ANTHEM ROTARY FOUNDATION_REDACTED.PDF
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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 Uconse #- (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. _ Applicant; Salem Edward John, Jr. (Must be an Officer/Member of the No! Middle Clty State Tip . Applicants home/cell — i Applicant's business phone: 623-900-1001 Charity Classic Golf Event ND wo >» on . Special Event Name: 6. Name of Non-Profit Organization, Candidate or Political Party/Gov.: Anthem Rotary Foundation 47-0930766 / 26-00640058 7. Non-Profit/IRS Tax Exempt Number: 8. Arizona Corporation Commission File #: 109477921 If out of State please specify: (Attach letter of good standing) 9. Event Location Name: !ronwood Country Club 10. Event Address: 41551 N Anthem Hills Dr, Phoenix, AZ 85086 Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days. **SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY** Days Date Day of Week nD Sap DAY 1: 11/10/2024 Sunday 09:00 AM 07:00 PM DAY 2: DAY 3: DAY 4: DAY 5: DAY 7: AUG-OS VE DAY 8: MARIC sy DAY 9: CLERK BOARD OF SUPERVISORS DAY10: 2/6/2023 Page 1 of 3 Individiinle racutirinn ADA accarmmnadatinnes nlanca call [4NI6A9.9099 SECTION 2 What type of security and contro! 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 contro! bartiers, if applicable.) 2 2 Number of Police Number of Security Personnel [Fencing ClBaniers Must explain security measures: Maricopa County Sheriffs and Security Personnel will be on site patrolling the event. SECTION 3 What is the purpose of this event? [4lon-site consumption (Flofi-site (auction/wine/distilled spirits pull) both Howis 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) [-] Will this event be held on a curently licensed premises and within the already approved and licensed area? (Must altach a letter from the licensed premises with an explanation of the option checked below) Name of Business LUcense Number Phone (Include Area Code) CPtace 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 [bispense 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 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.) (loft 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? (1 Yes [4] No If yes, attach letter of explanation. 2. How many special event days have been issued to this organization during the calendar year? 3 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. } (Yes 1 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 fo be the special event contractor} Dyes [INo 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 Individiiate racniiringa ADA Aecaramndatinne nlance call [ANV6A9.2009 Anthem Rotary Foundation Percentage: 100% Name: Address: 3655 W Anthem Way, #109 / PMB 107, Phoenix, AZ 85086 Street City State Zp Name: Percentage: Address: Street Clty State ap 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. A 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: I, (Print Name) La aLb Dules SAL Enq TR 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, AG b> ee ae / Signature LOCAL GOVERNING BODY Date Received: 1, recommend [LIAPPROVAL [J DISAPPROVAL (Government Official) On behalf of (City, Town, County) The local governing body (city, town or municipality where the fair/festival will take place) may require additional applications to be completed and submited. Please check with local government as fo 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 CDlapPpROVAL CI DISAPPROVAL BY: 2/6/2023 Page 3 of 3 Indivichinle racniiirina ADA ArcArmadatinnc nNlanca call [AN216A9-9999 Edward John Salem Jr Anthem Rotary Foundation 3655 W Anthem Way #109 PMB 107 Anthem, AZ 85086 August 1, 2024 Arizona Department of Liquor Licenses and Control 800 W Washington St, 5" Floor Phoenix, AZ 85007 To whom it may concern, With regard to section 3 of the Special Event License Applications, | am including the following information: For our upcoming “Autumn Fest in Anthem special event as well as both Charity Classic events, all spirits and beverages are supplied to the Anthem Rotary Foundation by a wholesale distributor. The company is Crescent Crown Distributing, 1640 W Broadway Rd, Mesa, AZ 85202 Please contact me i you have any questions. Thank you. Sincerely, Gla ML, 4 Edward John Salem Jr.