Redacted Application - HAMPTON INN & SUITES BUCKEYE VERRADO (#386055).pdf

Received in the Buckeye City Clerk's office April 09, 2026 at 10:16 a.m. by LCA

State of Arizona
Department of Liquor Licenses and Control

Created 04/08/2026 @ 11:15:24 AM
Local Governing Body Report

LICENSE

Number: Type: 011 HOTEL / MOTEL
Name: HAMPTON INN & SUITES BUCKEYE VERRADO
State: Pending
Issue Date: Expiration Date:
Original Issue Date:
Location: 21245 W ROOSEVELT STREET

BUCKEYE, AZ 85326

USA
Mailing Address: FT

BUCKEYE, AZ 85326

USA
Alt. Phone:
Email:

AGENT

Name: DAVID ALLEN WATKINS
Gender: Male
Correspondence Address: Po

BUCKEYE, AZ 85326

USA
Alt. Phone:
Email a

OWNER

Name: VERRADO HOSPITALITY LLC
Contact Name: DAVID ALLEN WATKINS
Type: LIMITED LIABILITY COMPANY
AZ CC File Number: 23425574 State of Incorporation: SD
Incorporation Date: 09/13/2022
Correspondence Address:

BUCKEYE, AZ 85326

USA
Alt. Phone: ia o™ NN (\;
Email eS MY

Officers / Stockholders ly

Page 1 of 4

Name: Title: % Interest:

HARVEY CHASE JEWETT IV Member 30.95
JEFFREY ALLAN STOCKERT President 30.95
MITCHELL THOMAS HOFFMAN Member 10.08

VERRADO HOSPITALITY LLC - Member
Name: HARVEY CHASE JEWETT IV
Gender: Male

Correspondence Address:
BUCKEYE, AZ 85326

USA
Alt. Phone: |
Email TO
VERRADO HOSPITALITY LLC - President
Name: JEFFREY ALLAN STOCKERT
Gender: Male

Correspondence Address:
BUCKEYE, AZ 85326

USA
Phone’ a
Alt. Phone: a

El: eS

VERRADO HOSPITALITY LLC - Member
Name: MITCHELL THOMAS HOFFMAN
Gender: Male

Correspondence Address:
BUCKEYE, AZ 85326

USA
Alt. Phone: |
Emu: RO" 4
MANAGERS
Name: NICOLE JULIEANNE LEMOS

Gender: Female

Correspondence Address:
BUCKEYE, AZ 85326
USA

Alt. Phone:

Email: es

APPLICATION INFORMATION

Application Number: 386055
Page 2 of 4

Application Type: New Application
Created Date: 02/27/2026

QUESTIONS & ANSWERS

011 Hotel / Motel

1) Are you applying for an Interim Permit (INP)?
No
2) Are you one of the following? Please indicate below.
Property Tenant
Subtenant
Property Owner
Property Purchaser
Property Management Company
Property owner asch2roprryistanegementeompany—
3) Is there a penalty if lease is not fulfilled?
No
4) Is the Business located within the incorporated limits of the city or town of which it is located?
Yes
5) What is the total money borrowed for the business not including the lease?
Please list each amount owed to lenders/individuals.
Dacotah Bank - $8,129,077.67
6) Are there walk-up or drive-through windows on the premises?

No
7) Does the establishment have a patio?

Yes

Is the patio contiguous or non-contiguous (within 30 feet)?

contiguous

8) _ Is your licensed premises now closed due to construction, renovation or redesign or rebuild?

Yes

If yes, what is your estimated completion date?

03/04/2026

DOCUMENTS

DOCUMENT TYPE FILE NAME UPLOADED DATE
QUESTIONNAIRE HJewett PIO.pdf 02/27/2026
QUESTIONNAIRE Dwatkins PIO 2025 date.pdf 02/27/2026
ORGANIZATIONAL DOCUMENTS — Owners.docx 02/27/2026
ALIEN STATUS IMG_1313.jpeg 02/27/2026
ALIEN STATUS IMG_1314.jpeg 02/27/2026
ALIEN STATUS Alien Status form.pdf 02/27/2026
DIAGRAM/FLOOR PLAN Hampton Buckeye First Floor.pdf 02/27/2026
DIAGRAM/FLOOR PLAN liquor floor 2-4.pdf 02/27/2026
RESTAURANT OPERATION PLAN Hampton Menu - Modified.docx 02/27/2026
RESTAURANT OPERATION PLAN _ AZDPS information.pdf 02/27/2026
RECORDS REQUIRED FOR AUDIT _ records required for audit.pdf 02/27/2026

RESTAURANT OPERATION PLAN Title 4 basic cert of completion.pdf 02/27/2026
Page 3 of 4

RESTAURANT OPERATION PLAN

MISCELLANEOUS
QUESTIONNAIRE
QUESTIONNAIRE

Title 4 managment cert of
completion.pdf

fingerprints completed.pdf
mhoffman.pio_260211_190423.pdf
jstockert.pio_260211_190358.pdf

NLemos fingerprinting AZ background
receipt.pdf

NLemos basic training.pdf
NLemos Management training.pdf
Nicole Lemos- PIO.pdf

Nicole Lemos Alien_Status.pdf
NLemos ID.pdf

Restaurant Operation Plan.pdf

BAR EQUIPMENT LAYOUT 7-16-
25.pdf

dw PIO complete 2025.pdf
DW Alien Status Form.pdf
DwatkinsIDfront.jpeg
DwatkinsIDback.jpeg
MHoffman PIO 2025.pdf

Statement of Liquor Licenses -
Hoffman.pdf

JStockert PIO 2025.pdf

Jeffrey Stockert Statement of LL in
AZ.pdf

HJewett PIO.pdf

Statement of Liquor Licenses -
Jewett.pdf

Nlemos fingerprint info.jpeg
NLemos fingerprint info2.jpeg

Page 4 of 4

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Arizona Department of Liquor Licenses and Control
https://www.azliquor.gov DLLC USE ONLY

(602) 542-5141 | Job #¢
— 7 EE a A :
RESTAURANT OPERATION PLAN ner =
RESTAURANT SERIES 12 AND (
HOTEL/MOTEL SERIES 11 ONLY Ucense #:

Hampton Inn and Suites Buckeye Verrado

2.Must indicate the equipment below by Make, Model, and Capacity:

1. Name of restaurant (Please print):

LIST ONLY THE FOLLOWING - NO ATTACHMENTS

‘Grill none

Oven | Ventless High Speed Oven - XpressChef MRX2 17.2cuft

Freezer Upright Reach-in freezer Everest ESF1 23cuft

Refrigerator Upright Reach-in refrigerator - Everest ESR2 48 cuft, Dual Zone Wine Fridge - Summit SWC3066B Undercounter Beer Cooler - Summit SCR5 10BLCSS S cuft
Sink 3 compartment sink - Advance Tabco T9-3-54-L 91° overall length Hand sink at bar - Lacross CL12HS-ST Hand Sinks - Advance Tabco 7-PS-80 10°x14.5* sink bow
Dish Washing Facilities High Tempe Undercounter Dishwasher - CMA UC65e M3 20"x20" Glass Washer - CMA GL-C 25 1/8 x 25 1/4 x 39"
Food P. ion C = :

(mensions) |Mixing Station - Lacrosse MS5-36CTCHSRBDL+10
Other Direct Draw Beer Dispenser - Beverage-Air DD94HC-1-B

3. Attach a copy of your FULL menu with pricing INCLUDING NON-ALCOHOLIC BEVERAG

4. What percentage of your public premises is used primarily for restaurant dining?
(Do not include kitchen, bar, hi-top tables, or game area.) 0 %

5. Does your restaurant have a bar area that is distinct and separate from the dining area? Llyes No
(If yes, what percentage of the public floor space does this area cover?) 0 %

6. List the seating capacity for:

a) Restaurant dining area of your premises: {O
(DO NOT INCLUDE PATIO SEATING) -
b) Bar area {20
total 20
5/5/2025 Page 1 of 2 LIC-APPREQ-RESTOP-001

Individuals requiring ADA accommodations please call (602)542-2999

7. What type of dinnerware is primarily used in your restaurant? W]Reusable Lbisposable LBoth

8. Does your restaurant contain any games, televisions, or any other entertainment? [ves O No

If yes, specify what types and how many (examples: 4-TV’s, 2-Pool Tables, 1-Video Game, etc.)
4-TVs in Bar

9. Do you have live entertainment or dancing? Dives No
If yes, what type and how often (example: DJ-2 x a week, Karaoke-2 x a month, Live Band-1 x a month, etc.)

10. List number of employees for each position:

Position How many

Cooks 0

Bartenders one

Hostesses

Managers

O10 |O

Servers

Other ( )

Other ( )
Other ( )

1, (Print Full Name) Jeffrey A Stockert , hereby swear under penalty of perjury and in compliance
with A.R.S. § 4-210(A)(2) and (3) that | have read and understand the foregoing and verify that the information and

statements that | have made herein are true and correct to the best of my knowledge.

Applicant Signature: ED.

5/5/2025 Page 2 of 2 LIC-APPREQ-RESTOP-001
Individuals requiring ADA accommodations please call (602)542-2999

"OG 3 iO tia, pert pn 45

The Roosevelt Bar Signature Driuks & Lite Bites Menu

The Best Old Fashioned - Angostura Bitters, demerara/simple syrup 20z Bulliet Bourbon served

with a large ice cube and garnished with a Luxardo maraschino candied cherry.
(Mid shelf +$2 Top Shelf +$4, double[.750z] $5)

$11

Verrado Manhattan - A blend of rye whiskey or 20z bourbon, sweet vermouth, Angostura bitters,

stirred to perfection and garnished with a maraschino cherry.
(Mid shelf +$2 Top Shelf +$4, double[.750z] $5)

$12
Reserved Paper Plane - Bourbon, Amaro Nonino, Aperol, and fresh lemon juice. Garnished with a

twist of lemon, it's a refreshing choice for discerning palates.
(Mid shelf +$2 Top Shelf +$4, double[.750z] $5)

$14
Ground Floor Margarita - Premium tequila, a splash of Triple Sec, and House Margarita mix. Served

in a salt-rimmed glass and garnished with a lime wedge.
(Mid shelf +$2 Top Shelf +$4, double[.750z] $5)

$i
Top Floor Margarita - Crafted with the finest premium tequila, a splash of Grand Marnier or
Cointreau, and freshly made margarita mix, perfectly balanced with agave nectar and garnished with a lime

wedge.
(Double[.750z] $5)

$20
Victory Martini - Our Martini is expertly mixed with your choice of gin or vodka and a touch of dry

vermouth, served chilled in a martini glass. Garnished with a lemon twist or a classic olive.
(Mid shelf +$2 Top Shelf +$4)

$14
Late Cosmo - Vibrant blend of vodka, Triple Sec, cranberry juice, and fresh lime juice. Garnished with a

twist of lime.
(Mid shelf +$2 Top Shelf +$4)

$14
Engineers Negroni -Gin, Campari, and sweet vermouth, stitred together and garnished with a slice of
orange peel. $15

Lobby Sidecat_- Cognac with the citrusy brightness of fresh lemon juice and a hint of sweetness from

triple sec. Garnished with a twist of lemon.
VIP Sidecar with (20z) Hennesey and (.750z) Cointreau +$7.00

$13
House Mule - Vodka, fresh lime juice, and fever tree ginger beer, served in highball glass. Garnished
with a lime wedge.
Mid shelf +$2 Top Shelf +$4, double[.750z] $5)
$12

"OG 9 1G thay. dept aH G15

Draft Beers $6
Canned Beer $7
Canned Ciders $

Seltzers - $8
Wine $12

Non-Alcoholic Selections

Mocktails $5-$10
Soda $5
Juice $6
Red Bull - $6

Wine Selections

Chardonnay
Sauvignon Blanc
Prosecco
Pinot Grigio
Pinot Noir
Cabernet Sauvignon

Lite Bites Menu

Chips and Salsa $6

Chips & Guac $8

Chips & Queso $8
Chips & Spinach Dip $8
Pita Bread & Hummus $6

Pita Bread & Hummus $6
Mozzarella sticks (6) $8
French Fries $6
Truffle Fries $9
Small Pizza $7
Taquitos (5) $7
Fried Ravioli $7
Buffalo Cauliflower $9
Pretzels & Cheese $6
Vegetable Spring Rolls (5) $8
Wings (6) $10
Chicken Tenders (3) $8
Soup of the Day $8
Beef Sliders (2) $10
Chicken Yakitori Skewers $12
Chicken Tenders & Fries $12
Wings & Fries $14
Sample Platter $16
Cheesecake $7

26 9 i Lig Dept pa BiG
Arizona Department of Liquor Licenses and Control
https://www.azliquor.gov DLLC USE ONLY

(602) 542-5141 ern. SS
uel oD
‘Cau

licerSe#: = 7

RECORDS REQUIRED FOR AUDIT

RESTAURANT/HOTEL/MOTEL

In the event of an audit, you will be asked to provide to the Department any documents necessary to determine
Compliance with A.R.S. §4-205.02(G). Such documents requested may include however, are not limited to:

1.Name of restaurant (Please piivite TY oman Van cl Su.ke N (S wl M hay VEX ro

2. All invoices and receipts for the purchase of food and spirituous liquor for the licensed premises.

3. A list of all food and liquor vendors US Foods, Sysco, Southern Glazers, RNDC, Breakthru Bev, Hensley, Crescent Crown
4. The restaurant menu used during the audit period

5. A price list for alcoholic beverages during the audit period

6. Mark-up figures on food and alcoholic products during the audit period

7. A recent, accurate inventory of food and liquor (taken within two weeks of the Audit Interview Appointment)

8. Monthly Inventory Figures - beginning and ending figures for food and liquor

9. Chart of accounts (copy)

10. Financial Statements-Income Statements-Balance Sheets

11. General Ledger

A. Sales Journals/Monthly Sales Schedules
1) Daily sales Reports (to include the name of each waitress/waiter, bartender, etc. with sales for that day)
2) Daily Cash Register Tapes - Journal Tapes and Z-tapes
3) Dated Guest Checks
4) Coupons/Specials/Discounts
5) Any other evidence to support income from food and liquor sales

B. Cash Receipts/Disbursement Journals

1) Daily Bank Deposit Slips
2) Bank Statements and canceled checks

12. Tax Records

A. Transaction Privilege Sales, Use and Severance Tax Return (copies)
B. Income Tax Return - city, state and federal (copies)

C. Any supporting books, records, schedules or documents used in preparation of tax returns

5/5/2025 Page 1 of 2
Individuals requiring ADA accommodations please call (602)542-2999

y nn, te on ttt
13. Payroll Records 735, 7 tO cig. beet an G6

A. Copies of all reports required by the State and Federal Government
B. Employee Log (A.R.S. §4-119)
C. Employee time cards (actual document used to sign in and out each workday)

D. Payroll records for all employees showing hours worked each week and hourly wages

14. Off-site Catering Records (must be complete and separate from restaurant records)

A. All documents that support the income derived from the sale of food off the license premises.
B. Al! documents which support purchases made for food to be sold off the licensed premises.
C. All coupons/specials/discounts

The sophistication of record keeping varies from establishment to establishment. Regardless of each licensee’s accounting
methods, the amount of gross revenue derived from the sale of food and liquor must be substantially documented.

REVOCATION OF YOUR LIQUOR LICENSE MAY OCCUR IF YOU FAIL TO COMPLY WITH
A.R.S, §4-210(A)7 AND A.R.S. §4-205.02(G).

A.R.S. §4-210(A) 7

The licensee fails to keep for two years and make available to the department upon reasonable request all invoices,
records, bills or other papers and documents relating to the purchase, sale and delivery of spirituous liquors and, in
the case of a restaurant or hotel-motel licensee, all invoices, records, bills or other papers and documents relating to
the purchase, sale and delivery of food.

A.R.S. §4-205.02(M)
For the purpose of this section:

Restaurant: an establishment that derives at least forty percent (40%) of its gross revenue from the sale of food
Gross revenue: the revenue derived from all sales of food and spirituous liquor on the licensed premises regardless of

whether the sales of spirituous liquor are made under a restaurant license issued pursuant to this section or under any
other license that has been issued for the premises pursuant to this article.

Declaration:

|, (Print Name) David Watkins , declare under penalty of perjury that | am

authorized to submit this application. | have read the contents and to the best of my knowledge believe all statements

made on this application to be true, correct, and complete. tin al
Signature: > \\/.

*MAKE A COPY OF THIS DOCUMENT AND KEEP IT WITH RECORDS REQUIRED BY THE STATE*

5/5/2025 Page 2 of 2
Individuals requiring ADA accommodations please call (602)542-2999

Arizona Department of Liquor Licenses and tonal. PH 4229
https://www.azliquor.gov ~ ~ F “DLL USE ONLY

(602) 542-5141 wb# DK GQOSS
Cane

License #

Personal Information
Questionnaire

\o6.0

->)

ATTENTION APPLICANT: This is a legally binding document. An investigation of your background will be

conducted. Incomplete applications will not be accepted. False or misleading answers may result in the denial or
revocation of a license or permit and could result in criminal prosecution.

THE COMPLETED QUESTIONNAIRE NEEDS TO BE SUBMITTED TO THE DEPARTMENT ALONG WITH A $22. FEE, AND FD-258
FINGERPRINT CARD, THAT HAS BEEN SEALED IN AN ENVELOPE, AND SIGNED OR INITIALED BY THE FINGERPRINT TECHNICIAN, MUST
INCLUDE THE FINGERPRINT VERIFICATION FORM. MUST BE COMPLETED BY A RECOGNIZED FINGERPRINT SERVICE OR LAW

ENFORCEMENT AGENCY.

Agent: a person who
is designated by an
applicant or licensee
to receive
communications from
the department and to
file and sign
documents submitted
to the department on
behalf of the applicant
or licensee. An agent
is not a manager.

A.R.S. §4-202(A)

Controlling Person:
person directly or
indirectly possessing
control of an applicant
or licensee.

A.R.S. §4-101(10).
Manager: An

individual (not an
entity) approved by
the Department of
Liquor who has the
authority to organize,
direct, carry out,
control or to
otherwise operate the
day-to-day operations
of a liquor-licensed
business

A.R.S. §4-101(22) and

. Social Security 7 )|hCOU

. Driver's License #:
. Are you a resident of Arizona? [Vlyes [No
Email address: rrr
- Home Address: iy

. Daytime phone #: kD Alternative phone #:

. License Number:

. Business Address:

A.R.S. §4-202(C)

5/5/2025

SECTION - 1 INDIVIDUAL INFORMATION

WIAGENT LIconTROLLING PERSON (1 MANAGER
- Name: Watkins, David A\\On
Last First Middle

Birth Date: aT

(NOT a public record)

State Issued: Arizona

(NOT a public record)

(NOT a public record)

Date of residency: 01/15/2002

SECTION 2 — LICENSED BUSINESS INFORMATION

. Business Name (doing business as): Hampton Inn & Suites Buckeye Verrado

21245 W Roosevelt St Buckeye, AZ FF Qy

Page lof2
Individuals requiring ADA accommodations please call (602)542-2999

SECTION 3 — DAY TO DAY OPERATIQN QF-BUSINESS 4 x10

Must attach copies of Basic and Management Title 4 training certificates for person managing the day to day
operation of the licensed business.

Who is managing the day to day operations? CAgent Cicontrolling Person [¥]Manager
Nicole Lemos

Name of persons who will be handling the day to day operations:

SECTION 4 —- BACKGROUND

If you answer “YES” to any Question 1 through 5 YOU MUST attach a signed statement. Give complete details including
dates, agencies involved and dispositions. CHANGES TO QUESTIONS 1-5 MAY NOT BE ACCEPTED

ray

Have you owned, or been a controlling person of any entities that held a liquor Yes [] No
license in Arizona, or any jurisdiction, in the past 5 years?

2. Have you been cited, arrested, indicted, convicted, or required to appear in Yes [] No
court for violation of ANY criminal law or ordinance, regardless of the
disposition, even if dismissed or expunged, within the past 5 years?

3. Has an entity in which you are or have been a controlling person had an Yes [] No VY
application or license rejected, denied, revoked, or suspended in or outside of
Arizona within the last 5 years? A.R.S.§4-202(D

4. Have you had ANY administrative law citations, compliance actions, or Yes [] No
consents, in any jurisdiction in the past 5 years? (Do not include civil traffic
tickets)
A.R.S.§4-202,4-210
*Administrative Law Violations are any civil penalties, fines, suspension,
or revocations of your liquor license.

5. Has anyone EVER obtained a judgement against you the subject of which Yes [[] No
involved fraud or misrepresentation?

SIGNATURE

1, (Print Full Name) David Watkins hereby swear under penalty of perjury and in

compliance with A.R.S. § 4-210(A)(2) and (3) that | have read and understand the foregoing and verify that
the information and statements that | have made herein are true and correct to the best of my knowledge.

me sou, 02/11/2026

Signature:

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Individuals requiring ADA accommodations please call (602)542-2999

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Arizona Department of Liquor Licenses and Control
https://www.azliquor.gov DLLC USE ONLY

(602) 542-5141 me 9 §5S

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ALIEN STATUS

License #:

Title IV of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (the "Act"), 8 U.S.C. §
1621, provides that, with certain exceptions, only United States citizens, United States non-citizen nationals, non-
exempt "qualified aliens" (and sometimes only particular categories of qualified aliens), nonimmigrant, and certain
aliens paroled into the United States are eligible to receive state, or local public benefits. With certain exceptions, a
professional license and commercial license issued by a State agency is a State public benefit.

Arizona Revised Statutes § 41-1080 requires, in general, that a person applying for a license must submit documentation
to the license agency that satisfactorily demonstrates the applicant’s presence in the United States is authorized under
federal law.

Directions: All applicants must complete Sections |, Il, and IV. Applicants who are not U.S. citizens or nationals
must also complete Section Il.

Submit this completed form and a copy of one or more document(s) from the attached "Evidence of U.S. Citizenship,
U.S. National Status, or Alien Status" with your application for license or renewal. If the document you submit does
not contain a photograph, you must also provide a government issued document that contains your photograph. You

must submit supporting legal documentation (i.e. marriage certificate) if the name on your evidence is not the same
as your current legal name.

SECTION I—- APPLICANT INFORMATION

David Watkins

APPLICANT NAME (Print ortype)

SECTION ft — CITIZENSHIP OR NATIONAL STATUS

Are you a citizen or national of the United States? Yes O No - If yes, indicate place of birth:

iy Joliet 'e Illinois United States

COUNTRY

Sta

\f you answered Yes,1) Attach a legible copy of a document from the list below.

Drivers License

2) Nameof document:

If you answered No, you must complete Sections III.

5/5/2025 Page 1of3 LIC-GEN-ALIENSTAT-001
individuals requiring ADA accommodations please call (602)542-2999

EVIDENCE OF U.S. CITIZENSHIP, U.S. NATIONAL. STATUS; STATUS

TS fr

You must submit supporting legal documentation (i.e. marriage certificate) if the name on your evidence is not
the same as your current legal name.

Evidence showing authorized presence in the United State includes the following:

Ts

10.

12.

13.

5/5/2025

An Arizona driver license issued after 1996 or an Arizona non-operating identificationcard.

A driver license issued by a state that verifies lawful presence in the United States.

A birth certificate or delayed birth certificate showing birth in one of the 50 states, the District of Columbia,
Puerto Rico (on or after Jan. 13, 1941), Guam, the U.S. Virgin Islands (on or after January 17, 1917), American
Samoa, or the Northern Mariana Islands (on or after November 4, 1986, Northern Mariana Islands local time)

A United States certificate of birth abroad.

A United States passport. ***Passport must be signed***

A foreign passport with a United States visa.

An I-94 form with a photograph.

A United States citizenship and immigration services employment authorization document or refugee

travel document.
A United States certificate of naturalization.

A United States certificate of citizenship.

. Atribal certificate of Indian blood.

A tribal or bureau of Indian affairs affidavit of birth.

Any other license that is issued by the federal government, any other state government, an agency of this state

or a political subdivision of this state that requires proof of citizenship or lawful alien status before issuing the

license.

Page 2 of 3 LIC-GEN-ALIENSTAT-001
Individuals requiring ADA accommodations please call (602)542-2999