WILDERNESS VOLUNTEERS_REDACTED.PDF

CSR:
Amount:

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
(602) 542-5141
Application MUST be submitted to the Department of Liquor 10 days prior to the event.

License #:

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: Henderson Carrie J

(Must be an Officer/Member of the No! i
2. Applicant's mailing address:

Cily State Zip

3. Applicants home/cell phone} Applicant's business phone: 928-255-1128

4. Appicants emai cere: ln

Pass Mountain Trail Runs & Punisher Night Trails

5. Special Event Name:

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

91-1821692

7. Non-Profit/IRS Tax Exempt Number:

429 If out of State please specify:

8, Arizona Corporation Commission File #; £08167 ee
(Attach letter of good standing)

9. Event Location Name: Usery Mountain Regional Park
3939 N Usery Pass Rd, Mesa, AZ 85207

10. Event Address:

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

**SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**

DAY 1: 11/9/2024 Saturday 8:00AM 11:00PM
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6: RECEIVEN
DAY 7: AUG 9-9 292
DAY 8: MARICO!
DAY 9: CLERK BOARD OF SUPERVISORS
DAY10:

2/6/2023 Page 1 of 3

Individuals requiring ADA accommodations please call (602)542-2999

SECTION 2 What type of security and control measures will you take fo 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.)

0 Number of Police 1 Number of Security Personnel ZlFencing Carriers

Must explain security measures: The beer tent will be surrounded by wind fencing on all sides with one enti

The entrance/exit will be monitored by a staff member for the duration of the event. All patrons aged :

SECTION 3 What is the purpose of this event?

WZlOn-site consumption (Co t-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}

A) MZ] 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) (Will this event be held on a curently 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 alcoho! 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 to licensee

[bispense 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

Lisplit 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.)

Loft 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 2] No If yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar year? 6

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. }

WZ] Yes CINo If yes, please provide the Name of the Special Event Contractor: Aravaipa Running, LLC

4, Is 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)

(1 Yes WINo if yes, please provide the Name of Licensee: License #:

5. List the name of the Individual or Organization that will receive revenues, MUST EQUAL 100 PERCENT.

Attach additional sheet if necessary.

2/6/2023 Page 2 of 3
Individuals requiring ADA accommodations please call (602)542-2999

Name: Wilderness Volunteers Percentage: 85

Address: PO Box 22292 Flagstaff AZ 86002
Street City State Zip

Name: Aravaipa Running, LLC. Percentage: 35

Address: 2401 S 24th St Phoenix AZ 85034
Street Cily 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) Carrie Henderson , 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.

Signature

LOCAL GOVERNING BODY

Date Received:
I, recommend LIJAPPROVAL [1 DISAPPROVAL
(Government Official) (Title)

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

The local governing body (city, town or municipality where the fair/festival will take place) may require additional
applications to be completed and submitted. Please check with local government as to how far in advance they require
these applications to be submitted. Additional licensing fees may also be required before approval may be granted.

AZDLLC USE ONLY

CIAPPROVAL LC] DISAPPROVAL BY: DATE:

2/6/2023 Page 3 of 3
Individuals requiring ADA accommodations please call (602)542-2999

TRAIL RUNS

SITE MAP

?)
The beer tent is a 20ft x 20ft
tent top with no walls that is
surrounded by wind fencing,
and sectured to the ground
with T-posts. The fencing ;
extends an extra 5ft on two of ™ |
| the sides making the service
area 25ft x 25ft. There is one
entrance/exit that is manned
| for the entirety of the event.
4 No alcohol is allowed to leave |

| the fenced-in area.

Diagrams are to scale. ‘ q
Ty,