UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 South 900 West • PO Box 30408 • Salt Lake City UT 84130-0408 • (801) 977-6800 • Fax 977-6888 www.abc.utah.gov “RESTAURANT 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. All licensing requirements must be fully satisfied in order to complete your application. Because there are a limited number of restaurant licenses, you will be notified of the next monthly Utah Alcoholic Beverage Control Commission meeting when your application will be considered for issuance for a license. We request that a representative attend the meeting to make a brief presentation. Incomplete applications will not be considered for licensing. Please print or type (illegible information may delay processing). 1._____Completed Application form (enclosed). 2._____Ownership entity organizational papers for business: a) if a corporation, submit a copy of the articles of incorporation; b) if a partnership, submit a copy of the written agreement; c) if a limited liability company, submit a copy of the articles of organization. 3._____Criminal history background check information (see application form). 4._____Written consent from either city/town council or county commission whichever is applicable (form enclosed). 5._____Evidence of proximity to schools, churches, libraries, playgrounds and/or parks. See #15 on application. 6._____Copy of current local business license. 7._____$10,000 restaurant cash or corporate surety bond. (form enclosed). 8._____Certificate of insurance for public liability and liquor liability “dram shop” coverage (minimum coverage is $500,000 per occurrence/$1,000,000 in the aggregate). 9._____Scaled floor plan (8-1/2" x 11") of restaurant, highlighting areas for storage, sale and consumption of alcoholic beverages. 10.____$250 application fee (non-refundable). 11.____$1,750 initial license fee (make checks payable to UDABC). 12.____Copy of menus and posted price list for alcoholic beverages. Enclosed are copies of Utah law and commission rules pertaining to restaurants, and a list of factors considered in the evaluation of license applications. If you have any questions concerning these forms or the application process, please contact our DABC Licensing and Compliance Division at (801) 977-6800. Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL APPLICATION FOR RESTAURANT LIQUOR LICENSE 1. Restaurant name: ________________________________________________________________ 2. Applicant/owner of business: _______________________________________________________ 3. Location: ______________________________________________________________________ Street City State Zip 4. Mailing address: _________________________________________________________________ Street or PO Box City State Zip 5. Restaurant phone: ____________ Other phone: _________________ Fax: __________________ 6. Manager: ____________________ DOB __________ SS# ________________ DL#____________ 7. Contact Person: ___________________________ 8. Owner of real property & building: __________________________________________________ 9. List name of previous business at this location:________________________________________ 10. List any other alcoholic beverage licenses previously and/or currently held by applicant/principals: ______________________________________________________________________________ ______________________________________________________________________________ 11. Date opened for business: _____________________ (or projection) _______________________ 12. Days and hours of operation:________________________________________________________ 13. Total seating capacity: _______________ Number of parking stalls: _______________________ 14. Square footage of facility: ____________ 15a. Projected monthly revenue: Food Sales $ _______________ Alcohol Sales $ _____________ 15b. Projected yearly (12 month) cost of liquor, wine, and heavy beer: $ ___________________ 16. List any private or public schools, churches, public libraries, public playgrounds or parks located within 600' of the restaurant. See Utah Code 32A-4-101(4)(5) and (6) as to how proximity is determined and measured and also for an explanation on variances. Property Address Measured Distance ______________________________________________________________________________ ______________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Rev 5.25.07 17. Ownership: Check appropriate box and provide the requested information in the spaces below. ( add additional sheets if necessary ) [] Applicant is an individual: List below information for: (a) Individual (b) All Managers [] [] [] Applicant is a partnership: List below information for: (a) All Partners (b) All Managers Applicant is a corporation: List below information for: (a) Any Stockholders owning at least 20% of the corporation (b) All Corporate officers and directors (c) All Managers Applicant is a limited liability company (LLC): List below information for: (a) Any members owning at least 20% of the company (b) All Managers TITLE__________NAME___________________________HOME ADDRESS__________________________________ HOME PHONE #___________________DR LIC #___________DOB___________SS#____________%OWNED_____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE__________NAME___________________________HOME ADDRESS__________________________________ HOME PHONE #___________________DR LIC #___________DOB___________SS#____________%OWNED_____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE__________NAME___________________________HOME ADDRESS__________________________________ HOME PHONE #___________________DR LIC #___________DOB___________SS#____________%OWNED_____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE__________NAME___________________________HOME ADDRESS__________________________________ HOME PHONE #___________________DR LIC #___________DOB___________SS#____________%OWNED_____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. 18. Criminal History. The Commission may not grant a restaurant liquor license to any person who has been convicted of a felony under any federal or state law or any violation of any federal or state law or local ordinance concerning the sale, manufacture, distribution, warehousing, adulteration, or transportation of alcoholic beverages. The Commission may not grant a restaurant liquor license to any person who has been convicted of any crime involving moral turpitude or, on two or more occasions within the last five years, has been convicted of driving under the influence of alcohol, any drug, or the combination of alcohol and any drug. This proscription also applies to any officers, partners, managers, managing agents, directors, stockholders who hold at least 20% of the total issued and outstanding stock of an applicant corporation, members who own at least 20% of an applicant limited liability company and to any person employed to act in a supervisory or managerial capacity. Please list all criminal offenses other than minor traffic offenses of which you or any of the above persons have ever been convicted: Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com NAME CRIMINAL OFFENSE DATE OF CONVICTION _____________________________________________________________________ In addition, a criminal history background check must be furnished on each person listed above and in subparagraph 17. This may be done as follows: a. Utah residents: If any person listed has been a resident of Utah for at least one year, he/she must have a criminal history background check run by the Utah Bureau of Criminal Identification (BCI). Two forms must be submitted to BCI: (1) “Application for Criminal History Record Review” (BCI Form 98-1-03) and (2) “Waiver” (authorizing BCI to forward the results directly to DABC). Copies of these forms are available on the web at http://www.bci.utah.gov/Records/RecOwnRecord.html or at: Utah Bureau of Criminal Identification 3888 W 5400 S PO Box 148280 Salt Lake City UT 84114-8280 Tel: 801-965-4445 Fax: 801-965-4749 Note that Form 98-1-03 requires fingerprints (which can be taken at the BCI office or at any local law enforcement agency). Submit the forms together with a processing fee of $10.00 to BCI. BCI will directly notify DABC if the person has a criminal history or has been cleared. In most cases, BCI will notify DABC of the results within a week or two after BCI receives your completed forms. b. Non Residents: Out of state residents or persons who have resided in Utah for less than one year must have a criminal history background check run by the Federal Bureau of Investigation. zWrite a letter requesting a background check “for personal review”. (suggested form letter enclosed) zHave fingerprints taken on a standard fingerprint card that can be obtained from a local police station or criminal identification bureau. You may download the fingerprint card here: http://www.fbi.gov/hq/cjisd/pdf/fpcardb.pdf Submit the fingerprints with the request. zInclude a certified check or money order for $18.00 payable to the U.S. Treasury. Send to: Federal Bureau of Investigations Atten: Special Correspondence Unit 1000 Custer Hollow Road Clarksburg, West Virginia 26306 zThe FBI will send a written response to the person making the request. zForward the original response document from the FBI to the DABC. Because there is currently a waiting period of up to six months for FBI background checks, the applicant may get a national background check from a third-party provider and be licensed while waiting for the FBI check to arrive. The applicant must still provide the FBI check when it becomes available. c. Third-Party National Background Check Rules and Procedures: 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 providing the required 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 Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com 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 attests in writing that all request(s) for any required F.B.I. criminal history background report(s) have been submitted to the F.B.I, and provides the following information and documentation: (a) the date the request(s) were submitted to the F.B.I. (b) a copy of the written request(s) submitted to the F.B.I. (c) a copy of the fingerprint card(s) submitted to 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 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. 19. Applicant agrees to immediately notify the department of any change in ownership, management, and if a corporation, any change in the officers/directors, and understands that failure to do so may result in immediate suspension of license. 20. Have you as an applicant, or any proprietor, partner, managing agent, director, officer, stockholder owning at least 20% corporation stock, or if a limited liability company, any member owning at least 20% of the company, had a state alcoholic beverage license, permit, or agency revoked within the last three years? __________ If so please explain. ______________________________________________________________________________ ______________________________________________________________________________ 21. The undersigned verifies that 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. a. ______________________ b. State Payroll Withholding Tax #: ______________________ c. State Dept. of Workforce Services #: ______________________ d. 22. State Sales Tax #: Federal Taxpayer Identification #: ______________________ The undersigned verifies that proprietor/applicant is at least 21 years of age. Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com 23. The undersigned hereby voluntarily consents that representatives of the of Alcoholic Beverage Control Department, Commission, Utah Bureau of Criminal Investigation (Alcoholic Beverage Law Enforcement), and other law enforcement agencies shall be admitted immediately and permitted without hindrance or delay to inspect the entire premise and all records of the licensee. 24. Applicant agrees as a condition of licensing that 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 qualifications of a licensee may result in suspension or revocation of the liquor license and forfeiture of its compliance bond. 25. The undersigned applicant does not and will not discriminate against persons on the basis of race, color, sex, religion, ancestry, or national origin. 26. The undersigned acknowledges that he/she has read and understands the statements made herein, and that execution hereof is done voluntarily and by authorization of the applicant/organization, and that any false statement made on this application or any related document is a second degree felony. 27. The undersigned hereby makes application to the Utah Alcoholic Beverage Control Commission for a restaurant liquor license and certifies that the information contained herein and attached hereto is true and correct. Date: ___________________________ STATE OF ________________________ COUNTY OF_______________________ ________________________________ Applicant/owner of business Subscribed & sworn to before me this _______ day of ____________________, ________. ________________________________ Authorized signature ________________________________ Name/title Rev 5.25.07 _______________________________ Notary Public SEAL: American LegalNet, Inc. www.FormsWorkflow.com “FULL-SERVICE RESTAURANT LIQUOR LICENSE” LOCAL CONSENT Date: _________________________ Attn: DABC Licensing & Compliance Section __________________________________________________, [ ] City [ ] Town [ ] County hereby grants its consent to the issuance of a full-service restaurant liquor license to: Business Name: ________________________________________________________________ Applicant / Business Owner: ______________________________________________________ Location Address: ______________________________________________________________ Pursuant to the provisions of Utah Code 32A-4, Part 1, this license allows for the storage, sale and consumption of liquor on the premises. Furthermore, the applicant has met all ordinances and requirements relating to issuance of local business license(s). [ ] Check if applicable LOCAL CONSENT FOR PROXIMITY VARIANCE In accordance with Utah Code 32A-4-101(4), the local authority also grants consent to a variance regarding the proximity of this establishment relative to a public or private school, church, public library, public playground, or park. Rev 5.25.07 _____________________________________ Authorized Signature _____________________________________ Print Name / Title American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL RESTAURANT LIQUOR LICENSE APPLICATION EVALUATION FACTORS The Alcoholic Beverage Control Department and Commission utilize factors for evaluating a restaurant liquor license application, including, but not limited to: 1. Location factors such as: - proximity to and density of other outlets in the area, - traffic flow, - demographics, - population to be served, - proximity to any educational, religious and recreational facility such as public schools, nursery schools, infant day care centers, trade and technical schools, churches, public libraries, public playgrounds, and parks. 2. Physical characteristics such as: - condition of the premises, - square footage, - seating capacity - parking availability. 3. Management experience: - familiarity with food and alcoholic beverage operations, - familiarity with financial record keeping, - management scheme employed by the restaurant, - length of time in operation, - past compliance with alcoholic beverage laws and rules. 4. Nature or type of restaurant operation: - type of menu items offered and emphasized, - whether emphasis is on an adult clientele rather than minors, - gross sales of food items. 5. Public input. NOTE: Keep this and refer to it for presentation before the DABC Commission. Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com (Suggested form letter to FBI) Date: _________________________ Federal Bureau of Investigation Attn: Special Correspondence Unit 1000 Custer Hollow Road Clarksburg, West Virginia 26306 I am requesting a personal identification criminal history background check for my own personal review. Per your requirements, I am including a standard fingerprint card and a certified check or money order for $18.00 payable to the U.S. Treasury. Please provide me with a written response to the address listed below. I understand that it may take up to six weeks or longer for the FBI to perform this background check. Thank you for your attention to this matter. Signed: __________________________________ Full Name: __________________________________ Mailing Address: ________________________________ Street or PO Box __________________________________ City / State / Zip Code Telephone: Rev 5.25.07 __________________________________ American LegalNet, Inc. www.FormsWorkflow.com Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 S 900 W • PO Box 30408 • Salt Lake City, UT 84130-0408 • Phone (801) 977-6800 • Fax (801) 977-6889 “RESTAURANT LIQUOR BOND” BOND # _______________________ KNOW ALL PERSONS BY THESE PRESENTS: That Principal, _________________________________________, a restaurant 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 Utah 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 a restaurant liquor license pursuant to the provisions of 32A-4, Part 1, 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 Utah Alcoholic Beverage Control Commission and the Utah 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 the laws, rules and directives or orders as the commission or department may issue, then this bond shall be in full force and effect and payable to the Utah Department of Alcoholic Beverage Control. This bond shall run for a continuing term effective ________________________ unless canceled by service of written notice upon the Utah Department of Alcoholic Beverage Control, which cancellation shall be effective 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. ___________________________________ Surety ___________________________________ Principal / Licensee ___________________________________ Attorney in fact ___________________________________ Authorized signature { Corporate Seal } Rev 5.25.07 __________________________________ Name / Title 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 Signature & Seal Note: Corporate surety's own affidavit also acceptable Rev 5.25.07 American LegalNet, Inc. www.FormsWorkflow.com