HomeMy WebLinkAboutItem 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
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City KZ County name:
Date application received:
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տ Recommend this license be granted
տ Recommend this license be denied
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DatePrinted Name
dƌĂĚĞ Name
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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
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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