SOUTHWEST WILDLIFE CONSERVATION CENTER 11.11.23 REDACTED .PDF
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2/6/2023
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Individuals requiring ADA accommodations please call (602)542-2999
CSR:
Amount:
Arizona Department of Liquor Licenses and Control
800 W. Washington St. 5th Floor Phoenix, AZ 85007
(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.
1. Applicant:
(Must be an Officer/Member of the Non Profit Entity) Last
First
Middle
2. Applicant’s mailing address:
Street
City
State
Zip
3. Applicants home/cell phone:
4. Applicant's email address:
5. Special Event Name:
6. Name of Non-Profit Organization, Candidate or Political Party/Gov.:
7. Non-Profit/IRS Tax Exempt Number:
8. Arizona Corporation Commission File #:
If out of State please specify:
(Attach letter of good standing)
9. Event Location Name:
10. Event Address:
Dates and Hours of Event - Days must be consecutive and may not exceed 10 consecutive days.
DLLC USE ONLY
Job #:
Date Accepted:
CSR:
License #:
**SEPARATE APPLICATION FOR EACH “NON-CONSECUTIVE” DAY**
Days
Date
Day of Week
Event Start
Time AM/PM
License End
Time AM/PM
DAY 1:
DAY 2:
DAY 3:
DAY 4:
DAY 5:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY10:
SPECIAL EVENT LICENSE
APPLICATION FEE $25.00 PER DAY
RECEIVED
10/10/2023
MARICOPA COUNTY
Clerk Board of Supervisors
Haas Oliver Jamie Katherine
Pass Mountain Trail Runs & Punisher Night Runs
Southwest Wildlife Conservation Center
86-0765249
07187250
Usery Mountain Regional Park
3939 N Usery Pass Road, Mesa, AZ 85207
11/11/2023
Saturday
8:00AM
11:59PM
2/6/2023
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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.)
_________________Number of Police _________________ Number of Security Personnel Fencing Barriers
Must explain security measures:
SECTION 3 What is the purpose of this event?
On-site consumption
Off-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) 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 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)
Place 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
Dispense 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
Dispense 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
Split 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.)
Off 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?
Yes No 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 No If yes, please provide the Name of the Special Event Contractor:
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)
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.
1
ID check and wristbands to those 21 years of age and older. Security pers
3
Aravaipa Running, LLC
2/6/2023
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Individuals requiring ADA accommodations please call (602)542-2999
Date Received: ______________________
I, ____________________________________ _____________________________ recommend APPROVAL DISAPPROVAL
(Government Official) (Title)
On behalf of _____________________________, _____________________________, _____________,
(City, Town, County) Signature Date
Phone
Name:
Percentage:
Address:
Street
City
State
Zip
Name:
Percentage:
Address:
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.
NO ALCOHOLIC BEVERAGES SHALL LEAVE A SPECIAL EVENT UNLESS THEY ARE IN AUCTION WINE OR DISTILLED SPIRITS PULL
SEALED CONTAINERS OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE.
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
LOCAL GOVERNING BODY
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
ATTACH DIAGRAM
Declaration:
I, (Print Name)
, declare under penalty of perjury that I am
authorized to submit this application. I 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
APPROVAL DISAPPROVAL BY: _______________________________
DATE: _________________________
Southwest Wildlife Conservation Center
60
8711 E Pinnacle Peak Rd, PMB 115, Scottsdale, AZ 85255
Aravaipa Running, LLC
40
2401 S 24th St, Phoenix, AZ 85034
Jamie Haas Oliver