UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 South 900 West • PO Box 30408 • Salt Lake City, UT 84130-0408 • (801) 977-6800 • FAX (801) 977-6888 www.abc.utah.gov INTERNATIONAL AIRPORT LOUNGE LIQUOR LICENSE APPLICATION CHECKLIST The items below must be completed and submitted by the 10th of the month or earlier, so that your application can be processed in a timely manner. Because there are a limited number of licenses available, you will be notified of the next monthly Utah Alcoholic Beverage Control Commission meeting when your application will be considered. We request that a representative attend the meeting to make a brief presentation. 1. Completed application (form enclosed). 2. Criminal history background check information (see application form). 3. Written consent from the city council. (form enclosed) 4. Written consent from international airport authority. 5. Copy of local business/alcoholic beverage license(s). 6. $10,000.00 cash of corporate surety bond (form enclosed). 7. Certificate of insurance for public liability/dram shop coverage (Minimum $500,000 per occurance/$1,000,000 in the aggregate). 8. Scaled floor plan (8-1/2”x11”) of airport lounge facility highlighting areas for storage, sale and consumption of alcoholic beverages. Lounge must be located in terminal beyond the airport security point. 9. Copy of the Articles of incorporation with certificate, if incorporated; or partnership agreement if applicable. 10. $1,000.00 application fee (non refundable). 11. $1,000.00 annual license fee for period ending October 31. Make checks payable to UDABC. 12. Copy of sign to be used on the premises to inform public of availability of alcoholic beverages. Enclosed are copies of Utah law and Commission Rules pertaining to airport lounge liquor licenses, and a list of factors considered in the evaluation of license applications. If you have questions concerning these forms of the application process, please contact the licensing and compliance section at (801) 977-6800. 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL APPLICATION FOR AIRPORT LOUNGE LIQUOR LICENSE 1. Business name:___________________________________________________________ 2. Applicant/Owner of business: _______________________________________________ 3. Location:________________________________________________________________ Airport Terminal 4. City State Zip Mailing address: __________________________________________________________ Street P.O. Box City State Zip 5. Business phone: __________________________ Other phone: ____________________ 6. Manager: _______________________Contact person: ___________________________ 7. Ownership: Check appropriate box and provide the requested information in the space below: (add additional sheets if necessary) [] Applicant is an individual: List below information for: [] Applicant is a partnership: List below information for: [] Applicant is a corporation: List below information for: [] Applicant is a limited liability company (LLC): List below information for: (a) (b) (a) (b) (a) Individual Managers All Partners Managers Any Stockholder owning at least 20% of the corporation (b) All Corporate officers (c) Managers (a) Any members owning at least20% of the company (b) Managers TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com 8. Criminal History. The law prohibits persons who have been convicted of certain crimes from being in the alcoholic beverage business. This applies to any applicant, proprietor, partner, managing agent, director, or officer of the business. This also applies to any stockholder owning at least 20% of the corporation stock, or if a limited liability company, any member owning at least 20% of the company. Please list all criminal offenses other than minor traffic offenses of which you or any of these persons (including persons listed in subparagraph 7) have ever been convicted. NAME CRIMINAL OFFENSE DATE OF CONVICTION In addition, a criminal history background check must be furnished on each person listed above and in subparagraph 7. This may be done as follows: a. Utah residents: If any person listed has been a resident of Utah for at least two years, he/she shall submit a fingerprint card to the DABC and consent to a fingerprint criminal background check by the Utah Bureau of Criminal Identification. b. Non Residents: Out of state residents or persons who have resided in Utah for less than two years shall submit a fingerprint card to the DABC and consent to a fingerprint criminal background check by the Federal Bureau of Investigation (F.B.I). An informed consent and release of liability form is included with this application. Fingerprint cards are available at law enforcement agencies. You may download the fingerprint card at this web address: http://www.fbi.gov/hq/cjisd/pdf/fpcardb.pdf Submit the form(s) to the DABC with a processing fee of: • $15.00 per card for BCI background checks, or • $34.25 per card for FBI background checks. In the case of an undue delay in the processing of an F.B.I. criminal background check, here are the rules and procedures for obtaining a third-party national background check: An application that requires F.B.I. criminal history background report(s) may be included on a commission meeting agenda, and may be considered by the commission for issuance of a license, permit, or package agency if: 1). the applicant has completed all requirements to apply for the license, permit, or package agency other than the department receiving the F.B.I. criminal history background report(s); 2). the applicant attests in writing that he or she is not aware of any criminal conviction of any person identified in the application that would disqualify the applicant from applying for and holding the license, permit, or package agency; 3). the applicant has submitted to the DABC the necessary fingerprint card(s) required for the application and consented to the fingerprint criminal background check(s) by the F.B.I. 4). the applicant at the time of application supplies the department with a current criminal history background report conducted by a third-party background check reporting service on any person for which an F.B.I. background check is required; and 5). the applicant stipulates in writing that if an F.B.I. report shows a criminal conviction that would disqualify the applicant from holding the license, permit, or package agency, the applicant shall immediately surrender the license, permit, or package agency to the department. A suggested attestation/stipulation letter that satisfies the above requirements is enclosed. A third-party national criminal background check can be obtained by; • searching the yellow pages under Background Screening • searching the internet under Background Screening or Background Checks Because the DABC is State Agency, we cannot recommend any one background screening service over another. It is your responsibility however, to obtain the most complete, nationwide, criminal history available for the application process. 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com 9. Owner of real property and building:_____________________________________________ ___________________________________________________________________________ 10. List any other alcoholic beverage licenses previously and/or currently applicant/principals: ___________________________________________________________________________ 11. Date lounge opened for business: _______________________(or projection)______________ 12. Days and hours of operation: ____________________________________________________ 13. Total seating capacity: __________________________ 14. Square footage of facility: _______________________ 15. Monthly gross sales: _______________ (or projection): _______________ 16. By signing below, the applicant attests that: a) the applicant is in compliance with all federal and state laws pertaining to the payment of taxes and contributions to unemployment and insurance funds. The following are tax identification numbers of the business. i. State Sales Tax #: ______________________ ii. State Payroll Withholding Tax #: ______________________ iii. State Dept. of Workforce Services #: ______________________ iv. Federal Taxpayer Identification #: ______________________ b) the proprietor/applicant is at least 21 years of age. c) consent is granted to representatives of the Alcoholic Beverage Control Department, Commission, State Bureau of Investigation (Bureau of Alcoholic Beverage Law Enforcement), and other law enforcement agencies to be admitted immediately and permitted without hindrance or delay to inspect the entire premises and all records of the licensee. d) he/she has read and will abide by the provisions of Title 32A, Utah Code, and all rules of the commission and directives of the Department of Alcoholic Beverage Control; and understands that failure to adhere thereto or to no longer possess the qualifications of a licensee may result in suspension or revocation of the liquor license and forfeiture of compliance bond. e) the applicant does not and will not discriminate against persons on the basis of race, color, sex, religion, ancestry, or national origin. 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com 17. Applicant agrees to immediately notify the department of any change in ownership, and if a corporation, any change in officers/directors; and understands that failure to do so may result in immediate suspension of license. 18. The undersigned acknowledges he/she has read and understands the statements made herein, that execution hereof is done voluntarily and by authorization of said applicant/organization; and that any false statements made on this application or any other related document is a second degree felony. 19. The undersigned hereby makes application to the Utah Alcoholic Beverage Control Commission for an airport lounge liquor license and certifies that the information contained herein and attached hereto is true and correct. Dated this __________ day of ___________________, 20____. ____________________________________ Applicant/Owner STATE OF ________________________ COUNTY OF_______________________ ___________________________________________ Authorized signature Subscribed & sworn to before me this _______ day of ___________________, ________. ____________________________________ Name/Title _______________________________ Notary Public SEAL: 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL AIRPORT LOUNGE LIQUOR LICENSE LOCAL CONSENT Date: ____________________________ Utah Department of Alcoholic Beverage Control Licensing & Compliance Section 1625 South 900 West PO Box 30408 Salt Lake City, Utah 84130-0408 ___________________________________________________(City) (Town)(County) hereby grants its consent to the establishment of an airport lounge liquor license for _______________________________________________________________________owned by ____________________________________________________________ and located at the ________________________________________________________________pursuant to the provisions of 32A-4, Part 2, Utah Code, for the purpose of storage, sale, and consumption of liquor on the premises. Furthermore, said organization has met all local ordinances relating to issuance of local business license(s). _________________________________ Authorized signature _________________________________ Name/title 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL AIRPORT LOUNGE LIQUOR BOND BOND # _________________________________ KNOW ALL PERSONS BY THESE PRESENTS: That principal, __________________________________________________, an airport lounge liquor licensee, doing business as ______________________________________,and surety, __________________________, a corporation organized and existing under the laws of the state of ________________, and authorized to do business in Utah, are held and bound unto the Department of Alcoholic Beverage Control in the sum of $10,000, for which payment will be made, we hereby bind ourselves and our representatives, assigns, and successors firmly by these presents. Dated this_______ day of _______________________, ____. THE CONDITION OF THIS OBLIGATION IS SUCH THAT: WHEREAS, the above principal has made application to the Utah Alcoholic Beverage Control Commission for an airport lounge liquor license pursuant to the provisions of 32A-4, Part 2, Utah Code. NOW, THEREFORE, if said principal, its officers, agents and employees shall faithfully comply with the provisions of Title 32A, Utah Code, and the rules and directives of the Department of Alcoholic Beverage Control, then this bond shall be void; but, if said principal, its officers, agents and employees fail to comply with the provisions of said laws, rules, and directives or orders as the department or commission may issue, then this bond shall be in full force and effect and payable to the Department of Alcoholic Beverage Control. This bond shall run for a continuing term effective ____________________ unless canceled by service of written notice upon the Department of Alcoholic Beverage Control, which cancellation shall be effective thirty (30) days after receipt of such notice, provided however, that no part of this bond shall be withdrawn or canceled while violations, legal actions or proceedings are pending against said licensee/principal. _____________________________ Principal _______________________________ Surety _____________________________ Attorney in Fact _______________________________ Authorized signature _______________________________ Name/title 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com {STATUTORY AFFIDAVIT FOR CORPORATE SURETY} STATE OF: _________________________ COUNTY OF: ________________________ On the _______day of _____________________, ____, personally appeared before me, _____________________________ who, being by me duly sworn, did say that he/she is the attorney in fact of surety, ________________________________________ and that said instrument was signed in behalf of said surety by authority, and acknowledged to me that he/she as such attorney in fact executed the same. __________________________________ Notary Public Note: Corporate surety's own affidavit also acceptable 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com AIRPORT LOUNGE LIQUOR LICENSE APPLICATION EVALUATION FACTORS The Alcoholic Beverage Control Department and Commission utilize the following factors for evaluating an airport liquor lounge license application, including, but not limited to: 1. Physical characteristics such as: - condition of the premises, - square footage, - seating capacity, - location in airport, - proximity to other airport lounges in the airport. 2. Management experience: - familiarity with alcoholic beverage operations, - familiarity with financial record keeping, - management scheme employed by the airport lounge, - length of time in operation, - past compliance with alcoholic beverage laws and rules. 3. Nature and type of lounge operation. __________________________________________ __________________________________________________________________________ 4. Public input._______________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Note: Keep this sheet and refer to it as needed for presentation before the ABC Commission. 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com INFORMED CONSENT AND RELEASE OF LIABILITY PURPOSE: To determine, in accordance with Utah Code 32A-1-702 and 32A-1-703, if an applicant with the Department of Alcoholic Beverage Control has been: convicted of a felony under federal or state law; convicted of a violation of a federal law, state law, or local ordinance concerning the sale, manufacture, distribution, warehousing, or transportation of an alcoholic beverage; convicted of a crime involving moral turpitude; convicted on two or more occasions within the previous five years, driving under the influence of alcohol, a drug, or the combined influence of alcohol and a drug. RELEASE I hereby authorize the Department of Alcoholic Beverage Control (DABC) to investigate my criminal history records to ascertain any and all information which may be pertinent to my qualifications as an applicant with the DABC. The release of any and all information is authorized whether it is of record or not, and I do hereby release all persons, firms, agencies, companies, groups or installations, whomsoever, from any damages of or resulting from, furnishing such information to the DABC. I further agree that a copy of this release will remain in my application file. ______________________________________________________________________ Name (please print; last, first, middle initial) _______________________________ Formerly used last names (please print) _______________________________ Signature 6.03.08 _________________________________ Applicant/ doing business as _________________________________ Date American LegalNet, Inc. www.FormsWorkflow.com (suggested attestation/stipulation letter to the DABC for a third-party national criminal background check) Date: ________________________ To whom it may concern: I, _____________________________, attest: 1. That I have submitted to the DABC the necessary fingerprint card(s) required for the application and consented to the fingerprint criminal background check(s) by the F.B.I. 2. That I am not aware of any criminal conviction that would disqualify me from applying for and holding a Utah Department of Alcoholic Beverage Control license or permit. I stipulate that if an F.B.I. report shows a criminal conviction that would disqualify me from holding the license, permit, or package agency, I shall immediately surrender the license, permit, or package agency to the department. I am enclosing a national criminal history background report from a third party background check reporting service. _____________________________________ Signature _____________________________________ Name/Title 6.03.08 American LegalNet, Inc. www.FormsWorkflow.com