MARICOPA TRAIL + PARK FOUNDATION_REDACTED.PDF

DLLC USE ONLY

Job #:

SPECIAL EVENT LICENSE
APPLICATION FEE $25.00 PER DAY

Date Accepted:

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; _ Derrick Brian Douglas

(Must be an Officer/Member of the Non Profit Enti First Middle

2. Applicant's mailing address:

City State Zip

3. Applicants home/cell phone: Applicant's business phone; __ 823-235-6897

4. Applicant's email address
Javelina Jundred

5. Special Event Name:

Maricopa Trail + Park Foundation

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

7. Non-Profit/IRS Tax Exempt Number: 20-0707991

8. Arizona Corporation Commission File #: 10952170 __If out of State please specify:
(Attach letter of good standing)

9. Event Location Name: McDowell Mountain Regional Park
10. Event Address: 18300 McDowell Mountain Drive, Fort McDowell, Arizona 85264

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: 10/25/2024 Friday 10:00 AM 9:00 PM
DAY 2: 10/26/2024 Saturday 10:00 AM 11:59 PM
DAY 3: 10/27/2024 Sunday 12:00 AM 12:00 PM
DAY 4:

DAY 5:

DAY 6:

DAY 7:

DAY 8:

DAY 9:

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 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.)

0 Number of Police 4 Number of Security Personnel [Fencing [Barriers

Must explain security measures: Event ID check & wristband for patrons 21 years and older will be issued

at event entry/registration. Area for alcohol sales is designated and consumption limited to designatg

SECTION 3 What is the purpose of this event?

On-site consumption [ott-site (auction/wine/distilled spirits pull) Dsoth

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) [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 ona 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)

DPlace 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

Dodispense 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

Lbispense and serve all 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

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 alcoho! 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 [¥] No If yes, attach letter of explanation.

2. How many special event days have been issued to this organization during the calendar year? 0

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 alcoho! on behalf of the licensee. If no special event contractor is listed, the licensee is

responsible for the sales and service of alcohol. }

Yes] No If yes, please provide the Name of the Special Event Contractor: Aravaipa Running LLC

4. |s 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 [¥]No 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; Maricopa Trail + Park Foundation Percentage: 75

Address; 805 N 4th Ave, Suite 703. Phoenix, AZ 85003

Street . City State Zip
Name: Aravaipa Running Percentage: 29
Nachere! 2401 S 24th Street Phoenix, AZ 85034
Street City 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.

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) Brian Derrick 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 on esac

LOCAL GOVERNING BODY
Date Received:

I, recommend CIAPPROVAL [I DISAPPROVAL
(Government Official) (Title)

On behalf of

(City, Town, County) Signature

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

COAPPROVAL CI DISAPPROVAL BY:

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

Javelina Jundred 100 Mile Endurance Run Event:
Beer Garden and Serving Areas

The event lot has barricades blocking the entrance and exits of the main event and will be monitored by security. The Beer Garden
serving area will have a licensed bartender checking ID's at the point of sale. Event specific wristbands will be distributed to those 21
and over. The second serving area is the disco in picture two. A small bar will open at 7:00 pm and the serving area and a bartender
will be inside the disco which is a fenced in arena.. Security is posted on the outside checking ID and distributing wristbands to 21 and
over. Both areas are controlled event locations within the McDowell Mountain Regional Park.

Main
Event/  . Course/fenced area @ BAR/SERVING AREA ID CHECK SWORN * conrnacr

Vendors

SERVING AREA 1

) y MEDICAL
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