The URL can be used to link to this page

Home My WebLink AboutItem 05 Cork & Bottle Shoppe Liquor License AGENDA ITEM SUMMARY Meeting Date: 6/7/2021 Meeting Type:Regular Meeting Staff Contact/Dept.:Robin Holman - DPW Staff Phone No:541-726-3662 Estimated Time: Consent Calendar S P R I N G F I E L D C I T Y C O U N C I L Council Goals: Mandate ITEM TITLE: LIQUOR LICENSE APPLICATION FOR A CHANGE OF OWNERSHIP FOR MAHA SHAKTI LLC, DBA: CORK & BOTTLE SHOPPE. ACTION REQUESTED: Endorsement of OLCC Liquor License Application for Cork & Bottle Shoppe, located at 812 Beltline Rd. Springfield, OR 97477. ISSUE STATEMENT: The owner of Maha Shakti LLC has requested the City Council to endorse its OLCC Liquor License Application. ATTACHMENTS: Attachment 1: OLCC Liquor License Application. DISCUSSION/ FINANCIAL IMPACT: The license endorsement for Maha Shakti LLC, DBA: Cork & Bottle Shoppe is for a Change of Ownership with Off-Premises Sales. The license application has been reviewed and approved by the appropriate City Departments. OREGON LIQUOR CONTROL COMMISSION LIQUOR LICENSE APPLICATION 1. Application. Do not include any OLCC fees with your application packet (the license fee will be collected at a later time). Application is being made for: License Applied For:CITY AND COUNTY USE ONLY Date application received and/or date stamp: Name of City or County: € Brewery If Location Brewery Additional location (2"d) € (3'd) € € Brewery-Public House (BPH) 1" location BPH Additional location (2"d) € (3'd) € € Distillery € Full On-Premises. Commercial Recommends this license be: € Granted € Denied B/: € Full On-Premises, Caterer € Full On-Premises, Passenger Carrier € Full On-Premises, Other Public Location € Full On-Premises, For Profit Private Club Date:€ Full On-Premises. Nonnrofit Private Club € (irnwprSalps Privilpop((igP11sJnr;itinn - - a - a a - a - - a -- a a a o a a - 5 - l- - a I - a - -- o a - a a Dateapplicationreceiovetcdc: UsEONj-%-lY(30)"rl Date application accepted: ' 5 J31 g ( GSP Additional location (2"d) € (3'd) € € Limited On-Premises @ Off-Premises € Warehouse € Wholesale Ma!t Beverage & Wine License Action(s):€ Winery 1" Location Winery Additional location (2"d) € (3'd) € (,ith) @ (sth) @ 2.ldentifytheapplicant(s)applyingforthelicense(s). ENTITY(example:corporationorLLC)orlNDMDUAL(S)1 applying for the license(s): MAHA SHAKTI, LLC App#l: NAME OF ENTITY OR INDIVIDUAL APPLICANT App#2: NAME OF ENTIT/ OR INDMDUAL APPLICANT App #3: NAME OF ENTITY OR INDMDUAL APPLICANT App#4: NAME OF ENTITY OR INDMDUALAPPLICANT 3. Trade Name of the Business (Name Customers Will See) CORK & BOTTLE SHOPPE 4. Business Address (Number and Street Address of the Location that will have the liquor license) 812 BELTLINE ROAD City SPRINGFIELD County LANE Zip Code 97477 I Read the instructions on page I carefully. If an e3 is applying for the license, list the name of the as an applicant. If an individual is applying as a sole proprietor (no entity), list the as an applicant. OLCC Liquor License Application [Rev. 9.28.20)Attachment 1, Page 1 of 3 OREGON LIQUOR CONTROL COMMISSION LIQUOR LICENSE APPLICATION 5. Trade Name of the Business (Name Customers Will See) CORK & BOTTLE SHOPPE 6.DoesthebusinessaddresscurrentlyhaveanOLCCIiquorlicense? [Jyts LJNO 7.DoesthebusinessaddresscurrentlyhaveanOLCCmarijuanalicense? ['l-YES F""INO 8. Mailing Address/Pa Box, Number, Street, Rural Route (where the OLCC will send yourlicense certificate, renewal application and other mailings as described in OAR 845-004-0065jlJ.) 812 BELTLINE ROAD a' SPRINGFIELD Stae OR Zip COde 97477 9. Phone Number of the Business Location 541-736-3959 10. Email Contact for this Applicat.on and for the Business SSNOORANI@COMCAST.NET 11. Contact Person for this Application SALEEM S NOORANI Phone Number 541-619-5850 Contact Person's Mailing Address (if different)City State Zip Code Please note that liquorlicense applications are public records. A copy of the application will be posted on the OLCC website for a period of several weeks. ATTESTATION: *"READ CAREFULLY AND MAKE SURE YOU UNDERSTAND BEFORE SIGNING THIS FORM"* I understand that marijuana is on the licensed premises. This includes marijuana use, consumption, ingestion, inhalation, samples, give-away, sale, etc. I attest that all answers on all forms and documents, and all information provided to the OLCC as a part of this application are true and complete. I affirm that I have read OAR 845-005-0311 and all individuals (sole proprietors) or entities with an ownership interest (other than waivable ownership interest per OAR 845-005-0311[6]) are listed as license applicants in #2 above. I understand that failure to list an individual or entity who has an unwaivable ownership interest in the business may result in denial of my license or the OLCC taking action against my license in the event that an undisclosed ownership interest is discovered after license issuance. Applicant(s)SiHnature * Each individual (sole proprietor) listed as an applicant must sign the application below. * If an applicant is an entity, such as a corporation or LLC, at least one INDMDUAL who is authorized to sign for the entity must sign the application. * Anindividualwiththeauthoritytosignonbehalfoftheapplicant(suchastheapplicant'sattorneyoranindividualwith power of attorney) may sign the application. If an individual other than an applicant signs the application, please provide written proof of signature authority. Attorneys signing on behalf of applicants may list the state of bar licensure and bar number in lieu of written proof of authority from an applicant. Applicants are still responsible for all information on this form. SALEEM S NOORANI SALEEM NOORANI Dlgllally slgned by SALEEM NOORANI Oala 2021 04 30 08 21 48 -D7'OD' App. #1: (PRINT NAME)App #1: (SIGNATURE)App #1: Signature Date Atty. Barlnformation (if applicable) App. #2: (PRINT NAME)App #2: (SIGNATURE)App #2: Signature Date Atty. Bar Information (if applicable) App. #3: (PRINT NAME)App #3: (SIGNATURE)App #3: Signature Date Atty. Bar Information (if applicable) App. #4: (PRINT NAME)App #4: (SIGNATURE)APP #4: Signature Date Atty. Bar Information (if applicable) OLCC Liquor License Application iRev. (1.28.20)Attachment 1, Page 2 of 3 Attachment 1, Page 3 of 3