LEADERSHIP WEST INC. _REDACTED.PDF

RECEIVED

NOV 28 2023
MARICOPA COUNTY

| CSR: CLERK BOARD OF SUPERVISORS
Amount:
DLLC USE ONLY
Job #;
SPECIAL EVENT LICENSE ee =
APPLICATION FEE $25.00 PER DAY - _—
CSR
Arizona Department of Liquor Licenses and Control Wcense
800 W. Washington St, 5" Floor Phoenix, AZ 85007
(602) 542-5141

ion MUST he submitted to the Department of Liquor 10 days prior to the event.

SECTION | Applicant must be a member of a qualifying nonprofit organization, political party, or Govemmen entity and
horized by an Officer, Director, or Chairperson of the Organization.

1, Applicant:
(Must be on Officer/Member of the Non Pr

2. Applicant's mailing address:
8. Applicants home/cell phi

4. Applicant's email address

5. Special Event Name: Weert fam UaYeS
6. Name of Non-Profit Organization, Candidate or ) Parly/Gov.: YO ZNED West, Ine.

7. Non-Profit/IRS Tax Exempt Number: Bor om! S21¢7.
8. Arizona Corporation Commission File #: 105221 Fir out of State please specify:

9. Event Location Name; Desert Farm Lights
10. Event Address: 14629 W Peoria Avenue Waddell, AZ 85355

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

ee
(Attach letter of good standing)

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

Daye pate Day si Week Bh aA
Te aie TA 5:00pm 10:00pm
DAY 2: Wisse WD 5:00pm 10:00pm
DAY 3: (2\ 2 Nw. 5:00pm 10:00pm
paras  YLA24 +R) 5:00pm 10:00pm
DAY 5: \2\40 Sot 5:00pm 10:00pm
oars:  IZIAI Sun 5:00pm 10:00pm
DAY 7: 5:00pm 10:00pm
DAY 8:
DAY 9:
DAY 10: ee oe _

2/6/2023 Page 1 of 3

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

SECTION 2 What lype of security and control measures will you lake fo prevent violations of liquor lave at this event?
(st type ond number of police security personnel and type of fencing of control barters, H applicable.)

2
——— _Number of Police ____ Number of Securlly Personnel CFencing Dornier

Must explain security measures: We have fencing around the peremeter of the event. We will have security roaming the event and

at the enterance and exit

SECTION 3 Whatis the purpose of this event?

[n-site consumption (Cott-site (auction/wine/distilled spirits pull) Dtoth

How is this special event goi i i J
going to conduct all dispensing, serving, and selling of spirituous liquors?
Check one of the following boxes, (R-19-318) ° "

A) E11 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)

8) QWil 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)

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

Didispense and serve all spirituous liquors under retailer's license — Business operates normally, minimum of 25% of grass
revenue from alcohol sales is donated fo licensee

Didispense and serve all spirituous liquors under special event - The special event licensee 6 in charge of selling alcohol that was
Pur chased or donated by the special event licensee. The retailers exiting alcohol inventory must be separated from any alcohol
used during the special event. Must attach lelter from the location suspending license for duration of special event

Csplit 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.)

Dot 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?
Dyes TANo IF yes, attach letter of explanation.

2. How many special event days have been issued fo 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 6 listed, the licensee

responsible for the sales and service of alcohol. )

Yes CINo If yes, please provide the Name of the Special Event Contractor Pour Masters

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 [J 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 requiing ADA accommodations please call (602)542-2999
cc

Nome: West Valley Events and Marketing, LLC

Percentage: 1%

———_ OE

Nome Led shu West Ine “ Percentage: 25% °
soot S.ulard Ne. Nondale Az. Pate

Meore read ARS. § 4208.02 Special evel icant: ues cn R1?-1-205 Reautemenls fot. Spectal Event licen,
ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.

Surprise Arizona 85374

NA ON WINE OR DIST)

SECTION § License premises diag)
authorized to sell, dispense or serve
of your special event licensed
Measures and security position.

ATTACH DIAGRAM

fam. The licensed premises for your special event is the area in which you are
alcoholic beverages under the provisions of your license. Please attach a diagram
Premises. Please show dimensions, serving areas, fencing, barricades, or other control

Ifthe special event will be held ata location without a permanent liquor license or it the event will be on any pottion of a location
that is not covered by the existing liquor license, this application must be approved by the local goveming body before submitting
to the Department of Liquor Licenses and Control. Please contact the local goveming board for addilional information.

APPLICANT SIGNATURE

Declaration:

|, (Print Name) Hl IDn Beminant declare under penalty of perjury that | am
authorized to submit this application. | have rea the contenis of
believe all statements made on this application to be true, correc’

LOCAL GOVERNING BODY

Date Received:

(Government Official)

On behalf of

(City, Town, County)

body , town or municipality where the falr/festval will take place) may require additional
copiccdionn ph har arya submitted, Please check with local goverment as to how far In advance they require
these applications fo be submitted. Additional licensing fees may also be required before approval may be granted.

AZDLLC USE ONLY

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

a ;
Police Stationed |