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Home My WebLink About20231701.tiffRESOLUTION RE: APPROVE PERMIT APPLICATION AND REPORT OF CHANGES 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 the 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 application. 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 the 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 application. 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., 2023. ATTEST: C� hi l Weld County Clerk to the Board BLJtharn APP Deputy Clerk to the Bo County torney Date of signature: t- ZI ZbZ5 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO :14 Mite-Freeman, Chair Lori Sai Gam.SOCRSISK I BE), CACAPPL O -I (OC(3 2023-1701 LC0013 DR 8442 (01/14/22) 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 ❑ Individual ❑ Limited Liability Company License Number X Corporation 21650890120 ❑ Partnership 2. Name of Licensee Circle K Stores, Inc 3. Trade Name of Establishment (DBA) Circle K#2709846 4. Address of Premises (specify exact location of premises) 10963 West 1-25 Access Rd. 5. Business Email Address licenseandpermits@cstbrands.com City Longmont County Weld State CO ZIP 80504 Business Phone Number 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.) ❑ Manager's Registration (Tavern) ❑ Manager's Registration (Lodging & Entertainment) $75.00 $75.00 $75.00 pursuant to ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Retail Warehouse Storage Permit (ea) $100.00 Wholesale Branch House Permit (ea) $100.00 Change Corp. or Trade Name Permit (ea) $50.00 Change Location Permit (ea) $150.00 Winery/Limited Winery Noncontiguous or Primary Manufacturing Location Change $150.00 Change, Alter or Modify Premises X Change of Manager (Other Licenses section 44-3-301(8), C.R.S.) NO FEE $150.00 x Total Fee: Addition of Optional Premises to Existing H/R $100.00 x Total Fee: Section B — Duplicate License Addition of Related Facility to an Existing Resort or Campus Liquor Complex ❑ Duplicate License $50.00 $160.00 x 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 debiled as early as the same day received by the State. If converted, your check will not be returned. 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 1 DR 8442 (01/14/22) Instruction Sheet For All Sections, Complete Questions 1-5 Located on Page 1 X 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 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 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 Local Liquor Licensing Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor Licenses submit to 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 Local Liquor Licensing Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor Licenses submit to 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 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 to Local Liquor Licensing Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor Licenses submit to 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. 2 DR 8442 (01/14/22) ' Storage Permit I 5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit etc.) • Retail Warehouse Permit for: • On —Premises Licensee (Taverns, Restaurants • Off —Premises Licensee (Liquor stores) • Wholesalers Branch House Permit Address of storage premise: City , County ZIP 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 6. Change of Trade Name or Corporation Name supporting documents) of State, or of State, and • Change of Trade name/DBA only • Corporate Name Change (Attach the following 1. Certificate of Amendment filed with the Secretary 2. Statement of Change filed with the Secretary 3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement. Old Trade Name New Trade Name Old Corporate Name New Corporate Name Change of Location 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 City County ZIP (b) Address of proposed New Premises (Attach copy of the deed or lease that establishes possession of the premises by the licensee) Address City County ZIP (c) New mailing address if applicable. Address City County State CO 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. 3 DR 8442 (01/14/22) Winery/Limited WineryNoncontiguous or Primary Manufacturing Location Change 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: City County ZIP Change of Manager 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 (attach Individual History DR 8404-I H/R, Tavern and Lodging & Entertainment only) Former manager's name Eric Larson New manager's name Jumar Gordon (b) Date of Employment 7/19/2021 Has manager ever managed a liquor licensed establishment? © Yes • No Does manager have a financial interest in any other liquor licensed establishment? • Yes © No If yes, give name and location of establishment Circle K Modify Premises or Addition of Optional Premises, Related Facility, or Sidewalk Service Area 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. (a) Describe change proposed (b) If the modification is temporary, when will the proposed change: Start (mo/day/year) End (mo/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? (If yes, explain in detail and describe any exemptions that apply) • Yes ■ No (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 authorized by resolution or ordinance the issuance of optional premises? ■ Yes • 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. Documentation may include but is not limited to a statement of use, permit, easement, or other legal permissions. 4 DR 8442 (01/14/22) Campus Liquor Complex Designation 11. Campus Liquor Complex Designation An institution of higher education or a person who contracts with the institution to provide food services (a) I wish to designate my existing Liquor License # to a Campus Liquor Complex O Yes O No Additional Related Facility 12. 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. (a) Address of Related Facility (b) 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 therein is true, correct, and complete to the best of my knowledge thereto, and that all informationor Signature Print name and Title Date l4April O'Neal 04/06/2023 t,,,,,T, Report and Approval of LOCAL Licensing Authority (CITY / COUNTY) The foregoing application has been e iii' . ed and the premises, business conducted and character of the applicant is satisfactory, and we do repo ,gF'�. 2::'.,V;t, if granted, will comply with the applicable provisions of Title 44, Articles 4 an • <�` : ,.Jf) \• • ed. Therefore, This Application is Approved. Local Licensing Authority (City or Coun ` ig} , 4.0.Date filed with Local Authority Weld County, Colorado , �.‘•!!., 1♦1 4/6/2023 Signature am -=6.... ri Title Mike Freeman, Chair Date �' , .,... 4 Board of County Commissioners 6/19/2023 i •ATE Licensing Authority The foregoing has been examine•®«- �',.'ith the filing requirements of Title 44, Article 3, C.R.S., as amended. Signature I Title Date 5 0.7.0,1& -/Tod ,„, June 4, 2022 COLORADO Department of Revenue Enforcement Division - Liquor b Tobacco CIRCLE K STORES, INC. D/B/A CIRCLE K STORES 19500 BULVERDE ROAD, SUITE 100 SAN ANTONIO, TX 78259 Physical Address: 1707 Cole Boulevard, Suite 300 Lakewood, CO 80401 Mailing Address: P.O. Box 173350 Denver, CO 80217-3350 Re: State Master Fite for Circle K Stores, Inc. Account # 21-65089-0000 Dear Sir or Madam: This is to advise you that the Colorado Liquor Enforcement Division has, at your request, revised the "master file" for the above -listed licensee. As of the date of this letter, our master file includes the following items, which you have submitted: 1. Individual History Records (Form DR 8404-I) for the following persons: Dennis Tewell Kathy Cunnington Mark Tate Marcella Rocha 2. Fingerprint cards bearing the names and birth dates of the persons listed in paragraph 1, above. All the fingerprint cards have been submitted by us to the Colorado Bureau of Investigation. The CBI and FBI have checked the prints and reportedly found no record of any criminal history for those listed above. 3. Certificate of Authority or a Certificate of Good Corporate standing from the Colorado Secretary of State which indicates that Circle K Stores, Inc. is a corporation authorized to do business in Colorado. When filing a new application for additional licensed locations, you must check with the local licensing authority to determine what documents they may require to process your application. Please feel free to provide them with this letter, as many local authorities will not require you again to submit fingerprint cards to them if you have already submitted such documents to the Division. This letter will serve to inform the local authorities exactly which documents you have already submitted to the State Enforcement Division. Finally, once the local authority has approved your new license or transfer of ownership application, it must be sent to the Division. DR 4041B (05/02/19) The local authority need not send change of corporate structure information previously reported to the Division, as listed in and approved by this letter. The only documents which are needed for a new or transfer of ownership application by the Division are: 1. The approved application signed by the local authority; 2. The appropriate fees; 3. A copy of this letter; 4. Proof of possession of the premises; 5. A diagram of the licensed premises; 6. Completed form DR 8442, and an Individual History Record (DR -8404-I) if manager's registration is required. Sincerely, fi2cckdGt_ _57/ -ate -A;iyeaf) Michelle Stone-Principato Division Director 2 DR 40418 (06/14/17) June 1, 2023 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 ATTN: LICENSING DEPARTMENT CIRCLE K STORES, INC. 19500 BULVERDE ROAD SUITE 100 SAN ANTONIO, TX 78259 RE: PERMIT APPLICATION AND REPORT OF CHANGES FORM FOR A FERMENTED MALT BEVERAGE AND WINE OFF -PREMISES (COUNTY) LIQUOR LICENSE - 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 to register a manager for a liquor license at the property described as: 10963 West 1-25 Access Road, Longmont, Colorado 80504. The meeting is scheduled for Monday, June 19, 2023, 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, Chloe A. White Deputy Clerk to the Board Supervisor cc: Weld County Attorney's Office Chloe White From: Sent: To: Subject: Attachments: Good afternoon, Chloe White Thursday, June 1, 2023 2:18 PM licenseandpermits@cstbrands.com NOTICE OF HEARING - Register a Manager - Circle K Stores, Inc. Notice of Hearing - Register Manager - Circle K Stores, Inc.pdf This is to advise you that the Weld County Board of Commissioners will hear your request to register a manager for a liquor license at the property described as: 10963 West 1-25 Access Road, Longmont, Colorado 80504. The meeting is scheduled for Monday, June 19, 2023, 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 -copy 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: cwhite4weld.gov 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. 1 WELD COUNTY LIQUOR LICENSE CERTIFICATE OF MAILING FIRST NAME COMPANY CIRCLE K STORES, INC., ATTN: LICENSING DEPARTMENT ADDRESS SAN ANTONIO TX 19500 BULVERDE ROAD, SUITE 100 POSTAL CODE 78259 licenseandpermits@cstbrands.com I hereby certify that I have sent a notification of hearing date 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 1st day of June, 2023. Cp,Qra C, . r -A tbz, Chloe A. White Deputy Clerk to the Board Supervisor June 21, 2023 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 BEVERAGE AND 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. 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 Monday, June 19, 2023. If you have questions or need additional information, please do not hesitate to contact me at (970) 400-4213. Very truly yours, eas2„, a. Chloe A. White Deputy Clerk to the Board Supervisor cwhite@weld.gov 6/21/23, 11:49 AM FedEx Ship Manager - Print Your Label(s) N D rn C7 Co 1p o m" z� 0918 0981 gZ11 11-191M13/10 A1I IOINd d0£:06 Nnr - f1H1 ra J232023040501w 18011, X08 Od a' O n '- 0 fJ Oc vm OZ v „ m0 m z m� v_ OS T (n m0 m z m z c m 583J2/29ABFE2D gam= Q,�m wot2 rn zWZ � W After printing this label: 1. Use the 'Print' button on this page to print your label to your laser or inkjet printer. 2. Fold the printed page along the horizontal line. 3. Place label in shipping pouch and affix it to your shipment so that the barcode portion of the label can be read and scanned. Warning: Use only the printed original label for shipping. Using a photocopy of this label for shipping purposes is fraudulent and could result in additional billing charges, along with the cancellation of your FedEx account number. Use of this system constitutes your agreement to the service conditions in the current FedEx Service Guide, available on fedex.com.FedEx will not be responsible for any claim in excess 010100 per package, whether the result of loss, damage, delay, non-delivery,misdelivery,or misinformation, unless you declare a higher value, pay an additional charge, document your actual loss and file a timely claim.Limitations found in the current FedEx Service Guide apply. Your right to recover from FedEx 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 $1,000, e.g. jewelry, precious metals, negotiable instruments and other items listed in our ServiceGuide. Written claims must be filed within strict time limits, see current FedEx Service Guide. https://www.fedex.com/shipping/shipmentConfirmationAction.handle?method=doContinue 1/2 6/21/23, 11:49 AM FedEx Ship Manager - Print Your Label(s) Shipment Receipt Address Information Ship to: LIQUOR ENFORCEMENT DIVISION COLORADO DEPARTMENT OF REVENUE PO BOX 17087 DENVER, CO 802170087 US 3032052300 Ship from: CHLOE WHITE WELD COUNTY 1150 O STREET RM 166 GREELEY, CO 80631 US 9704004225 Shipment Information: Tracking no.: 772518608160 Ship date: 06/21/2023 Estimated shipping charges: 8.30 USD Package Information Pricing option: FedEx Standard Rate Service type: Priority Overnight Package type: FedEx Envelope Number of packages: 1 Total weight: 1.50 LBS Declared Value: 0.00 USD Special Services: Pickup/Drop-off: Drop off package at FedEx location Billing Information: Bill transportation to: COUNTYOFWELD-483 DEPARTMENT NAME: WELD CLERK TO THE BOARD SENDER NAME: CHLOE A. 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Maximum for items of extraordinary value is $1000, elry,preciousmetals,negot ableinstrumentsandotheritems listed In our Service Guide.Written claims must be filed within strict time limits; Consult the applicable FedEx Service Guide for .Theestimated shippingcharge maybe different thantheactual charges for your shipment.Diffeences mayoccur based onactual weight, dimenion, and other factors. Consult the applicable FedEx Service Guide or the Fed Ex Rate Sheets for details on how shipping charges are calculated. https://www.fedex.com/shipping/shipmentConfirmationAction.handle?method=doContinue 2/2 Hello