ࡱ> FICDE[ fbjbjUU ?b?b^+  8@&""888cccN@P@P@P@P@P@P@$BEJt@cA"ccct@88 @   cj88N@ cN@  69Z<8s:::@@0@:E@E8Z<EZ<cc ccccct@t@ ccc@ccccEccccccccc B \: APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE Company name (LLC, Inc): ____________________________________________________ Doing business as: __________________________________________________________ Business address (location): ____________________________________________________________________________ Mailing address: _______________________________________________________________________________________ Business e-mail address: ___________________________________________________________________ Phone number: (_____) _____________________ Other number: (_____) _______________________ The following section to be completed by City Staff: Date Received by Auditors Office: _______________ Investigations Fee Paid ($250) ______Yes ______ No Date Paid: __________________ Check # _____________ Reviewed Police Department by: _________________________ Date: _____________________ Comments (or see attached report): ______ Approval Recommendation ______ Denial Recommendation _________________________________ ____________________________ Chief of Police Date Reviewed Liquor Control Committee on (date): ______________________________ ______ Approval Recommendation ______ Denial Recommendation (See attached comments or minutes) Reviewed City Commission on (date): ______________________________________ ______ Approval ______ Denial This application is for the Class or Classes of Licenses checked: ( ) Class A Authorizes the licensee to sell on-sale only. ( ) Class B Authorizes the licensee to sell off-sale only. Off-Sale licensed premises must be no closer than 100 feet to any grocery store, drug store or gasoline service station or any part thereof. ( ) Class B Limited Authorizes the licensee to sell off-sale only. Off-Sale licensed premises must be no closer than 100 feet to any grocery store, drug store or gasoline service station or any part thereof. License is Non Transferable. ( ) Class AB Authorizes the licensee to sell on-sale or off-sale. Off-Sale licensed premises must be no closer than 100 feet to any grocery store, drug store or gasoline service station or any part thereof. ( ) Class ABH Authorizes the licensee to sell on-sale or off-sale, at hotels & motels with 100 or more guest rooms only. ( ) Class ABH Limited Authorizes license may be issued to persons engaging in on-sale of beer and wine or hosting managers specials, solely for guests or patrons of extended stay and limited service hotels or motels ( ) Class ABH-RZ Authorizes the licensee to sell on-sale or off-sale, to hotel guests in a Renaissance Zone with 15 guestrooms. ( ) Class C Authorizes the licensee to sell beer on-sale only. No food sales required. Physical bar is allowed. ( ) Class D Authorizes the licensee to sell beer off-sale only. ( ) Class DD License shall only be issued to a domestic distillery owner or operator who has obtained a license from the ND State Tax Commissioner. No food sales required. ( ) Class E In nature of a special permit, shall authorize the holder of an existing on-sale license in the sale of On-sale only alcoholic beverages on such premises designated on the permit. ( ) Class F Authorizes the licensee to sell on-sale only served at table or booth; no bar allowed. Requires 50% or more of its annual gross receipts from the sale of prepared meals and not alcoholic beverages. ( ) Class FA Authorizes the licensee to sell on-sale only, physical bar is allowed. Requires 50% or more of its annual gross receipts from the sale of prepared meals and not alcoholic beverages. ( ) Class FA-Golf On USGA Golf Course or 9 or more holes. Requires 25% receipts of food sales from April to October and 50% the rest of the year. ( ) Class FA-Entertainment Authorizes the licensee to sell on-sale only, in a place of amusement or in a recreational establishment. Requires non-alcoholic sales to exceed alcohol sales. ( ) Class G Authorizes the licensee to sell wine and sparkling wine on-sale only, served at table or booth, no bar. Requires 50% food sales. ( ) Class H Authorizes the licensee to sell beer on-sale only, served at table or booth, with no bar allowed and requires 50% food sales. ( ) Class I Authorizes the licensee to sell beer, wine, and sparkling wine on-sale only. A physical bar is allowed and requires 65% food sales. ( ) Class I Entertainment Authorizes the Licensee to sell on-sale only of beer, wine and sparkling wine in a recreational establishment or place of amusement. A physical bar is allowed and 65 % of non-alcohol sales required. ( ) Class J Authorizes the licensee to sell on-sale only at a non-profit organization for military purposes. ( ) Class L Authorizes the licensee to sell on-sale only on an excursion boat operating on the Red River. ( ) Class M Authorizes the licensee to operate a Microbrew Pub or Domestic Winery and sell on-sale and off-sale offered in conjunction with another license. Allows the sale of Growlers. ( ) Class N Authorizes the licensee to sell on-sale only at a stadium with a minimum seating capacity of 2500. ( ) Class O Authorizes the licensee to operate a winemaker and/or vendor of winemaking supplies and related services. ( ) Class P Authorizes the licensee to operate a domestic winery and to sell wine on-sale and off-sale. Allows limited beer sales. ( ) Class RZ-V Authorizes the licensee to sell on-sale only, located in an approved Renaissance Zone. The venue should be designed and intended to be used as a private event center or entertainment venue with square footage of at least 10,000 square feet and capacity of at least 300 people. The Venue must derive 60% or more of its annual gross receipts from the sale of tickets. ( ) Class W Authorizes the licensee to sell wine and sparkling wine on-sale only. A physical bar is allowed and no food sales required. ( ) Class Y Shall authorize the production brewery to obtain a brewer license and a retailer license. Must be licensed by the State Tax Commissioner. No food sales required. ( ) Class Z Authorizes the licensee to sell on-sale only issued to individuals not currently holding another A, AB, ABH, or ABH-RZ. A physical bar is allowed and no food sales required. The following section to be completed by the applicant: ALL APPLICANTS must initial #1 - #9 and sign in the space provided below. 1.______All applicants must assure there is adequate off-street parking for my business (within the direction of and as approved by the City Commission). Membership in the current City parking program (e.g.P.O.P) may place me in compliance with this requirement. 2._____I have received a copy of the Alcoholic Beverage Ordinance(s) of the City of Fargo, read the ordinances and am familiar with the conditions and requirements of these ordinances. 3._____If granted an alcoholic beverage license, I will obey, abide by and comply with the State of North Dakota Liquor Control Act, and the City of Fargo Alcoholic Beverage ordinances, as well as any amendments to either of these, which may be made from time to time. 4._____I understand either, I, my manager(s), or both of us must attend a yearly meeting (date and time to be announced) with representatives from the Police and Health departments to discuss law enforcement and safety concerns as a condition of license renewal. 5._____I understand that the premises described in the application, if licensed for alcoholic beverage sales, may be inspected at any time by the Chief of Police, or any officer of the Police or Health Departments as allowed by city ordinances and state law. My employees and I will cooperate with such inspections. 6._____I understand that all employees, managers and owners engaged in mixing, pouring or service of alcoholic beverages MUST attend Server Training. 7._____I am familiar with the question, answers and other information as it appears in the complete application of an alcoholic beverage license, and the answers and information are, to the best of my belief and knowledge, true, complete and accurate. (Note: This application must be made under oath before a Notary Public.) 8._____I recognize the City of Fargo is subject to open records laws contained in chapter 44-04 of the N.D. Century Code. Section 44-04-18.4 contains an exception for trade secrets, proprietary, commercial, and financial information. I agree in submitting the application, that I have familiarized myself with this law. If any information being forwarded to the City of Fargo is claimed as confidential or proprietary under this section, I must clearly indicate this in writing when I submit this application, pointing out, in detail, why the information submitted is claimed as an exemption under section 44-04-18.4. I further agree to respond to, as well as to aid the City, in responding to any claim under 44-04-21.1 concerning this claim of confidentiality under 44-04-18.4. 9._____ I understand that the license will expire on June 30 of each year and a renewal process will need to be completed. This process will include a completed renewal application, payment in full for the required annual fee, a completed roster for each employee who pours or serves alcohol, attendance of Server Training for those listed on the roster, and a copy of your certified food sales if applicable to your license. Applicant printed name: _______________________________ Signature: __________________________________________ Applicant printed name: _______________________________ Signature: __________________________________________ Applicant printed name: _______________________________ Signature: __________________________________________ Applicant Information: (2 pages) Name: (first) (middle) (last) (maiden name) Address: (address) (city) (state & zip) How long have you lived at this address? ____________________________________________________________ Provide your address history for the past 5 years: From__________ to __________ Address: ________________________________________________________ From__________ to __________ Address: ________________________________________________________ E-mail address: ________________________________________________________________________________ Home phone number: (_____) ________________________ Other number: (_____) _____________________ Date of Birth: __________________________ Place of Birth: _________________________________________ List each drivers license you have ever had and the state of issue: DL#: ______________________________ State of Issue: _______________________ Dates: ________________ DL#: ______________________________ State of Issue: _______________________ Dates: ________________ Has your drivers license ever been suspended or revoked? _______ Yes ______ No If yes, where and when. If yes, have you ever been issued a citation for driving after your license was suspended or revoked? ______ Yes _____ No If yes, where and when? Have you ever been convicted, plead guilty, or plead no contest to any law of the U.S., or any state, or of any local ordinance (other than traffic)? (DUI should not be considered a traffic offense and therefore must be listed) _____ Yes _____ No If yes, provide the date of arrest, location, charge, and sentence of each conviction. Have you been issued a citation for any alcohol-related offense? _____ Yes _____ No If yes, provide the date of arrest, location, charge of each conviction. List all federal, state, and local licenses (including liquor licenses; excluding drivers licenses) you currently hold, formerly held, or may have an interest in: Have any of the above named licenses ever been suspended or revoked? _____ Yes _____ No If yes, list the dates and reasons for the suspensions or revocations: List your employment/business history for the past 7-year period: From: _________ to _________ Business name: __________________________________________________ Address: ____________________________________ Position/Title: _________________________________ From: _________ to _________ Business name: __________________________________________________ Address: ____________________________________ Position/Title: _________________________________ From: _________ to _________ Business name: __________________________________________________ Address: ____________________________________ Position/Title: _________________________________ Do you currently own or have a financial interest in any other business that sells or serves alcoholic beverages? ______ Yes ______ No If yes, list each business below: Have you ever manufactured, sold, or distributed alcoholic beverages on the wholesale or retail level? ______ Yes ______ No If yes, indicate where, when, and for whom below: Do you have any current or prior management experience working for a business that sells or serves alcohol? ______ Yes ______ No If yes, describe below: Make copies as needed for each shareholder/partner with 5% or greater interest in the company. Operator/Manager Information Are you going to operate/manage this business personally? ______ Yes ______ No If no, who will operate/manage it? Name: __________________________________________________________________________________________ (first) (middle) (last) (maiden name) Address: __________________________________________________________________________________________ (address) (city) (state & zip) Home phone number: (_____) ___________________ Other number (_____) _________________________ Date of Birth: ______________________ Place of Birth: ___________________________________________ (Important: The name and other information about your manager must be provided before a license can be issued. If the manager changes during the course of the license period, you must provide the City Auditors Office with updated information about the new manager immediately.) Business Site Plan On this page (or on attached pages if additional space is needed), provide a detailed diagram and description of the design, location, and square footage of the premises to be licensed. The scale should be stated, such as 1 = 20. The direction N should be indicated towards the top. The diagram should include placement of all pertinent features of the interior of the licensed premises, such as seating areas, kitchens, offices, repair areas, restrooms, etc. The exterior parking area should also be shown. Operational and Financial Issues Briefly describe your business concept, including your analysis of how this model fits into the proposed location (i.e., describe the suitability of the fit into the existing neighborhood or business area). (Use additional pages if necessary) Describe in detail how you intend to address/prevent each of the following concerns at your Business: (Use additional pages if necessary) Over-serving, intoxicated or disorderly patrons: Safety and security issues, including crowd control: Minors on the premises, including consumption by minors: Noise concerns, especially from nearby residences of other businesses: Do you plan to feature live entertainment? ______ Yes ______ No If yes, describe what you envision at the time, including how often such entertainment will take place. What is your total business indebtedness for the entity, excluding lease costs? ___________________________ Does any one creditor represent more than 10% of that sum? ______ Yes ______ No If yes, list each creditor below. (Total must equal 100%) Name Address Phone # % Owed ____________________ _____________________ ________________ _______ ____________________ _____________________ ________________ _______ ____________________ _____________________ ________________ _______ Have you ever filed a petition of bankruptcy? ______ Yes ______ No If yes, when and what were the circumstances? Please list at least three business references: Name Address Phone # _________________________ _________________________ ________________ _________________________ _________________________ ________________ _________________________ _________________________ ________________ Is this application for a motel or hotel with 100 or more guest rooms? ______ Yes ______ No Is this application for a lodge or club? ______ Yes ______ No If yes, number of members in good standing ____________________________________________ Date of organization incorporation ______________________________________________________ Please make the necessary copies of the Credit Check Authorization and the Criminal History Request on pages 12 and 13 as needed for each of the Owner/Officers and Manager of your business or organization. Complete pages 5, 6 and 7 for each owner/officer and manager. Thank you. Credit Check Authorization This form will authorize Experian to furnish all reports and findings of the following individual to the Fargo Police Department, 222 4th Street North, Fargo, ND 58102. By releasing this credit information to the Fargo Police Department, your credit information may become public information due to the current North Dakota law regarding open records. Last Name: ___________________________________________________________________ First Name: ___________________________________________________________________ Middle Name:_________________________________________________________________ Home Address:________________________________________________________________ Date of Birth:__________________________________________________________________ Social Security Number:__________________________________________________________ You are authorized to release a complete credit check finding to the City of Fargo/Fargo Police Department. This credit check is being done for a license application. _______________________________________ _________________________________ Signature Date Please forward the above records to: Fargo Police Department Investigations 222 4th Street North Fargo, ND 58102 Records (701) 241-1420 Fax (701) 241-8272 Fargo Police Department 222 4th Street North, P.O. BOX 150 Fargo, North Dakota 58103 RECORDS DIVISION REQUEST FOR CRIMINAL HISTORY INFORMATION The information requested in Parts 1 and 2 of this form are mandatory in order to conduct the record search. PART 1 DATE: ____/____/____ REQUESTOR'S NAME: ____________________________________________________________ ADDRESS: __________________________________________________________ CITY: _______________________________________________________________ STATE: ____________________________________ZIP: _____________________ PART 2 RECORD SUBJECT'S NAME:_______________________________________________________ DATE OF BIRTH: ____/____/____ ADDRESS: ____________________________________________________ CITY:_________________________________________________________ STATE: _____________________________ZIP: ______________________ PART 3 COMPLETE ONE OR MORE OF THE FOLLOWING: SOCIAL SECURITY NO: ______ - ___ - _______ DRIVERS LICENSE NO: _______________________________STATE: ____________________ TO REPORT A CRIME DEPARTMENT FAX ADMINISTRATION INVESTIGATIONS (701) 235-4493 (701) 241-8272 (701) 241-1427 PHONE (701) 241-1405 FAX (701) 297-7789 FAX (701) 241-1407 If applicant is an INDIVIDUAL, complete this portion: STATE OF NORTH DAKOTA ) )ss. County of Cass ) I, ______________________________, do hereby swear that I am the Applicant named above; that I have read the application and know the contents thereof; that the information contained and offered therein is true and correct to the best of my knowledge. _________________________________________ Signature Subscribed and Sworn before me this ______ day of ____________________, 20___ _________________________________________ Notary Public (SEAL) If applicant is a PARTNERSHIP, complete this portion: STATE OF NORTH DAKOTA ) )ss. County of Cass ) We, ______________________________, ________________________________ ______________________________, _________________________________ do hereby swear that we are the Applicants named above; that we have read the application and know the contents thereof; that the information contained and offered therein is true and correct to the best of our knowledge. ______________________________, ________________________________ ______________________________, _________________________________ Signatures Subscribed and Sworn before me this ______ day of ____________________, 20___ _________________________________________ Notary Public (SEAL) If applicant is a CORPORATION OR LLC, complete this portion: STATE OF NORTH DAKOTA ) )ss. County of Cass ) ______________________________ and ____________________________________ do hereby swear that they are the President and Secretary, respectively of Corporation which is the Applicant named above; that they have read the application and know the contents thereof; that the information contained and offered therein is true and correct to the best their knowledge. _________________________________________ Name of Corporation (Corporate Seal) __________________________________________ Presidents Signature __________________________________________ Secretarys Signature Subscribed and Sworn before me this ______ day of ____________________, 20___ _________________________________________ Notary Public (SEAL) EMPLOYEE ROSTER FOR A NEW ALCOHOLIC BEVERAGE LICENSE Please make additional copies as needed. Business Name_______________________________________________________________________ ____________________________________________ ______________________________ Print name of person completing form Phone Number Additionally, pursuant to City of Fargo ordinance 25-1512 Section E at the time of renewal each year, licensee shall provide the City with a roster of employees. Please complete the roster of any employees who serve, pour or sell alcoholic beverages in your establishment and their supervisors. 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