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SECTION 10 1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years? DYes 12 No (If yes, attach explanation.) 2. How many special event licenses have been issued to this location this year? 1 (The number cannot exceed 12 events per year; exceptions under A.R.S. §4-203.02(D).) 3. Is the organization using the services of a promoter or other person to manage the event? Ekes 112INo (If yes, attach a copy of the agreement.) 4. List all people and organizations who will receive the proceeds. Account for 100% of the proceeds. The organization applying must receive 25% of the gross revenues of the special event liquor sales. Attach an additional page if necessary. Name SCW Boomers Club Percentage: 100 Address Sun City West, AZ 85376 Street City State Zip Name Percentage: Address Sheet City State Zip 5. Please read A.R.S. § 4-203.02 Special event license; rules and R19-1-205 Requirements for a Special Event License. Note: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY. "NO ALCOHOLIC BEVERAGES SHALL LEAVE SPECIAL EVENT UNLESS THEY ARE IN AUCTION SEALED CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE" 6. 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 3 Number of Security Personnel OFencing 12 Barriers Explanation: Club members will act as security personel SECTION 11 Date(s) and Hours of Event. May not exceed 10 consecutive days. See A.R.S. § 4-244(15) and (17) for legal hours of service. Event Start License End Date Day of Week Time AM/PM Time AM/PM DAY 1: Dec. 31, 2015 Friday 8:30PM 12:30AM DAY 2: DAY 3: DAY 4: DAY 5: DAY 6: DAY 7: DAY 8: DAY 9: DAY 10: 8/13/2015 Page 2 of 4 Individuals requiring ADA accommodations call (602)542-9027. SECTION 12 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. The following space is to be used to prepare a diagram of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades, or other control measures and security position. II J ELAIN-10A -1 Kitchen Serving Area Tri NEW 6' DOUBLE BLDG. B DOOR-N: in .Ei FLOOR PLAN NTI4" 'SCALE! *MISS" 1*-0. Kuentz Women's Club A rcki -CAD (1116) $ *Clam* 662 3623 Oft (4601 Me 2. $68-2614 Imp" et:11 VI. AfK,FING TS, PLLO 1,4o2krchl CADAichllactiszam 8/5/14 Page 3 of 4 Individuals requiring ADA accommodations call (602)542-9027.