woodbury county board of supervisors agenda item(s) …€¦ · class c beer permit for chet's...

WOODBURY COUNTY BOARD OF SUPERVISORS AGENDA ITEM(S) REQ

Date: _ 10/8/15 _ _

Weekly Agenda Date: --'-'10"'""/""'"'13"'""/""'"'15,,_ _ _ _

DEPARTMENT HEAD I CITIZEN: County Auditor - Pat Gill

ACTION REQUIRED:

Approve Ordinance 0 Approve Resolution 0 Approve Motion t8i

Give Direction 0 Other: Informational 0 Attachments D

WORDING FOR AGENDA ITEM: Consideration and approval for Liquor License for Chet's Moville Market.

EXECUTIVE SUMMARY: N/A

BACKGROUND: N/A

FINANCIAL IMPACT: Unknown at this time.

RECOMMENDATION: Approval

ACTION REQUIRED: Motion by second by to approve an application for a 12-month, Class B Native Wine Permit

with Sunday sales for Chet's Moville Market, effective 11/12/15 through 11/11/16.

Approved by Board of Supervisors March 3, 2015.

Office Of The AUDITOR/RECORDER

Of Woodbury County PATRICK F. GILL Auditor/Recorder

To:

From:

Date:

Subject:

Board of Supervisors

Patrick F. Gill~tor & Recorder

October 8, 2015

Class C Beer Permit for Chet's Moville Market, Moville, Iowa

Court House - Rooms 103 620 Douglas

Sioux City, Iowa 51101

Phone (712) 279-6702 Fax (712) 279-6629

Please approve and receive for signature, an applicaton for a 12-month, Class B

Native Wine Permit with Sunday sales privileges, for Chet's Moville Market, 741

Frontage Road, Moville, Iowa. The permit would be effective 11/12/15 through

11/11/16.

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State of lo1va ALCOHbUe BEVER~~ DIVISION

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Applicant License BC0029492, Chet's Moville Market, Moville After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

LENGTH OF LICENSE REQUESTED:

(Choose one of the followlng):

® 12 month

License Status: Submitted to Local Authority

O s month Original issu~ date o~ 1111212009 I MM/DDIYYYY license: I..__ --------'·

Issue date o! curren~ I MM/DD/YYYY license: IL. --------'·

O s month

0 14 day

O s day License effect.iv, 11 /12/2015 I MM/DDIYYYY date: ..__ - -------'·

License expiratio!l 11/11/2016 I MM/DDIYYYY date:!.._ __ ______ _._

Number of ~aysi0 notice: IL. _ _____ ___.

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70 day notice: lo ~=========::::::::!

Cancel date:

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Iowa Alcoholic Beverages Division 191 8 SE Hulsizer Road, Ankeny, IA 50021

Toll Free 866.lowaABD (866.469.2223) Local 515.281 .7400

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Copyright ©2009 State of Iowa Alcoholic Beverages Division. All Rights Reserved.

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State of lo1Va ALCOHOLIC BEVER~~ DIVISION

Alcohol Tobacco

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Privileges BC0029492, Chet's Moville Market, Moville After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

Select one or more of the privileges you wish to have for your Class C Beer Permit (BC). If no privileges are applicable please leave all boxes unchecked and hit the next button.

PRIVILEGES:

i;zJ Class B Native Wine Permit

0 Class B Wine Permit (Carryout Wine - Includes Native Wine)

0 Living Quarters

0 Outdoor Service

0 Sunday Sales

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Terms and Conditions Privacy Policy

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Applicant BC0029492, Chet's Moville M a rke t , Moville After completlon click on )he NEXT link lo continue to the next screen, or the BACK fink to return to the previous screen. The navigation finks on the top may also be used to move around the application.

Corporation Name/Sole Proprieto1Chet & Li d 1 Name/Partnership Name(s)· n a, nc.

: Chet's Moville Market Name of Business (D/B/A)

Address of Premise. · 741 Frontage Rd.

Address Line 2:

City

County:

: Moville

Woodburv

Zip: j51039

v i

I (Sole ProprietotJhlp·, Partnership, Co.rpora·tion, etc.)

vi

Business Phone: '"'lc1_1_2"'")_87_3_-3_7_7_7 _____ ~ Cell / Home Phone: 1(712) 253-1829

D Same Address

Malllng Address: !Box 636

Malllng Address Line 2: I-· -----------..,-----------.=========v::;j--' City: Kingsley State: ._ll_ow_a ______ __.,

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z1p:ls102a

Contact Name: Floyd C. Davis

Phone: (712 873-3777

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Iowa AlcOhollc Beverages Division 1918 SE Hulsl2er Road, Ankeny, IA 50021

Toll Free 866.lowaABD (866.469.2223) local 515.281 .7400


Copyright 02009 State of Iowa Alcohollc Beverages Division. All Rights Reserved.

Email Address: [email protected]

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Status of Business BC0029492, Chet's Moville Market, Moville After completion cl ick on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

Indicate how the business will be operated (Choose one of tho following):

0 Sole Proprietorship 0 Publicly Traded Corporation

0 General Partnership 0 Limited Liabil ity Company

0 Limited Partnership

@ Privately-Held Corporation

0 Municipality

0 Non-Profit Association

Corporate ID Number: ~12_1_8_4_12 ____ ~1 Federal Empl;'J;141-1481039

Federal Employer ID Applied For: O

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Ownership BC0029492, Chet's Moville Market, Moville After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

Corporate applicant's, list all shareholders having 10% or more Interest in the corporation and all officers and directors of the corporation regardless of ownership Interest Sole Proprietors shall also Include their spouse even ii the spouse owns 0% Interest Non-profit corporations or associations need to list officers. Partnerships and Committees not registered with the Secretary of State office wlll need a trade name filing from their county recorder's office.

If you want to change ownership Information at renewal time please finish the renewal with the current ownership listed. When you are finished please go to the Action List and submit an Ownership Update Application along with the license renewal.

Owners:

Name Address Percentage

Floyd Davis 419 Dover St., Kingsley, IA, 51028 100.00 % View

First! Name: I Last Name: I I

Address: I Address! Line 2:

City: I I State: I Please Select vi Zip: I I

Position: I I SS#: I I Citlz~~~1 Please Select v Date o~ Birth: MM/00/YYYY

I ~. 0, Ownership: I

Add I Please make sure you press "Add" after each owner's information Is listed above before pushing the next button. © Prev Next (!)

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Criminal History BC0029492, Chet's Moville Market, Moville After completion click on the NEXT fink to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

j No v i

j No v i

I None v i

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Since this license was last issued, has anyone listed in the ownership screen been convicted of a felony offense in Iowa or any other state of the United States? If yes, list on the next (Violations) screen.

Since the license was last Issued, have any of the owners listed in the ownership screen been charged, arrested, indicted, convicted or received a deferred judgment for any violation of any state, county, city, federal or foreign law? All information shall be reported regardless of the disposition, even if dismissed or expunged. Include pending charges. DO NOT include traffic violations, except those that are alcohol related. If yes, list violations on the next (Violations) screen.

If no arrests, indictments, summons or convictions are applicable sinco the license was last issued, select 'NONE'.

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Premises Information BC0029492, Chet's Moville Market, Moville After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

Has the premises configuration changed since IN v I last year? ~-_o _ _ ___ _._

Control of premises:

Own Q

Lease @

Other 0 explain:

Premises type: I Grocery Store vi Loca1

1:= ========:::;

1:------'

Authority: County "'.'.

License City: ._I M_o_v_il_le ________ v_.I City Population: 1618

License Woodbu County: ry County Population: 102172

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General Premises Information BC0029492, Chet's Moville M a rket, Moville After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application.

~' Y_e_s _ _ ___ v~~ell groceries?

I No v jAre other l!quor, wine or beer businesses accessible from the interior of . lyour premises?

160000 !Square footage of the entire retail sales area of the business, including L----- larea of walk-in coolers that are accessible to the public. This includes all

areas where non-alcohol products are also sold. Do not include areas that are not accessible to the public (offices, bathroom, kitchen, storage area etc.).

l~Y-e-5-----v-eoes your premises conform to all local and state health, fire and ..... --------'·building laws and regulation? Selling beer in a container other than the original container (growler):

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DI will be filling and selling beer in a growler. I understand the growler shall be no larger than 72 ounces and shall be securely sealed by a method authorized by the Iowa Alcoholic Beverages Division (Division). I understand the growler shall not be filled until the time of the sale from a keg purchased from a licensed beer wholesaler. I understand the person filling the growler shall be at least eighteen years of age and be employed by me. I understand the growler filling and refilling operation shall be compliant with applicable state and federa l food safoty statutes and regulations and I have fulfilled the Iowa Department of Inspections and Appeals (DIA) permit requirements. I understand that I cannot sell beer to another retail license or permit holder or to persons who are under legal age, intoxicated, or simulating intoxication. I will not begin filling and selling growlers until I have the approval from the Division. I understand that a failure to comply with applicable laws and rules will result in a fine, and/or suspension or revocation of my license/permit.

D Agree Food Permit Number: To ensure compliance with Iowa fo._o_d- sa_f_e_ty_a_n_d_ li_ce_n_s_in- g-sta__.tutes and regulations, please visit https:/lia.foodprotectiontaskforce.com/library/ and review the Fact Sheet for Businesses Filling Growlers or contact your local food licensing agency.

E!'.] I will NOT be fill ing and selling beer in a growler.

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Applicant Signature Market, Moville

BC0029492, Chet's Moville

Complete the information below and click Finish to complete the application Note that the license fees will only be withdrawn from accounts after the ABO approves the license.

This application must be completed by a person listed in the Ownership Section.

I hereby declare that all information contained in the Application is true and correct. I understand that misrepresentation of material facts in the Application is a crime and grounds for denial of the license or permit under Iowa taw. I further understand that, as a condition of receiving a license, the licensed premises is subject to inspection during business hours by appropriate local, state and federal officials.

NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen.

Owner's Signature: jFloyd Davis Date: j10/07/2015 MM/DD/YYYY

Tentative effectivel11/12/2015 I MM/DD/YYYY date: .... ---------'·

Amount to be transferred from your$ 385.00

account: Funds will be pulled from your account 2 days after ABO approves the license.

You are ready to submit the application for your license to sell alcoholic beverages in the State of Iowa. By providing the bank information requested and clicking on "finish" you are indicating that you are an owner or authorized user of the bank account listed and that you hereby authorize ABO to debit the account in the amount indicated above.

~~IM~"IO....._~~-----------------'' $ 1~--~--' --~~----------------~ CC11.u.112

I~

Ban" Routing Banl<·Account Chock N&:imlier Number Number

Applicant's Banklxxxxxxxxxxxxxxxxxx Name: L·----------------------'

Ap~licant's BanklXxXXXXXXXXXXXXXXXX Routing Number: .

Repeat Bank Routing'~---------------------,

Number: '---------------------~ The routing number will ALWAYS be 9 digits long. If you are unsure of your routing or

account number, call your bank.

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Applicant's Accoun~xxxxxxxxxxxxxxxxxx Number: -

RepeatAccoun..-~~~~~~~~~~~~~~~~~~~~

Number: .__~~~~~~~~~~~~~~~~~~--'

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Credit cards are not accepted. Your bank information is transferred over a secure connection and is completely confidential.

BY CLICKING ON THE "FINISH" BUTTON, I AGREE TO THE TERMS AND CONDITIONS OF USING MY BANK ACCOUNT AS A PAYMENT METHOD, WHICH ARE LISTED BELOW, I\ AND AUTHORIZE THE STATE OF IOWA TO DEBIT MY BANK ACCOUNT FOR THE LICENSING FEE LISTED ABOVE.

Please print a copy of this page for your records before clicking the "FINISH" button.

Finish I If you are not taken to a confirmation screen after clicking on "Finish", please see the notes

at the top of the applicant signature screen to find out why the application was not submitted.

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Local Authority Endorse ment BC0029492, Chet's Moville Market,

Moville Complete the information below and c lick SUBMIT to endorse the Renewal.

LICENSE INFORMATION

Local Authority: County of Woodbury

Daytime Phone for Local Authority: 1(71 2) 279-6465

0 License Approved

0 License Denied Reason For Denial:

0 License Timely Filed Reason For Timely Filfng:

Effective Date: 11/121201 5

CHECK LIST

Fire Inspection completed : YesO NoO

Health inspection completed

Was a DCI background check non YesO NoO

Yes 0 NoO

I 1

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Signature: 0 Date:

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Copyright @2009 Slate ol Iowa Alcoholic Beverages Division. All Rights Reserved.

Expiration Date: 11/11/2016

Fee Amount: $385.00 Local Authority Share: $300.00

I MM/DDIYYYY

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. BEVER~~- DIVISION Alcohol Tobacco

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License History BC0029492, Chet's Moville Market, Moville View All History

I License Number OBA Comment

BC0029492 Chet's Moville Renewal Application Market signed.


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Comment Last Updated Date By

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woodbury county board of supervisors agenda item(s) …€¦ · class c beer permit for chet's...

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