APPLICATION FOR LIQUOR LICENSE CHECKLIST - PEDAL-PUB NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.nebraska.gov Hot List: YES / NO Class Type New/Replacing # License Number Initial PEDAL-PUB VEHICLE means a multi-passenger, human-powered vehicle The holder of a pedal-pub vehicle license may sell alcoholic liquor in individual drinks to customers who are 21 or older to consume while they are on or in the pedal-pub vehicle and may allow such customers to consume alcoholic liquor not purchased from the licensee. Licensee shall serve alcoholic liquor in opaque plastic containers that prominently display the licensee's trade name or logo or some other mark that is unique to the licensee under the licensee's pedal-pub vehicle license and shall require the use of such containers for the consumption of alcoholic liquor not purchased from the licensee. No customer shall take any open container of alcoholic liquor from the pedal-pub vehicle or consume the alcoholic liquor after leaving the pedal-pub vehicle. A customer may take unopened containers of alcoholic liquor not purchased from the licensee from the pedal-pub vehicle. Licensee shall not allow open containers of alcoholic liquor to leave the pedal-pub vehicle. The licensee shall be responsible for picking up and disposing of any litter or other waste or any personal property that originates from the pedal-pub vehicle and lands on public or private property. Provide all the items requested. Failure to provide any item will cause this application to be returned or placed on hold. All documents must be legible. Any false statement or omission may result in the denial, suspension, cancellation or revocation of your license. If your operation depends on receiving a liquor license, the Nebraska Liquor Control Commission cautions you that if you purchase, remodel, start construction, spend or commit money that you do so at your own risk. Prior to submitting your application review the application carefully to ensure that all sections are complete, and that any omissions or errors have not been made. You may want to check with the city/village or county clerk, where you are making application, to see if any additional requirements must be met before submitting application to the state. Office use only PAYMENT TYPE ______________________ BARCODE AMOUNT: ______________________ Received: ______ FORM 150 REV JUNE 2015 PAGE 1 OF 7 American LegalNet, Inc. www.FormsWorkFlow.com REQUIRED ATTACHMENTS Each item must be checked and included with application or marked N/A (not applicable) 1._____Fingerprints are required for each person as defined in new application guide, found on our website under "Licensing Tab" in "Guidelines/Brochures". See Form 147 for further information, this form MUST be included with your application. 2. ____Enclose application fee of $95, check made payable to the Nebraska Liquor Control Commission or you may pay online at www.ne.gov/go/NLCCpayport. 3. ____Enclose the appropriate application form; Individual License (requires insert form 1) Partnership License (requires insert form 2) Corporate License (requires insert form 3a & 3c) Limited Liability Company (LLC) (requires form 3b & 3c) 4. ____If buying the business of current Pedal-Pub operator: a) Provide a copy of the purchase agreement from the seller (must read applicants name) b) Provide a copy of alcohol inventory being purchased (must include brand names, container size & quantity) c) Enclose a list of the assets being purchased (furniture, fixtures and equipment) 5.____Enclose a list of all property to be used in the Pedal-Pub operation 6.____ For citizenship enclose U.S. birth certificate; U.S. passport or naturalization paper a. For proof of residency enclose a copy of your Nebraska voter registration b. See guideline for further assistance http://www.lcc.nebraska.gov/brochures.html 7.___Corporation or Limited Liability Company (LLC) must enclose a copy of articles of incorporation; as filed with the Nebraska Secretary of State's Office. 8.___Submit a copy of your detailed business plan, to include: a. How you plan on disposing of waste alcohol b. How is vehicle equipped for use on the road, i.e. lights, signs 9.___ Submit a photocopy of your opaque plastic container that will be used in the licensed vehicles I acknowledge that this application is not a guarantee that a liquor license will be issued to me, and that the average processing period is 60 days. Furthermore, I understand that all the information is truthful and I accept all responsibility for any false documents. ____________________________________________________________________ Signature ____________________ Date FORM 150 REV JUNE 2015 PAGE 2 OF 7 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR LIQUOR LICENSE PEDAL-PUB NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.nebraska.gov/ CLASS OF LICENSE FOR WHICH APPLICATION IS MADE AND FEES Class Q Pedal-Pub $95 check made payable to the Nebraska Liquor Control Commission or you may pay online at www.ne.gov/go/NLCCpayport Duplicate License fee $1 each, number of duplicates needed ______ A duplicate license must be posted in each pedal-pub vehicle where alcoholic liquor is sold or consumed Term of license runs from May 1 ­ April 30 CHECK TYPE OF LICENSE FOR WHICH YOU ARE APPLYING Individual License (requires insert form 1) Partnership License (requires insert form 2) Corporate License (requires insert form 3a & 3c) Limited Liability Company (LLC) (requires form 3b & 3c) CONTACT NAME Commission will call this person with any questions we may have on this application Name_______________________________________________ Phone number________________________________ Email address_____________________________________________________________________________________ FORM 150 REV JUNE 2015 PAGE 3 OF 7 American LegalNet, Inc. www.FormsWorkFlow.com PREMISES INFORMATION Location where the records, invoices and alcohol are being maintained Trade Name (doing business as)______________________________________________________________________ Street Address #1_________________________________________________________________________________ Street Address #2_________________________________________________________________________________ City