GOLDEN ROLLER SKATES_REDACTED.PDF

DLLC USE ONLY

Job #:
SPECIAL EVENT LICENSE —
APPLICATION FEE $25.00 PER DAY ;
CSR:
Arizona Department of Liquor Licenses and Control - -
800 W. Washington St. 5!" Floor Phoenix, AZ 85007 eens a

: (602) 542-5141
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.
Lisa Rene'

1. Applicant; Gates

(Must be an Officer/Member of the Non Profit Entity; First Middle
3. Applicants home/cell nol <=— Applicant's business phone: 480-435-7335
4, Applicant's email a =—ri(<(i<‘; TSCrdr

Nashville Nights, Christmas in the Desert
Golden Roller Skates Inc.

5. Special Event Name:

6. Name of Non-Profit Organization, Candidate or Political Party/Gov:

88-1097917
#: 23343049 _ it out of State please specify:

{Attach letter of good standing)

7. Non-Profit/IRS Tax Exempt Number:

8. Arizona Corporation Commission File

9. Event Location Name: Rancho del Pacifico
45225 E. Riggs Road, Gilbert, AZ 85298

onseculive and may not exceed 10 consecutive days.

10. Event Address:
Dates and Hours of Event - Days must be c

+*SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**
Event Start License End
Days Pals Day or werk Time AM/PM Time AM/PM
DAY 1: 42-17-22 Saturday 12:00 PM 10:00 PM
DAY 2:
DAY 3: & &
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DAY 4: >
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DAY 5: = Seo.
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DAY 6: aon
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DAY 7: = on™
DAY 8: & Ze
DAY 9: é
DAY10:
Page 1 of 3

11/7/2022
Individuals requiring ADA accommodations please call (602)542-2999

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.)

Must explain security measures:
Off duty police will be onsite. Security personnel will be checking IDs and patrolling

Number of Police 20 Number of Securify Personnel [Fencing parriers
Venue has fencing and safety fencing will be set-up around perimeter.

in and outside the venue.

SECTION 3 What is the purpose of this event?
[Mlon-site consumption [off-site (auction/wine/distilled spirits pull) Loboth

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) 4] 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)
Cplace 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

Lbispense and serve all spirituous liquors under retailer's license — Business operates normally, minimum of 25% of gross
revenue from alcohol sales is donated to licensee

Libispense and serve alll spirituous liquors under special event - The special event licensee is in charge of selling alcohol 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

Cspiit 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.)

Clot 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?
C1Yes No if yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar year?

3. ls 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. }

Dennis Petty/DDP Worldwide
Yes No If yes, please provide the Name of the Special Event Contractor: y

4, ls 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, 1 1, or 12 license are automatically qualified to be the special event contractor)

CyYes [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. 25

Golden Roller Skates, Inc. Percentage:

3601 S. Salt Cedar Street, Chandler, AZ 85286

city State Zip

Name:

Address:
Street

e: DDP Worldwide

1667 E Everglade Ln, Gilbert, AZ. 85298

Address:
Street City State
Please read A.R.S. § 4-203.02 Special event license; rules and R19-1-205 Requirements fora Special Event License.
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.

Percentage: 9

Nam

Zip

‘AINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE,

PULL SEALED CONT.

mises for your special event is the area in which you are

der the provisions of your license. Please attach a diagram

SECTION 5 License premises diagram. The licensed pre
or other control

authorized fo sell, dispense or serve alcoholic beverages un
of your special event licensed premises. Please show dimensions, serving areas, fencing, barricades,

measures and security position.
vor license or if the event will be on any portion of a location

proved by the local governing body before submitting
| governing board for additional information.

It the special event will be held ata location without a permanent liq
that is not covered by the existing liquor license, this application must be ap
to the Department of Liquor Licenses and Control. Please contact the local

APPLICANT SIGNATURE

Declaration: | ,
1, (Print Name) Lisa Gates , 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 “Ee

Signature

LOCAL GOVERNING BODY

Date Received:

recommend DIAPpROVAL L DISAPPROVAL

\,
(Government Official) (Title)

On behalf of ,
(City, Town, County) Signature

AZDLLC USE ONLY

DapprovVAL 01 DISAPPROVAL BY:

occ OEE

SS

11/7/2022 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-29997

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