HomeMy WebLinkAbout20241643.tiffRESOLUTION
RE: APPROVE PERMIT APPLICATION AND REPORT OF CHANGES FORM TO
REGISTER A MANAGER, AND AUTHORIZE CHAIR TO SIGN - CIRCLE K STORES,
INC., DBA CIRCLE K STORE #2709846
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, the Board has been presented with a Permit Application and Report of
Changes Form for Circle K Stores, Inc., dba Circle K Store #2709846, to register a manager, in
connection with its' Fermented Malt Beverage and Wine Off -Premises (County) License, for the
sale of malt beverages and vinous liquors in sealed containers not for consumption at the place
where sold, located at 10963 West Interstate 25 Access Road, Longmont, Colorado 80504, and
WHEREAS, after review, the Board deems it advisable to approve said form, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Permit Application and Report of Changes Form for Circle K Stores,
Inc., dba Circle K Store #2709846, to register a manager, in connection with its' Fermented Malt
Beverage and Wine Off -Premises (County) License, for the sale of malt beverages and vinous
liquors in sealed containers not for consumption at the place where sold, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said form.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 19th day of June, A.D., 2024.
ATTEST:
Weld County Clerk to the Board
Deputy Clerk to the Board A
APPROVED ASFORM
Date of signature: Lf�Z4 Z�
BOARD OF COUNTY COMMISSIONERS
WELD COU
Kev oss, Chair
erry L. Buc ro-Tem
i e eeman
K. James
Lori Saine
c c.: 6C1CRS ( b&IS K), CA(MG), 2024-1643
APPL LC0013
O'7t%Co(b19
DR 8442 (02/23/23)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
(303) 205-2300
Permit Application and Report of Changes
All Answers Must Be Printed in Black Ink or Typewritten
1. Applicant is a
❑X Corporation........................ Individual
License Number
21-65089-0120
❑ Partnership........................ Limited Liability Company
2. Name of Licensee
3. Trade Name of Establishment (DBA)
Circle K Stores, Inc.
Circle K #2709846
4. Address of Premises (specify exact location of premises)
5. Business Email Address
10963 W 1-25 Access Rd
SATXlicense@circlek.com
City County State ZIP Business Phone Number
Longmont Weld CO 80504 303-678-0539
SELECT THE APPROPRIATE SECTION BELOW AND PROCEED TO THE INSTRUCTIONS ON PAGE 2.
Section A— Manager Reg/Change
Section C
❑ Manager's Registration (Hotel & Restr.) ........... $30.00
❑ Retail Warehouse Storage Permit (ea) ............ $100.00
❑ Manager's Registration Tavern
9 9 ( ) ...................... $30.00
$100.00
❑ Wholesale Branch House Permit (ea) ...............$100.00
Change Corp. or Trade Name Permit (ea)......... $50.00
❑❑
Manager's Registration
(Lodging & Entertainment) .......................... $30.00
❑ Change Location Permit (ea)........................... $150.00
❑X Change of Manager (Other Licenses pursuant to
❑ Winery/Limited Winery Noncontiguous or Primary
section 44-3-301(8), C.R.S.) NO FEE
Manufacturing Location Change.............................$150.00
❑ Change, Alter or Modify Premises
Please note that Manager's Registration for Hotel &
$150.00 x Total Fee:
Restaurant, Lodging & Entertainment, and Tavern licenses
❑ Addition of Optional Premises to Existing H/R
requires a local fee with submission to the local licensing
authority as well. Please reach out to local licensing
$100.00 x Total Fee:
authorities directly regarding local processing and fees.
Section B — Duplicate License
❑ Addition of Related Facility to an Existing Resort or
Campus Liquor Complex
$160.00 x Total Fee:
❑ Duplicate License ............................................. $50.00
❑ Campus Liquor Complex Designation ............... No Fee
❑ Sidewalk Service Area ........................................$75.00
$75.00
Do Not Write in This Space — For Department of Revenue Use Only
Date License Issued License Account Number Period
The State may convert your check to a onetime electronic banking transaction. Yourbankaccount maybudebcdasemihssamedayccecadbytheStaufcoruertsyyoucheckoa/cc debited as early as the same day received by the State. If converted, your check will not TOTAL AMOUNT
be returned. If your check is rejected due to insufficient or uncollected funds, the Department DUE $ .00
of Revenue may collect the payment amount directly from your bank account electronically.
2024-1643
Page 1 of 5
DR 8442 (02/23/23)
Instruction Sheet
® Section A
To Register or Change Managers, check the appropriate box in section A and complete
question 9 on page 4. Proceed to the Oath of Applicant for signature. Submit to State Licensing
Authority for approval.
❑ Section B
For a Duplicate license, be sure to include the liquor license number in section B on page 1
and proceed to page 5 for Oath of Applicant signature.
❑ 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 5 for Oath of Applicant signature.
Submit to the State Licensing Authority for approval.
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 5 for Oath of Applicant signature.
Submit to the State Licensing Authority for approval.
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 5 for Oath of Applicant
signature. Retail Liquor License submit to the Local Liquor Licensing Authority (City or County). Manufacturer,
Wholesaler and Importer's Liquor Licenses submit to the State Liquor Licensing Authority.
4) To modify Premise, or add Sidewalk Service Area, go to page 4 and complete question 10. Submit the
necessary information and proceed to page 5 for Oath of Applicant signature. Retail Liquor License submit
to the Local Liquor Licensing Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor
Licenses submit to the State Liquor Licensing Authority.
5) For Optional Premises go to page 4 and complete question 10. Submit the necessary information and proceed
to page 5 for Oath of Applicant signature. Retail Liquor License submit to the Local Liquor Licensing Authority
(City or County).
6) To Change Location, go to page 3 and complete question 7. Submit the necessary information and proceed
to page 5 for Oath of Applicant signature. Retail Liquor License submit permit application or report of change
to the Local Liquor Licensing Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor
Licenses submit to the State Liquor Licensing Authority.
7) Winery/Limited Winery Noncontiguous or Primary Manufacturing Location Change, go to page 4,
and complete question 8. Use this section to make a current Noncontiguous Manufacturing Location into a
Primary Manufacturing Location, or a Primary Manufacturing Location into a Noncontiguous Manufacturing
Location. To be eligible for a Winery/Limited Winery Noncontiguous or Primary Manufacturing Location
Change, you must be a Colorado state licensed manufacturer of vinous liquor pursuant to section 44-3-402 or
44-3-403, C.R.S.
8) Campus Liquor Complex Designation, go to page 5 and complete question 11. Submit the necessary
information and proceed to page 5 for Oath of Applicant signature.
9) To add another Related Facility to an existing Resort or Campus Liquor Complex, go to page 5 and
complete question 12.
5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit
❑ Retail Warehouse Permit for:
❑ On —Premises Licensee (Taverns, Restaurants etc.)
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❑ Off —Premises Licensee (Liquor stores)
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❑ Wholesalers Branch House Permit
Address of storage premise:
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City , County ZIP
Attach a deed/lease or rental agreement for the storage premises.
Attach a detailed diagram of the storage premises.
6. Change of Trade Name or Corporation Name
0 Change of Trade name/DBA only
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0 Corporate Name Change (Attach the following supporting documents)
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1. Certificate of Amendment filed with the Secretary of State, or
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2. Statement of Change filed with the Secretary of State, and
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3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement.
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Old Trade Name
New Trade Name
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Old Corporate Name
New Corporate Name
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 44-3-311(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
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City County ZIP
c(b)
Address of proposed New Premises (Attach copy of the deed or lease that establishes possession of the
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premises by the licensee)
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as
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.
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8. Winery/Limited Winery Noncontiguous or Primary Manufacturing Location Change
Select the option that applies to your situation:
❑ Make a current Primary Manufacturing Location (Location 1) into a Noncontiguous Location (Location 2); or
Make a current Noncontiguous Manufacturing Location (Location 1) into a Primary Manufacturing Location
(Location 2).
(a) Address of Location 1:
City County ZIP
(b) Address of Location 2:
County ZIP
9. Change of Manager or to Register the Manager of a Tavern, Hotel and Restaurant, Lodging & Entertainment
liquor license or licenses pursuant to section 44-3-301(8), C.R.S.
(a) Change of Manager
Former manager's name Jumar Gordon
2
New manager's name Mario Martinez
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(b) Date of Employment 06/10/2022
Has manager ever managed a liquor licensed establishment'?...............................................W 0 Yes ❑ No
Does manager have a financial interest in any other liquor licensed establishment? ............ ❑ Yes IN No
If yes, give name and location of establishment
10. Modification of Premises, Addition of an Optional Premises, Addition of Related Facility, or Addition of
a Sidewalk Service Area
NOTE: Licensees may not modify or add to their licensed premises until approved by state and local authorities.
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(a) Describe change proposed
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(b) If the modification is temporary, when will the proposed change:
Start (mo/day/year) End (mo/day/year)
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NOTE: THE TOTAL STATE FEE FOR TEMPORARY MODIFICATION IS $300.00
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(c) Will the proposed change result in the licensed premises now being located within 500 feet of any public or
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private school that meets compulsory education requirements of Colorado law, or the principal campus of any
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college, university or seminary?
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(If yes, explain in detail and describe any exemptions that apply) ......................................... ❑ Yes 0 No
a(d)
Is the proposed change in compliance with local building and zoning laws? .......................... ❑ Yes ❑ No
(e) If this modification is for an additional Hotel and Restaurant Optional Premises has the local authority
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authorized by resolution or ordinance the issuance of optional premises? ............................. ❑ Yes 0 No
(f) Attach a diagram of the current licensed premises and a diagram of the proposed changes for the
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licensed premises.
(g) Attach any existing lease that is revised due to the modification.
(h) For the addition of a Sidewalk Service Area per Regulation 47-302(A)(4), 1 C.C.R. 203-2, include
documentation received from the local governing body authorizing use of the sidewalk. Documentation may
include but is not limited to a statement of use, permit, easement, or other legal permissions.
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11. Campus Liquor Complex Designation
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An institution of higher education or a person who contracts with the institution to provide food services
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(a) I wish to designate my existing Liquor License # to a Campus
Complex........................................................................................................................ ❑ Yes O No
mLiquor
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12. Additional Related Facility
To add a Related Facility to an existing Resort or Campus Liquor Complex, include the name of the Related
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Facility and include the address and an outlined drawing of the Related Facility Premises.
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(a) Address of Related Facility
a(b)
Outlined diagram provided....................................................................................................... ❑ Yes O No
Oath of Applicant
I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments
thereto, and that all information
therein is true, correct, and complete to the best of my knowledge
Signa re
Print name and Title Date
Susan Krill Licensing Clerk 3 •a
Report and Approval of LOCAL Licensing Authority (CITY / COUNTY)
The egoing application has been examined and the premises, business conducted and character of the applicant is
satisfactory, and we do report that
ranted, will comply with the applicable provisions of Title 44,
Articles 4 and 3,
. Therefore, This Application is Approved.
Local Licensing Authority (City or County)
Date filed with Local Authority
Weld Cou or
4/17/2024
Signaturel%itl
Kevin D. Ross, Chair Date
rd of Count Commissioners 06/19/24
Licensing Authority
The foregoing has been examined an
i e filing requirements of Title 44, Article 3, C.R.S., as amended.
Signature
Title Date
o21,t 1L
Page 5 of 5
1861 ili'
U Cp�N1 Y
June 6, 2024
Attn: Susan Krill, Licensing Associate
Circle K Stores, Inc.
dba Circle K Store 2709846
17319 San Pedro Avenue
Suite #400
San Antonio, TX 78232
Clerk to the Board
Phone: (970) 400-4225
Fax: (970) 336-7233
1150O Street
P.O. Box 758
Greeley, Colorado 80632
www.weld.gov
RE: Renewal Fermented Malt Beverage and Wine Off -Premises (County) Liquor License and
Permit Application and Report of Changes Form to Register a Manager — Circle K Stores,
Inc., dba Circle K Store #2709846
Dear Applicant:
This is to advise you that the Weld County Board of Commissioners will hear your request for
renewal of a liquor license, and to register a manager, at the property described as: 10963 West
Interstate 25 Access Road, Longmont, Colorado 80504. The meeting is scheduled for Monday,
June 19, 2024, at 9:00 a.m., in the Chambers of the Board of County Commissioners of Weld
County, Colorado, Weld County Administration Building, 1150 O Street, Assembly Room,
Greeley, Colorado 80631. While this is a public meeting and you are welcome to attend, your
attendance is not mandatory at this time. The meeting will be live -streamed at www.weld.gov.
If you have any questions concerning this matter, please do not hesitate to contact me at
(970) 400-4213 or cwhite@weld.gov.
Sincerely,
Cs-
Chloe A. White
Deputy Clerk to the Board Supervisor
cc: Weld County Attorney's Office
Chloe White
From: Chloe White
Sent: Thursday, June 6, 2024 1:54 PM
To: satxlicense@circlek.com
Subject: Notice of Hearing - Renewal Liquor License / Manager Registration - Circle K Stores,
Inc., dba Circle K Store 2709846
Attachments: Notice of Hearing - Renewal Liquor License and Register Manager - Circle K Store
2709846.pdf
Good afternoon,
This is to advise you that the Weld County Board of Commissioners will hear your request for renewal of a
liquor license, and to register a manager, at the property described as: 10963 West Interstate 25 Access Road,
Longmont, Colorado 80504. The meeting is scheduled for Monday, June 19, 2024, at 9:00 a.m. While this is a
public meeting and you are welcome to attend, your attendance is not mandatory at this time. The meeting will
be live -streamed at www.weld.gov. Please see the attached letter for further information (hard -copy and receipt
to follow).
Sincere regards,
Chloe A. White
Deputy Clerk to the Board Supervisor
Weld County Clerk to the Board's Office
1150 O Street
Greeley, CO 80631
Tel: (970) 400-4213
Email: cwhiteiEweld.aov
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.
Weld County Liquor License
Certificate of Mailing
First Name '
Last Name
Company
Address I
City
State'
Postal
Code
Susan
Krill
Circle K Stores,
17319 San Pedro
San Antonio
TX
78232
Inc., dba Circle K
Avenue, Suite #400
Store 2709846
licenseandpermits@cstbrands.com
I nerevy certiry mar i nave sent a nourication or nearing sate letter in accordance witn the notitication requirements
of Weld County in the United States Mail, postage prepaid First Class Mail by letter as addressed on the attached list
this 6th day of June, 2024.
Chloe A. White
Deputy Clerk to the Board Supervisor
June 20, 2024
Clerk to the Board
Phone: (970) 400-4225
Fax: (970) 336-7233
1150 O Street
P.O. Box 758
Greeley, Colorado 80632
www.weld.gov
Colorado Department of Revenue
Liquor Enforcement Division
P.O. Box 17087
Denver, Co 80217-0087
RE: Application for Renewal of a Fermented Malt Beverageand Wine Off -Premises (County)
License, and Permit Application and Report of Changes Form to Register a Manager —
Circle K Stores, Inc., dba Circle K Store #2709846
To Whom It May Concern:
Please see the attached renewal application and a copy of all supporting documentation, as well
as a Permit Application and Report of Changes Form to Register a Manager, regarding the
property described as: 10963 West Interstate 25 Access Road, Longmont, Colorado 80504. The
associated fees were paid online and a copy of the receipt is in the packet. The Weld County
Board of Commissioners approved the application on Wednesday, June 19, 2024.
If you have questions or need additional information, please do not hesitate to contact me at
(970) 400-4213.
Very truly yours,
c2P-Qfr
Gtr.
Chloe A. White
Deputy Clerk to the Board Supervisor
cwhite@weld.gov
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After printing this label:
CONSIGNEE COPY - PLEASE PLACE IN FRONT OF POUCH
1. Fold the printed page along the horizontal line.
2. Place label in shipping pouch and affix it to your shipment.
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Transaction Record FedI®
TRACKING NO.: SHIP DATE: ESTIMATED SHIPPING CHARGES:
776969379518 Jun 20, 2024 9.03 USD
From address To address
CHLOE WHITE
WELD COUNTY
1150 O STREET RM 166
80631 CO GREELEY
US
Phone: 9704004225
cwhite@weldgov.com
LIQUOR ENFORCEMENT DIVISION
COLORADO DEPARTMENT OF REVENUE
PO BOX 17087
802170087 CO DENVER
US
Phone: 3032052300
Package information
Pieces Weight
Dimensions (LxWxH) Carriage value Package options
1 x 0.60 lb
n/a
Packaging type:
Service: Pickup / drop-0ff type:
Your Packaging
FedEx Priority Overnight I'll drop off my shipment at a FedEx
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Billing information
Bill transportation cost to:
******483 P.O. No.: CHLOE A. WHITE
Bill duties, taxes and fees to:
Invoice No.: CTB
Your reference:
CLERK TO THE BOARD Department No.: 10400
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for any loss, including intrinsic value of the package, loss of sales, income interest, profit, attorney's fees, costs, and other forms of damage whether direct, incidental,
consequential, or special is limited to the greater of $100 or the authorized declared value. Recovery cannot exceed actual documented loss. Maximum for items of
extraordinary value is $1000, e.g., jewelry, precious metals, negotiable instruments and other items listed in our Service Guide. Written claims must be filed within strict
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