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Home My WebLink AboutItem 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