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7103 characters
DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE
Date Accepted:
APPLICATION FEE $25.00 PER DAY
CSR:
Arizona Department of Liquor Licenses and Control -
800 W. Washington St. 5" Floor Phoenix, AZ 85007 license #:
Zow! (602) 542-5141
Ww Application MUST be submitted to the Department of Liquor 10 days prior to the event.
SECTION _1 Applicant must be a member of a qualifying nonprofit organization, political party, or Government entity and
authorized by an Officer, Director, or Chairperson of the Organization.
1. Applicant; _Cholieu, Marion
(Must be an Officer/Member of the Non Profit Entit Last First Middle
City State Zip
3. Applicants home/cell — Applicant's business phone:
4. Applicant's email — |
5. Special Event Name: Adrenaline Night Rides
6. Name of Non-Profit Organization, Candidate or Political Party/Gov; Clean Up Papago
7, Non-Profit/IRS Tax Exempt Number: 87-4356360
8. Arizona Corporation Commission File #: 23282857 If out of State please specify:
; . {Attach letter of good standing)
9. Event Location Name: McDowell Mountain Regional Park
10, Event Address: 16300 McDowell Mountain Park Drive Fort McDowll, AZ 85264
Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.
**SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**
Event Start License End
Days Date Day of Week Time AM/PM Time AM/PM
DAY 1:
DAY 2: 5/19/2023 Friday 7:00PM 11:59PM og
in
DAY 3: 2
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DAY 4: OF
So
2G £
DAY 5: oO =
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DAY 6: ao
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DAY 7: me 8
22
DAY 8: =
fo)
DAY 9: a
DAY10:
11/7/2022 Page 1 of 3
Individuals requiring ADA accommodations please call (602)542-2999
QSAlz034
SECTION 2 What type of security and control measures will you take to prevent violations of liquor laws at this event?
(List type and number of police/security personnel and type of fencing or control barriers, if applicable.)
Number of Police 1 Number of Security Personnel Fencing Cobarriers
ust explain security measures: Our beer garden is fully fenced in with one entrance/exit. Our licensed bag
ensures every patron is 21+ and distributed wristbands. He/She also ensures no alcohol leaves the
designated beer area.
SECTION 3 What is the purpose of this event?
Wlon-site consumption [off-site (auction/wine/distilled spirits pull) Cboth
How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors?
Check one of the following boxes. (R-19-318}
A) [Z Special Event being held on an unlicensed premises will require approval and signature by the Local Governing
Body on page 3. (If checked move to section 4)
B) C1 will this event be held on a currently licensed premises and within the already approved and licensed area?
(Must attach a letter from the licensed premises with an explanation of the option checked below)
Name of Business license Number Phone (Include Area Code)
LPlace license in non-use - Special Event Licensee selling all alcohol without retailer involvement
Must attach letter from the location suspending license for duration of special event
LiDispense and serve alll spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated fo licensee
Libispense and serve alll spirituous liquors under special event - The special event licensee is in charge of selling alcoho! that
was purchased or donated by the special event licensee. The retailers existing alcohol inventory must be separated from any
alcohol used during the special event. Must attach letter from the location suspending license for duration of special event
Lsplit premise between special event and retail location - Both the special event licensee and the retailer will conduct
sales of alcohol. (These sales will be done in separate areas. If alcohol is donated or purchased by the special event licensee
it must be in a separate area than the alcohol that is dispensed by the licensed retailer.)
Cot sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer will still be permitted to conduct all normal sale
and service of alcohol.
SECTION 4
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
(1 Yes /INo If yes, attach letter of explanation.
2. How many special event days have been issued to this organization during the calendar year?
3. Is the Organization using the services of a Special Event Contractor? (A licensee can utilize the services of a special
event contractor who may purchase and sell alcohol on behalf of the licensee. If no special event contractor is listed, the
licensee is responsible for the sales and service of alcohol. )
Aravaipa Runnin
Wl yYes J No If yes, please provide the Name of the Special Event Contractor: P 9
4. |s the organization using the services of a series 6, 7, 11, or 12 licensee to manage the sale or service of alcohol?
(Licensees who hold a series 6, 7, 11, or 12 license are automatically qualified to be the special event contractor)
LJ Yes IZ No if yes, please provide the Name of Licensee: License #:
11/7/2022 Page 2 of 3
Individuals requiring ADA accommodations please call (602)542-2999
5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.
Attach additional sheet if necessary.
0,
Name: Clean Up Papago Percentage: 100%
Address: 1419 N. Oak St. Tempe, AZ 85288
Street City State Zip
Name: Percentage:
Address:
Street City State Zip
Please read A.R.S. § 4-203.02 Special event license; rules and R19-1-205 Requirements for a Special Event License.
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
SECTION 5 License premises diagram. The licensed premises for your special event is the area in which you are
authorized to sell, dispense or serve alcoholic beverages under the provisions of your license. Please attach a diagram
of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control
measures and security position.
==> ATTACH DIAGRAM
If the special event will be held at a location without a permanent liquor license or if the event will be on any portion of a location
that is not covered by the existing liquor license, this application must be approved by the local governing body before submitting
to the Department of Liquor Licenses and Control. Please contact the local governing board for additional information.
APPLICANT SIGNATURE
Declaration:
|, (Print Name) Marion Cholieu , declare under penalty of perjury that | am
authorized to submit this application. | have read the contents of this application, and to the best of my knowledge
believe all statements made on this application to be true, correct and complete. ;
/ \
OP
Signature>7
LOCAL GOVERNING BODY
Date Received:
I, recommend CIAPPROVAL C1 DISAPPROVAL
(Government Official) (Title)
On behalf of , , ,
(City, Town, County) Signature Date Phone
AZDLLC USE ONLY
DIAPPROVAL C1] DISAPPROVAL BY: DATE:
11/7/2022 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999