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Application For Private Club Locked Front Door LIC1005 - Arizona

Application For Private Club Locked Front Door Form. This is a Arizona form and can be used in Liquor Licenses And Control Statewide .
 Fillable pdf Last Modified 4/26/2011
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Arizona Department of Liquor Licenses and Control 800 W Washington 5th Floor Phoenix, AZ 85007-2934 www.azliquor.gov (602) 542-5141 APPLICATION FOR PRIVATE CLUB LOCKED FRONT DOOR 1. Club Name: __________________________________________________________ Club License Number: ________________________ 2. Club/License Location: ______________________________________________________________________________________________ 3. Agent's Name: ______________________________________________________________________________________________________ 4. Mailing Address: _____________________________________________________________________________________________________ 5. Business Phone: ____________________ Daytime Contact Number: _____________________Club Phone: _____________________ 6. Provide a complete explanation of the reasons for your request to lock your front door, including the security and safety concerns. (use reverse side of this form and additional sheets in needed.) 7. Local law enforcement authority has reviewed this application. Comments, if any, by the local enforcement agency may be made on the back of this form. X _____________________________________________________________________________________________________________________ (Authorized Law Enforcement Signature) (Title) (Agency) (Date) 8. When the premises is occupied, the Club hereby agrees to provide immediate access to law enforcement, fire fighters and emergency medical personnel. We understand that permission to lock the front door may be revoked by the Director should the club violate any of the Laws or Administrative Rules of the State of Arizona. I, (Print Full Name) ________________________________________________________, hereby declare that I am the APPLICANT filing this application. I have read the application and the contents and all statements are true, correct and complete. State ___________________County of __________________ The foregoing instrument was acknowledged before me this X ____________________________________________ (Signature) My Commission Expires on: ____________________ _________day of ___________________________, _________________ Day Month Year _____________________________________________________________ (Signature of Notary Public) 8/24/2015 Page 1 of 2 Individuals requiring ADA accommodations please call (602)542-9027 American LegalNet, Inc. www.FormsWorkFlow.com ARS. 4-228. A. FRONT ENTRANCE LOCK PROHIBITED; EXCEPTION B. C. EXCEPT AS PROVIDED IN THIS SECTION, AN ON-SALE LICENSEE SHALL NOT LOCK OR PERMIT TO BE LOCKED THE FRONT ENTR ANCE TO A LICENSED ESTABLISHMENT UNTIL ALL PERSONS OTHER THAN THE LICENSEE OR THE LICENSEE'S EMPLOYEES ON DUTY HAVE LEFT THE PREMISES. THIS SECTION DOES NOT PROHIBIT LOCKING THE PREMISES IMMEDIATELY AFTER THE CLOSING OF THE PREMISES IF AN EMPLOYEE AND ONE OTHER PERSON REMAIN ON THE PREMISES. IF THE HOLDER OF A CLUB LICENSE ISSUED PURSUANT TO SECTION 4-205 HAS BONA FIDE CONCERNS REGARDING THE SAFETY OF CLUB MEMBERS AND THEIR GUESTS, THE LICENSEE MAY APPLY TO THE DIRECTOR FOR PERMISSION TO LOCK THE FRONT ENTRANCE TO THE LICENSED ESTABLISHMENT. THE APPLICATION SHALL BE ON A FORM PRESCRIBED BY THE DIRECTOR AND SHALL INCLUDE A DESCRIPTION OF THE SAFETY CONCERNS. THE DIRECTOR SHALL DETERMINE IN THE DIRECTOR'S DISCRETION WHETHER TO GRANT PERMISSION TO LOCK THE FRONT ENTRANCE TO A CLUB LICENSE. THE DIRECTOR SHALL CONSIDER, AMONG OTHER FACTORS, THE SAFETY CONCERNS DOCUMENTED BY THE CLUB LICENSEE AND THE LOCATION, METHOD OF OPERATION AND REGULATORY HISTORY OF THE CLUB. FIRE FIGHTERS, LAW ENFORCEMENT OFFICERS, EMERGENCY MEDICAL PERSONNEL AND THE DIRECTOR SHALL HAVE IMMEDIATE ACCESS BY MEANS OF A MASTER KEY, MASTER CARD OR OTHER SIMILAR DEVICE TO THE LICENSED ESTABLISHMENT AT ALL TIMES THAT THE ESTABLISHMENT IS OCCUPIED. AT ANY TIME THE DIRECTOR MAY REVOKE PERMISSION TO LOCK THE FRONT ENTRANCE GRANTED PURSUANT TO THIS SECTION. 6a. Additional applicant explanation of request: 7a. Local Law enforcement agency comment: DLLC USE ONLY DIRECTOR APPROVES DISSAPROVES APPLICATION _______________________________________________ _________________ For private Club locked front door Signature Date 8/24/2015 Page 2 of 2 Individuals requiring ADA accommodations please call (602)542-9027 American LegalNet, Inc. www.FormsWorkFlow.com
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