The URL can be used to link to this page

Home My WebLink AboutItem 07 Lucky Lizard Liquor LicenseAGENDA ITEM SUMMARY Meeting Date: 12/6/2021 Meeting Type: Regular Meeting Staff Contact/Dept.: Robin Holman - DPW Staff Phone No: 541-726-3662 Estimated Time: Consent Calendar SPRINGFIELD Council Goals: Mandate CITY COUNCIL ITEM TITLE: LIQUOR LICENSE APPLICATION FOR A CHANGE OF OWNERSHIP FOR WC OPERATING COMPANY LLC, DBA: LUCKY LIZARD. ACTION Endorsement of OLCC Liquor License Application for Lucky Lizard, located at REQUESTED: 1979 Mohawk Blvd. Springfield, OR 97477. ISSUE The owner of WC Operating Company LLC has requested the City Council to STATEMENT: endorse its OLCC Liquor License Application. ATTACHMENTS: Attachment 1: OLCC Liquor License Application. DISCUSSION/ The license endorsement for WC Operating Company LLC, DBA: Lucky Lizard is FINANCIAL for a Change of Ownership with Limited On -Premises Sales. The license IMPACT: 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: ❑ Brewery 1'1 Location Brewery Additional location (2nd) ❑ (3`d ❑ Brewery- Public House (BPH) 11 location BPH Additional location (2nd) ❑ (31 ❑ ❑ Distillery ❑ Full On -Premises, Commercial ❑ Full On -Premises, Caterer ❑ Full On -Premises, Passenger Carrier ❑ Full On -Premises, Other Public Location ❑ Full On -Premises, For Profit Private Club ❑ Full On -Premises, Nonprofit Private Club ❑ Grower Sales Privilege (GSP) I" location GSP Additional location (2nd) ❑ (3"d) ❑ ® Limited On -Premises ❑ Off -Premises ❑ Warehouse ❑ Wholesale Malt Beverage & Wine ❑ Winery 11 Location Winery Additional location (2nd) C) (3'd) ❑ (&h) ❑ (51h) ❑ CITY AND COUNTY USE ONLY Date application received and/or date stamp: Name of City or County: Recommends this license be: ❑ Granted ❑ Denied By: Date: OLCC USE ONLLl Date application received:10 2} Date application accepted: 10 X1.02( License Action(s): �'10 2. Identify the applicant(s) applying for the license(s). ENTITY(exorrrple. corparatlon or LLQ orlNDIVIDUAL(S)r applying for the license(s): WC Operating Company, LLC App#1: NAME OF ENTITY OR INDIVIDUAL APPLICANT App#2: NAME OF ENTITY OR INDIVIDUAL APPLICANT App#3: NAME OF ENTITY OR INDIVIDUAL APPLICANT App#4: NAME OF ENTITY OR INDIVIDUAL APPLICANT 3. Trade Name of the Business (Name Customers Will See) Lucky Lizard 4. Business Address 11979 Mohawk Blvd City Springfield and Street Address of the Location that will have the liquor license) County Lane Zip Code 97477 Read the instructions on„Rage 1 carciully. if an enti is applying for the license, list the name of the enti as an applicant, If an idividual is applying as a sole proprietor (no entity), list the individual as an applicant. OWC Uquar License Application lRev.9,29,20) Attachment 1, Page 1 of 5 OREGON LIQUOR CONTROL COMMISSION LIQUOR LICENSE APPLICATION S. Trade Name of the Business (Name Customers Will See) Lucky Lizard 6. Does the business address currently have an OLCC liquor license? YES NO 7. Does the business address currently have an OLCC marijuana license?YES NO 8. Mailing Address/PD Box, Number, Street, Rural Route (where the OLCC will send your license certificate, renewal application and other mailings as described in OAR 845-004-0065 1 .) 363 High 5t. City Eugene State OR Zip Code 91401 9. Phone Number of the Business Location 541-465-3986 10. Email Contact forthis Application and for the Business juiieoja@gmail.com 11. Contact Person for this Application Julie Cale Phone Number 541-510-3560 Contact Person's Mailing Address (if different) City State .Zip Code Please note that liquor license 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 ARID MAKE SURE YO[JINDERSTAND BEFORE SIGNING THIS FORM" I understand that marijuana is prohibited 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 OWC as a part of this application are true and complete. I affirm that I have read OAR .943-005-0311 and all individuals (sole proprietors) or entities with an ownership interest (other than wa)vable ownership Interest per OAR 845.005.0311161) are listed as license applicants in #2 above. I understand that failure to list an individual or entity who has an unwalvable 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. A2pltcant(s) Sixnature • 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 INDIVIDUAL who Is authorized to sign for the entity must sign the application. ■ An Individual with the authority to sign on behalf of the applicant (such as the applicant's attorney or an individual with 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 applica t. Applicants are still responsible for alll4armation an this fort). Michael Chamberlin 1011121 App. #1: (PRINT NAME) App #1: [SIGNATURE) App #1: Signature Date Atty. Bar Information (if applicable) App. #2: (PRINT NAME) App #2: (SIGNATURE) App #2: Signature Date Atty. Bar Information (if applicable) App. 03: (PRINT NAME) App 1913: (SIGNATURE) App #3: Signature Data 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 (Rev. 9.28.20) Attachment 1, Page 2 of 5 Oregon Liquor Control Commission 6099=1 LIMITED LIABILITY COMPANY LLC QUESTIONNAIRE Ws LLC Name. WC Operating Company, LLC Trade Name of Business (Name Customers Will See) Lucky Lizard The LLC named in this document is a (see page 1 for definitions): Manager -Managed LLC 0 Member -Managed LLC 'his section Is ONLY for a manager -managed LLC. Directions on page 1. You may Include Information on a separate sheet. Name of Mana in Member lease rint Name of Managing Member lease rant 3erald A. Scott Michael D. Chamberlin This section Is for BOTH a manager -managed LLC and a member-rnanaged LLC. (Directions on Dacie 1, You may includa infnrmatinn on a separate sheet.) __._.. Name of Member leaseprint) Percentage of issued membersbjp held Elmer's Restaurants, Inc. 100% Thla CARtrnn In nNi V 1nr an 1 1 r urUh fhn 11.1-1 nif7— fnr-4.0 ....... .. a v............- ---..10.....1.....,1 F ..., a .w awws anocs. Name leaseprint) PresidentTitle slu r' Secretary Treasurer Vice president with responsibility over the operation of the business SFRVFR Fnilr_ATfnki nVaimp FF fnlrawff^nr nn `.— fl Name leaseprint) Date of Birth Susan Herzog slu r' SIGNATURE (Directions on page 1) NAME of Signin on (please type pt) Michael Chamberlin 1011121 SIGNAFTURE of signing person (may electronically sign) DATE This box for OLCC use ONLY `. 2 Only for an applicant of record: SOS Numbar"t (� Current at time of issuing license (yeslno) Does the entity hold, or has it ever held, an OLCC-Issued liquor license? Rev: 10.7.20 wrrf r .. . Page 2 of 2 L J Attachment 1, Page 3 of 5 IS W 0 4GOtltrO. �Y: F U CORPORATE R i 1 N ^; Corporation or Foreign Corporation Name Elmer's Restaurants, Inc. Trade Name of Business (Name Customers Will See) Lucky Lizard LIST OFFICERS f please foltnw riirartinnn nn nnna 9 f eh. -4 % Title Name leaseprint) President (if required) Gerald A. Scott Secretary (if required) Mike Chamberlin Treasurer (fist only if have one) Vice president with responsibility over the operation of the business (list only if have one) J III Ramos LIST RnARn AF nIRFCTORS [Plaaca fnlFnw rlirartimm nr. r. -'I V— --A ... F. ......% Name leaseprint) Name lease rint William Service Brune Davis Rich Brooks Dick Williams LIST SHAREHOLDERS Please follow directions on pffie 1. You ma 1 include information on a separate street. Name leaseprint) Percentage of issued shares held SFRUFR FntiCATinm np-miam `F rPlcssea fnilnuu rurnrHnnc nn --i 41 Name leaseprint) Date of Birth Susan Herzog OFFICER'S SIGNATURE (Please follow directions on page 1) NAME of Signing Officer (please type or print) Niches! Chamberlin DATE 10/1/21 SIGNATURE of This box OLCO use ONLY yy c� k123(' Only for an applicant of record: SOS Number Current at the time of issuing the license (yea/no) Pte' Does the entity hold, or has It ever held, an OLCC-issued liquor license? 0 Page 2 of 2 14- l L L lT V 56) 11 �l Attachment 1, Page 4 of 5 OREGON LIQUOR CONTROL COMMISSION BUSINESS INFORMATION Please Print or Type Applicant Name: WC Operating Company, LLC Phone: 541-465-3966 Trade Name (dba): Lucky Lizard Business Location Address: 1979 Mohawk Blvd City: Springfield ZIP Code: 97477 Seasonal Variations: ❑ Yes 0 No If yes, explain: ❑ Live Music ❑ Recorded Music ❑ DJ Music ❑ Business Hours: Nude Entertainers Outdoor Area Hours: The outdoor area is used for: Sunday lam to 2.30em Sunday NIA to NIA ❑ Food service Hours: to Monday Ism to 2:30M Monday NIA to WA ❑ Alcohol sorvice Hours: to Tuesday lam to 2.30am Tuesday WA to WA Wednesday lam to 2aoam Wednesday WA to WA O Enclosed, how Thursday lam to 2302m Thursday WA tO WA The exterior area is adequately viewed and/or Friday Tem to 210am Mriday MA to NIA supervised by Service Permittees, Saturday lam to 2.10em Saturday NIA to NIA (Investigator's Initials) Seasonal Variations: ❑ Yes 0 No If yes, explain: ❑ Live Music ❑ Recorded Music ❑ DJ Music ❑ Dancing ❑ Nude Entertainers Check all that apply: ❑ Karaoke ❑ Coin-operated Games ❑ Video Lottery Machines ❑ Social Gaming ❑ Pool Tables ❑ Other: Restaurant: 8 Outdoor: Lounge: Other (explain): 6 video gaming Banquet: Total Seating: 14 Sunday NIA to WA Monday WA to NIA Tuesday NIA to NLA Wednesday NIA to WA Thursday NIA to WA Friday NIA to NIA Saturday NIA to NIA OLCC USE ONLY Invesilgatar Veriflad Seating _(V) JI) Investigator Initials: Li— Date: ( I— 4--t `Z I I understand if my answers are not tr a and anrrlpletehe t9 may deny my license a pii ation. Applicant Signature: Date: �� ✓ 9-600-452-OLCC (6522) WWW Oregon mov/oicc (rev. 77101) Attachment 1, Page 5 of 5