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Home My WebLink AboutItem 06 AIS ARCO ampm #7203 Liquor License AGENDA ITEM SUMMARY Meeting Date: 11/20/2023 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 BP PRODUCTS NORTH AMERICA INC., DBA: ARCO AMPM #7203. ACTION REQUESTED: Endorsement of OLCC Liquor License Application for ARCO ampm #7203, located at 4202 Main St. Springfield, OR 97478. ISSUE STATEMENT: The owner of BP Products North America Inc. has requested the City Council to endorse its OLCC Liquor License Application. ATTACHMENTS: 1: OLCC Liquor License Application. DISCUSSION/ FINANCIAL IMPACT: The license endorsement for BP Products North America Inc., DBA: ARCO ampm #7203 is for a Change of Ownership with Off Premises Sales. The license application has been reviewed and approved by the appropriate City Departments. OLCC Liquor License Application (Rev. LIQUOR LICENSEAPPLICATION WĂŐĞϭŽĨϰ Check the appropriate license request option: տ New Outlet | տ Change of Ownership | տ Greater Privilege | տ Additional Privilege Select the license type you are applying for. More information about all license types is available online. Full On-Premises տ Commercial տ Caterer տ Public Passenger Carrier տ Other Public Location տ For Profit Private Club տ Nonprofit Private Club Winery տ Primary location Additional locations:տ2nd տ3rd տ4th տ5th Brewery տ Primary location Additional locations:տ2nd տ3rd Brewery-Public House տ Primary location Additional locations:տ2nd տ3rd Grower Sales Privilege տ Primary location Additional locations:տ2nd տ3rd Distillery Primary location Additional tasting locations:;hƐĞƚŚĞ/^ddĨŽƌŵ,ZͿ տ Limited On-Premises Off Premises Warehouse WholesaleMalt BeverageandWine >K>'KsZEDEd USE ONLY >K>'KsZEDEd͗ ĨƚĞƌƉƌŽǀŝĚŝŶŐǇŽƵƌƌĞĐŽŵŵĞŶĚĂƚŝŽŶ͕ƌĞƚƵƌŶƚŚŝƐ ĂƉƉůŝĐĂƚŝŽŶƚŽƚŚĞĂƉƉůŝĐĂŶƚt/d,ƚŚĞ ƌĞĐŽŵŵĞŶĚĂƚŝŽŶŵĂƌŬĞĚďĞůŽǁ City KZ County name: Date application received: 2SWLRQDO'DWH6WDPS5HFHLYHG%HORZ տ Recommend this license be granted տ Recommend this license be denied տ EŽZĞĐŽŵŵĞŶĚĂƚŝŽŶͬEĞƵƚƌĂů DatePrinted Name dƌĂĚĞ Name 3OHDVHVSHFLI\FLW\25FRXQW\ ^ŝŐŶĂƚƵƌĞ QRWERWK ARCO ampm #7203 (SPRINGFIELD) City of Springfield Attachment 1, Page 1 of 7 LIQUOR LICENSE APPLICATION WĂŐĞϮŽĨϰ Please note: liquor license applications are public records. OLCC Liquor License Application (Rev. ) APPLICANT INFORMATION Identify the applicants applying for the license. This is the entity (example: corporation or LLC) or individual(s) applying for the license. Please add an additional page if more space is needed. Name of entity or individual applicant #1: Name of entity or individual applicant #2: Name of entity or individual applicant #3: Name of entity or individual applicant #4: BUSINESS INFORMATION Premises street address (The physical location of the business and where the liquor license will be posted): City: Zip Code: County: Business phone number: Business email: City: State: Zip Code: Does the business address currently have an OLCC liquor license? Yes No Does the business address currently have an OLCC marijuana license? Yes No AUTHORIZED REPRESENTATIVE – A liquor applicant or licensee may give a representative authorization to make changes to the license or application on behalf of the licensee or to receive information about a license or application. Representative Name: Phone number: Email: Mailing address: City: State: Zip Code: I give permission for the below named representative to: ܆Make changes regarding this license/application on my behalf. ܆^ŝŐŶĂƉƉůŝĐĂƚŝŽŶĨŽƌŵƐregarding this license/application on my behalf. ܆Receive information about the status of this application, including information about pending complianceaction or communications between OLCC and the licensee/applicant. 4MOUNTAINS,INC. Trade Name of the Business (name customers will see): ARCOAMPM#7203 4202 MAIN STREET SPRINGFIELD 97478 LANE 760-617-4511 eric@4-mountains.com Business mailing address (where we will send any items by mail as described in OAR 845-004-0065[1].): 2600JamesThorntonWay LouisvilleKY 40245 BP Products North America Inc JoyCriss 502-572-1217 joy.criss@bp.com 2600JamesThorntonWay LouisvilleKY40245 Attachment 1, Page 2 of 7 LIQUOR LICENSE APPLICATION WĂŐĞϯŽĨϰ OLCC Liquor License Application (Rev. ) APPLICATION CONTACT INFORMATON – Provide the point of contact for this application. If this individual is not an applicant or licensee, the Authorized Representative section must be filled in and the appropriate permission(s) must be selected. Application Contact Name: Phone number: Email: TERMS x “Real property” means the real estate (land) and generally whatever is erected or affixed to the land (for example, the building) at the business address. x “Common area” is a privately owned area where two or more parties (property tenants) have permission to use the area in common. Examples include the walking areas between stores at a shopping center, lobbies, hallways, patios, parking lots, etc. An area’s designation as a “common area” is typically identified in the lease or rental agreement. ATTESTATION – OWNERSHIP AND CONTROL OF THE BUSINESS AND PREMISES x Each applicant listed in the “Application Information” section of this form has read and understands OAR 845-005-0311 and attests that: 1. At least one applicant listed in the “Application Information” section of this form has the legal right to occupy and control the real property proposed to be licensed as shown by a property deed, lease, rental agreement, or similar document. 2. No person not listed as an applicant in the “Application Information” section of this form has an ownership interest in the business proposed to be licensed, unless the person qualifies to have that ownership interest waived under OAR 845-005-0311. 3. The licensed premises at the premises street address proposed to be licensed either: a. Does not include any common areas; or b. Does include one or more common areas; however, only the applicant(s) have the exclusive right to engage in alcohol sales and service in the area to be included as part of the licensed premises. x In this circumstance, the applicant(s) acknowledges responsibility for ensuring compliance with liquor laws within and in the immediate vicinity of the licensed premises, including in portions of the premises that are situated in “common areas” and that this requirement applies at all times, even when the business is closed. 4. The licensed premises at the premises street address either: a. Has no area on property controlled by a public entity (like a city, county, or state); or b. Has one or more areas on property controlled by a public entity (like a city, county, or state) and the public entity has given at least one of the applicant(s) permission to exercise the privileges of the license in the area. Eric LeVaughn Stubbert 760-617-4511 eric@4-mountains.com ARCOAMPM#7203 Attachment 1, Page 3 of 7 LIQUOR LICENSE APPLICATION WĂŐĞϰŽĨϰ OLCC Liquor License Application (Rev. ) x Each applicant listed in the “Application Information” section of this form has read and understands OAR 845-006-0362 and attests that: 1. Upon licensure, each licensee is responsible for the conduct of others on the licensed premises, including in outdoor areas. 2. The licensed premises will be controlled to promote public safety and prevent problems and violations, with particular emphasis on preventing minors from obtaining or consuming alcoholic beverages, preventing over-service of alcoholic beverages, preventing open containers of alcoholic beverages from leaving the licensed premises unless allowed by OLCC rules, and preventing noisy, disorderly, and unlawful activity on the licensed premises. 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. Print name Signature Date Atty. Bar Info (if applicable) Print name Signature Date Atty. Bar Info (if applicable) Print name Signature Date Atty. Bar Info (if applicable) Print name Signature Date Atty. Bar Info (if applicable) ARCOAMPM#7203 Eric LeVaughn Stubbert Eric LeVaughn Stubbert Digitally signed by Eric LeVaughn Stubbert Date: 2023.10.13 08:31:38 -07'00'10/13/2023 DonaldMartinez Attachment 1, Page 4 of 7 Rev: Page 2 of 2 Oregon Liquor &DQQDELV Commission CORPORATE QUESTIONNAIRE Corporation or Foreign Corporation Name _____________________________________________________________________________ Trade Name of Business (Name Customers Will See) __________________________________________________________ LIST OFFICERS (Please follow directions on page 1. You may include information on a separate sheet.) Title Name (please print) President (if required) Secretary (if required) Treasurer (list only if have one) Vice president with responsibility over the operation of the business (list only if have one) LIST BOARD OF DIRECTORS (Please follow directions on page 1. You may include information on a separate sheet.) Name (please print)Name (please print) LIST SHAREHOLDERS (Please follow directions on page 1. You may include information on a separate sheet.) Name (please print)Percentage of issued shares held SERVER EDUCATION DESIGNEE (Please follow directions on page 1) Name (please print)Date of Birth OFFICER’S SIGNATURE (Please follow directions on page 1) NAME of Signing Officer (please type or print) _______________________________________________________________ ____________________________________________________________________ DATE __________________________ SIGNATURE of signing officer (may electronically sign) This box OLCC use ONLY 'oes the entity hold, or has it ever held, an OLCC-issued liquor license? ____________________________________________ 4 MOUNTAINS, INC. ARCO ampm #7203 (SPRINGFIELD) Eric LeVaughn Stubbert Eric LeVaughn Stubbert N/A N/A Eric LeVaughn Stubbert Eric LeVaughn Stubbert 100% N/A OFF PREMISES APPLICATION Eric LeVaughn Stubbert Eric LeVaughn Stubbert Digitally signed by Eric LeVaughn Stubbert Date: 2023.10.13 08:09:40 -07'00'October 13, 2023 PRINT FORM RESET FORM Attachment 1, Page 5 of 7 OREGON LIQUOR & CANNABIS COMMISSION BUSINESS INFORMATION Please Print or Type Applicant Name:Phone: Trade Name (dba): Business Location Address: City:ZIP Code: DAYS AND HOURS OF OPERATION Business Hours: Outdoor Area Hours: The outdoor area is used for: Sunday to Monday to Tuesday to Wednesday to Thursday to Friday to Sunday to Monday to Tuesday to Wednesday to Thursday to Friday to Food service Hours: to Alcohol service Hours: to Enclosed, how The exterior area is adequately viewed and/or supervised by Service Permittees. Saturday to Saturday to (Investigator’s Initials) Seasonal Variations: Yes No If yes, explain: ENTERTAINMENT DAYS & HOURS OF LIVE OR DJ MUSIC *Minor Entertainers in an area prohibited to minorsQHHGSULRU DSSURYDOIURPWKH2/&& SEATING COUNT Restaurant: Banquet: Outdoor: Lounge: Other (explain):Total Seating: Live Music Recorded Music DJ Music Dancing Nude Dancing Live Entertainment Minor Entertainers hibited to minorsQHHGSULRU Karaoke Coin-operated Games Video Lottery Machines Social Gaming Pool Tables Other: Sunday Monday to to Tuesday to Wednesday to Thursday Friday Saturday to to to OLCC USE ONLY Investigator Verified Seating: (Y) (N) Investigator Initials: Date: I understand if my answers are not true and complete, the OLCC may deny my license application. Date:Applicant Signature: ________________________________________ _____________________ www.oregon.gov/olcc Rev: Check $//that apply: $5&2DPSPLVSODQQHGRSHQIRUKRXUGD\SHU\HDU 121( 4 MOUNTAINS, INC.(760) 617-4511 ARCO ampm #7203 (SPRINGFIELD) 4202 MAIN STREET SPRINGFIELD 97478 24 hrs open N/A 24 hrs open N/A N/A N/A N/A N/A 24 hrs open N/A N/A24 hrs open N/A 24 hrs open N/A 24 hrs open N/A 24 hrs open N/A NONE NONE NONE NONE NONE NONE NONE NONE 0 0 0 0 N/A 0 Eric LeVaughn Stubbert Digitally signed by Eric LeVaughn Stubbert Date: 2023.10.13 07:49:51 -07'00'OCTOBER 13, 2023 Attachment 1, Page 6 of 7 DocuSign Envelope ID: 15FA9AC2-6F4F-4549-8ED6-B2498EF4B0FB 10/20/2023 Attachment 1, Page 7 of 7