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Home My WebLink About20171201.tiffRESOLUTION RE: APPROVE PERMIT APPLICATION AND REPORT OF CHANGES FOR A CHANGE OF MANAGER AND AUTHORIZE CHAIR TO SIGN - VIPER 2, INC., DBA BORDERLINE 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 an Application and Report of Changes from Viper 2, Inc., dba Borderline, for a Change of Manager, in connection with its Tavern Liquor License, for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, located at 68947 Highway 85, Carr, CO 80612, 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 Application and Report of Changes from Viper 2, Inc., dba Borderline, for a Change of Manager, in connection with its Tavern Liquor License, for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, 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 1st day of May, A.D., 2017. BOARD OF COUNTY COMMISSIONERS WELD CO NTY, COLO ' DO ATTEST:/ ;4k. Weld County Clerk to the Board Date of signature: \/`-'t I1 u ie A. Cozad, Chair Sean P. Conway arbara Kirkmey CC= S-toatCo °L PPL S©CRS , Ca.C FR) 5/LI /l7 2017-1201 LC0047 Ad Permit Application and Report of Changes eat License Iumber if 0-1 05 & 0000 Anawees• Must Re Printed In Black Ink Or Typowrrtten area rat> $ . fl 1 Q TF ai ''AP R A MMNXXXXXX (-110-113'5 a©0ocO J�k' ra !tam.. VrOtof MAT R S CTION BEL.t W AND PROCEED TO TkiE INSTRttCTICk ON PA ar ea i eg a n t+ as E� ate s ta;Tavern) Ec8�3;`tet`� R£tS t0t€53' s;. "In 12-4, nh i'ti213ua InePE:,tt (ea) .. or Trams Name Perrti (ea .....,.,. 0 Taa?£ftn CFinVeraini;..... - - - Do Not Wrlto in TMs Space - For Department of Revenue Use Only €a&;acs a.y£?>% adtax+3v.>m'ks;≤ FKgo-[ incgea:Ami a:i ixsirmxaAwkfte ae.. m:sta ,i nousa `.*watTl sax: y,sefi Y4M+1$4.S..tat . it,, oR.4 2tem65A. G1'i: ..3fi:SAS.c5. 5xN Gat3eiN?4 TOTAL AMOUNT DUE ISO O,1 tc�ra=;eel ��aA instruction beet Complete Questions 1-4 Located on Page 4 ter Or PAattagsts, check the ap s 4> Proceed to of Apptrcant for eig ttt3t1 El For a Duplicate' license, he sure to inciutta the ileum t=:tense number (n section B on paste 1 and proceed to page 4 for Oath of 40cent signature, A:and complete VtuaaSo€'z atate Licensing Author Section C book the Appropriate bas to soolom C t r p ≥nt tat . ftetaii Warthouse Ste€aye f'crazit, tf s to page e 3 conittleto question a (he .sore 3z -r chece Ito Qpr.ate box), Submit the n ts.c3ry lofty -make) and pr;,= geed to page a for Oath orAppti)ant signature. psi to State Licensing Atuttiortt for approvas, ancit aYoinie Pasmit, 9a to µage 3 and co.N ete ua tion rhot sum to .,oicesoecy sn to:f;ation and i”ozo xd to page a far Oath of Apptice AothOitty for approval ripesratioe kame,. go to ::age 3 and complete quo -shot O-a0-aw .vote to chaoh necessary information and orcxef to gage a rot Oath of Applicant te. Robe Liquor Litense submit €a Leal Liquor Lit nti g Authority (City or Colonel). fdattutccturer, <tuGt Ltt e?:sSs soh -ilia to Stale Liquor Ltc ens,ng A'Aft.* tty: 4) to mottity Premise, go to page 4 and corrivic'le question 0, Submit the necessary adorrrt iiem and proceed to page a for Oath of Applicant s gnatut a. Retcs LiQucr License- satinet tc Locet Liquor Authority (City or County). Manufacturer, l shoitfl er' and tr cporter s L ?ptzrxr w c oeade etthmit to State Liquor- t>ti,:ensirt Amway S) Foe Q 3C₹PX3aa3 3 remises or f%a#ataaY. acil tin go ₹r papa a ape₹ ;�-,ra�₹?rte ex=astzon a. ;�uz3zrzt az s nc,enss:szy Sr�f� eza:zs�rt aa::€ proad to po e Pzar t=�a'₹th �:=f F pots:.₹ nt st .r at₹tre Y+e€aiI Liquor license s₹+t r₹th to LoS Lt 7uor Licenono Act h rity t' € y cr Ctean€y3 tea=+: 'act rtra, 's tz( €Lace€sd and E r,pJ fat's Woo Licenses eubEn it State Liquor Ucene€::-;g Authority t 7ti Change Location, go to poky 3 and <orrOote uuestssn 7. Sotanti. tt>,e necessary cnforntatt n rind proceed to page 4 for Oath e# Applrant stgntltu e. Retail liquor License 4obroir to Latat n.tQuar cicensintj AuatOcitY fatty Or Oountty). usaru'afturerr: stelotes for and trncortera L€ou+te .senses tarot; to State Liquor Licensing Author€ty. 7) Tavern Conversion; go to cage 4 gld ₹xxnP'srate q e9tione i 7. Sett twit the n ,esear'y information and Proceed to page 4 for Oath of Applicant stgnctcrre West fra completed be Ara/tar 9t0 2097; a the l*s>7 ;aonvora;,,,r, W31/ no longer be pernaltergt. Subrntt to Local Licensing ty (sty or aunty) for atpprcAa€. Rib$€..'s#z3r @t:#₹Zf$5`.. ES3ier P$tiYf#4 or t�s3a#i Wareho¢ se P rrnit €or; C3 ,°i3 Y�'>.�E₹.£"•d:S•:. §i3.'w#;:tzlliAf7$i a CW Preri s L ,ensae € E uor stott,i dVVFsa€es E cws are sCt € alas a Par₹caat #et L dfaerarn Ert7$es. mud arete f a r€e Gh e7t Attact₹ ₹`3a & n a a€9 t:,Cftx'rC ng tda z f C,ea4₹f#nate of:Arn r orne s f74aa WSI the Sec etary of State. a i. ateE€aeE4Y of C iar e i¢ d t?'• the S&r r'j° ref State fs4is₹Y re$ at Ce rpora€e retina. L#rnst e L at €#stp, Fzetr#3ere Yis uSY:?d:$3••a f £i4a i �aa�. Feim.. or atA'$ e N�a.^a1 �••��,� New Egoo>orm £¢ano 9$ O? €✓seam . €aEM L SUS: An emaoa€ on tc vharn'e tat* tn3s r£ry Yana n y t nt araaea totwace iak₹£.. *;# a sans Netsi7dpa %S YR₹a +niia` 5111 #cSca₹ awboei Sate is €Ynt with Lott Authority e, Ponts < 3£ oatrrsn± prefrssSf Ct, „C'tie ty a4 £sa afi $i3$ pair) 4ce17sa Ena§ suns Iss ora a } ube.e €gist di t $ o ur z ' Neev er4e:$e fA# 9 h op it f. e sy e r #arsee ₹1,.₹ ea9£ roses #Y t#te ik nsee=' £d, sTtt„ac Betas₹q?ri. rtiS ₹ pte$ees*c 3 i Edi:5q Er € ₹a€nme EY xler managed a scar£sPst al3snire»t?:.. �r§i32i i C4 a iinendai in4 f '6k 1Ei o' j 11 kE ii i:itiic gabr, ar an4 i,• r, 9. Modification of Prendsea. Addition of an Option& 3*reenisoa, or Addlt Namit' rx nn n•iy, id desr . od a y x # s Linn that a CJf 3i3i•.£i:P 4q EF,} EC9:: £bi t33}F%.1 f't A'ti n siy mete 1 < O. Tavern Conversion �v£ote, Mau be £ aipse&t. 3v si`i0.. I Pf:Ea£€ert£ f #ih5 aF f� i4'A3 P to �G�+'16 #} e# £pm�+!f'v'{` sine SOW leRi7etta Oath of Ap0hOait1't •� 't cz r -f:: a i �aao f? \Y ip>! 1* ≥ a :4 ? EE's C< i, <�+ .f > ?•�, <`; the fi.. gf�:: 2 :r.atiad '{, nd off.`.: ¢�3��H :.Y2.+.≤L. 4 +.�. fi3 b, f:: ;:�t`� 8 0,...Jt � `?f � C.>..>. .te:.�fLL 'tf3 s 3�. r�z, ;'� ,,� �': ...�T � <��+ .'•'ef%asi. ^'•.`yEfa< i?<3t:...: iofdi'.r'.ai°Ew? 't.4"-3oin :. #..4.. :%r<»s...:`.Ote It; "t3a :...?*;: u3 °:�) •^,S)°< �."�.- t R : x# p Ewa i o€ LOCAL ic.ss inn A ut o ityCOUNTY) i L toE <i ) m3 i s - 2° C< a< M a .3�+ < t§a. .se i; 'r d.33.�i� - 3:sr >E t.- £� i# o <,.r i`;]a t 3.0 3Z S ;i-- 9 cif � .a i F3. bawl - ��fi ��. at"1�..� :'C �. �L#`Ei Z. < L.v <v L Le �3 c3 :�L <3 ->.t �`�i y t.;:O rEV01 t.?,4.3t 3t`.`f. ##a if Ta<ite . wiii Z ^ `<. y with the applIdable umd rcrs s ' #t3 < 2A,•<ftlL: <ta and 47, C S., ad ke Wd. TI 3,4Q? : TtFmm Appikstion is A04. -4.04d, We L d ;C. un t.r..,.C.Q,..pwr> l 2 .,,?.Q 17, • Chair, Count Commissioners 5/1 2017 ,Ropoft ct' STATE L..L.ralos*htq Aoth ritt Nt 0.20/ 7- /ao/ MEMORANDUM TO: Weld County Attorney's Office DATE: April 25, 2017 FROM: Chloe A. Rempel, Deputy Clerk to the Board SUBJECT: Permit Application and Report of Changes — Viper 2, Inc., dba Borderline The Weld County Board of Commissioners and the State of Colorado approved an application for a Transfer of Ownership of a Tavern Liquor License from Busy, Inc., dba Borderline Galley and Coffeehouse to Viper 2, Inc., dba Borderline in 2005. The owner of Viper 2, Inc., dba Borderline, Kim Chavez, completed an Individual History Record and submitted to Weld County requirements at that time. Karen Martin was registered as a manager of the establishment on April 13, 2015. She is no longer employed at Viper 2, Inc., dba Borderline, and the owner is requesting that Ms. Martin be removed as the registered manager. Kim Chavez, the owner, will be adopting all responsibilities of a registered manager. 2017-1201 LCOO9'7 LC DOH "7 DRa1W-I (sep2) COLORADO DEPARTENT of REVENUE LIQUOR ENFORCEMENT DIVISION 1811 PIERCE STREET RM 10M DENVER CO Keel INDIVIDUAL HISTORY RECORD To be completed by each individual applicant, all general partners of a partnership, all limited partners owning 10% (or more) of a partnership; aD officers and directors of a corporation, all stockholders of a corporation owning 10% (or more) of the stock of such corporation; all limited liability company MANAGING members, Officers or other limited liability company members with a 10% (or more) ownership interest in such company and all managers of a Hotel and Restaurant ore Tavern License. NOTICE: This individual history record provides basic Information which is necessary for the licensing authority Investigation. All questions must be answered in their entirety or your application may be delayed or not processed. EVERY answer you give will be checked for its truthfulness. A deliberate falsehood or omission will Jeopardize the application as such falsehood within itself constitutes evidence regarding the character of the applicant. 1. Nine of suer as x Pr Yno�1, Y r Full Name (last, ml ) v. aKP'n m& Lhn it.. 3. List any other names you have used. — 4. Mailing address different front real ) NA- Home Telephone .I03 ass -8'709 years. b. List as residence addresses below. Include current and previous addresses for the past five STREET AND NUMBER CITY, STATE, ZIP FROM TO //C�nt :x53 KJ. IfA Gbri �e, Prtcfrnlej Cu. 2oc t/ '4, tarn �" 9(0787e✓1/Fr (?o[wr+- vpisiontsvey eo moc 'In go' / Pk/c_se Blithh ,, ,./ /t-� l �(J�6v{�LCUV 7. U. S. Citizen? Yes ID No If lure ze �ern^s where lll� wrt _ /1.0t_ erne of District Court JLO..., Naturalization Certificate Number /-g•-- Date of CerMicallon kii- if an Men. Give Men's Registration Card Number LC Permanent Residence Card Number till.. a. mo t Weight 5.11 iqo Hair Color Eye Color 81.N'Btu Sex F Race /9/ 9. Do you have a - • • r . - - kfYes ❑No _ - - - - 10. List the name(s) of relatives working in or holding a financial Interest In the Colorado alcohol beverage industry NAME OF RELATIVE RELATIONSHIP TO YOU POSITION HELD NAME OF EMPLOYER Nit 11. Have you ever applied for, held, or had an Interest in a State inventory, to any liquor or beer licensee? If yea, answer In of Colorado Liquor peer License, or loaned money, furniture or fixtures, equipment or No data[. NI Yes 12. Have you ever been convicted of a crime, or received a suspended sentence, delerngvlentence, or forfeited ball for any offense In criminal or military court or do you have any charges pending? (II yea, explain in detail.) O Yes lIYCI No 13. Have you ever received a violation nonce, suspension or revocation, r liquor law violation, or have you applied for or been denied a liquor or beer license anywhere In the U.S.? II yes, explain in dean. O Yea NO 14. al all current and farmer employers or businesses engaged In within the last live yea (Attach separate sheet II necessary) NAME OF EMPLOYER Lompa 6z, Mitt MO Main S�.Lan �nf ('0. Lender VV f lL�irlaii /57L1) W. kV - Q��cida, C�v" ^G �2/U Jo? re%20'y�ern�tn Cir POSITION HELD Lender 'As FROM TO amid iz�oa 15. FInancial Information. rr cG Total purchase price S J�Q, 111-4 -1. (it buying en existing business) OR list the total amount of your investment in the new business, Including notes, loans, cash, services or equipment end operating capital S Provide details of Investment. You must account for the sources of ALL cash (how acquired). Attach a separate sheet It needed. Type: Cash, Services or Equipment Where Obtained (Swings, Checking, Account. etc.) Amount Iu,tai 6r2 n/G olwrlOnk Pen s/an!WOI /G la ss V a✓o,oc9. Coo, Loan Information (attach copies of all notes or bans) Nam* of Lender Address Tan Sec tally Amount 6,12 60 Qohtzokroe - 18. Give name of bank where business account will be maintained; name the amount will be maintained under; and the name or names of persons authorized to draw thereon. 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 01) Title liour Date ADDRESS (STREET, NUMBER, CITY, STATE, MP) MAY -10-2005 MON 09:54 AM COMPASS BANK May 13, 2005 Letter of Recommendation Kimberly Chavez Weld County Liquor Division To Whom It May Concern: FAX NO. 3034855937 P. 02/07 I am writing this letter of recommendation for Kimberly Chavez. I have known Kimberly for 33 years as I am ha mother. She has always been a high achiever and very School high energy. in whatever task she would take on. She bas had ajob from High until present and bas been a biai peifpimei in eiicrtssi:'Since 1495 *ten Inc muted her husband they have been very respbmible in their finances and have a strong understanding of what it takes to mewed in life. Her husband alsoof histrong s irk ethic and has always been responsible at his job as well as taking ily. 1 feel Kimberly has shown that she can own and run a very succeastbl business. Kimberly has a great since of value personally and professionally. Kimberly demonstrates sound business decisions. Dieu Todd Vice President, Vacua Bak Colored, 720 9474051 NAY -18-2005 NON 0855 AN C0NPASS BANK cd s COIAMPO DISFAFMAVIT OFMat n MO... OOVI NOR O FAX NO. 3034855937 P. 08/07 CS WA V. Told CaINS PIS no Kowa a Sulu tens oaww.00sm+aaa" ro0 Pm) PM pan man May 14, 2005 Mt Rorke; This is a letter of recommendation for Kimberly Chaff who is in the process of applying for a liquor license in the state of Wyoming. I have been in law enforcement for 19 years, for the past 4 years I bays been a Background Investigator. I come in contact with all types of people and personalities and can determine what kind of person they are in a matter of minutes. I have known Kimberly foe the past 13 years. She is a very manna, responsible and a bard working individual. Her work ethic and integrity are something to be adatirad. If granted this liquor license you can be rest assured that it would � ely any bbehavior responsible bands. Kimberly would not, now or in the Adore,Adore,o at the establishment that would put the license in jeopardy. If you have any thither questions, please feel free to call meat 303 239 4452. Susan Chavez Background Investigator Colorado State Patrol FYr6 LOa1 iee' MAY -18-2005 NON 0855 AM COMPASS BANK FAX Na 3034855837 P. 01/07 May is, 2005 Weld County Liquor Division Regarding: Kimberly Chavez with Vipers Inc. Letter of Recommendation: I have know Kimberly Chavez for over m years and know that within that time frame she has been very active within our local Chamber and has established herself well within the community. She is very knowledgeable and has a very strong financial background. Kimberly is very responsible and will be a successful business tive attitude anowner works veryin well with people; usiness venue. is a strohas overy ng team player. Sincerely, Hello