HomeMy WebLinkAbout20150994.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, and 3.2% fermented malt beverages for consumption by the drink on the premises
only, located at 68947 US Highway 85, Carr, Colorado 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 3.2% fermented
malt beverages for consumption by the drink on the premises only 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 13th day of April, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WD COUNTY, COLORADO
ATTEST: dictoctiC1 , , e :oe
Weld County Clerk to the Board
l
BY fI 0opn.cL/'Qh �R P
itty Clerk to t
rbara K
irkmeyer, Chair
Mike Freeman, Pro-Tem
e -._P. Conway
APPROVED AS TO FORM: I il. �:6Lli'
County Attorney,
Date of signature: ry
zad
eve Moreno
CC" 53/LC.; prazt u #_e
2015-0994
LC0047
DR 6442 (09/24/09) Pa
COLORADO DEPART
LIQUOR ENFORCEM
DENVER, COLOR
ye 80261 APR
R Etti 2015
APR 2 7 2015 PERMIT APPLICATIOPPC
.�►YVD REPORT OF CHANGES
WELD COUN___
C
RE
APR
LIQUO
FOR DEPARTMENT USE ONLY
EIVEV RECEIVED
21 2015 MAR 1 0 2015
LD COUNTY
ENF. D1 tWMMI SIIONER:
3 41901Nt 1(lat7D'ENSE NUMBER 14-t?)rj21)CO>
ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN
LOCAL LICENSE FEE $ 15
APPLICANT SHOULD OBTAIN A COLORADO LIQUOR & BEER CODE BOOK TO ORDER CALL (303) 370-2165
1. Applicant is a
libt(Corporation
PRESENT LICENSE NUMBER
❑ Individual
❑ Partnership El Limited Liability Company
��,
)4&
`r^1
Ar V 10
0 tS ) WOO
111 lll...���[[[ l./ /�-t/�✓lJ
2. Name
of Licensee
v 2 I r��
3. Trade Name
fordo(
I
rre
4.Locat
nAddress
IJ(
le
C County
Uavr Y
SELECT THE APPROPRIATE SECTION BELOW AND
Section A — Manager reg/change
License Account No.
el s .
PROCEED TO THE INSTRUCTIONS
,..Section
2210-100 (999) III Retail Warehouse
ZIP
��. 61�
ON PAGE 2.
,C
Storage Permit (ea) $100.00
1983-750 (999) DI Managers Registration (Hotel & Restr.)..$75.00
2012-760 (999)% Manager's Registration (Tavern) $75.00
❑ Change of Manager (Other Licenses) NO FEE
2200100 (999) Wholesale Branch House Permit (ea).... 100.00
2260-100 (999) IN Change Corp. or Trade Name Permit (ea) .50.00
2230-100 (999) ❑ Change Location Permit (ea) 150.00
2280-100 (999) ❑ Change, Alter or Modify Premises
Section B — Duplicate License
$150.00 x Total Fee
• Liquor License No.
2220-100 (999) O Addition of Optional Premises to Existing H/R
$100.00 x Total Fee
2270-100 (999) • Duplicate License $50.00
1988-100 (999) O Addition of Related Facility to Resort Complex
$75.00 x Total Fee
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
DATE LICENSE ISSUED
LICENSE ACCOUNT NUMBER
PERIOD
-750 (999)
-100 (999)
The State may convert your check to a onetime 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 returned lf your check is rejected TOTAL
due to insuficientorun ole ed funds,tle DepaNnen o Re enue ney olect
the payment amount directly from yourbanka«oumef Revenue
AMOUNT DUE
$ T .00,(t
2015-0994
DR 8442 (09/24/09) Page 2
INSTRUCTION SHEET
FOR ALL SECTIONS, COMPLETE QUESTIONS 1-4 LOCATED ON PAGE 1
Section A
To Register or Change Managers, check the appropriate box in section A and complete question
8 on page 4. Proceed to the Oath of Applicant for signature (Please note: Hotel, Restaurant, and
Tavern licensees are required to register their managers).
Li Section B
For a Duplicate license, be sure to include the liquor license number in section B on page 1 and
proceed to page 4 for Oath of Applicant signature.
11
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 4 for Oath of Applicant signature.
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 4 for Oath of Applicant signature.
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 4 for Oath of Applicant
signature.
4) To modify Premise, go to page 4 and complete question 9. Submit the necessary information and
proceed to page 4 for Oath of Applicant signature.
5) For Optional Premises or Related Facilities go to page 4 and complete question 9. Submit the necessary
information and proceed to page 4 for Oath of Applicant signature.
6) To Change Location, go to page 3 and complete question 7. Submit the necessary information and
proceed to page 4 for Oath of Applicant signature.
DR 8442 (09124/09) Page 3
,
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..
s
.�w,.,
5. Retail Warehouse Storage Permit or a Wholesalers
H Retail Warehouse Permit for:
❑ On —Premises Licensee (Taverns, Restaurants
Branch House Permit
etc.)
■ Off —Premises Licensee (Liquor stores)
D 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.
fa
..a .."
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
•;
ve-
Old Corporate Name
New Corporate Name
a
^
t' w
x
fk,,,
o
. k<.
�,:zR:
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 12-47-
311 (1) C.R S Your application must be on ei,le with the local authority thirty (30) days before a public hearing can be held.
Date ,led 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 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.
DR 8442 (09/24/09) Page 4
go/5-o99yL
8. Change of Manager or to Register the Manager of a Tavern or a Hotel and Restaurant liquor license.
(a) Change of Manager (attach Individual History DR 8404-I H/R and Tavern only)
Former manager's name
New manager's name 141()
(b) Date of Employment I( -a
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
9. Modi,cation of Premises, Addition of an Optional Premises, or Addition of Related Facility
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 modi ,cation is temporary, when will the proposed change:
Start (mo/day/year) End
NOTE: THE TOTAL STATE FEE FOR TEMPORARY MODIFICATION IS 5300.00
(mo/day/year)
(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 Li
(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 or Resort Complex Related
Facility, 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.
Local Licensing Authority (City or County) Date filed with Local Authority
Weld County, Colorado
Signature
Signature
Title
Chair, Board of Weld
Count Commissioners
Date
APR 1 3 2015
Title Date
DR 8404-I (07/25/11)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE STREET RM 108A
DENVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership,
and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation,
and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a
limited liability company, and members owning 10% or more of the company; and any intended registered manager of
Hotel and Restaurant or Tavern class of retail license.
NOTICE: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions
must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate
so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application.
1. Name of Bur ��"
► per 2, INC clbA Boyd ri tiv-Ne
2. Your Full Na e (last, first, middle) n I
Q IS 1'11. (V` QA"--,
4. Mailing address (if different from residence)
10 US B @yexv w $a0O7
5. List current residence addres Include any previous addreses within the last five years (attach separate sheet if necessary).
3. List ny othe mes you have used.
e
STREET AND NUMBER CITY, STATE, ZIP
FROM
TO
Current
10 EIS w y Z5
Previous
0ael cAnne, $a007
a009
6. List all employment within the last five years. Include any se f employment. (Attach separate sheet if necessary)
NAME OF EMPLOYER OR BUSINESS
ADDRESS (STREET, NUMBER, CITY, STATE, ZIP)
V; per zin5iaixxr Ae_ lC L $5 0:arr
POSITION HELD FROM
TO
7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry.
NAME OF ELATIVE
RELATIONSHIP TO YOU
POSITION HELD
NAME OF LICENSEE
(i\
8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or
inventoryto any licensee? If yes, answer in detail.
Yes I,XJ No
9. Have you ever received a violation notice, suspension, or revocation for a liquor I w violation, or have you applied for or been denied a liquor or beer
license anywhere in the United States? If yes, explain in detail. U Yes No
10. Have you ever been convicted of a crime or received a
or do yo have any charges pending? (If yes, explain in detail.)
' Yes No
suspended
sentence, deferred sentence, or forfeited bail for any offense in criminal or military court
11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (if yes, explain in detail.)
--' Yes J$No
12. Have ou ever had any professional license suspended, revoked, or denied? (If yes, explain in detail )
Yes No
PERSONAL AND FINANCIAL INFORMATION
Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential.
The personal information required in question #13 is solely for identification purposes.
13a. Dat of Bir h b. Social Security Number SSN ' c. Place of Birth J Citizen?
_4 �I 1• D ,U.S.Yes ! 'No
e. If Na ralized, le to where f. When (((����— I g. Name of istrict Court
Af A i Al Ah.
Naturalization rtificate Number
i. Date of Ce ification ; j. If an Alien, Give lien's Registration Card Number' I k. Permanent Re idence Card Number
I. Hei ht m. �eiigght n. Hair Color
5r rl i'6O :Brown
o. Eye Color : p. Sex q. Race i r. Do you have a current Driver's License? If so, give' number and state
&fePh r w ' :XYes No \
14. Financial Information. �j
/
a. Total purchase price $ .._ `f ��'
�',l''-
$
(if buying
an existing business) or investment being made by the applying entity, corporation,
partnership, limited liability company, other
b. List the total amount of your investment ig f is busin s including
stock purchases or fees paid $__�
any notes, loans, cash, services or equipment, operating capital,
c. Provide details of the Investment described in 14.b. You must account for all of the sources of this investment. Attach a separate sheet if needed.
Type: Cash, Services or Equipment
Source
, Amount
. 1
` S ` f -1),�_ l` c.�LPrs
pe:.,c.-4 rt& ,
t
, 7,5 ,ir(/
d. Loan Information (attach copies of all notes or loans)
Name of Lender
Address
Term
Security
Amount
n1 4
N 4
N 11
Oath of Applicant
I decl_ e under penalty of pry at this plication and all attachjs are true, correct, and complete to the best of my knowledge.
Aut�� rized Signatur:
Titl //
J_y_
2 Mar 15
TO: Whom it may concern
Subject: Character Reference
I have worked and known Karen Martin for more than a year and three months. Karen is a firm but fair
person, well liked amongst co-workers and customers. Karen is a very dependable person and can
handle any additional responsibilities given to her.
7 C7
-Brian S. Keller Griffin
307 sib
C
Susan Chavez
166 S. Trail Blazer Road
Fort Lupton, CO 80621
720 771 9730
January 30, 2015
To whom it may concern:
I would like to recommend Karen Martin for the position of Manager with Borderline Lottery. Karen has been in
the acting Managerial position since July of 2013 and has been employed with us since November of 2007.
Karen does an excellent job in this position and is an asset to our organization. She has good customer service
skills, is extremely organized, can work independently, and is able to effectively multi -task to ensure that all tasks
are completed in a timely manner.
Karen is always willing to offer her assistance and step up if/when a fellow employee can't make it in for their shift.
Karen is an asset to this employer and I recommend her for the manager position.
With regards,
Susan Chavez
Owner
Borderline Lottery
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PO Box 758
Greeley CO 80632
RECEIPT
DAT7.
NO. 88037
RECEIVED FROM 1 4CIShai' t? , 0 .�c,L,.
ADDRESS , ,r
(� hQ 424$15)
HOW PAID
CASH
CHECK
MONEY
ORDER
-75-
00
RECEIPT DATE 3-io-Is
Olvot
�9'iA Qh.Luu .
RECEIVED FROM
ADDRESS
S� c 4L d ot-i. and 14Viao
"O 88038
FOR
HOW PAID
CASH
CHECK
MONEY
ORDER
o2t.c3O
t.�oo�I
•% �1 By4.60.414.„
RECEIPT DATE 3-10 III- NO. 88039
i.
URECEIVED FROM F✓('ZC ((iLF , O U c�.I I ti .
MI ADDRESS
(c.1 �f
U d (� HOW PAID �j'r��J -^+''7y
CASH LUX)
CHECK
MONEY
ORDER
50
BY
S 3S.5o
FOR e' 1 �IJ1�Ui phlraltcli
VIPER 2, INC
BORDERLINE
4853 Kingbird Drive
Firestone. CO 80504
720-937-6151
Pay to the
Ord
Wells Fargo Bank Wyoming, N.A.
GL
03
nk
Date
Page 1 of 1
North Jail Complex
2110 O Street
Greeley, CO 80631
Phone 970-356-4015
Receipt
Your Reference Number:
2015069002-5
03/10/2015 11:50 AM
TRANSACTIONS
Finger Printing - Citizen
2O15O69O02-5-1
DESCRIPTION
Processing Fee
PAYMENT
Check
;eED FROM: martin,karen
ADDRESS: 10 us highway 85
CITY: cheyenne
STATE: WY
ZIP CODE: 82007
PHONE NUMBER: 7209376151
RE•M.ARKS: liq lic
Thanks and have a great day!
$10.00
AMOUNT
$10.00
TOTAL AMOUNT:
$10.00
$1O.OO
https://ireceipt-prod-web.co.weld. co. us/weldcountyprod/my/0/l ast_event_vicwer/htm_stan... 3/10/2015
20150327-03241
DATE 03/16/2015
SO WELD COUNTY RECORDS GREELEY
1950 "0" STREET
GREELEY, CO 80631
RE: MARTIN,KAREN CECILIA
SOC: XXX-XX-
DATE OF BIRTH:
No Colorado record of arrest has been located based on above
name and date of birth or through a search of our fingerprint
files.
The Colorado Bureau of Investigation's database contains
detailed information of arrest records based upon fingerprints
provided by Colorado law enforcement agencies. Arrests which are
not supported by fingerprints will not be included in this
database. On occasion the Colorado criminal history will
contain disposition information provided by the Colorado
Judicial system. Additionally, warrant information, sealed
records, and juvenile records are not available to the public.
Since a record may be established after the time a report was
requested, the data is only valid as of the date issued.
Therefore, if there is a subsequent need for the record, it is
recommended another check be made.
Falsifying or altering this document with the intent to
misrepresent the contents of the record is prohibited by law
and may be punishable as a felony when done with intent to
injure or defraud any person.
Sincerely,
Ronald c. Sloan, Director
Colorado Bureau of Investigation
Page 1
Rafaela Martinez
From:
Sent:
To:
Subject:
Janet Lundquist
Monday, March 16, 2015 9:20 AM
Rafaela Martinez
RE: Tavern Liquor License Report of Changes (Manager's Registration) - Viper 2, Inc.
This is an existing location. Public works doesn't have any comments at this time.
Thanks,
Janet Lundquist
Traffic Engineer
Weld County Public Works Dept.
P.O. Box 758, Greeley, CO 80632
Tele-970.356.4000 ext 3726
Fax- 970.304.6497
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.
From: Rafaela Martinez
Sent: Monday, March 16, 2015 9:05 AM
To: Bethany Pascoe; Bob Choate; Dan Joseph; Deb Adamson; Frank Piacentino; Janet Lundquist; Lisa Carpenter; Roy
Rudisill
Subject: Tavern Liquor License Report of Changes (Manager's Registration) - Viper 2, Inc.
Hello!
In accordance with the procedure for Liquor Licenses, please review all records on
the following document for any associated reports/incidents during the last year
and return your report to the Weld County Clerk to the Board's Office within two
weeks. Your report will be used by the Board of County Commissioners in
considering Approval of this Applicants Report of Changes (Manager's Registration).
PLEASE RESPOND NO LATER THAN: March 31, 2015
Applicant: Viper 2, Inc. dba Borderline
File Location: LCOO47
MEMORANDUM
Rafaela Martinez, Deputy Clerk to the Board March 27, 2015
From: Bethany Pascoe, Zoning Compliance Officer, Dept. of Planning Services
Subject: LC0047
Review of the following liquor license renewal by the Department of Planning Services shows the following:
42-07852-0000
Viper2, Inc.
dba Borderline
68947 Highway 85
Carr, CO 80612
Zone District: A (Agricultural)
This use is permitted through an Amended Use by Special Review (AmUSR-1096) permit.
Based upon my computer and case files, staff is not aware of any active zoning violations on the above
mentioned property.
SERVICE, TEAMWORK, INTEGRITY, QUALITY
RECEIVED
To: Weld County Board of Commissioners
From: Deputy Lisa Carpenter
Date: April 3, 2015
RE: Viper 2, Inc., dba Borderline
Dear Commissioners,
WELD COUNTY
COMMISSIONERS
I have researched and found no reported calls for service at Viper 2, Inc., dba Borderline,
located at 68947 Hwy 85, Carr, CO 80612, for the Calendar year of 2014 to present day.
I find no grounds for disapproval for the renewal of the liquor license.
Respectful) bmitted,
Deputy Lisa Carpenter
Community Resource Officer
Weld County Sheriff's Office
1950 "O" Street
Greeley, CO 80631
WELD COUNTY SHERIFF'S OFFICE
CommunityResource Office
LIQUID'? ENFORCEMENT WORKSHEET
•1950 O'Strobt
Greeley, Colorado 80631
Voice (970) 355-4015 • Fax (970) 334-5457
❑ Inspection Report
Incident Report
CPoTh
G_m+eimnename: S�ck(?c Licensee Name
License &/Ty ._crA) 7I.)O -c q 9
Addrss_ ( c c� �il7 \ Pe scoCcia lm tK ,,c,,
k—
t�ry
re s�[e,z� , L on �o7 it
ArZ� � C .(-.. �.�/ �-
Yes No ILIA
Date o` Report/Incident G''O-
State Liquor License Posted '¶,
J
Manager Registered Y/
License in Control of Premises
State Sales Tax License Posted
County Liquor License Posted
Trade Name Properly Registered
Federal Form 11* Call (800) 398-2822
Premises Physical Control Adequate ✓ II
1
Food Service License Posted
Acceptable Dispensing System �/I
MinorWaming Sign Posted
1 Oft Premise Storage Licensed .\/
Meals and Snacks Available I V
1 Only Permitted Items Sold ✓
Cleanliness Me uate
/
I Alcohol From Permitted Source Ivy
Discuss Sales of Liquor to Minors
'✓
I
Books & Invoices Available
_
VII
Alcohol Beverage Stock Acceptable
Discuss Sales to Intoxicated Persons
❑Warning LlFollow-Up Inspection
Violation:
Subject.
1 lime:
DOB.
Clothing -
Address:
HAN Phone G'.
Date
Mir I
I Eye,:
1 /
Ckatw,
Date
Hair:
Stale:
1
City:
Scale: � y4 -
Summons I.. Coed Date:
Edd-rn Yes
Chctm: Yes NO
NO
Narrative:
Deputy: �� �t1�.1r
(`A
Date: C C111,
Memorandum
TO: Rafaela Martinez
FROM: Dan Joseph
SUBJECT: Liquor license inquiry
DATE: March 30, 2015
CC: Cindy Salazar; Debra Adamson
In response to your request, Environmental Health Services has reviewed the Retail Food Service
Establishment file for Borderline, located at 68947 IIighway 85, in Carr, 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(dco.weld.co.us or by phone at 970-304-6415 extension 2206.
Thank you.
Dan Joseph
Environmental Specialist III
VIPER 2, INC
BORDERLINE
4853 Kingbird Drive
Firestone. CO 80504
720.937-6151
Pay to the
Ordenof ..
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