conspicuously posted in the place above dent gibed. This license is only valid through shown above. Questions concerning this license should be addressed to the Department Liquor Enforcement Division, 1375 Shermantrek 13effver, CO 80261. In testimony whereof, I have hereunto set my hand: OLM October 6, 2011 (Xatait, //-lea ) Division Director Executive $117.50 under the provision and shall be the expiration date of Revenue, aii,k_ Director DR 8400 (11/09/06) LIQUOR OR 3.2 BEER LICENSE COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION DENVER, COLORADO 80261 HIGHLANDLAKE INC *7029-9-5 Pee. So')? 6St MEAD CO 80542 This renewal reflects no changes from the last ap- plication. Complete page 2 and file now! ❑ 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 14-27324-0000 License Type 2126 Liability Information 03 206 451110 C 111087 Business Location. 16983 CR 5 MEAD CO Current License Expires NOV 09, 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 renewalmust be returned to your CITY OR. COUNTY Licensing Authority at least 45 days prior to the expire lion 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 Date 7-i9 -ad // Business Phone WO-87-V2O1 s 40.0... Title D /G)AlRcf Jen/SCA)—,(7/r si.� ,t:r Sales Tax Number / 4/-73.,4f- cood REPORT AND APPROVAL OF CITY OR COUNTY LICENSING A HORITY 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. ,b Weld County, Colorado P Date 09/1 1 Signature / / /« -C /.;,4 Y - �— Title Barbara Kirkmeyer, Chai $bard of Commissioners A S f6/ OO NOT ACH. DR 8400 (11/09/06) Make check payable to: LIQUOR OR 3.2 BEER LICENSE check to a one timeelectro COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION early as the same day recei DENVER, COLORADO 80261 if your check is rejected due enue may coiled the payment am tate may convert your • ount may be debited as check will not be returned. L ds, the Department of Rev- nking account electronically. Business Name HIGHLANDLAKE INC LICENSE NUMBER (Use for all reference) 14-27324-0000 PERIOD 11-12 TYPE OF LICENSE ISSUED 3.2 PERCENT BEER RETAIL LICENSE (ON/OFF PREMISES) CASH FUND 2330-100(999) $ 50.00 STATE FEE 2126-750(999) $ 25.00 COUNTY 85% OAP 2190-100(999) $ 42.50 $ 117.50 2011-2405 LCW3S DR 8401 (02/19/09) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1881 PIERCE 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 #/QhZ,%,,C6/ —./ £tivG State License Number /V - 7L3..49 - D�a 1. Operating Manager /l? y Lte-N.56,,J Home Address /7042 BLS l%If).sidj (10 Y4 %a Date of Birth 2. Do you 'Save legal possession of the premises for which this application for license is made? Are the premises owned or rented: /hi 9drrf if rented, expiration date of lease: Yes / I[ 3 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 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? tf 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. Yes No 8. 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 No / ❑ r—�/ f ✓I 7. Corporation or Limited Liability Company (LLC) or Partnership applicants must answer these questions. Since the date of filing of the lest 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 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 an supporting documentation, and fees your Local Licensing Authority immediately. Yes No ❑ I . / V Yes No ❑ 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 4879, 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 swom 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 v II Printed nameDate tit/4.2y-±e,os-e-.t1 7 /4_caerl y MEMORANDUM ft ig To: Esther Gesick, Deputy Clerk to the Board VIVD�. From: Bethany Salzman, Zoning Compliance Officer COLORADO Date: August 5, 2011 Subject: Liquor License Referral Review of the following liquor license renewal by the Department of Planning Services shows the following: License Number: 14-27324-0000 Applicant: Mary Jensen dba Highlandlake, Inc. 16983 CR 5 PO Box 652 Mead, CO 80542 Zone District: A (Agricultural) This use has existed prior to zoning and a Nonconforming Use File (NCU-141), has been set up by the Department of Planning Services. Any expansion or remodel may require updated zoning permits. The Department of Planning Services is not aware of any violations occurring on the property at this time. SERVICE, TEAMWORK, INTEGRITY, QUALITY MEMORANDUM TO: ESTHER GESICK FROM: DAN JOSEPH ENVIRONMENTAL HEALTH SERVICE SUBJECT: LIQUOR LICENSE INQUIRY DATE: AUGUST 6, 2011 CC: CINDY SALAZAR; DEBRA ADAMSON In response to your request, Environmental Health Services has reviewed the Retail Food Service Establishment file for Highland Lake, located at 16983 CR 5, in Mead, 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 a,co.weld.co.us or by phone at 970-304-6415 extension 2206. Thank you. Dan Joseph Environmental Specialist Ill LIQUOR/BEER RENEWAL REVIEW FORM Date: August 16, 2011 TO: {DEPUTY} FROM: CTB SUBJECT: Liquor License Check In accordance with the new 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 renewal of the liquor and/or beer license. PLEASE RESPOND NO LATER THAN: AUGUST 17, 2011 ESTABLISHMENT: HIGHLANDLAKE, INC. DBA HIGHLANDLAKE, INC. 16983 WELD COUNTY ROAD 5 MEAD, CO 80542 Current license expires: November 9, 2011 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) i 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: O 2_ 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) —716?415 L T� m Dg ti tablishment Owner, Please Print Date 6seablishment Signature Deputy'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. To: Weld County Board of Commissioners From: Deputy Jeremy Frey Date: August 27, 2011 RE: Highland Lake Inc. Dear Commissioners, I have researched and found no reported calls for service for Highland Lake Inc. located at 16983 County Road 5 Mead, CO 80542. On 082611 I inspected the business and found no issues. I find no grounds for disapproval for the renewal of the liquor license. Respectfully Submitted, Deputy Jeremy Frey Community Resource Officer Weld County Sheriff's Office 1950 "O" Street Greeley, CO 80631 WELD COUNTY S'HERIFF'S OFFICE Community'RespUrce Office L_1c LJr R ENFoRCEMCNT WORKSHEET • 1950'U'Stroet Greeley, Colorado 80631 Voice (970) 356-4015 • Fax (970) 304-6467 Inspection Report D Incident Report flame Trede Name: License #/ Type: Address: I L s} c, e c City, stale, Zip: Act & C. 0 State U • + License Posted State Sales Tax License Posted County Liquor License Posted Federal Forth 11 * Call X800) 398-2822 Food Service License Posted Yes o NfA Wyoming UFollow-Up Inspection Violation: Subject Cbthing: Address: H/W Phone it Narrative: Deputy: Ce) CR# Licensee Horne: pra.^ e,",s 4='� Dale of Report l incident e . G 11� Peron Contacted: j Lc� •. TI Telephone �: e� �� -8 7 — —f a - Istered License in Control of Premises Name Property Registered Premises Physical Control Adequate table Di -$ =nsi . S tern Off Premise Sb Licensed Onl Permitted Items Sold Alcohol From Permitted Source Discuss Sales oft.' • . to Minors Discuss Sales to Intoxicated Persons rcerrseee/R Representative Signature Date Date: Wgt: Eyes: DLIIDt Time: Hair: Slate: E Bence: Yes NO Photos: Yes NO Date: O3. -G O m O o U m c -c O U a_ AL` .) PO Box 758 PO Box 758 N CO O 0O 0 0 a) a) a) Greeley CO 80632 RECEIPT DATE g -c2-// NO. 85987 RECEIVED FROM NVM/t[ / -4,1-0e. - A�DD_RES/S CWu �N L fat!" •% 5o%o0 $ l or 7. 53 FOR LQOO ) HOW PAID CASH CHECK i ) 0 . 7 5o MONEY ORDER RECEIPT CEIVED FROM( ADDRESS FOR CASH CHECK MONEY 71/ HOW PAID DATE 2 // BY )1/ NO. 85988 Ia 117 BY r,� A II: 13 ..-�- t1 i ._ ii Name: aS. atitL t_,QYk, Type: 3.2% Ei,uti iquor License Renewal 661.1(frii) Date Referrals sent R -Z cc: Brad S -Z Environmental Health cc: Sara & Deb 8-a Planning Services Mtg Date 3- Z Sheriff's Office Void State Date Referrals received- glt? 8-8 Environmental Health 8-8 Planning Services Sheriffs Office BOCC Meeting Date (Monday) Copy of Receipts for State & County Draft Reso Save Reso in AgPending Put Full Packet in Agenda Tray Send to the State After license comes back from the State: Print License Print Updated Reso Mail License to Applicant Agenda Date Need Referrals by Date Paid to State Paid to County a 2890 0003 5709 92'49 0 0 U.S. Postal ServiceTM CERTIFIED MAILTM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Postmark Here Sent To o MUSA. JQf' r1 St er, Apt No.; or PO Box No. City. State, +4 (A) J -( a J 0 . t 7' . ua C-- Ia • Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can retum the card to you. • Attach this card to the back of the mailpiece, or on the front If space permits. 1. Article Addressed to: Ei 1 h`9xyuCt, T n Wi ?auk U°3a so5u a 2. Article Number (transfer from aerrh.v taboo D. Is delivery address • rffetent •m Rem 17 ❑ Yes If YES, enter delivery address below: 0 No 3. Service Type `El Certified Mail ❑ Registered ❑ Insured Mall ❑ Express Mall ❑ Return Receipt for Merchandise ❑ C.O.D. 4. Restricted Delivery? (Exha Fee) 70014 2890 0003 5709 9249 ❑Yes PS Form 3811, February 2004 Domestic Retum Receipt 102595.02-M-1540 i Hello