Utah > Statewide > Department Of Alcoholic Beverage Control
Package Agency Contract Application - Utah
| Package Agency Contract Application Form. This is a Utah form and can be used in Department Of Alcoholic Beverage Control Statewide . |
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UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 South 900 West · PO Box 30408 · Salt Lake City UT 84130-0408 · (801) 977-6800 · Fax 977-6888 website: www.abc.utah.gov PACKAGE AGENCY CONTRACT APPLICATION CHECKLIST Dear Applicant: The items below should be completed and submitted by the 10th of the month or earlier, so that your application can be processed in a timely manner. All licensing requirements must be fully satisfied in order to complete your application. You will then be notified of the next monthly Utah Alcoholic Beverage Control Commission meeting when your application will be considered for the issuance of a package agency contract. We recommend that a representative attend the meeting. If the package agency contract is granted, you must meet with the DABC accounting office to finalize the contract. 1. 2. Completed application form (enclosed). Ownership entity organizational papers for business: a) if a corporation, submit a copy of the articles of incorporation; b) if a partnership, submit a copy of the written agreement; c) if a limited liability company, submit a copy of the articles of organization. Criminal history background check fingerprints, consent forms, and fees. See #10 on application. Copy of local business license. Note: Type 3 package agency applicants are not required to submit a business license. Local consent from either city/town council or county commission, whichever is applicable. (Form enclosed) For types 1,4,5 non-consignment inventory, please submit $1,000 cash or corporate surety bond (form enclosed). Certificate of public liability insurance. Scaled floor plan (8-1/2" x 11") of package agency, highlighting areas for delivery, storage and sale of liquor. $125 application fee (non-refundable). Make check payable to UDABC. Note: Applicants for a type 2 or type 3 must first call 801-977-6800 to be pre-authorized. Evidence of proximity to schools, churches, libraries, playgrounds, and/or parks (600'). See #19 on application. 3. 4. 5. 6. 7. 8. 9. 10. Enclosed for your information are copies of statutes and rules pertaining to package agencies, as well as a list of factors considered in the evaluation of contract applications. If you have questions, contact the licensing and compliance section at (801) 977-6800. Effective July 1, 2011 v.11.2 page 1 of 34 American LegalNet, Inc. www.FormsWorkFlow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL APPLICATION FOR PACKAGE AGENCY CONTRACT 1. Please indicate the type(s) package agency you are applying for: [ ] *Type 1 Located in a Hotel, ski lodge, summer recreational area, or other resort environment to serve the general public and guests. In conjunction with another business where the primary source of income to the operator is not from the sale of liquor (e.g. small grocery stores in rural communities). Not in conjunction with another business, but is for the sole purpose of selling liquor. Located in a facility for the purpose of selling and delivering liquor to tenants or occupants of specific rooms which have been leased, rented, or licensed within the same facility, and is not open to the general public (e.g. hotel room service or private suites at sports arenas. Located within a winery, brewery, or distillery licensed by the commission. [ ] *Type 2 [ ] *Type 3 [ ] *Type 4 [ ] *Type 5 2. Name of Business: _________________________________________________________________ 3. Applicant/Owner of business: ________________________________________________________ 4. Agency location: __________________________________________________________________ Street City State Zip 5. Mailing Address: __________________________________________________________________ Street City State Zip 6. Agency Phone:_________________________ Other Phone: _______________________________ 7. Name/Title of package agent: _______________________________________________________ Phone: ____________________ Fax: ____________________ E-mail: __________________________ 8. Owner of real property & building. ____________________________________________________ Effective July 1, 2011 v.11.2 page 2 of 34 American LegalNet, Inc. www.FormsWorkFlow.com 9. Ownership: Check appropriate box and provide the requested information in the space below. (add additional sheets if necessary) [] Applicant is an individual: List below information for: (a) Individual (b) All Managers (a) All Partners (b) All Managers (a) Any Stockholder owning at least 20% of the corporation (b) All Corporate officers and Directors (c) All Managers (a) Any members owning at least 20% of the company (b) All Managers [] Applicant is a partnership: List below information for: [] Applicant is a corporation: List below information for: [] Applicant is a limited liability company (LLC): List below information for: TITLE____________NAME___________________HOME ADDRESS_______________________________________ HOME PHONE#______________DR LIC#_______________SS#______________DOB__________%OWNED______ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE____________NAME___________________HOME ADDRESS_______________________________________ HOME PHONE#_______________DR LIC#_______________SS#______________DOB__________%OWNED_____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE____________NAME___________________HOME ADDRESS_______________________________________ HOME PHONE#_______________DR LIC#_______________SS#______________DOB__________%OWNED_____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. 10. Criminal History. The law prohibits persons who have been convicted of certain crimes from being in the alcoholic beverage business. This applies to any applicant, proprietor, partner, managing agent, director, of officer of the business. This also applies to any stockholder owning at least 20% of the corporation stock, or if a limited liability company, any member owning at least 20% of the company. Please list all criminal offenses other than minor traffic offenses of which you or any of these persons (including persons listed in paragraph 9) have ever been convicted. NAME CRIMINAL OFFENSE DATE OF CONVICTION In addition, a criminal history background check must be furnished on each person listed above and in paragraph 9. This may be done as follows: Effective July 1, 2011 v.11.2 page 3 of 34 American LegalNet, Inc. www.FormsWorkFlow.com a. Utah residents: If
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