HomeMy WebLinkAbout20101567.tiff RESOLUTION
RE: APPROVAL OF RENEWAL APPLICATION FOR 3.2 PERCENT BEER RETAIL LICENSE
ISSUED TO KUM&GO, LC, DBA KUM &GO#913,AND AUTHORIZE CHAIR TO SIGN -
EXPIRES SEPTEMBER 14, 2011
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, Kum & Go, LC, dba Kum & Go #913, 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:
13799 Pacific Circle
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 2010-02 for the 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
September 14, 2011, 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.
U,-,.. 30, APni.
g i I_I 0 2010-1567
LC0051
RENEW 3.2 PERCENT BEER RETAIL LICENSE— KUM & GO, LC, DBA KUM & GO #913
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 19th day of July, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY LORADOE La
ATTEST: :� ! ,et) q rto L(.f
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ev u.l adema her, C it
Weld County Clerk to the B.! 1W ( �•
.ara Kirkmeyer, o-Tem
BY: i all
►�11A�lfu.` p ��
Dep Clerk t5 e Board � '
Sean /
�� ay
APP' .�D M:
,
/ • iiaan F. Garcia
ounty Attorney C
David E. Long
I Date of signature: y110
2010-1567
LC0051
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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
KUM & GO LC
KUM & GO #913
13799 PACIFIC CIR
MEAD CO 80542
ALCOHOLIC BEVERAGE LICENSE
Liability Information
Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT
12-40424-0028 03 095 445120 B 091509 SEP 14, 2011
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
TOTALFEE(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.
AUG 032010
Division Director Executive Director
License Number License Type
DR8400(11/09/06) LIQUOR OR 3.2 BEER LICENSE 12-40424-0028 2125
COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION Liability Information
DENVER,COLORADO 80261 03 095 445120 B 091509
Business Location
61,1.11 I.I IIur11..l.rrlh,,llh,,I,I„I6„Ih,,L,hI
13799 PACIFIC CIR
KUM & GO LC MEAD CO
KUM & GO #913 CurrenFLicense Expires
6400 WESTOWN PKWY SEP 14 , 2010
WEST DES MONIES IA 50266-7709 DEPARTMENTAL USE ONLY
Total Amount Due
Total Paid Date
$
This renewal reflects no changes from the last ap- Wholesaler, manufacturer, importer, and public transportation
plication. Complete page 2 and file now! system license renewals do not need Local Licensing Author-
ity approval and must be returned directly to the Colorado De-
Yes there are changes from the last application. partment of Revenue at least 30 days prior to the current li-
If applicant is a Corporation or Limited Liability com- cense expiration date.
pany, use DR 8177 and send in with this renewal.
Any other changes of ownership require a transfer This application for renewal must be returned to your CITY OR
of ownership. See your Local Licensing Authority COUNTY Licensing Authority at lent.45 days prior to the expire-
of von date of your current license. Failure to do so may result in
immediately. your license not being renewed.Include both pages of this renewal
and payment.
OATH OF APPLICANT
I declare under pen of perjury in the second degree that this application and all attachments are true,correct, and complete to the
best of my knowle .
Authorized Signs r . D mess Phone
/`` �11,� , Rio% o/ 70)cc s-ygcy
Title / /� Sa/ie Tax Number St 8j
REPORT AND APPROVAL OF CITY OR COUNTY LICENSING AUTHORITY
The foregoing application has been examined and the premises, business conducted and character of the applicant are satisfactory, and we
do hereby report that such license, if granted,will comply with the provisions of Title 12,Articles 46 -•- - C.R.S.
THEREFORE THIS APPLICATION IS APPROVED.Local Licensing Authority for \, t;A L
ld Coun Colorado J t � Z010
t
Signature CeativiC Cf,. Ttle Att 4 •" stir -
Chair, Board of Weld ,E) ,
¢ al Rao - Cher County Commissioners 1�"r�-• �- ��� •-� 7 �
l,:
--- 7^,.;07-nG7ACu _ ..CT 7FTArH he N(L'a DETACH..
DR 8400(11/09/06) Make to a o payable to'.Colorfe R account State may convert your
COLORADO DEPARTMENT OF REVENUE LIQUOR OR 3.2 BEER LICENSE check to netime ekdronkbank—ir-gip . ' nk may be debited as ^y
RENEWAL APPLICATION earyas the same day received by the SL nverted,your check will not be returned. 1 1
DENVER,COLORADO 80261 If your check is rejected due to insufficient or uncollected funds,the Department of Rev-
enue may collect the payment amount directly from your banking account electronically.
Business Name LICENSE NUMBER(Use for all reference) PERIOD
KUM & GO #913 12-40424-0028 09- 11
TYPE OF LICENSE ISSUED CASH FUND STATE FEE
3 . 2 PERCENT BEER RETAIL COUNTY 85% OAP
LICENSE (OFF PREMISES ) 2330- 100(999 ) 2125-750 ( 999 ) 2190- 100(999 )
$ 50 . 00 $ 25 . 00 $ 42 . 50
$ 117 . 51
LC (Ri/
2010-1567
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 N e of Establishment y State License Number
[�c�r A 7J/3 (2— - ‘/06—1-y TOO
1.Operating Manager Home Address Date of Birth
Lilt'c fvric_, er he -, L&coc nJ- RacJ�a- at- W
2. Do you have legal possession of the premises for w ch this application for license is made? Yes No
Are the premises owned or rentedQ(,n- If rented,expiration date of lease:
3. Has there been any change in financial interest(new notes,loans,owners,etc.)since the last annual application?If yes,explain in Yes No
detail and attach a listing of all liquor businesses in which these new lenders or owners,(other than licensed financial institutions)are
materially interested.
4. Since the date of filing of the last annual application, has the applicant,or any of its agents,owners,managers,principals,or lenders Yes No
(other than licensed financial institutions),been convicted of a crime?If yes,attach a detailed explanation.
5. Since the date of filing of the last annual application,has the applicant,or any of its agents,owners, managers,principals,or lenders
(other than licensed financial institutions),been denied an alcoholic beverage license,had an alcoholic beverage license suspended or Yes No
revoked,or had interest in any entity that had an alcoholic beverage license denied,suspended or revoked?If yes,attach a detailed ❑
explanation.
6. Does the applicant,or any of its agents,owners,managers,principals,or lenders(other than licensed financial institutions), have a Yes No
direct or indirect interest in any other Colorado liquor license(include loans to or from any licensee,or interest in a loan to any y�y ❑
licensee)?If yes,attach a detailed explanation j, ��( n -? 4(c.c S. � � •✓sl
7. Corporation or Limited Liability Company(LLC)or Partnership applicants must answer these questions.
Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been:any officers or directors;or managing members;or general partners added to or deleted from ❑
applicant for renewal of a 3.2 beer or liquor license?
(b) Are there or have there been:any stockholders with 10%or more of the issued stock of the Corporation;or any members with Yes No
10%or more membership interest in the LLC;or any partners with 10%or more interest in the partnership added to or deleted
from the applicant for renewal of a 3.2 beer or liquor license?
(c) If Yes to(a)or(b),complete and attach Form DR 8177:Corporation,Limited Liability Company or Partnership Report of Changes,
and all supporting documentation,and fees your Local Licensing Authority immediately.
8. Sole proprietorships,Husband-Wife Partnerships or Partners in General Partnerships:
EVIDENCE OF LAWFUL PRESENCE
Each person identified above must complete and sign the following 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 Printed name Date
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MEMORANDUM
TO: JENNY VANEGDOM, CTB
1111€, FROM: DAN JOSEPH
ENVIRONMENTAL HEALTH SERVICE
SUBJECT: LIQUOR LICENSE INQUIRY
COLORADO DATE: JUNE 11, 2010
CC: CINDY SALAZAR; DEBRA ADAMSON
In response to your request, Environmental Health Services has reviewed the Retail Food
Service Establishment file for Kum & Go #913, located at 13799 Pacific Circle, 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
djosephna,co.weld.co.us or by phone at 970-304-6415 extension 2206.
Thank you.
Dan Joseph
Environmental Specialist III
MEMORANDUM
ttr To: Jenny VanEgdom, Deputy Clerk to the Board June 4, 2010
From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services
hiDe Subject: LC0051
COLORADO
Review of the following liquor license application by the Department of Planning Services shows the following:
Kum & Go, LC
dba Kum & Go#913
13799 Pacific Circle
Mead, CO 80504
Zone District: PUD, C-3/ 1-1 (Z-555)
Legal Description: Lot 1, Lyons 66 Pacific Commerce Park, Weld County, Colorado
Property Owner:
Ashworth at 60th LC
6400 Westown Pkwy
West Des Moines, IA 50266
This site is situated within the Mixed Use Development (MUD) area and is part of the Lyons 66 Pacific
Commerce Park Subdivision. This use is permitted through an amended Site Plan Review (AmSPR-394)
permit.
No violations are occurring on the property at this time.
SERVICE,TEAMWORK,INTEGRITY,QUALITY
Jr
LIQUOR/BEER RENEWAL REVIEW FORM
Date: July 14, 2010
TO: {DEPUTY}
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: APRIL 28, 2010
ESTABLISHMENT: KUM & GO LP
DBA KUM & GO #913
13799 PACIFIC CIRCLE
MEAD, CO
Current license expires: September 14, 2010
✓ No concerns W‘24,
eputy'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 of the date and time of the
Board of Commissioner's hearing.
U.S. Postal ServiceTM
CERTIFIED MAILTM RECEIPT
D-' (Domestic Mall Only;No Insurance Coverage Provided)
M1
For delivery information visit our webske at www.usps.twrrlo
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Postage r$
Certified Fee
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p Return Receipt Fee Here
(Endorsement Required)
Restricted Delivery Fee
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Total Postage 8 Fees
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PS Form 3800,June 2002 See ReversF for Instructions
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SEN aE': CaM•LETE THIS SECT1aN COMPLETE 1HtS SECTION oN •SLIVERY
• Complete items 1,2,and 3.Also complete A. Signature
Item 4 if Restricted Delivery Is desired. O Agent
• Print your name and address on the reverse ' In a '. '_
O so that we can return the card to you. of Addressee
II Attach this card to the back of the mailplece, B. Received by(Ponied flame) �, Date of Delivery
or on the front if space permits. '. n.n /' 'C,(r-'i� ' r
1. Article Addressed to: D. Is delivery address different fromm kern 17 • Yes
If YES,enter delivery address below: O No
1l It ti-,1. ,;b-,,./ _ 3. Service Type
.fl Certified Mail ❑Express Mall
❑Registered O Return Receipt for Merchandise
❑Insured Mail O C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
(Transfer from service labs° 7005 1820 0003 5224 7952
PS Form 3811,February 2004 Domestic Return Receipt 10250WA12-hi-1540
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