HomeMy WebLinkAbout20251329.tiffResolution
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 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.
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 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 Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 14th day of May, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppler: Excused
Kevin D. Ross: Excused
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
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2025-1329
LC0013
Instruction Sheet for Permit Application and Report of Changes
For All Sections, Complete Questions on Page 2
Section A
To Register or Change Managers, check the appropriate box in section A and complete question 10
on page 6. 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 8 for Oath of Applicant signature.
Section C
Check the appropriate box in section C
and proceed below.
For a Retail Warehouse Storage Permit, go to
page 4 complete questions in the section (be
sure to check the appropriate box). Submit the
necessary information and proceed to page 8
for Oath of Applicant signature. Submit to the
State Licensing Authority for approval.
For a Wholesale Branch House Permit, go
to page 4 and complete questions in the
section (be sure to check the appropriate
box). Submit the necessary information and
proceed to page 8 for Oath of Applicant
signature. Submit to the State Licensing
Authority for approval.
To Change Trade Name or Corporation
Name, go to page 4 and complete
questions in the section (be sure to check
the appropriate box). Submit the necessary
information and proceed to page 8 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.
To modify Premise, or add Sidewalk Service
Area, go to page 7 and complete all
questions. Submit the necessary information
and proceed to page 8 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.
For Optional Premises go to page 7 and
complete all questions. Submit the necessary
information and proceed to page 8 for
Oath of Applicant signature. Retail Liquor
License submit to the Local Liquor Licensing
Authority (City or County).
To Change Location, go to page 5 and
complete questions in the section. Submit
the necessary information and proceed to
page 8 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.
Winery/Limited Winery Noncontiguous or
Primary Manufacturing Location Change,
go to page 6, and complete questions in
the section. 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.
Campus Liquor Complex Designation, go to
page 8 and complete questions in the section.
Submit the necessary information and proceed
to page 8 for Oath of Applicant signature.
To add another Related Facility to an existing
Resort or Campus Liquor Complex, go to
page 8 and complete questions in the section.
DR 8442 (02/26/24) Page 1 of 8
DR 8442 (02/26/24)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
PO BOX 17087
Denver CO (303)2,2302170087 permit Application and Report of Changes
(303)205-2300
All Answers Must Be Printed in Black Ink or Typewritten
Applicant is a O Corporation ❑ Individual 0 Partnership ® Limited Liability Company
License Number
I21-65089-0120
Name of Licensee
(Circle K Stores, Inc
(ITrade Name of Establishment (DBA)
(Circle K #2709846
Address of Premises (specify exact location of premises)
10963 W I-25 Frontage Rd
City
ILongmont
County
IWeld
Business Email Address
ISATXlicense@circlek.com
State ZIP Code
c.3
X60504
Business Phone Number
3036780539
Select die Appropriate Section Below and Reference the Instructions on Page 1.
Section A — Manager
❑ Manager's Registration (Hotel & Restaurant) $30.00
❑ Manager's Registration (Tavern) $30.00
❑ Manager's Registration (Lodging & Entertainment) $30.00
❑X Change of Manager (Other Licenses pursuant to section 44-3-301(8), C.R.S.) No Fee
Please note that Manager's Registration for Hotel & Restaurant, Lodging & Entertainment, and
Tavern licenses requires a local fee with submission to the local licensing authority as well. Please
reach out to local licensing authorities directly regarding local processing and fees.
Section B — Duplicate License
❑ Duplicate License $50.00
Page 2 of 8
Section C
❑ Retail Warehouse Storage Permit (each) $100.00
❑ Wholesale Branch House Permit (each) $100.00
❑ Change Corporation or Trade Name Permit (each) _ $50.00
❑ Change Location Permit (each) $150.00
❑ Winery/Limited Winery Noncontiguous or Primary Manufacturing Location Change $150.00
❑ Change, Alter or Modify Premises $150.00 x
❑ Addition of Optional Premises to
Existing Hotel/Restaurant $100.00 x
❑ Addition of Related Facility to an Existing
Resort or Campus Liquor Complex $160.00 x
Total Fee:
Total Fee:
Total Fee:
❑ Campus Liquor Complex Designation No Fee
❑ Sidewalk Service Area $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 one time electronic banking transaction. Your bank account may be debited as early as
the same day received by the State. If converted, your check will not be retumed. If your check is rejected due to insufficient or
uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.
Total Amount Due $
00
DR 8442 (02/26/24)
Page 3 of 8
Storage Permit
Retail Warehouse Storage Permit or a Wholesalers Branch House Permit
❑ Retail Warehouse Permit for:
❑ On —Premises Licensee (Taverns, Restaurants etc.)
❑ Off —Premises Licensee (Liquor stores)
❑ Wholesalers Branch House Permit
Address of Storage Premise
City
County
ZIP Code
Attach a deed/lease or rental agreement for the storage premises.
Attach a detailed diagram of the storage premises.
Change Trade Name or Corporate Name
❑ Change of Trade Name/DBA only
❑ Corporate Name Change (Attach the following supporting documents)
1. Certfficate of Amendment filed with the Secretary of State, or
2. Statement of Change filed with the Secretary of State, and
3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement.
Old Trade Name
New Trade Name
Old Corporate Name
New Corporate Name
DR 8442 (02/26/24)
Page 4 of 8
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
Address of current premises.
Address
Date of Hearing
City
County
ZIP Code
Address of proposed New Premises
(Attach copy of the deed or lease that establishes possession of the premises by the licensee)
Address
City
New mailing address if applicable.
Address
County
ZIP Code
City
County
State ZIP Code
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.
DR 8442 (02/26/24)
Page 5 of 8
Winery/Limited Winery Noncontiguous or Primary Manufacturing Location Change
Select the option that applies to your situation:
O Make a aarrent Primary Manufacturing Location (Location 1) into a Noncontiguous Location
(Location 2); or
O Make a current Noncontiguous Manufacturing Location (Location 1) into a Primary
Manufacturing Location (Location 2).
Address of Location 1:
Address
City
Address of Location 2:
Address
County
ZIP Code
City
County
ZIP Code
Change of Manager
Change of Manager or to Register the Manager of a Tavern, Hotel and Restaurant, Lodging &
Entertainment iquor license or licenses pursuant to section 44-3-301(8), C.R.S.
Change of Manager
Former Manager's Name
Mario Martinez
New Manager's Name
lAngela Gardner
Date of Employment
I05/01/2024
Has manager ever managed a liquor licensed establishment? C) Yes 0 No
Does manager have a financial interest in any other liquor
licensed establishment? O Yes 0 No
If yes, give name and location of establishment
DR 8442 (02/26/24)
Page 6 of 8
Modify Premises or Addition of Optional Premises, Related Facility, or Sidewalk Service Area
Note: Licensees may not modify or add to their licensed premises until approved by state and
local authorities.
(a) Describe change proposed
(b) If the modification is temporary, when will the proposed change:
Start (month/day/year) End (month/day/year)
Note: The total state fee for temporary modification is $300.00
(c) Will the proposed change result in the licensed premises now being located
within 500 feet of any public or private school that meets compulsory
education requirements of Colorado law, or the principal campus of any
college, university or seminary? O Yes 0 No
(If yes, explain in detail and describe any exemptions that apply)
(d) Is the proposed change in compliance with local building and zoning laws? 0 Yes 0 No
(e) If this modification is for an additional Hotel and Restaurant Optional Premises
has the local authority authorized by resolution or ordinance the issuance of
optional premises? O Yes 0 No
(f) Attach a diagram of the current licensed premises and a diagram of the proposed changes for the
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.
Documenlation may include but is not limited to a statement of use, permit, easement, or other
legal permissions.
DR 8442 (02/26/24)
Page 7 of 8
Campus Liquor Complex Designation
An institution of higher education or a person who contracts with the institution to provide food services
I wish to designate my existing:
Liquor License Type
Liquor License Number
l
to a Campus Liquor Complex O Yes O No
Additional Related Facility
To add a Related Facility to an existing Resort or Campus Liquor Complex, include the name of the
Related Facility and include the address and an outlined drawing of the Related Facility Premises.
Address of Related Facility
Address
City
State ZIP Code
Outlined diagram provided O 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.
Print Name Title
INiccole Heard
Sig
e
Licensing Analyst
Date MM/DD/YY)
cc32�1ms
Report and Approval of Local Licensing Authority (City / County)
The foregoing application has been examined and the premises, business conducted and character of
the applicant is satisfactory, and .�•�•,��; �rt that such permit, if granted, will comply with the applicable
provisions of Title 44, Article `�� • i �. s amended. Therefore, This Application is Approved.
Local Licensing Authority (City * o ) �!1 Date filed with Local Authority
Weld County, Colora
Si • nature
e
erry L. Buck, Chair
Board of Count Commissioners
04/22/25
Report of State Licensing Authority
Date
MM/DD/YY
The foregoing has been examined and complies with the filing requirements of Title 44, Article 3,
C.R.S., as amended.
Signature
Title
Date (MM/DD/YY)
DR 8442 (02/26/24)
Page8d8 d 8
Clerk to the Board's Office
Phone: (970) 400-4225
1150 O Street
P.O. Box 758
Greeley, Colorado 80632
www.weld.qov
April 28, 2025
NICCOLE HEARD
CIRCLE K STORES INC
DBA CIRCLE K STORE 2709846
17319 SAN PEDRO AVE SUITE 400
SAN ANTONIO TX 78232
Re: Application for Renewal of Fermented Malt Beverage and Wine Off -Premises
(County) License — Circle K Stores, Inc., dba Circle K Store #2709846
Dear Licensee:
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 Wednesday, May 14, 2025, 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.qov.
If you have questions or need additional information, please do not hesitate to contact me
at (970) 400-4227 or Iflesnerna.weld.gov.
Respectfully,
dA5eli A4..02444}-(
Leah Flesner
Deputy Clerk to the Board
Enclosures: Receipt
cc: Weld County Attorney's Office
Page 1 of 1
Leah Flesner
From:
Sent:
To:
Cc:
Subject:
Attachments:
Good afternoon,
Leah Flesner
Monday, April 28, 2025 4:06 PM
SATXLicense@circlek.com; Heard, Niccole
Chloe White
Notice of Hearing - Circle K Stores, Inc., dba Circle K Store #2709846
Notice of Hearing - Circle K Stores, Inc., dba Circle K Store #2709846.pdf
This is to advise you that the Weld County Board of Commissioners will hear your request for renewal of a liquor
license, and to reg}ster a manager at the property described as: 10963 West Interstate 25 Access Road, Longmont,
Colorado 80504. The meeting is scheduled for Wednesday, May 14, 2025, 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. Please see the attached
letter for further information (hard -copies to follow).
Thank you,
COUNTY,CO
Leah Flesner
Deputy Clerk to the Board
Desk: 970-400-4227
P.O. Box 758, 1150 O St., Greeley, CO 80632
0®0®O
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First Name Last Name
I
NICCOLE I HEARD
Weld County Clerk to the Board's Office
Certificate of Mailing Form
Company I Address 1 ; City State `Postal Email
Code
CIRCLE K ; 17319 SAN SAN I TX 78232
STORES PEDRO AVE ANTONIO
INC DBA SUITE 400
CIRCLE K
STORE
2709846
SATXLicense@circlek.com;
amberheard@circlek.com
I hereby certify that I have sent a letter in accordance with the notification requirements of Weld County in the United States
Mail, postage prepaid First Class Mail by letter as addressed on the attached list this 28th day of April, 2025.
Leah Flesner
Deputy Clerk to the Board
Page 1 of 1
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