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Home My WebLink About20092661.tiff RESOLUTION 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, 2010 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$57.50 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 2009-04 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, 2010, 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. 2009-2661 LC0035 Ain_ 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 October, A.D., 2009. �Gj`` BOARD OF COUNTY COMMISSIONERS k ` � a WE D43gQ�TYLO Jt ATTEST: ✓f�{ '� �//!�// (1 (:(977,v liam F. Garcia, Chair Weld County Clerk to the B d �J ",: ! CUSED ; ., Deputy Cler to l ouglas Rademacher, Pro-Tem BY e p Y the Board r H3V { Ji Sean P. Conway APF,OrD AS F M: , lc 1 l k i i _'< c- Barb a Kirkmeyer County Attorney David E. Long I 4.h5/e f Date of signature: 2009-2661 LC0035 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 HIGHLANDLAKE INC 16983 CR 5 MEAD CO 80542-9737 ALCOHOLIC 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, 2010 Type Name and Description of License Fee 2126 3.2 PERCENT BEER RETAIL $ 75.00 LICENSE (ON/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. DEC 1 1 20[9 Division Director Executive Director �? '� � r a m \ x r � o-dik x 1 < / � i` ✓r�1 t � �t y a 3f9J try o- 1"xl°`t' FG '0u� 1f , ."Ik Y q �a�l o- lAtr. .a'+"Y ^Cr` �^ar ,� ' �'" A *11.1/4 R u"�ya R'yTa "'+,ci ,� rr, i U.. aA+R 'dywc� 2t. g '• R F 4 y 4 A.yp ° e k a``WWMM ,P. 'r'�rc:WW--41ai :74 .t. l --,-*/.4.,, j k S+aP, ti' ' Y 4 '.4)44).0.0.01.00.2q..,140.20.1,4.21).20.2.0.-44:AfoJ:A��U n A •✓n J ' 9 4 A J 9 > '1,"�3, 5 a2.4�a' +tJ,, -01 J 4., O,�tl,f; M3A A9 A V3tl , �j ^� - 1 1 tl d N dOJ tl�a A3U;A J U U tl: aye Y� p 'b etg dl f-disiA A l J n J 1 my. �" ? s ° 3r�Jt $v ge rr#r a.A3r1 .0.114.40.4?).- m ° >a9 ht,,*. 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A JI e Y f�"u O H �. -t g �,�.� MqA '3A »�p3tlgs �$$MM„„ ��-' / i t.♦ � "C� �sxA.3U 9 14, - T � ,�fiw"•• .•,e elf. .fit ,p ,t ¢dry , v _' F { 4 -� .- �' , an , , , s , , 1 u ��y�,v� � �b `r �l a�i - N. �'W� �`V '' �liff '"jp wt r ' r> ` ' r e. ,o ,iWAr ti A ,.t� L �� i Iff ,. ,r . s`C{ ., f s''r}.�� Si `/A v rod j% +{z ar _ }: License Number Type 27324-0000 License Ty DRa400n+foa'o6) LIQUOR OR 3.2 BEER LICENSE 26 COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION Liability Information DENVER,COLORADO80261 03 206 451110 C 111087 Business Location 16983 CR 5 HIGHLANDLAKE INC MEAD CO 17029 RD 5 Current License Expires MEAD CO 80542 NOV 09, 2009 DEPARTMENTAL USE ONLY Total Amount Due Total Paid Date $ % This renewal reflects no changes from the last ap- Wholesaler, manufacturer, importer,and public transportation f� 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- 0 Yes there arechangestrom the last application. partment of Revenue at least 30 days prior to the current li- lt 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 COUNTY Licensing Authority at least 45 days prior to the expire- of ownership. See your Local Licensing Authority lion 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 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 7 7 0�� Date Business Phone �,e, The 4 7 � 1 `3i©�35+a 3 Sales Tax Number REPORT AND APPROVAL OF CITY OR COUNTY LICENSING AUTHORITY The foregoing application has been examined and the premises,business conducted and character of the applicant are satisfactory,and we do hereby report that such license,if granted,will comply with the provisions of Title 12,Articles 46 and 47,C.R.S. THEREFORE THIS APPLICATION IS APPROVED. . Local Licensing Authority for r' r`n Weld County, Col do ' p IU9 Signature / rite Chair, Board of Weld t ''G William F. Garcia ttb County Commissioners t ,�'7. . ' 'Lf T DETACH u DO NO Y g tc t r.o dstaETACH DO NOT DETACH Y "�I _i--. M k he k paYai*t (' b .. k. Rny t't Re,i1u0The St t' y=Wen Yom DR 8400O1/09/061LIQUOR OR 3.2 BEER LICENSE l Ato ne Oncbl lbanke i,tid real bagac y oe debited as COLORADO DEPARTMENT OF REVENUE p ikeca,redyenebeany one"tr ve*ep,Wdr --k will not be returned 21 DENVER,COLORADO 80261 RENEWAL APPLICATION ii you,check's'ejected due to insummem n ._-- . •..lheDenanmentorRee- enue may collect the payment amount deec:n loan you,banking account elx'uontrillr Business Name LICENSE NUMBER(Use for all reference) PERIOD HIGHLANDLAKE INC 14-27324-0000 11- 10 TYPE OF LICENSE ISSUED CASH FUND STATE FEE 3 .2 PERCENT BEER RETAIL COUNTY 85% OAP LICENSE (ON/OFF PREMISES) 2330- 100( 999) 2126-750(999) 2190- 100(999) $ 50 . 00 $ 25. 00 $ 42.50 $ 117. 50 2009-2661 • /- 00035- DR 8401 (02/19)00) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1881 PIERCE LAKEWOOD,CO 80261 303)205-2300 ATTACHMENT TO LIQUOR OR 3.2 BEER LICENSE RENEWAL APPLICATION This page must be completed and attached to your signed renewal application form. Failure to Include this page with the application may result in your license not being renewed. Trade Name of Establishment State License Number 1k�chlcubitLnke. .:hcr as-is 1. rating Maria Home Address Date of Birth {��ry E, 5evIsevl (10.1q 1.ttR5 (Y1elt�+, Co $os4z Yes No 2. Do you have legal possession of the premises for which this application for license is made? � ❑ Are the premises owned or rented: 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 r materially interested. 4. Since the date of tiling 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. KI 5. 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 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?II 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 LI -cifJ' licensee)?If yes,attach a detailed explanation. 7. Corporation or Limited Liability Company(LLC)or Partnership applicants must answer these questions. Since the date of filing of the last annual license application: Yes No (a) Are there,or have there been:any officers or directors;or managing members:or general partners added to or deleted from ❑ applicant for renewal of a 3.2 beer or liquor license? L2SI (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 C J' from the applicant for renewal of a 3.2 beer or liquor license? (c) I1 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 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 Printed name Date lb / M �ensQP O rat a MEMORANDUM TO: JENNY VANEGDOM, CTB ' FROM: DAN JOSEPH C� ENVIRONMENTAL HEALTH SERVICE SUBJECT: LIQUOR LICENSE INQUIRY COLORADO DATE: SEPTEMBER 16, 2009 CC: CINDY SALAZAR; SARA EVANS In response to your request, Environmental Health Services has reviewed the Retail Food Service Establishment file for Highland Lake Inc., located at 16983 WCR 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(auico.weld.co.us or by phone at 970-304-6415 extension 2206. Thank you. Dan Joseph Environmental Specialist III (iste;;NMEMORANDUM 't To: Jenny VanEgdom, Deputy Clerk to the Board WI From: Bethany Salzman, Zoning Compliance Officer Date: September 3, 2009 COLORADO Subject: Liquor License Referral Review of the following liquor license renewal by the Department of Planning Services shows the following: 14-27324-0000 Highlandlake, Inc. dba: Highlandlake, Inc. 16983 CR 5 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. Cc: Trevor Jiricek, Director SERVICE,TEAMWORK,INTEGRITY,QUALITY Jennifer VanEgdom From: Glen Cowan Sent: Wednesday, October 07, 2009 10:59 AM To: Jennifer VanEgdom Subject: RE: Referral for Highlandlake, Inc. (Mead) Jenny, My apologies(Again).There were no concerns to note. If you have any questions please let me know. Glen Original Message From:Jennifer VanEgdom Sent: Wednesday,October 07, 2009 9:26 AM To: Glen Cowan Cc: Ken Poncelow Subject: Referral for Highlandlake,Inc. (Mead) Glen, I still haven't received a referral response for this establishment. I really need to get a hearing scheduled (which does not require a Deputy's presence since it is a 3.2% license)and get the renewal paperwork to the State. Are there any major concerns the Board should be made aware of? Thanks! Jenny VanEgdom I I Deputy Clerk to the Board of County Commissioners II Weld County,Colorado I I (970)356-4000,ext.4228 I 1915 10th Street, 3rd Floor,Greeley,Colorado 80631 II www.co.weld.co.us 1 • Highland Lake, Inc. 17029 CR 5 Mead, CO 80542 November 16, 2009 To: Colorado Dept of Revenue PO Box 758 Greeley, CO 80632 Attn: Sharon From: Mary Jensen Re: Replacement Check for Liquor License • Please find enclosed our check no 2232 in the amount of$117.50 for payment of renewal of the liquor license for Highland Lake Inc. It is my understanding that you received an unsigned check with our application. Please shred the check you are holding and use the enclosed check instead. Thank you for your diligence in contacting us to clear this up. Hello