SPECIAL EVENT LICENSE FOR HEMP LEGACY FOUNDATION_REDACTED.PDF

RECEIVED

NOV 08 2023

MARICOPA COUNTY
CLERK BOARD OF SUPERVISORS

DLLC USE ONLY
Job #:
SPECIAL EVENT LICENSE —
APPLICATION FEE $25.00 PER DAY ‘
CSR:
Arizona Department of Liquor Licenses and Control -
800 W. Washington St. 5 Floor Phoenix, AZ 85007 Ucense #:

MzOw . (602) 542-5141
Ww 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.

1. Applicant:
(Must be an Officer/Member of thb N

2. Applicant's mailing address
3. Applicants home/cell phone} licant's business phone:
4. Applicant's email address

5. Special Event Name:

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

7. Non-Profit/IRS Tax Exempt Number: Uy ~ L404 R007

8. Arizona Corporation Commission File #: \A\tod 3A Df out of State please specify:

(Attach letter of good standing)

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 consecutive days.

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

Days Date Day of Week ie A poorer
DAY |: \2 -2e The 5:00pm 10:00pm
DAY 2: 19-2 re fa 5:00pm 10:00pm
DAY 3: 123-33 Nhs 5:00pm 10:00pm
DAY 4: Vo: QA. FQ... 5:00pm 10:00pm
DAY 5: 19-30 ee 5:00pm 10:00pm
DAY 6: 1-3 on 5:00pm 10:00pm
DAY 7: 5:00pm 10:00pm
DAY 8:

DAY 9:

DAYIO:

2/6/2023 Page 1 of 3

Individuals requiting 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 baniers, if applicable.)

2 Number of Police Number of Security Personnel (Fencing Cobaniers

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 What is the purpose of this event?

[Z]J0n-site consumption Clott-site (auction/wine/distilled spirits pull) CJpoth

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) 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) E) Will this event be held on a 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 Ucense Number Phone (Include Area Code)

(Clplace 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 alcoho! sales is donated to licensee

Cibispense 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 alcoho! inventory must be separated from any alcoho!
used during the special event. Must attach lelter 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 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?

CyvesCINo If yes, attach letter of explanation.

2. How many special event days have been issued to 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 is listed, the licensee is
responsible for the sales and service of alcohol. }

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

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 to be the special event contractor)

(Yes [1 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 af 3
Individuals requiring ADA accon\mpedations please call (602)542-2999

Name: West Valley Events and Marketing, LLC Percentage: “9%

cere:

Sheet Clty Slate Zp
Name: Percentage: 25%
Address:

Sheet Giiy State Zp

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 goveming 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) , 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
pe

Signatute /

LOCAL GOVERNING BODY

Date Received:

(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 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

DIAPPROVAL C1 DISAPPROVAL BY:

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

uty Police Walking