HomeMy WebLinkAboutItem 07 Endorsement of OLCC Liquor License- Get N Go GroceryAGENDA ITEM
SUMMARY Meeting Date: 1/18/2022
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 AND
CHANGE OF TRADE NAME FOR UNIQUE BUNGALOW INC DBA: GET N
GO GROCERY -5.
ACTION
Endorsement of OLCC Liquor License Application for Get N Go Grocery -5,
REQUESTED:
located at 30 E Street Springfield, OR 97477.
ISSUE
The owner of Unique Bungalow Inc has requested the City Council to endorse its
STATEMENT:
OLCC Liquor License Application.
ATTACHMENTS:
Attachment 1: OLCC Liquor License Application.
DISCUSSION/
The license endorsement for Unique Bungalow Inc, DBA: Get N Go Grocery -5 is
FINANCIAL
for a Change of Ownership and Change of Trade Name with Off -Premises Sales.
IMPACT:
The license application has been reviewed and approved by the appropriate City
Departments.
OREGON LIQUOR CONTROL COMMISSION PRINT FORM; Kime
LIQUOR LICENSE APPLICATION RESET FORM
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:
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 ONLY
Date application received: 11/29/21
Date application accepted: 11/29/21
License Action(s):
C/O, C/TN
2. Identify the applicant(s) applying for the license(s). ENTITY(example: corporation or LLC) orINDIVIDUAL(S)1
applying for the license(s):
UNIQUE BUNGALOW INC
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)
GET N GO GROCERY -5
4. Business Address (Number and Street Address of the Location that will have the liquor license)
30 E STREET
City County Zip Code
SPRINGFIELD LANE 97477
1 Read the instructions on page 1 carefully. If an entity is applying for the license, list the name of the entity as an applicant. If an
individual is applying as a sole proprietor (no entity), list the individual as an applicant.
OLCC Liquor License Application (Rev. 9.28.20)
Attachment 1, Page 1 of 3
License Applied For:
❑
Brewery 1St Location
Brewery Additional location (2"d) ❑
(3rd) ❑
❑
Brewery -Public House (BPH) 1St location
BPH Additional location (2"d) ❑ (3rd)
❑
❑
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) 1" location
GSP Additional location (2"d) ❑ (3rd)
❑
❑
Limited On -Premises
Z
Off -Premises
❑
Warehouse
❑
Wholesale Malt Beverage & Wine
❑
Winery 1St Location
Winery Additional location (2"d) ❑ (3rd)
(4th) ❑
❑
(5th) ❑
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 ONLY
Date application received: 11/29/21
Date application accepted: 11/29/21
License Action(s):
C/O, C/TN
2. Identify the applicant(s) applying for the license(s). ENTITY(example: corporation or LLC) orINDIVIDUAL(S)1
applying for the license(s):
UNIQUE BUNGALOW INC
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)
GET N GO GROCERY -5
4. Business Address (Number and Street Address of the Location that will have the liquor license)
30 E STREET
City County Zip Code
SPRINGFIELD LANE 97477
1 Read the instructions on page 1 carefully. If an entity is applying for the license, list the name of the entity as an applicant. If an
individual is applying as a sole proprietor (no entity), list the individual 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)
GET N GO GROCERY -5
6. Does the business address currently have an OLCC liquor license?
F71
VINJ
YES
1:1
NO
7. Does the business address currently have an OLCC marijuana license?
YES
NO
8. Mailing Address/PO 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(11.)
5306 OLYMPIC CIRCLE
City EUGENE
State OR
Zip Code97402
9. Phone Number of the Business Location
10. Email Contact for this Application and for the Business
541-726-8860
mnu_mandy@yahoo.com
11. Contact Person for this Application
Phone Number
MANDIP KAUR
541-214-4313
Contact Person's Mailing Address (if different)
City State
Zip Code
5306 OLYMPIC CIRCLE
EUGENE OR
97402
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 AND MAKE SURE YOU UNDERSTAND 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 OLCC as apart of
this application are true and complete.
I affirm that 1 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) Signature
• 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 applicant. Applicants are still responsible for all information on this
form.
MANDIP KAUR i
App. #1: (PRINT NAME) App #1: (SIGNATURE) App #1: Signature Date Atty. Bar Information (if applicable)
UPINDERJIT S. DHANJU 1112-2-1-11
App. #2: (PRINT NAME) App 2: (SIGNATURE) App #h Signakure bate 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 (Rev. 9.28.20)
Attachment 1, Page 2 of 3
?�Go�GO
°�DI�Cip OREGON LIQUOR• • • •
1M
BUSINESS INFORMATION
Please Print or Type
Applicant Name: UNIQUE BUNGALOW INC
Trade Name (dba): GET N GO GROCERY -5
Business Location Address: 30 E STREET
City: SPRINGFIELD, OR
Phone: 541-726-8860
ZIP Code: 97477
Seasonal Variations: ❑ Yes 0 No If yes, explain:
malgarglim
X
Kelagm
❑
Live Music
Business Hours:
Karaoke
Outdoor Area Hours:
The outdoor area is used for:
❑
Coin-operated Games
❑
DJ Music \ ❑
Video Lottery Machines
Sunday
7AM
to 11 PM
Sunday to
❑ Food service Hours/ to
Monday
7AM
to 11 PM
Monday
❑ Alcohol service s: to
Tuesday
Wednesday7AM
7AM
to 11 PM
to 11 PM
Tuesday to
Wednesday N/A � to
\\
❑ Enclosed, how r`,,
Thursday
7AM
to 11 PM
Thursday�_ to
The exterior area is adequately viewed and/or
Friday
7AM
to 11 PM
Friday ' to
supervised b)/Service Permittees.
Saturday
7AM
to 11 PM
Saturday to
(Investigator's Initials)
Seasonal Variations: ❑ Yes 0 No If yes, explain:
malgarglim
X
Check all that apply:
❑
Live Music
❑
Karaoke
❑
Recorded Music
❑
Coin-operated Games
❑
DJ Music \ ❑
Video Lottery Machines
❑
Dancing
❑
Social Gaming
❑
Nude Ente/ners
❑
Pool Tables
❑
Other: N/A
Restaurant: Outdoor:
Lounge: Other (explain):
Banquet: Total Seating:
Sunday
X
Monday
—�� to
Tuesday\'
to
Wednesday to
Thursday_
to
Friday
to
Saturday
to
OLCC USE ONLY
Investigator Verified Seating:_(Y) _(N)
Investigator
I understand if my answers are not true and complete, the OLCC may deny my license application.
Applicant Signature: /'_ C -6-- Date: 11/22/2021
1-800-452-OLCC (6522)
www.oregon.gov/okc (rev. 12/07)
Attachment 1, Page 3 of 3