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HomeMy WebLinkAboutD-2411-18 Recording Committments from Costas Restaurant Group, LLCSPONSOR: Councillor Kimball ORDINANCE NO. D-2411-18 AN ORDINANCE OF THE COMMON COUNCIL OF THE CITY OF CARMEL, INDIANA, RECORDING THE COMMITMENTS OF COSTAS RESTAURANT GROUP, LLC MADE PURSUANT TO OBTAINING A THREE-WAY ALCOHOLIC BEVERAGE PERMIT Synopsis: This ordinance records the commitments made by Costas Restaurant Group, LLC that are required by the City in order to obtain one of the three-way alcoholic beverage permits authorized by Indiana Code § 7.1-3-20-16.8. WHEREAS, the City of Carmel ("City") adopted Ordinance D-2288-16, which requires applicants for a three-way alcoholic beverage permit authorized by Indiana Code § 7.1-3-20-16.8 (the "Permit") to make certain commitments to the City regarding the project as a condition precedent to obtaining said Permit from the Indiana Alcohol and Tobacco Commission; and WHEREAS, Costas Restaurant Group, LLC ("Applicant") is applying for a Permit and makes the required commitments to the City as set forth in Exhibit A, which is attached hereto and incorporated herein by this reference (the "Commitments"); and WHEREAS, pursuant to Carmel City Code § 6-228(d), the Mayor has reviewed the Commitments and materials submitted by the Applicant and recommends that the Council accept them as submitted. NOW, THEREFORE, the Common Council ordains and states as follows: Section 1. The foregoing Recitals are fully incorporated herein by this reference. Section 2. In accordance with Carmel City Code § 6-228, the Carmel Common Council hereby accepts the Commitments as set forth in Exhibit A regarding Costas Restaurant Group LLC's application for a three-way alcoholic beverage permit issued by the Indiana Alcohol and Tobacco Commission pursuant to Indiana Code § 7.1-3-20-16.8. Section 3. These commitments may only be modified with the approval of the Carmel Common Council. Section 4. This Ordinance shall be in full force and effect from and after its passage and signing by the Mayor. Ordinance D-2411-18 Page One of Two This Ordinance was originally prepared by Jon A. Oberlander, Carmel Senior Assistant City Attorney, on 01/22/18 at 12:03 p.m. It may have been subsequently revised. However, no subsequent revision to this Ordinance has been reviewed by Mr. Oberlander for legal sufficiency or otherwise. SPONSOR: Councillor Kimball PASSED by a Common Council of the City of Carmel, Indiana, this/—!Lday ofz�luY, 2018, by a vote of ayes and 10 nays. N UNCIL FOR THE CITY OF CARMEL Kevin D. Rider, President rrell, Vice -President Laura D. Campbell H. Bruce Kimball ` *h Presented by me to the Mayor of the City o Carme , 1 a this d 2018, at 1, oo Christine S. Pauley, Olery-Treasurer Approved by me, Mayor of the Cit of C el, Indiana, thi,2� d�f a 2018, at M. es Brainard, Mayor A'f TE 4 Stine S. PaulK, Clerk -Treasurer Ordinance D-2411-18 Page Two of Two Pages This Ordinance was originally prepared by Jon A. Oberlander, Carmel Senior Assistant City Attorney, on 01/22/18 at 12:03 p.m. It may have been subsequently revised. However, no subsequent revision to this Ordinance has been reviewed by Mr. Oberlander for legal sufficiency or otherwise. WRITTEN COMMITMENT BY COSTAS RESTAURANT GROUP, LLC, IN FURTHERANCE OF ITS REQUEST TO OBTAIN A THREE WAY BEVERAGE PERMIT IN THE CITY OF CARMEL, INDIANA, PURSUANT TO ORDINANCE NO. D-2288-16. Costas Restaurant Group, LLC ("CRG") by its principals Jon Costas and Evan Costas, make the following written commitment as required under Carmel City Ordinance No. D- 2288-16. 1. Company. CRG is an Indiana limited liability company that currently owns and operates four restaurants in Indiana. The company is owned by father/son team, Jon and Evan Costas. Its primary financial office is located at 402 Wall Street, Suite 31, Valparaiso, IN 46383. 2. Office. CRG has leased the building located at 89 First Avenue, SW, Carmel, Indiana 46032, for the location of its fourth "Burgerhaus" restaurant. This location is in the Arts and Design District for the City of Carmel. See Appendix A. 3. Theme. Burgerhaus is a small business adventure of father son team, Jon and Evan Costas from Valparaiso, Indiana. Their quest was to take a great American tradition – the hamburger—and make it international. Burgerhaus brings the exotic flavors from around the globe to your Hoosier community. Our desire is that each visit by a guest is more than a meal, but an exploration of the finest USDA prince beef combined with zesty natural ingredients from far away places. Unique appetizers, creative salads, "Haus Specials", craft beer, fine wines and premium cocktails provide tasty destinations for the entire family. Our motto is our quest, to serve "The Finest in the Known World". In addition to feeding Hoosiers, Burgerhaus strives to be a responsible global citizen. In 2014 we began a partnership with Kids Alive, International we call "Full Belly Full Heart". For every burger sold, we provide a balanced meal to a hungry child in dire third world poverty. We have provided over a half a million meals so far and hope to soon reach 1,000,000 meals provided in the next several years. 4. Nature and Type of Dining. Our new Carmel location is a full service restaurant that will seat approximately 106 patrons. Attached, as Appendix B and C, are copies of our current menu as well as the design layout of the Carmel restaurant, currently being built - out. Burgerhaus will be open daily from 11 am to approximately 1 I pm. 5. Applicant's Business Experience. Jon Costas has been a small business owner for almost 40 years. He and his son Evan entered into the restaurant industry in 2010 when they opened a Le Peep franchise in Valparaiso. In 2012, they established the Burgerhaus concept in Valparaiso. Since then they have added locations in Indianapolis (on the canal at 9" street) (2013) and in Schererville (2015). 6. Benefits to the City of Carmel. CRG currently employs 120 team members. We anticipate hiring approximately 30-40 new employees for this location, with an estimated IMIDR 1errIZ annual payroll of $550,000. The restaurant is located in a beautiful newly refurnished building and will feature high quality furnishings and d6cor. In addition to the complete restoration of this building by the owner, Burgerhaus is investing an additional $950,000 in build out and equipment in the premises. Burgerhaus will offer a spacious outdoor dining experience in front of its building along First Avenue. The building and interior will reinforce the quality brand that Carmel residents have come to expect. Moreover, Burgerhaus is not a chain, but a family owned business that prides itself on civic involvement. We look forward to being very engaged in the Carmel community. Finally, we anticipate that this Burgerhaus will provide approximately 60,000 meals per year for children in third world poverty throughout our partnership with Kids Alive International. 7. Agreements. The applicant agrees that the permit, if issued shall not be transferred from the premises for which it is issued or from the Permit holder to whom it is issued. The applicant agrees that all of the terms set forth in this commitment shall be binding upon the Permit applicant, the Permit holder, and each and every lessee and/or proprietor of the permitted premises. The applicant agrees that it and every lessor of the permitted premises shall remain open to the public a minimum of six (6) days and thirty (30) hours per week, and that table and /or counter wait staff shall be available at all such times. The applicant agrees that if issued the Permit it will forward both to the council and the mayor a copy of any application to renew such Permit, as well as provide the same with timely notice of any filings, hearings, or other proceedings regarding or pertaining to such Permit renewal application. 8. ATC Application. Attached, as Appendix D is the completed Indiana ATC application, State Form 51189, which will be submitted to the ATC upon approval by the City of Carmel of this application. ALL OF WHICH IS AGREED TO AND AFFIRMED BY COSTAS RESTAURANT GROUP, LLC. Costas Restaurant Group, LLC By its Owners: Date: /Z//�-ZJ) 7 J4-Costd Evan Costas Date: /,Z 1'1� -2 0 �- "EXHIBIT Z � lZ, ' I • ' a �-" udbugs Cajura-Cafe -a +-- elTlntematio "al � : Mai W Main E �,r i Pizza (Carme) - ' eace Water Wine r r--r---K— ...... '-...:: i Jo'e s Butch�r�ShoP i 4 ` and Fish Market Donatello's Italian � `f •f y t a 1! e .� �► : , . r. r W 'Southwest P-1 Av , 1 stStSW 1st St SW 1st St _. ^.� �. ,,. 3D a A. The Great Frame Up �- - Google FRESH GREENS Add grilled dteken sucas.'avocado to salads fro, , $3 each Add Ah, Tuna for an additional s5. THE VALPARAISI II The fountain of youth from the vale of paradise. Mixed greens topped with Bartlett pears. fennel, ondred walnuts. crarsmn, blue cheese crumbles & champagne vusargnette TEX-1E1 TACT SALAD 14 An edible jalapefw cheddar tortilla shell filled with mixed greens and topped with marinated carne asacia steak. shredded cheddar cheese, fresh lalapeho. our Haus-made guacamole, refried black beans. pito de gallo. green onions and Gnashed with our lalapeno sour cream THE SANTORINI 10 Fresh mixed greens. kalamata olives. thinly sliced red onions. pepperoncmis, tomatoes, cucumbers. Feta crumbles & crispy pita chips with a creamy feta dressing. THE GREENLAND 9 Iceberg lettuce wedge with Applewood smoked bacon. tomatoes. cheddar cheese. green onions. Haus croutons & ranch dressing. THE RDRA RDRA II Mixed greens with black beans. corn, onions. tomatoes, roasted red peppers, topped with guacamole & tortilla chips Served with a side of chipotle ranch dressing THE SRANGNAI 15 Sliced seared tuna served rare on a bed of mixed Asian greens, oranges, snap peas, red peppers fuhenned cucumbers & crispy wontons. with a toasted sesame vma;grette dressing. DRESSINGS: • balsamic vinaigrette • creamy feta • toasted sesame vinaigrette • ranch • blue cheese • champagne vinaigrette chiootle ranch HAUS SPECIALS Served wiM your cho ce c Haus fines, side sakid or southwest coleslaw Upgrade to any premium side for an add hood V TAIPEI CNICKEN LETTUCE WRAP 12 Five butter lettuce leaves served with marinated grilled chicken. crunchy veggies Is cilantro. ready for you to wrap' Topped with a sweet & spicy sauce GALAPAGIS FISH TACOS 14 Three cam tortillas with blackened -seasoned. grilled fish, citrus slaw. pito de gallo & a refreshing avocado aioh. 5A,t, a crock- o, ,ceas to �� ema cnxea BRISTOL FISH A CHIPS IS Lightly hand -battered crispy fish. Served with french fries or you can substitute for coleslaw, a side salad or upgrade to any of our specialty Haus Imes MEDITERRANEAN PORTOBEILO II Balsamic galled mushroom cap with Brie cheese. baby spinach. caramebzed onions & garlic mayo on a brioche bun. NAPOLI CHICKEN SANDWICH 12 Grilled chicken breast, spinach tomato. pesto & fresh mozzarella. Served on tomato foacua bread THE MARKET STREET GRILLED CHEESE IB Two slices of tomato, white cheedar. Amencan cheese. 5 verb cream cheese. Served on buttered sourdough FULL BELLY, FULL HEART 1 raddition to feeding Hoosiers, Burgerhaus strives to be a responsible global citizen. In 2014 we, began a partnership with Kids Alive, International we call "Full Belly Full Heart'. For every burger sold, we provide a balanced meal to a hungry child in dire third world poverty. We have provided over S00,000 meals so far and hope to soon reach 1,000,0)0 with your help. 171 yM% -WELCOME TO• BUAGEANAUS © © a INDIANAPOLIS. IN SCHERERVILLE.IN VISITBURGERHAUS COM VALPARAISO,IN CARMEL IN IFX" �I*DT_A_ - - V oir I 'L 4-PP>v�vD rV 9- Z B'x BURGERHAUS THE FINEiST IIN THE KNOWN WORLD EXPLORATIONS NEW ORLEANS PICKLE CHIPS 8.5 Tempura fried pickles, served with our own zesty peppercorn ranch BUFFALO SHRIMP 12 Eight succu ent shrimp that are seasoned in our Haus blend of spices. deep fried and tossed in buffalo sauce Served over mixed greens with a side of ranch. CASTROVILLE PARMESAN ARTICHOKE DIP 9 The heartiest & freshest available. Served with crispy tortilla chips. BELFAST ONION RINGS 8.5 They're golden & deliciousl Served with Haus-made savory remoulade. LA PUEBLA CHIPS & GUACAMOLE 9 Haus-made creamy guacamole bursting with flavor. Served with our own crispy corn chips. ABRUZZO BRUSCHETTA 8.5 Fresh mozzarella. basil, tomato & garlic layered on four toasted slices of French bread & topped with a drizzle of balsamic reduction. CAIRO HUMMUS PLATTER B Haus-made hummus served with soft pita chips & a stack of fresh veggies. Topped with a drizzle of roasted pepper aioh. POINT LOMA CARNE ASADA FRIES 12 We top our Haus fries with melted cheddar, marinated carne asada steak, our Haus-made guacamole. falapeno sour cream. pito de gallo and cilantro. SIDES MACHU PICCHU CHILI 416 Served with sour cream, cheese & chives MAC 'N CHEESE 4 TODAY'S HAUS SOUP 3 15 SIDE SALAD 4 SPECIALTY HAUS FRIES Serves two or more • SWEET POTATO (made with cinnamon sugar) $6 SPICY BLUE CHEESE (seasoned with Togarashi) S7 GARLIC PARMESAN TRUFFLE OIL 57 CAJUN 55 MACHU PICCHU CHILI CHEESE S7 SOFT DRINKS, ICED TEA & COFFEE Coca-Cola products 52.79 Premium Flavored ¢ed tea (Monin syrup) S3 MILKSHAKES The world s best ice cream to make the worlds most delicious shakes. Chocolate, vanilla & strawberry! Burgerhaus is a small business adventure of father son team, Jon and Evan Costas from Valparaiso, Indiana. Their quest was to take a great American tradition - the hamburger - and make it international Burgerhaus brings the exotic flavors from around the globe to your Hoosier community Our desire is that your visit here is more than a meal. but an exploration of the Finest USDA Prime beef combined with z natural ingredients from far away places (ktioue appetizers. creative salads -Haus Specials-. craft beer and fine wines provide tasty destinations for the entire family. Thank you for being our guest today. -¢M. tad %rozz &do GOURMET BURGERS All of our certified USDA Prime burgers come with a choice of Haus Fries, southwest coleslaw, or side salad. Upgrade to any premium side for an additional $2 THE HAUS Our classiccreation served on a brioche bun with butter lettuce. tomato onions & your choice of cheese • Cheddar. American, chipotle Monterey. or Swiss • Add 51.50 for fresh mozzarella. Gouda, feta, blue. Brie or goat cheese • Make it a double beef patty for an additional $4 • Substitute a portobello mushroom cap. grilled chicken breast. ground turkey patty, or a vegetarian black bean patty - no charge • Add bacon for an additional 51.50 THE AUSSIE A combo of thick Applewood smoked bacon. Gouda cheese. a fried egg, mayo. butter lettuce & beefsteak tomato. Served on a whole wheat bun. Good on ya, mate' THE MONACO 13 Cheddarcheese, sauteed onions & mushrooms. avocado. arugula & fine wine mayo. Elegant & vintage, served on a pretzel bun. THE TUSCAN 12 Fresh mozzarella, beefsteak tomato, thinly sliced red onion, fresh basil baby spinach, garlic mayo & flavored with a balsamic reduction. Served on a brioche bun. Buon appetitol THE SANTIAGO 14 Jetset to a sensational mix of chipotle Monterey, avocado. tomato. butter lettuce. chipotle mayo & fried jalapenos on a pretzel bun. THE COZUMEL Island grilled pineapple. guacamole. American cheese. onions. jalapenos, mayo, butter lettuce & beefsteak tomato served on a whole wheat bun. THE BATON ROUGE 15 Our take on the Jambalaya burger is served on a brioche bun with butter lettuce. andouille sausage, shrimp, cheddar cheese. a Haus-made cajun creole topping. spicy remoulade and topped with crispy onions THE AMERICAN 14 Hardwood Applewood smoked bacon. blue cheese. caramelized onions. mayonnaise. mustard, butter lettuce & beefsteak tomato on a whole wheat bun U -S -AI U -S -AI THE VIENNA Bacon. beer -braised onions, bacon jam, swiss cheese. arugula & mayo- Served on a brioche bun. THE BOZEMAN I Savory seven -ounce turkey patty topped with chipotle mayo. roasted red pepper. avocado, butter lettuce & chipotle Monterey cheese Served on a pretzel bun. THE KYOTO Six tounces of sushi grade AN tuna balanced with yuzu-kosho mayo. spinach. & honey -citrus soy -sesame vinaigrette. Served on a brioche bun. Chef recommends at medium -rare. • RARE - es red center • MED RARE warm red center • MED p " o fine • MED WELL - °: :.­.,...�• -,f mnk • WELL DONE 4 Burgerhaus proudly serves only USDA Prime beef, the finest and most Flavorful beef available. Consuming raw or undercooked meats. poultryseafoodeggs. or unpasteurized milk may increase your risk of food home dines /fi Ppe-?v /) i4- C- N EQUIPMENT PLAN BURGERHAUS 0 ah Wn s s=n OA■M AY. W +�■ �•aco®a. c 891stAnnt�eSW�� Ili ass�nK• mo.srrno•, . a�..w na p. �nw Ni ro)ro.■ti an��w.■m -_ _ _-_ Cam�ei, Indimw�6032 �A-. 'EXHIBIT 6 oCt?- APPLICATION FOR NEW OR TRANSFER PERMIT State Form 51189 (R5 / 2-17) •v � Approved by State Board of Accounts, 2017 INSTRUCTIONS: 1. Type or print legibly. 2. Include payment. 3. Do not complete shaded areas. 4. Marl to the address at the end of this application form. 5. If there is no opening for this applied permit or there is an omission, this application will be returned. 6. Please attach a completed Property Tax Clearance — Form 1, if applicable, which can be found at t, : 24V_ . 7. Please attach a copy of your Registered Retail Merchant Certificate from Indiana Department of Revenue. 8. Please attach a cofro*ted County Verification of Business Location form. if applicable, which can be found at hr cc;/atc/2409.htm This agency is requesting your Social Security Number in accordance with IC 4-1-8-1; disclosure is mandatory, and this record cannot be processed without it. STEP 1: GENERAL INFORMATION This permit type will allow you to sell. This permit type is for Type of application Beer On -premise consumption (Retailer) ErNew application Wine ❑ Off -premise consumption (Dealer) ❑ Transfer owner Liquor ❑ Other (Specify) Transfer location Please briefly describe your business that qualifies you for this permit type Permit number (Required for transfers.) Resywvra n f- This ownership entity s: (Check one) ❑ Sole Owner ❑ Limited Partnership ❑ Municipality ❑ Simple Partnership ❑ Limited Liability Partnership ❑ Club Association ❑ Corporation Limited Liability Company ❑ Club Corporation Business entity making this application Telephone number of applicant COs tai Rts�►drwrf t (9r^s vP , LAG ( z/9 ) Y6 y- gar/ Doing business as (DBA) 6v.'yCrhor of Restcrv/'u rs Location where alcoholic beverages will be dispensed (number and street) ,/� 3 L 8% `iRft 4venve St,) . Carwne6 r 7 City/ Town State ZIP code E-mail adcress Telephone number of premises evq,r G tris/tbv/'yC/'haNS • �orlij General Questions Part 1 HAA7f/ /-d &1 1. The proposed premises is located in what county? 2. Is the proposed permit premises located inside the corporate limits of a city / town? ® Yes ❑ No 3. If yes, please name the incorporated city / town. o r C 4. If no, please name the unincorporated community which has been known by that name for more than ten (10) years. (This is only required for a beer or a beer and wine application.) 5. Is there at least 200 feet between this premise and any church or school? 15Yes ❑ No 6. If no, have you obtained a written statement from the church or school pursuant to IC 7.1-3-21-11(c)(1)? If es, please attach statement. Yes No Business address, it different than premises address Check here to use business address as mailing address: Name Costwl eeS-t rfV1-a rj f 671. J v o LLC Address (number and street, city, state, and ZIP code) Str�st Svlf� !/"1/purc,rro yd3�3 General Questions Part 2 1. Do you understand that you must have a Federal Identification number? PfYes ❑ No 2. Do any individuals, corporations, limited liability companies, limited liability partnerships, or stock owners, members, or partners of such entities have any interest, either directly or ❑ Yes 9 No indirectly, in any distiller, vintner, farm winery, rectifier, brewer, primary source of supply, or wholesaler permit? 3. As owner, do you manage the premise? Yes ❑ No It no, please complete Step 6, Manager's Questionnaire. FOR OFFICE USE ONLY Dale received (mm/dd/yy) Permit number Permit type Ouota check Jurisdiction Checked by Base fee receipt number Balance due Refund Catering receipt number Balance due Refund Date reviewed (mmIddryy) Hearing date of Local Board (mm/dd/yy) Commission approved Permit issued Date of expiration (mmrddryy) Permit released Remarks "EXHIBIT • `7dir 12T General Questions Part 2 (continued) 4. Do you sell tobacco products? ❑ Yes KNo If yes, please provide the Tobacco Sales Certificate number. 5. Do you know that an Excise Officer may enter, inspect, and search your permit premise without a warrant or other process to determine if you are complying with the provisions gYes ❑ No of the Indiana alcoholic beverage laws I rules? 6. Do you have the right to possess (rent, lease, mortgage, or own) the permit premise for g(Yes ❑ No the term of the permit? STEP 2: ANNUAL FOOD SALES FOR EXISTING BUSINESSES ONLY" For the following permits: Type 209 (except golf courses); All retail permits with less than sixty percent (60%) ownership by Indiana residents; Retail permits with limited bar I family room separation. Date of begmr ing report (month, day. year) Date of ending report (month, day, year) Gross food sales (For retail permits, exclude carryout and catering sales.) B Gross alcoholic beverage salesI C. Total gross sales (column A + B) (For convenience stores exclude gasoline and automotive oil products.) STEP 3: QUALIFICATIONS SOLE OWNER I PARTNERSHIP PERMIT: If applying as a sole owner or partnership for any type of permit, answer the following question: Are you now and have you been a continuous and bona fide resident of this state for five (5) years? 21 Yes ❑ No CORPORATION PERMIT: (PLEASE ATTACH COPY OF 'CERTIFICATE OF EXISTENCE' FROM THE INDIANA SECRETARY OF STATE.) If applying as a corporation for a retailer's permit, answer the following questions: Is at least sixty percent (60%) of the outstanding common stock owned by persons who have been continuous and bona fide residents of this State for five (5) years? (For exceptions, see IC 7.1-3-21-6.) ❑ Yes ❑ No If you meet an exception in IC 7.1-3-21-6, please list and continue to the questions pertaining to all individuals having an interest in this permit Is the applicant a retailer corporation with forty-one percent (41 %) or more of the common stock held by out of state stockholders? ❑ Yes ❑ No If yes, you must agree to and initial below. I hereby affirm that the annual gross food sales at the permit location currently exceed one hundred thousand dollars ($100,000) or in the case of a new applicant are expected to exceed two hundred thousand dollars ($200,000) by the end of the two (2) year period commencing on the date of issuance of the permit and will, thereafter, exceed one hundred thousand dollars ($100,000) per annum. Initial If applying as a corporation for a package liquor store, answer the following questions: Is at least sixty percent (60%) of the outstanding stock in the corporation owned by persons who have been continuous and bona fide residents of Indiana for five (5) years; and ❑ Yes ❑ No Does the stock described in the previous question constitute a controlling interest in the corporation? ❑ Yes ❑ No LLC I LLP PERMIT: (PLEASE ATTACH COPY OF 'CERTIFICATE OF EXISTENCE' FROM THE INDIANA SECRETARY OF STATE) If applying as a limited partnership, limited liability company, or limited liability partnership for a retailer's permit, answer the following questions: Is at least sixty percent (60%) of the ownership interest held by persons who have been continuous and bona fide residents of this State for five (5) years? (For exceptions, see IC 7.1-3-21-6.) 2rYes ❑ No If you meet an exception in IC 7.1-3-21-6, please list and continue to the questions pertaining to all individuals having an interest in this permit Is the applicant a retailer limited partnership, limited liability company, or limited liability partnership applying with forty-one percent (41%) or more of the ownership interest held by out of state residents? ❑ Yes PTNo If yes, you must agree to and initial below I hereby affirm that the annual gross food sales at the permit location currently exceed one hundred thousand dollars ($100,000) or in the case of a new applicant are expected to exceed two hundred thousand dollars ($200,000) by the end of the two (2) year period commencing on the date of issuance of the permit and will, thereafter, exceed one hundred thousand dollars ($100,000) per annum. Initial If applying as a limited partnership, limited liability company, or limited liability partnership for a package liquor store, answer the following questions. Is at least sixty percent (60%) of the partnership interest or sixty percent (60%) of the outstanding membership interest in the limited liability company owned by persons who have been continuous and bona fide residents of Indiana for five (5) years; and ❑ Yes ❑ No Does the partnership or membership interest described in the previous question constitute a controlling interest in the limited partnership, limited liability company, or limited liability partnership? ❑ Yes ❑ No A --- ao-(iz THE FOLLOWING QUESTIONS PERTAIN TO ALL INDIVIDUALS HAVING AN INTEREST IN THIS APPLICATION. Complete name NOTE: 'Individuals' referred to in all questions in the below section include LLCs, LI-Ps, corporations, partnerships, and all other business structures recognized under Indiana law as well as a natural person where applicable. Citizen of United States Have any individuals with an interest in this permit been convicted of a felony or a misdemeanor? ❑ Yes ff No (If yes, please attach letter with dates, court, conviction, and sentence.) aYes ❑ No Have any individuals with an interest in this application ever been convicted of, or found to have committed a violation of. 7,1107- SO✓GCef1 / rj ve (far /pNr017J */I the Indiana Alcoholic Beverage laws, rules, regulations, or orders of the ATC? ❑ Yes PI�No (ff yes, please attach an explanation, including permit number(s).) Are all individuals with an interest in this application citizens of the United States? �,/ {+y Yes ❑ No Are all individuals with an interest in this application of sound mind, good moral character, and good repute 9Yes ❑ No in the community in which they reside? Percent of ownership Sa �/u Are any individuals with an interest in this application a law enforcement officer, or an officer of a municipal corporation, ❑ Yes K No or govemment subdivision, of this state charged with any duty or function in the enforcement of Indiana Code Title 7.1? Social Security number ' Have any individuals with an interest in this application held a permit under this title and had the permit been revoked Citizen of United States within one (1) year prior to the date of this application? ❑ Yes 91 No (if yes, please provide the permit number(s) and an explanation.) ❑ Yes ❑ No Have any individuals with an interest in this application made an application for a permit of any type which was denied less than �./ one (1) year prior to this application for a permit (unless the application was denied by reason of a procedural or technical defect)? ❑ Yes Q9 No Do any individuals, corporations, limited liability companies, limited liability partnerships, partnerships, or stock owners, members, or Complete name partners of such entities have any interest, either directly or indirectly, in any other permits or endorsements of any kind issued under 14 Yes ❑ No Indiana Code Title 7.1 connected with, but not limited to, the production, distribution, transportation, or sale of alcoholic beverages? If yes, list permits below. (Attach additional sheet if necessary.) Permit numberys) X4 4 y3/34-7, AO Roe y930AI Zci ,CA ys33219 , �t,p�g3 yg3 Address (number and street, city, state, and ZIP code) Are you indebted to a person or an officer or agent of that person, who holds a brewers permit or wholesale permit, for a debt, Percent of ownership secured by a lien, mortgage, or otherwise upon the premises for which the beer retailers permit is to be applicable or upon any YNo of the property or fixtures in the premises, or used, or to be used in connection with the premises? ❑ Yes STEP 4. AFFIDAVIT OF OWNERSHIP Complete name Social Secur ry r•umber Date of birth (month, day, year) Citizen of United States # Jo n a th v e7 (01 5-7 aYes ❑ No Address (number and street, city, state, and ZIP code) 7,1107- SO✓GCef1 / rj ve (far /pNr017J */I Nature of interest Percent of ownership 1-50 yo ❑ Sole Owner ❑ Corporate President ❑ Stockholder B Partner ❑ Corporate Secretary ❑ Club Officer Complete name sodwnumbw Dale of birth (month, day, yeso Citizen of United Stales Eva•, A leraerder Cos tatf os/z2- /5k7 D(es ON. Address (number and street, city, state, and ZIP code) V7 Y PAXL OV.Il j4 if 140/awaas E i'6.3�r3 Nature of interest Percent of ownership Sa �/u ❑ Sole Owner ❑ Corporate President ❑ Stockholder MVartner ❑ Corporate Secretary ❑ Club Officer Complete name Social Security number ' Date of birth (month, day, year) Citizen of United States ❑ Yes ❑ No Address (number and street. city. state, and ZIP Code) Nature of interest Percef-of ownership ❑ Sole Owner ❑ Corporate President ❑ Stockholder ❑ Partner ❑ Corporate Secretary ❑ Club Officer Complete name Social Security number' Date of birth (month, day year) Citizen of United States ❑ Yes ❑ No Address (number and street, city, state, and ZIP code) Nature of interest Percent of ownership ❑ Sole Owner ❑ Corporate President ❑ Stockholder ❑ Partner ❑ Corporate Secretary ❑ Club Officer If you need more space, please attach additional sheets. "EXHIBIT_ A q0-rIZ STEP 5. PERMIT TYPE SPECIFIC QUESTIONS_ _ You must meet specific requirements to hold certain types of permits. Please answer only the following questions that are applicable to your permit application. LIQUOR RETAILER Is the proposed permit premise located in an incorporated city having a population of less than 5,000? ❑ Yes ❑ No If the answer is yes, have you attached to the application the enabling ordinance from the city consenting to the issuance of liquor retailers permits? ❑ Yes ❑ No CATERING HALL Are you applying for a special three-way catering hall permit that will allow you to sell alcoholic beverages for on -premises consumption only on a premises that is used only for private catered events and has accommodations for at least 250 individuals? ❑ Yes ❑ No CLUBS If you are applying for a club permit, please check the appropriate box ❑ Social Club ❑ Fraternal Club If a social club. does your association or organization meet the general requirements of IC 7.1-3-20-1? ❑ Yes ❑ No If a fratemal club. does your association or corporation meet the general requirements of IC 7.1-3-20-1 and the specific requirements of IC 7.1-3-20-7? ❑ Yes ❑ No If your club permit premises is outside the corporate limits, do you meet the requirements of IC 7.1-3-20-3? ❑ Yes ❑ No HOTELIf you are applying as a hotel, do you meet the general requirements of IC 7.1-3-20-18? ❑ Yes ❑ No HISTORIC DISTRICT If you are applying for an historic district permit, is the restaurant located in a district that is on the National Register of Historic Places ❑ Yes ❑ No that includes a county courthouse, a historic opera house, and a historic jail and sheriffs house pursuant to IC 7.1-3-20-16(g)? If yes, you must submit the appropriate verification, including a district map identifying the location of your restaurant, an approval letter from a city or town represertative that indicates whether the city or town adopted an ordinance that requires a written commitment pursuant to IC 7.1-3-19-17. and a copy of the ordinance creating the district. If the city or town ordinance requires a written commitment, you must also submit a copy of the written commitment. AIRPORT, REDEVELOPMENT, RIVERFRONT, RAILWAY STATION, CULTURAL CENTER, SPEEDWAY, LAKE FRONT If you are applying for a permit authorized by IC 7.1-3-20-16 or IC 7.1-3-20-16.8, do you meet the requirements for the designated permit? ❑ Yes ❑ No Specify the type of permit for which you are applying. NOTE: If you are applying for a municipal riverfront development permit (IC 7.1-3-20-16(d) and IC 7.1-3-20-16.1) or a lakefront development permit. motorsports development permit IC 7,1-3-20-16(k) or (1)), or redevelopment permit (IC 7.1-3-20-16.8), you must also submit a letter indicating that the statutory requirements have been met and the mayor's approval of the permit, a map of the district identifying the premises location, and a copy of the ordinance creating the district if you are applying for a permit in a publicly owned airport (IC 7.1-3-20-16(b)), union railway station (IC 7.1-3-20-16(c)). railway station (IC 7.1-3- 20-16(e)), cultural center (IC 7.1-3-20-16(0). or redevelopment district (iC 7.1-3-20-16(h) and (i)), please submit supporting documentation showing that your premises is located in a district that meets the qualification of the section authorizing the permit. If you are applying for a lakefront district permit pursuant to IC 7 1-3-20-16U) and tC 7.1-3-20-16-2, please submit a map of the district identifying the location of your restaurant. detailed information concerning the expenditures of the state, local. and federal funds on the municipal lakefront development project. and a copy of the local ordinance or resolution authorizing the municipal lakefront development project. DRUG STORE If you are the proprietor of a drug store, do you hold a valid permit issued by the State Board of Pharmacy? ❑ Yes ❑ No NOTE: You must designate on your floor plan the pharmacy area that has been submitted and approved by the State Board of Pharmacy. Permit number of pharmacy Date of issuance (month, day. year) Date of expiration (month. day. year) RIVERBOAT Are you applying for a riverboat I excursion permit and do you currently hold a valid riverboat owner's license issued by the Indiana Gaming Commission? ❑ Yes ❑ No License number of riverboat owner Date of issuance (month, day, year) Date of expiration (month, day, year) Are you applying for an adjacent landsite permit? ❑ Yes ❑ No HORSE TRACK Are you applying for a horse track permit and do you currently hold a valid recognized meeting permit issued by the Indiana Gaming Commission? ❑ Yes ❑ No Permit number of recognized meeting Date of issuance (month, day, year) Date of expiration (month, day, year) Are you applying for a satellite permit? ❑ Yes ❑ No License number n` satellite facility Date of issuance (month, day, year) Date of expiration (month. day, year) cr _ A, . 10 ari2 STEP 5. PERMIT TYPE SPECIFIC QUESTIONS (continued) BOAT (SEASONAL) _ If you are applying for a boat permit, do you engage in regular passenger service which makes regular runs ❑ Yes ❑ No in seasonal weather between established locations? BEER WHOLESALER Do you have available for investment capital and cash or property necessary and useful in your business, exclusively as a ,Yes ❑ No beer wholesaler, of at least $15,000 (exclusive of motor vehicles), and do you agree that you will, if the application is granted, Yes ❑ No actually make the investment and submit proof to the Commission before you engage in business as a beer wholesaler? ❑ Yes ❑ No BREWER ff I certify that the projected number of barrels of beer to be manufactured during the permit year will not exceed 90,000 barrels. 7K Yes ❑ No (A barrel equals thirty-one (3 1) gallons ) (Small Brewer) ❑ Yes ❑ No 1 certify that the projected number of barrels of beer to be manufactured during the permit year will exceed 90,000 barrels. t!rNo (A barrel equals thirty-one (31) gallons.) (Brewer) ❑ Yes ❑ No If a small brewer, do you own or lease a building separate from the brewery premises that is used to store and ❑ Yes ff No condition beer pursuant to IC 7.1-3-2-7(5)(K)? ❑ Yes ❑ No VINTER I DISTILLERY I FARM WINERY ❑ Yes 5 Check if you qualify and are applying for one of the following permits. ❑ Vintner (IC 7.1-3-12-1) ❑ Distiller (IC 7.1-3-7-2) ❑ Farm Winery (IC 7.1-3-12-3) MlYes ❑ No ❑ Artisan Distiller (IC 7.1-3-27-2) ❑ Farm Winery Brandy Distiller (IC 7.1-3-7.5-2) `Yes ❑ No BOND REQUIREMENTS ❑ Yes Cg�No The following applicants are required to file with this application the appropriate non -revocable surety bond, made payable to the State of Indiana. (Check the appropriate bond amount, if applicable.) If yes, list permit numbers (Attach additional sheet, if necessary) ❑ Brewer ($10,000) ❑ Liquor Wholesaler ($10,000) ❑ Vintner (excludes farm winery) ($10.000) Have you been convicted of a felony? ❑ Distiller ($10,000) ❑ Rectifier ($10,000) If yes. attach places and dates of arrest, court of record, and conviction and attach relevant court record(s). MICROWINE WHOLESALER Have you been found in violation of the Indiana alcoholic beverage laws, rules, regulations, or orders of the Commission? I certify that the annual projected number of gallons of wine and brandy sold will not exceed twelve thousand (12,000) gallons ❑ Yes ❑ No STEP 6. MANAGER'S QUESTIONAIRE Name of manager (last. first, middle initial) Social Security number ' Cos��r ecy4 _ Date of birth (month, day, year) Employee permit number of manager (month, day. year) 7Da,.feration O's-, /7 z /9 9�2 A11,1 Home address (number and street, city, state, and ZIP code) 1/79' a r /- i4 Ile r7 4f e V41 P(LiYrJ J I- /V Are you a citizen of the United States? ,Yes ❑ No Are you at least twenty-one (21) years old? Yes ❑ No Is of true that you are not an officer or employee of a person engaged in: Yes ❑ No The alcoholic beverage traffic, which person is a non-resident of this state: or ff The carrying on of any phase of manufacture of, traffic in. or transportation of alcoholic 7K Yes ❑ No beverages without a permit under this title when one is required by this title? Are you a law enforcement officer, or a non -elected officer of a municipal corporation or government subdivision t!rNo charged with any duty or function in the enforcement of Alcoholic Beverage Laws? ❑ Yes Has an alcoholic beverage permit held by you been revoked within one (1) year prior to the date of this application for a permit? ❑ Yes ff No Have you made an application for a permit of any type which has been denied less than one (1) year prior to this application 'Nci for a permit (unless the application was denied by a reason of a procedural or technical defect)? ❑ Yes 5 (If yes, please attach an explanation.) Are you now. and have you been for the last five (5) years a continuous and bona fide resident of the State of Indiana? MlYes ❑ No If no, does the permit premise you are managing have a minimum annual gross food sales of at least $100,000? `Yes ❑ No Do you hold a permit of any kind for the sale of alcoholic beverages in Indiana, or do you have any ❑ Yes Cg�No interest in any such permit, directly or indirectly. through ownership of stock or otherwise? If yes, list permit numbers (Attach additional sheet, if necessary) Have you been convicted of a felony? ❑ Yes No If yes. attach places and dates of arrest, court of record, and conviction and attach relevant court record(s). Have you been found in violation of the Indiana alcoholic beverage laws, rules, regulations, or orders of the Commission? ❑ Yes '�rNo If yes, explain on a separate attachment. Signatures of manager referred to in this schedule 'f%Ci-f!�1T �� biz STEP 7. FLOOR PLAN INSTRUCTIONS: Applicant must submit four (4) drawings on letter size paper (8%"x l 1). These drawings must show dimensions and identifications of any existing family room(s). seating arrangement(s), ballroom(s), service bar(s), dance floor area(s), kitchen area(s), restrooms, storage and office areas, exits, and alcoholic beverage display areas for all types of permits- Ptease sign and date each drawing. If a restaurant or a restaurant located in a hotel or motel, will anyone under the age of twenty-one (21) be guests to the permit premises? K Yes ❑ No If the answer to the above question is 'yes," there must be COMPLETE SEPARATION of the barroom from the room or rooms where individuals under the age of twenty-one (21) will be present Yes ZN. Are you requesting approval for limited separation? ❑ Yes NOTE: All drawings must be approved by the Commission before the permit is issued. We recommend you receive approval before construction begins. Contact your local excise district office. Contact information for local excise district offices can be found at htty.1/in qov/atc/isep/2379.htm. (Please attach all drawings to this application ) STEP 8. AFFIRMATION OF APPLICANT 1 certify that this application was completed by myself or by the preparer identified herein I certfy that I have read this completed document and that all information provided herein and on any attachments is true and correct. I UNDERSTAND THAT IT IS A FELONY TO MISREPRESENT OR FALSIFY ANY PORTION OF THIS APPLICATION OR ATTACHED DOCUMENTS. I hereby consent for the duration of the permit term to inspection and search by an enforcement officer, without a warrant or other process, of my licensed premises, any approved satellite facility, approved storage facility, and vehicles to determine compliance with the provision of Indiana Code 7.1. Note: The applicant MUST s gn this application unless the proper Power of Attorney forms are attached to this application. Signature of applicant A j Date sign (9m th, day. year) D Printed rame of applicant Title of applicant C1/,1d 4 COST/�J MlnoSfr, CiJh►� <J�iv�u�tt ts�v1/0 LSC. STEP 9. SIGNATURE OF PREPARER if applicable I certify that I have examined this application and the accompanying documents, and to the best of my knowledge and belief, they are true, correct, and complete t tat the applicant reviewed the completed form prior to signing. Signature of Date sign d (mon , day, year) (See attached fee schedule.) INDIANA ALCOHOL AND TOBACCO COMMISSION Printed rrarne of preparer Telephone number Evq� R ins t� Zig) 2y 2- STEP 10. FEES Please remit business check, certified check, or money order - MAIL COMPLETED APPLICATION, PAYMENT, AND application will not be processed without payment. SUPPORTING DOCUMENTS TO: (See attached fee schedule.) INDIANA ALCOHOL AND TOBACCO COMMISSION 302 West Washington Street, Room E114 Checks should be made payable to the Indiana Alcohol and Indianapolis, IN 46204 Tobacco Commission. For additional information: www.IN.gov/atc or (317) 232-2430