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DLLC USE ONLY Job #: Arizona Department Liquor License and Control 800 W Washington St. 5! Floor Date Accepted: Phoenlx, AZ 85007-2934 CSR: azliquor.gov : 602-542-5141 alcense &: SPECIAL EVENT LICENSE APPLICATION FEE $25.00 PER DAY A service fee of $25.00 will be charged for all dishonored checks (A.R.S § 44-6852 1-10 days consecutive days only, Cash, Checks or Money Orders Only SECTION. 1 Applicant must be a member of a qualifying nonprofit organization, political party, or Government entity and authorized by an Officer, Director, or Chalrperson of the Organization. 1. Applicant: Nancy Claussen 2. Applicant's mailing address: 3. Applicants home/cell —_— 4. Applicant's email address: Clly State up Applicant's business phone: 703-635-0238 SECTION 2 Name of Non-Profit Organization, Candidate or Political Party/Gov.: Pathway to Work SECTION. 3 Non-Profit/IRS Tax Exempt Number: 82-0854830 SECTION 4 Event Location: White Tank Regional Park, 20304 W. White Tank Mountain Road Waddell, AZ 85355 SECTION_S Dates and Hours of Event. Days must be consecutive but may not exceed 10 consecutive days. See A.R.S. § 4-244(15) and (17) for legal hours of service. **SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY** | 1 | 1 Event Start | Ucense End | Days j Date Day of Week Time AM/PM | Time AM/PM DAY 1: 2-25-23 Saturday 9am 10pm DAY 2: DAY 3: DAY 4: DAY 5: DAY 6: DAY 7: DAY 8: DAY 9: DAY10: 4/9/2021 Page 1 of 3 Individuals requiring ADA accommodations please call (602)542-9027 SECTION 6 What type of security and control measures will you take to prevent violations of liquor laws at this event? (Ust type and number of police/securily personnel and type of fencing or control bantets, if applicable.) Explanation: The area where beer will be consumed and served will be cordoned off with the use of metal barricades. Number of Police 2. Number of Security Personnel CFencing [Baniers There will be one entrance and exit to this area which Is monitored by event security. No beer will be allowed outside of the barricaded area. Those who are of legal drinking age will receive a wrist band after age verification by event security. SECTION 7 Will this event be held on a currently licensed premises and within the already approved premises? ClyYes[ZI No if yes, Local Goveming Body signature Is not required. Nome of Business Ucense Number Phone (Include Area Code) SECTION 8 How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors? Please read R-19-318 for explanation and check one of the following boxes. (Place license in non-use Chispense and serve all spirituous liquors under retailer's license [1bispense and serve all spirituous liquors under special event Ckpiit premise between speclial event and retail location SECTION 2 What is the purpose of this event? [on-site consumption [off-site (auction/wine/distilled spirits pull) [goth SECTION 10 1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years? Dyes 1 No tf yes, attach explanation. 2. How many special event days have been Issued to this organization during the calendar year? 1 3. Is the Organization using the services of a Licensed Contractor? Dyes HI No If yes, please provide the Name of the Licensed 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? D1 Yes HI No if yes, please provide the Name of Licensee: License #: 5. The applying non-profit organization must receive 25% of the gross revenues of the total liquor sales. List the names of the individuals or organizations who will receive the rest of the proceeds, MUST EQUAL 100%. Nome: Mangled Momentum Percentage: 75% Address: 1441 E Countrywalk Lane, Chandler AZ 85225 Name: Pathway to Work - Percentage: 25% f Address: 1445 E Guadalupe Rd, Ste 101, Tempe, AZ 85283 Street Cty State Up 4/9/2021 Page 2 of 3 Individuals requiring ADA accommodations please call (602)542-9027 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. 11 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 Ilcense or If the event will be on any portion of a location that Is not covered by the existing liquor license, thls application must be approved by the local government before submission to the Department of Liquor Licenses and Control. Please contact the local governing board for addifional application requirements and submission deadlines. Additional licensing fees may also be required before approval may be granted. For more information, please contact your local jurisdiction. SIGNATURE L, (Print Full Name) Nancy Claussen hereby swear under penalty of perjury and in compliance with A.R.S. § 4-210(A)(2) and (3) that I have read and understand the foregoing and verify that the information and GOVERNING BOARD Date Received: I, recommend LCIJAPPROVAL [J DISAPPROVAL (Goverment Oificlal) (Title) On behalf of , , j | (Ctty, Town, County) Signature Date Phone state employees: enforcement; notice B. An agency shall not base a licensing decision In whole or In part on a licensing requirement or condition that Is not specifically authorized by statute, rule or state tribal gaming compact. A general grant of authority in statute does not constitute a basis for imposing a licensing requirement or condition unless a rule is made pursuant to that general grant of authority that specifically authorizes the requirement or condition. D. This section may be enforced in a private civil action and relief may be awarded against the state, The cour! may award reasonable attomey fees, damages and all fees associated with the license application to a party that prevails in an action against the state for a violation of this section. E. Astate employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action or dismissal pursuant to the agency's adopted personnel policy. F. This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02. 4/9/2021 Page 3 of 3 Individuals requiring ADA accommodations please call (602)542-9027 Spokes & Ale Venue 2023 Barricades —---- Cones 1000’ of Barricades ‘COMPOUND ATHLETE PARKING7 CAMPING 1, Sip 11. ESI 2. Saddle Mtn 12. SanTan 3. Trail Manos 13. Quicklink 4. BOP 14. Sip 5, TCBC 15. Team Dawson 6. Pathway 16. Stillwell 7. Desert Monks 17. Fit Figure 8. Water 18. WVTA 9, Pindrop 19. Pea Eye 10. Pedal Haus