UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 South 900 West • PO Box 30408 • Salt Lake City, Utah • 84130-0408 • (801) 977-6800 • Fax (801) 977-6888 website: www.abc.utah.gov SINGLE EVENT PERMIT APPLICATION CHECKLIST The items below must be completed and submitted by the 10th of the month before any action may be taken by the Alcoholic Beverage Control Commission. The Commission meets monthly. Call the Licensing & Compliance Division at 977-6800 for the date of the next Commission meeting. 1.__ Application (form enclosed). 2.__ Local consent from city, town, or county. (form enclosed). 3.__ $1,000 single event cash or corporate surety bond (form enclosed). If the bond is in the form of a check, it must be left on deposit with the department until 30 days after the event. If the check is issued by other than the applicant organization, the attached third party liability agreement form must also be completed. 4.__ Proof of qualifying organization (NOT REQUIRED IF ALREADY ON FILE WITH THE DEPARTMENT FROM PREVIOUS EVENTS): (a) If incorporated, a copy of the certificate of existence & articles of incorporation. (b) If a political organization or church, a copy of (a) above or tax exempt filing with IRS. (c) If a local chapter or subunit of a corporation, church or political organization, a copy of (a) or (b) above, and a letter of authorization from the qualifying parent organization. (d) If a partnership, a copy of the partnership agreement. (e) If a Limited Liability Company (LLC), a certificate of existence. (g) If a state agency, political subdivision of the state including a county or municipality, items 1, 2, and 3 above are not required. 5.__ Scaled floor plan (8-1/2" x 11") of single event premises highlighting liquor sales, storage and consumption areas. 7.__ $100 permit fee (refundable if permit is not granted). Make check payable to Utah Department of Alcoholic Beverage Control. 8.__ Sales Tax Exemption Certificate (instructions and form enclosed) 9.__ Financial information return form to be completed & submitted within 30 days following the event in order to receive a refund of the $1,000 compliance bond. Enclosed are copies of the Utah Code and Commission Rules pertaining to single events. If you have any questions please contact our Licensing and Compliance Division at (801) 977-6800. Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL APPLICATION FOR SINGLE EVENT PERMIT 1. Name of organization: ______________________________________________________________ 2. Address: _________________________________________________________________________ Street PO Box City State Zip 3. Contact person: ____________________________ 4. Phone number: __________________ Fax:_________________ E-mail: _____________________ 5. Type of organization: (check one) [ ] Incorporated association [ ] Church [ ] Corporation [ ] Political organization [ ] Partnership [ ] Limited Liability Co. [ ] Utah state agency or a political subdivision of the state including a county or a municipality [ ] Check if a local chapter or subunit of any of the above. 6. Sales Tax Number: _________________________________________________________________ 7. Date organization was founded: _______________________________________________________ 8. Purpose of organization: _____________________________________________________________ 9. Qualifying organizations may apply for a permit type that allows either: A. Up to 4 permits per calendar year for a time period that that does not exceed 120 consecutive hours (5 days) for each permit; or B. Up to 12 permits per calendar year for a time period that does not exceed 72 consecutive hours (3 days) for each permit. 9a. Is this the applicant’s first permit request for this calendar year? [ ] YES [ ] NO 9b. If “yes”, please select the permit plan under which the application is to be considered: [ ] A. Up to 4 permits per calendar year for a time period that that does not exceed 120 consecutive hours (5 days) for each permit; or [ ] B. Up to 12 permits per calendar year for a time period that does not exceed 72 consecutive hours (3 days) for each permit. 9c. If “no”, this application will be considered under the permit type issued for this organization’s previous permit(s) this year. Please identify the previous permit type: [ ] A. 120 consecutive hour. [ ] B. 72 consecutive hour. 10. Name of event: ____________________________________________________________________ 11. Purpose of event: __________________________________________________________________ 12. Date(s) and hours of event: __________________________________________________________ ________________________________________________________________________________ Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com 13. Admission charge: $__________ Drink prices: [ ] Included [ ] Liquor $ ________ [ ] Wine $ _________ [ ] Beer $ _________ Total Attendance ________ Attendance per day if multi-day event: __________ 14. Name of location of event: _________________________________________________________ 15. Address of event: _________________________________________________________________ Street City Zip Name of person or group catering the event: ____________________________________________ 16. 17. List any private or public schools, churches, public libraries, public playgrounds or parks located within 600' of the premises of the event: Property Address Measured Distance ________________________________________________________________________ 18. Criminal History. The law prohibits 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 from holding a single event permit. The law also prohibits 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, or any drug, or the combination of alcohol and any drug from holding a single event permit. 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. If none, the undersigned applicant attests that the above persons have not been convicted of any disqualifying criminal offense. NAME CRIMINAL OFFENSE DATE OF CONVICTION _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com 19. Is this event a “large scale public event” where the attendance is estimated to be in excess of 1000 people OR an outdoor event (any size) that is open to the public? [ ] NO (if “no”, skip to question #20) [ ] YES If “yes” the following control measures are required: a. A separate location at the event where those wanting to purchase alcoholic beverages must show proof of age and either have their hand stamped or be issued a non-transferable wristband. b. The proof of age location(s) must be separate from the alcoholic beverage sales and dispensing location(s). c. Any person assigned to check proof of age shall have completed the alcohol server-training seminar outlined in Utah Code 62A-15-401. d. Alcoholic sales and dispensing location(s) shall be separate from food and non-alcoholic beverage concession locations. However, if the consumption of alcohol at the event is limited to a confined, restricted area within the event (such as a "beer garden"), then alcoholic beverages, food and nonalcoholic beverages may be sold at the same sales locations within the confined, restricted area. e. Alcoholic beverages shall be served in readily identifiable cups or containers distinct from those used for non-alcoholic beverages. f. No more than two alcoholic beverages shall be sold to a customer at a time. g. At least one person who has completed the alcohol server training seminar outlined in Utah Code 62A-15-401 shall be at each location where alcoholic beverages are sold and dispensed to supervise the sale and dispensing of alcoholic beverages. h. If minors may attend the event, all dispensing and consumption of alcoholic beverages shall be in a designated, confined, and restricted area where minors are not allowed without being accompanied by a parent or guardian, and where alcohol consumption may be closely monitored. To request a waiver of any of the above control measures: • Indicate the control measure(s) for which you are requesting a waiver: ________________ _________________________________________________________________________ • Please provide a written request and a reason as to why the commission should consider relaxing any of those requirements. List below any additional control measures as may be required in R817-2(4)(c) and (5) that will be taken at the event to reduce the possibility of minors being furnished alcohol and adults being over-served alcohol at the event (use a separate sheet of paper if necessary). Additional control measures can include but are not limited to the following: (i) Defining the premises by way of perimeter fencing with controlled entry/exit points (ii) Requiring a certain minimum number of law enforcement and/or security personnel at the event (iii) Placing limits on the variety of alcoholic beverages served at the event. (iv) Requiring that alcoholic beverages be distinguishable in appearance from non-alcoholic beverages. [ ] perimeter fencing, number of controlled entry/exit points: _______________________ [ ] number and type of security personnel: ______________________________________ [ ] other: _________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com 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. By signing below, the applicant attests that: • The information contained in this application is true and correct; • No minor is a partner or managing agent of the applicant partnership; a managing agent, officer, director, or stockholder who holds at least 20% of the total issued and outstanding stock of the applicant; or a manager or member who owns at least 20% of the applicant limited liability company; • No gambling or any other violation of law or ordinance will be allowed on the premises serviced by the single event permittee; • The applicant does not and will not discriminate against persons on the basis of race, color, sex, religion, ancestry, or national origin at the event; • He/she has read and will abide by the provisions of 32A-7 & 14a, 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 single event permittee may result in immediate suspension and/or revocation of the permit and forfeiture of the compliance bond; • Consent is given that authorized representatives of the commission, department, or any law enforcement officers will have unrestricted right to enter the premises during the event; and • That the person signing this application is authorized to act on behalf of the applicant. Dated this ______ day of________________, _______. State of ____________________________ County of __________________________ Subscribed & sworn to before me this __________ ________________________________ Authorized Signature ________________________________ Name/title Rev 6.12.08 day of ____________________, _________. ______________________________________ Notary Public SEAL: American LegalNet, Inc. www.FormsWorkflow.com LOCAL CONSENT SINGLE EVENT PERMIT Date: Utah Department of Alcoholic Beverage Control Licensing and Compliance Division 1625 So. 900 West P.O. Box 30408 Salt Lake City, Utah 84130-0408 Fax: 801-977-6889 To Whom It May Concern: ____________________________________________(City)(Town)(County) hereby grants its consent to the issuance of a single event permit to _______________________________________________ organization, for an event to be held at: Location: ________________________________________________________ Address: ______________________________________________________________________________ Street PO Box City State Zip On the _________________________ day(s) of __________________________, _______ during the hours of __________________________________________, pursuant to the provisions of Section 32A-7, Utah Code for the purpose of sale, storage and consumption of alcoholic beverages on the premises of the event. ____________________________________ Authorized Signature ____________________________________ Name/Title Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com Sales Tax Information for Single Event Permit Holders The prices of liquor, wine, and heavy beer at the liquor stores and package agencies do not include sales tax. The sales tax will be added at the cash register when members of the general public shop in a liquor store or package agency and bring their purchases to the cash register. Permit holders that make purchases at the cash register will be charged sales tax just like the general public. Single event permit holders may be able to purchase liquor from the department without paying the sales tax under these two conditions: 1. The permit holder must file tax commission form TC-721 with the DABC. A copy of this form is included in this application packet. Once filed, the permit holder can buy liquor, wine, and heavy beer exempt from sales tax at any DABC owned and operated state liquor store. If the permit holder buys from a local package agency that is a “contracted store” (not owned or operated by the DABC), the licensee has to file form TC-721 with the package agency in order to be able to purchase “sales tax exempt”; and 2. The permit holder must adhere to the liquor order procedures established by the DABC commission as follows: (a) Commission rule requires that orders must be placed in advance to allow department personnel sufficient time to assemble the order. The order shall include the business name of the permit holder, department permit number, and list the products ordered specifying each product by code number and quantity. The order may be telephoned or faxed to the store or agency. (b) The permit holder shall allow at least four hours for department personnel to assemble the order for pick-up. When the order is complete, the permit holder will be notified by phone and given the total cost of the order. The permit holder may pay for the product in cash, company check, cashier’s check, or debit card with a PIN. (c) The permit holder or the permit holder’s designee shall examine and sign for the order before it leaves the store, agency or satellite warehouse to verify that the product has been received. (d) Merchandise shall be supplied to the permit holder on request when it is available on a first come first serve basis. Discounted items and limited items may, at the discretion of the department, be provided to a permit holder on an allocated basis. Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com Name of business or institution claiming exemption (purchaser) Telephone Number City Street Address Authorized Signature State ZIP Code Name (please print) Title Date Name of Seller or Supplier: Department of Alcoholic Beverage Control The person signing this certificate MUST check the applicable box showing the basis for which the exemption is being claimed. Questions should be directed (preferably in writing) to Taxpayer Services, Utah State Tax Commission, 210 N 1950 W, Salt Lake City, UT 84134. Telephone (801) 297-2200, or toll free 1-800-662-4335. DO NOT SEND THIS CERTIFICATE TO THE TAX COMMISSION Keep it with your records in case of an audit. Sales tax account numbers with an “H” prefix are not to be used for tax-free purchases for resale or re-lease. RESALE OR RE-LEASE Sales Tax License No. ________________ I certify I am a dealer in tangible personal property or services that is for resale or re-lease. If I use or consume any tangible personal property or services I purchase tax free for resale, or if my sales are of food, beverages, dairy products and similar confections dispensed from vending machines (see Rule R865-19S-74), I will report and pay sales tax on the proper cost thereof directly to the Tax Commission on my next regular sales and use tax return. COMMERCIAL AIRLINES I certify the food and beverages purchased are by a commercial airline for in-flight consumption; or, any parts or equipment purchased are for use in aircraft operated by common carriers in interstate or foreign commerce. RELIGIOUS OR CHARITABLE INSTITUTION Sales Tax Exemption No. N ___ ___ ___ ___ ___ I certify the tangible personal property or services purchased will be used or consumed for essential religious or charitable purposes. This exemption can only be used on purchases totaling $1,000 or more, unless the sale is pursuant to a contract between the seller and purchaser. To be valid this certificate must be filled in completely, including a check mark in the proper box. A sales tax license number is required only where specifically indicated. Please sign, date and, if applicable, include your license or exemption number. NOTE TO SELLER: Keep this certificate on file since it must be available for audit review. NOTE TO PURCHASER: Keep a copy of this certificate for your records. You are responsible to notify the seller of cancellation, modification, or limitation of the exemption you have claimed. DO NOT SEND THIS CERTIFICATE TO THE TAX COMMISSION Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL SINGLE EVENT PERMIT FINANCIAL INFORMATION RETURN Permittee: ________________________________________________________________________ Event: Date of event: Phone number: ____________________ Person to contact: The following information must be supplied to the Utah Department of Alcoholic Beverage Control before you may receive refund of your $1,000 compliance bond. If you have any questions, contact the Licensing & Compliance Division at (801) 977-6800. Mail to: Utah Department of Alcoholic Beverage Control PO Box 30408 Salt Lake City, Utah 84130-0408 Receipts Purchases Admission/entrance fees Sales - alcoholic beverages Sales - other _____________ _____________ _____________ Beer _____________ Liquor _____________ Food _____________ Other _____________ Total receipts _____________ Total purchases _____________ Expenses Rent Wages Catering/subcontracting Supplies Other (please list) _________________ _________________ _________________ _________________ _________________ Total expenses _________________ Net proceeds from event _________________ Rev 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL SINGLE EVENT $1,000 BOND THIRD PARTY LIABILITY AGREEMENT The undersigned hereby consents to the use of this $1,000 check for the purposes of a single event compliance bond on behalf of: Single event permitee: _________________________________________________ Name of event: _______________________________________________________ Date of Event: ________________________________________________________ Name on check: _______________________________________________________ Furthermore, it is understood that said $1,000 must be left on deposit with the department for 30 days following said event, and that if said permit is rescinded, the $1,000 may be forfeited. ___________________________________ Authorized Signature ___________________________________ Name Rev 6.12.08 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 “SINGLE EVENT BOND” BOND # _______________________ KNOW ALL PERSONS BY THESE PRESENTS: That Principal, ___________________________________________, a single event permittee, 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 $1,000, 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 single event permit pursuant to the provisions of 32A-7, 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 permittee / principal. ___________________________________ Surety ___________________________________ Principal / Licensee ___________________________________ Attorney in fact ___________________________________ Authorized signature { Corporate Seal } Rev 6.12.08 __________________________________ 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 6.12.08 American LegalNet, Inc. www.FormsWorkflow.com