SOUTHWEST WILDLIFE CONSERVATION CENTER_REDACTED.PDF

Amount:
. a“ DLLC USE ONLY
a Job #:
«WENT Op, SPECIAL EVENT LICENSE
S, 4 Date Accepted:
SY ws APPLICATION FEE $25.00 PER DAY
AG Besa CSR:

«® _ 4 * Arizona Department of Liquor Licenses and Control -

Lg nn 800 W. Washington St. 5'” Floor Phoenix, AZ 85007 license #:

“ (602) 542-5141

if Type or Print with Black Ink

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. Appticant; Nolan_Michael_Patrick

Middle
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Sheet Clty State Zip

3. Applicants home/cell phone: Applicant's business phone: 480-471-9109

Southwest Wildlife Conservation Center

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

6. Non-Profit/IRS Tax Exempt Number: 86-0765249

7. Arizona Corporation Commission File #: 07187250 If out of State please specify:
(Attach letter of good standing)

8. Event Location Name: Usery Mountain Regional Park

9. Event Address: 3939 N Usery Pass Road, Mesa, Arizona 85207

Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.

pays Pate Pay of Week time AM/PM rime AM/PM

DAY 1: November 12, 2022 Saturday 8 AM 12 AM

DAY 2:

DAY 3:

DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY ®: RECEIVED

DAYIO: get 18-2022
9/21/2022 Page 1 of 3 MARICOPA COUNTY

Individuals requiring ADA accommodations please call (602) 542-26agERK BOARD OF SUPERVISORS

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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 [W]Fencing LBarriers
explanation; [D check and wristbands to those 21 years of age and older. Security

personnel will remain at the entrance/exit of the fenced in beer garden for the
duration of the event to ensure no alcohol leaves the designated beer garden.

Will this event be held on a currently licensed premises and within the already approved and licensed area?

Clyes No - If No, Local Governing Body signature is required.

Name of Business License Number Phone (Include Area Code)

SECTION 3 What is the purpose of this event?
[on-site consumption [lofi-site (auction/wine/distilled spirits pull) [Both

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)

LPiace 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

Libispense 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

[bispense and serve alll spirituous liquors under special event - The retailer 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

[split 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 alcoho! that is dispensed by the licensed retailer.)

(lof sale only - Wine/Distilled Spirits Pull, Live or Silent Auctions — Retailer wil 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?
Cyes [¥]No If yes, attach letter of explanation.
0

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 Running, LLC

Yes[_]No If yes, please provide the Name of the Special Event Contractor:

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, 11, or 12 license are automatically qualified to be the special event contractor)

D1 yes[VINo if yes, please provide the Name of Licensee: License #:

9/21/2022 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.

Name: Southwest Wildlife Conservation Center pexcorteue Oo
Address: 8711 E Pinnacle Peak Rd, PMB 115 Scottsdale, AZ 85255
Name: Aravaipa Running, LLC i percentage: 38 .
Address: 2401 S 24th St Phoenix, AZ 85034
Street City State Tip

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.
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) M anal Ae c le No dises , declare under penalty of perjury that | am
authorized to submit this application. | have read the contents of this application, and toythe best of my knowledge
believe all statements made on this application to be rg "ge co Wy

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Signature

LOCAL GOVERNING BODY

Date Received:

L; recommend CIAPPROVAL LI DISAPPROVAL
(Government Official) (Title)

On behalf of

(City, Town, County) Signature

AZDLLC USE ONLY

CDIAPPROVAL LJ DISAPPROVAL BY:

9/21/2022 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999

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