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HomeMy WebLinkAbout2011 - LCB Application DBRR-ABT-6001----Division-of-Alcoholic-Beverages-and Tobacco Application for New Alcoholic Beverage License and Tobacco Permit STATE OF FLORIDA DBPR Form DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6001 Revised 0912010 NOTE—This form must be submitted as part of an application packet If you have any questions or need assistance in completing this application,please contact the i Department of Business and Professional Regulation or your focal district office. Please submit your completed application to your local district office. This application may be submitted by mail,through appointment,or it can be dropped off. A District Office Address and Contact Information Sheet can be found on AB&T's page of the DBPR web site at the link provided below. http:lfwww.mvi;orida.comfdbcriabi,'district of icesllicensina.html `!t .33..3tl-i;)'r-.`;.[�_t; . SECT ON,i Ci ECK=LiICEpp_��SE CATEGORY' y. ' ;. ._ ,- >k.� ..vµ: - i• '0,License Series Requested Type/Class Requested Do you wish to purchase a Temporary License? a en ( tgi Yes ❑ No Child License Requested Number of Child Licenses Requested f 1 /X Retail Alcoholic Beverages ❑ Alcoholic Beverage Manufacturer l I 0 Beer/Wine/Liquor ❑ Retail Tobacco Products(must check one or more of the below) i1 +i Wholesaler DPipes Only ❑Over the Counter ❑Vending Machine !t ,L 3 ❑ Passenger Waiting Lounge c.=117.:44.7.3 -a;__c psra:?:::,rsx tea.::, s?-gym„.,„-- .. r. `.�o-sm i s * 1414:`%.3::-x .:4,: ga sE01'0 2qL10EA►SEI F,ORAflATIOtV f a us it If the applicant is a corporation or other legal entity,enter the name and the document number as registered i with the Flbrida Department of State Division of Corporations on the line below. t Full Name of Applicant:(This is the name the license will b issued in) Department of State Document# '' - -1l.' '.1_ ,ter,g:rti•1-4..u.a o if t-.3„C b 1 00000- ' ci Business Name(D/B!A) I j + i•s i :74(lc, rpli0©CC,5 ae3i-4 f r� �'`-t,flSLL2i\cdi'tw P..0.1-63;t 4n+ /.indtc f KiVa(Sica-CC-M. t . FEIN Number �1 Business Telephone Number I G^r-. i` -:��r..j rtts.) I 45 'o)`i4�c-:�1 '77a- Ct?8-e"7ia7 Location Address(Street and Number) 16 40 1-fle,ctrl iva/D r. 'ij City v t • County State Zip.Code F xl� rnrz ►11dtari t�+r�2y' FL �Ya4„>$ Check either: Location is within the city limits or❑ Location is in the unincorporated county l Contact Person I Telephone Number 1 bu i a �1rlAt.ts 1777-q,e-87 ,ext. { E-Mail Address t II 11 Mailing Address,(Street of P.O.Box) •...9 City - 1 State I Zip Code `' ABT District Office Recer,:yecD lM.®f&�@ • . At 1G .3 2011 WEST PALM BEACH DISTRICT LICENSING Auth.61A-1.023&61A•6.056,FAC 1 r i • - SECTION 3—RELATED PARTY PERSONAL INFORMATION —is This section must be completed for each person directly connected with the business, unless they are-a-current-licence. . _ 1. Business Name(D/B/A) _ I.� air }:l.,leis l< y�a5_ ;rrl /+:t ' ~ e ��' tl � tCLr � .ten �Z c I Social S:, •+ L ..r ' ; Home Tel=....- ,'tuber 1 Date of Bi.I . • = Weight Eye Color i Hair Color 3. Are you a U.S.citiz-n. . [Yes 0 No If no,immigration card number or passport number Home Address Street and Number • � - -. s .... , fl5. Do you currently own or have an interest in any business selling alco o is beverages, w o esale•} cigarette or tobacco products,or a bottle club? ❑Yes • -Na • If es, srovide the information re. ested below. The location address should include the ci and state. Business Name(D/B/A) license Number Location.Address • ' 6. Have you had any type of alcoholic beverage;or bottle club license, or cigarette, or tobacco permit refused,rev ked or suspended anywhere in the past 15 years? !, . i [J Yes 0-No If: .es-. .rov.ide the information r-•uested below.'The location address should include the ci and state. Business Name(D/B/A) Date Location Address 7. Have you been convicted of a felony within the past 15 years? ❑Yes fa No If yes, provide the information"requested below and provide a Copy of the Arrest-Disposition, as r-.uested in the A..lication Re.uirements checklist. Date Location ; Type of Offense ` 8. Have you been cony led of an offense involving alcoholic beverages anywhere within the past 51 years? ❑yeso If yes; provide the information requested below and provide a Copy of the Arrest Disposition, as,. requested in the A..ication R-.uirements checklist. - i' Date Location. Type of Offense - • , • I i { • _ Autr1.61A-1.0238 61A-5.056,FAC 2 • 9. Have you been arrested or issued a n ice to appear in any state of the United States or its territories —,-within-the-past 15-years-?—':]-Yes g.No 1 If es,provide the information k Y requested below and a Copy of the Arrest Disposition. Attach additional sheet if necessary. Date 1 Location Type of Offense 10_- I j Are you an'gfficial N with State police powers granted by the Florida Legislature? [T Yes [�7o NOTARIZATION STATEMENT .. . . "I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791,562.45 and 837.06, Florida Statutes, that I have fully disclosed any and all parties financially and or contractually interested in this business and that the parties are disclosed in the Disclosure of Interested Parties of this application. I further swear or affirm that the foregoing information is true and correct." STATE OF (.-. • ■ COUNTY OF In eIG AR,v(t - 0. ..= , T SIGNATURE The foregoing was(V).Sworn to and Subscribed OR( )Acknowledged Before me this I -2.4S Day r of ,20__,By }3frllge �� {1 N c�,nE. fl stn t who is( )personally (print name of rson making statement) - 1. E known to me OR(lerwho prodw-=°-- reu ,t n e. as identification. I f ' 40 Notary Publc,'State at Florida i w• ccmn'rganti DD943ss 'n"`-`" ^�;�' - - •. ,:,1>=> ion Expires: - i 2-5.3 I 9 , ota Public , _-__-_- --- • rY (ATTACH ADDITIONAL COPIES AS NECESSARY) • II I ! 'Social Security Number Under the Federal Privacy Act.disclosure of Social Security numbers is voluntary unless a Federal statute specifically requires it or allows states to collect the number. In this instance,disclosure of social security numbers is mandatory pursuant to Title.42 United States Code,Sections 653 and1654;and - sections 409.2577,409.2598,and 55939,Florida Statutes. Social Security Numbers are used to allow efficient screening of applicants and licensees by a Title IV-D.child support agency to-assure compliance with child support obligations. Social Security numbers must also.be recorded on all,professional and occupational license applications and are used for licensee identification pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of 1996(Welfare Reform Act), 104 Pub.L193, Sec.317. The State of Florida is authorized-to collect the social security number of licensees pursuant to the Social Security Act,42 U.S.C.405(c)(2)(C)(I). This information'is used to identify licensees for tax administration purposes. • III Auth.61A-1.023&61A-5.056,FAC 3 - . 1 SECTION 3-RELATED PARTY PERSONAL INFORMATION This section must be completed for each person directly cont nected.with the business, unless they 1: j-are_a-eurrent licensee. <<:cw is MO Mira'," l 1 .r1-7.....%/ . 1. Business f {f k6�1.n ` :=4.1 „ 4_ -^ems': tr'.F•` fi^ �5 i.e.-MI�_t4 nSt' s�'t ._.t. �5 2. Full Name of tndividu ;---) ` rnc3rtzt�� • ! c�J5A,n1 Social Securi Nu bed Home Tele.hone Number Date.1:'+i ■ . - Race Se H i t Wei t .Eye br Hair Col j 3. Are you uaa U.S.citizenn.. !Yes Cl No - if no,immigration card number or passport number ; • 4. Home Address(Street and umber). � I City - • • 5. Do you currently own or have an interest in any business selling alcoholic beverages, wholesale '• garette or cco products,or a-bottle dub? s Yes No �° if yes..provide the information requested below. The location address should include the city and state. i ' Business Name(018/A) Ltcense.:Number ; ` Location Address 6. •Have you had arty type of alcoholic beverage, or bottle club license, or cigarette,or tobacco'permit refused,revoked or suspended anywhere in the past 15 years? ❑ Yes __evoked If yes,provide the information requested below. The location address should include the city and state. Business Name(D/B/A) Date Location Address 7. .Have you been convicted of a felony within the'past 15 years? 0 Yes No• I� I If yes, provide the information requested below and provide a Copy'of the Arrest.Disposition, assI requested In the Application Requirements Checklist. _. Date Location :l Type.of Offense • i , 8. Have you been connvict.ed of an offense involving alcoholic,beverages anywhere.within;the past 5 r years? ❑Yes I d-No If yes, provide the information requested below and provide a Copy of the Arrest Disposition, as ; •!. requested in the Application.Requirements checklist. Date Location Type of Offense. • , Auth.61A-t.023&61A-5.0.56,PAC 2 I . I 1 • 9. Have you been arrested or issued a notice to appear in any state of the United States or its territories _Within-the-past-35-years-?Q yes—EiThilo If yes,provide the information requested below and a Copy of the Arrest Disposition. Attach additional sheet if necessary. Date Location �- • Type of Offense 10. Are you a�n� o� cial with State police powers granted by the Florida Legislature? ❑Yes C.No NOTARIZATION STATEMENT • 't swear under oath or affirmation under penalty of perjury_as provided for in Sections 559.791,562.45 and • 837.06, Florida Statutes, that I have fully disclosed any and all parties financially and or contractually interested in this business and that the parties are disclosed in the Disclosure of Interested Parties of this application. I further swear or affirm that the foregoing information is true and correct.' STATE OF ���G^r- G COUNTY OFD yvi km Pt l,y !';r,4- . APPLICANT SIGNATURE The foregoing was( )Sworn to and Subscribed OR(-1-Acknowledged Day Before me this .ofA c t� S7°•,20` (( ,t3ySC/ (f k1 re 4d.re-t-.r3 who is( )personally (print name of person making statement) known to me OR(y-ovllo produced '- t as identification. • _ REBECCA J ACOSTA Commission Exp M1_ atAt, _ Notary Public.state of stria+ It ` lotarylPublic a y Ceram.Expires A u g ;OS f (ATTACH ADDITIONAL COPIES AS NECESSARY) 'Social Security Number Under the Federal Privacy Act,disclosure of Social Security numbers is voluntary unless a Federal statute specifically requires it or allows states to collect the number. In this instance,disclosure of social security numbers is mandatory pursuant to Title 42 United States Code,Sections 653 and 654;and sections 409.2577,409.2598.and 559.79,Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child support agency to assure compliance with child support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and are used for licensee identification pursuant to the•Personal Responsibility and Work Opportunity Reconciliation Act of 1996(Welfare Reform Act),104 Pub.L.193, Sec.317. The State of Florida is authorized to collect the social security number of licensees pursuant to the Social Security Act,42 U.S.C.405(c)(2)(C)(I). This information is used to identify licensees for tax administration purposes. Auth.61A-1.023&61A-5.056,FAC 3 • • ti • ,-• : ;:SEC;liON,3--RELATED PARTY.-PERSONAL INFORMATION. :section-must he completed for eacti.person directly,connected with•the business •unless they', a're acnrrent licensee;.._,$' - —=i; - . 1. Business Name(D/B/A) ` Fisherman Landing Restaurant'" ! . Full Name of Individual : Debra Jean McManus . . • Social Security Number' Home Telephone Number .Date of Birth i • �.--ter. ......-.._. .... ...-- I , Race Sex Height Weight Eye Color Hair Color • • 3. i u a U.S.citizen? - . 0 Yes ❑ No If no,Immigration card number or passport number. • 4. H Street and Number) State de • 5. Do you currently own or have an interest in any business selling alcoholic beverages, wholesale cigarette or tobacco products,or a bottle dub? ❑Yes ® No • If yes,provide the information requested below. The location address should include the city and state. Business Name(018/A) License Number Location Address 6. Have you had any type of alcoholic beverage, or bottle dub license,or cigarette,or tobacco permit refused,revoked or suspended anywhere in the past 15 years? ❑ Yes 0 No I� If yes,provide the information requested below. The location address should include the city and stale. Business Name(0/5(A) I Date • Location Address I •, 7. Have you been convicted of a felony within the past 15 years? ❑Yes ®No I' If yes, provide the information requested below and provide a Copy of the Arrest Disposi'bon, as requested in the Application Requirements checklist. f. i Date Location Type of Offense 8. Have you been convicted of an offense involving alcoholic beverages anywhere within the past 5 years? ❑Yes No if yes, provide the information requested below-and provide a Copy of-the Arrest Disposition,as - • • requested in the Application Requirements checklist. j Date Location Type of Offense ' Auth 61A-t.023&63A-6.056,FAC 2 • t 9. Have you been arrested or issued a notice to appear in any state of the United States or its territories I: within the past 15 years? ❑Yes 0 No 4 ye vide the information requested below and a Copy of the Arrest Disposition. Attach additional sheet if necessary. - Date Location Type of Offense t _ _ '110. Are you an official with State police powers granted by the Florida Legislature? ®Yes No :NOTARIZATION STATEMENT • ' - °i swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791,562.45 and 1 • • 837.06, Florida Statutes, that I have fully disclosed any and all parties.financially and or contractually interested in this business and that the.parties are disclosed in the Disclosure of Interested Parties of thisi' application. I further swear or affirm that the foregoing information is true and correct" .$ STATE OFF�G r,.4 COUNTY oFj7 £.'C IC (2d/1 ,end /Y//42 � APPLfCAPfT t1A�URE I I The foregoing was 2 3^fig ng ( }Sworn to and OR( )Acknowledged Before me this sL �.7 Day E ! of U ! ,20 1 B i LA. ' Ce e, �1 Y e 44 / kfA9`Vg who is( )personally f! • (print name.of person.making statement) fi known to me OR rho roduced _ t ) . - • as identification. , • ,¢ $ ► AYte J.l ESPEHAArCCt :id b fib% 6ti�5tateattaorida 666���"°" r:;g Comro+sslG831aSion. xpires: ,���.t�� Note Pu.•' `Yco Fria-e esMarCh25,2015 1, (ATTACH ADDITIONAL COPIES AS NECESSARY) `Social Security Number Under the Federal Privacy Act,disclosure of Social.Security numbers is voluntary unless a Federal statute specifically requires it or allows states to collect the number. In this instance.disclosure of social security numbers is mandatory pursuant to Title 42 United Stales Code,.Sections 653 and 654;and sections 409.2577,409.2598,.and 559.79,Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title 1V-D child support agency to assure compliance with child support obligations. Social.Security numbers must also.be recorded.on all professional and occupational license applications and are used for•licensee identification pursuantto the Personal Responsibility and Work Opportunity RecdnciGation Act of 1996(Welfare Reform Act).t04 Pub.1.193, Sec.317..The.State of Florida is authorised to collect the social security number of licensees pursuant to the Social Security Act,42 U.S.C.405(c)(2)(C)(I). This information is used.to identify licensees for tax administration purposes. • Auth.61A-1.023&61A-5.056,FAC 3 0 k i - i - 3 i . . . . . 4. .. ;...: .2.: SECTION 4-DESCRiP:riON OF PREMISES TO BE LICENSED • •• • . • a' ' -'- ''';'. TO:BE-COMpLETED-ST:THE-APPLICAN •' — • Business Name(D/13/A}{-7* J. , - _4(42,-yis_64c1 ._ .'",„.. I.; ' • At': .iii-ACI Yes EJ I No 0 Is the proposed premises -vable or able to be moved? 2.— Yes 0 I No E Is there any access through the premises to any area over which you do • [ not have dominion and control? 3. Neatly draw a floor plan of the premises in ink,including sidewalks and other outside areas which are contiguous to the premises,walls,doors,counters,sales areas,storage areas,restrooms,bar , locations and any other specific areas which are part of the premises sought to be licensed. A multi-story budding where the entire building is to be licensed must show each floor plan. .. I r • — _ ___ 5 rck-e-u-66K g,01,•_,...,„, 1 . , •(,s,,,,..s,' - -±-i---:-4--i vs)-1— --. 1 ,,,*1 . _,-....0• - .. ---- R I'e r 1 ` .A '' ''' i ty • e ,... ! . 1 -,-.,- 1 j 1 I; f/ ' IL-A1--) 1 ..\ _______- It • - , • I . 4e6Ac\-4) cti2v'V' . . ‘De-&k-.1 l'C) • ---1 i .1 - ..) ' . -.•,. ■• I1 _ _ • . • -.----..„ -1,.. -, ■\:> - • ;` • 1 Auth.61A-1.023 S.61A-5.056,FAC 4 I . ' . 1 • - SECTION 5—APPLICATION APPROVALS • -FtttIFName-of Ao-olican1'iThisis the name a license IMO be issued in). r } : y^`i 511E-reAci-^c51• rYL\,lcj -Q=S -.i cinV 1)--c E;ZC ictf1 e:;itv ,.s9(�'.0CI l(lc Business Name(D/B/A) J p�� r�: � Fisherman's Landing Restaurant i 4r1t 4_rt '�'Ly� •1zt�'cac.j Street Address ; j 1540 Indian River Drive s City County State Zip Code ---. - _. Indian River FL 32958 I ZONING :.. I' ,i •:TO BE COMPLETED-BY THE ZONING AUTHORITY GOVERNING YOUR:BUSINESS LOCATION A. The location complies with zoning requirements.for the.sale of alcoholic beverages or wholesale 1 tobacco products pursuant'to this application for a Series aopP license. B, This approval includes outside areas which are contiguous to the premises whiglyare to be part of the premises sou..t to be It ensed and-are identified on the sketch?" ❑ Yes lX'I No II: Signed ii!J�/,'rd -, Date 11�• // f Title ��•'rvt 4 _ e-t, //1:U J ' /- j1 l: •SALES TAX TO-BE COMPLETED BY THE DEPARTMENT OF REVENUE I I The named applicant for a license/permit has complied with the Florida Statutes concerning registration for i Sales and Use Tax. ii n •I 1. This is to verify that the current owner as named in this application has filed all returns and that all outstanding billings and returns appear to have been paid through the period ending -7/3,/-Ao•• - ;i or the liability has been acknowledged and agreed to be paid by the applicant. This verificatiofi does not constitute a certificate as contained in Section 212.10(1),F.S,(Notapplicable if no transfer involved). 2. Furthermore,the named applicant for an Alcoholic Beverage License has complied with Florida Statutes iI concerning registration for Sales and Use Tax,and has paid any applicable taxes due. • - i I Signed !./.- --- .�/- ��•u� f�!;i ate r/vg 54 1 r � i Title % `1 1 (�, i- Department of Revenue Staiepi `/ cT? r s= •i NOD -'• ;7 W Mfr f.r¢'^ • HEALTH • - _ . 1• !-• TO-BE-COMPLETED BY THE DIVISION•OF HOTELSAND RESTAURANTS -. f OR COUNTY HEALTH AUTHORITY 1' OR DEPARTMENT OF HEALTH �, . •- OR DEPARTMENT OF AGRICULTURE&CONSUMER SERVICES. i The above establishmen complies with the requirements of the Florida Sanitary Code. Signed Date Zr"'iq•1 t 3, /► j• t iI ITitle 5ar,.'E*ti-u, ctrt+� ScA-&1 Specmit31 Agency � Zcc c%, �$ rzan-C 1• •1 I • Auth.S1A-1.023&61A-s.056,FAC 5 : • — SECTION 8-SPECIAL LICENSE REQUIREMENTS • i -DESNOT-A—FO Y O BEER AND WINE LICENSES j Busine s Name(DIBIA) • t-S S - \ !'rl5 }1.3f?rikl h! s xi.S ; I\CV 1i'V0.1-1 'Sr �'. ,�'•,��� r> Please check the appropriate'Sceciat Alcoholic Beverage License'box ui wriich you are applying. Fill in the corresponding requirements for each Special License type. Ij ❑Quota Alcoholic Beverage License ❑Special Alcoholic Beverage License ❑Club Alcoholic Beverage License This license is issued pursuant to ,Florida Statutes or Special Act,and as such we acknowledge the following requirements must be met and maintained: • • • ii if • Please initial and date: Ii Applicants Initials Date Ii Auth.61A-1.023&61A-5.056,FAC 7 ! • { 1 it f _9 SECTION 9-.DISCLOSURE OF INTERESTED PARTIES 1 d N re—radure to disclose an in et rest ect or indirect,could result in denial,suspension and/or revocation of your license. ,1 Business Name(D/B/A) , •i • ^ Fisherman's Landing Restaurant ' -n , , ,�`,:- ;I 1. Nfnen applicable,please complete the appropriate section below. Attach extra�ne I Titfe/Positicn Name _ Stocr% frresident rnp .. pr,on-ry-wo. '1f2pnN _ • T' Ir ti j _ �—• • I fl lce President ���1 L...' 1 -t Secretary Treasurer Sj Director(s) • • .1 • Stockholder(s) —I l %I i LIMITED LIABILITY COMPANY LLC/LC • ,'Managing Member(s) Debra McManus f,and/or Managers Whey Keane t Members ' (must be printed if n there are no . managing members h or managers 11 'LIMITED PARTNERSHIP(LTD/1 P/LTDLLP) General Partner(s) ! ,4 !(i P Limited Partner(s) 4 I I; Bar Manager(Fraternal Organizations of National Scope only): ;i DIRECT INTEREST 1 Name of Individual or Entity(if a legal entity.list name under which the entity does business and its principles) li Title/Position Name Stock% it . 'I 2. Are there any persons not fisted above who have guaranteed or co-signed a lease or loan,or any person !7 j or entity who has loaned money to the business that is not a traditional lending institution? F ❑Yes Q No i !! If yes,and the terms create a direct interest in the business,you must list the person(s)or entity and li it indicate which of the below applies. Each directly interested person must submit fingerprints and a related d •a •ersonaf information sheet. Co.ies of a•reements must be submitted with this a••tication. Name Guarantor Co-signer Lender Interest Rate _ i ■ List 1 III _ o °a 1 o L ___ —__.-- _ _ .............-...._____._ _ * • Anti!.61A•1.021 S 61A-5.056,FAC 8 , • 1 �@ - II • SECTION 0M -AFFIDAVIT OF APPLICANT • •t O_TARI 4.11OI REQUIRED }R "Business-Na ,, -me(DJS/A r — / r Y / ' a •s as i/ w 1 ai / ' "I,the undersigned individually,or if a registered legal entity'•r rise] and its related parties,hereby swear or affirm that t am duty authorized to make the above and foregoing application and,as such,I hereby swear or affirm that the attached sketch is a true and correct representation of the premises to be licensed and agree ut that the place of business,if licensed,may be inspected and searched during business hours or at any time business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic Beverages and Tobacco,the Sheriff,his Deputies,and Police Officers for the purposes of determining compliance with the beverage and retail tobacco laws." r1 swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791,562.45 and j i ' 637.06,Florida Statutes,that the foregoing information is true and that no other rson or pe entity except as t ,indicated herein has an interest in the alcoholic beverage license and/or tobacco permit,and all of the above listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic beverage license - and/or tobacco permit." STATE OF Yle6'3 i fr COUNTY OF Sr'4.0144 1 1 i f • B. '' :` ./xA: i//1(X) 5 Q0/ /1,r,i �L =S1G_ E i 9 APPLICANT ATU The forego' s(�,Saarn�.and'S°�ubscribed OR( }Acknowledged Before me this a Day of ,20,/f ,By P�‘ o Te..4 ! + aJS who is( )personally (print name(s)of person(s)making statement) it known to me ORho produced as idenfification :1 p : 4s, 11 //� , �� � Nola Public - fit' it L' r. E fi l ft t. .. Fc t' f Auth.61A.1.023&G1A-6.458,FAC 9 • I- • i ��s'h"-° - k r67da t�$ {�i! Ot4 $Iflt fO''p ' IGAt "� �:. .._ �M•ii � gyft, wr r3 ' xis• - - .i.1:.lfzeixt TS r `i-rib.m5RECitjiliE9 yw, x : x`�„.-' '"�'i- ,,i Business Name(D/B/i" ,, {, r;. ...(..rd CiV. - c• C _ _ 1! i;1,the undersigned individually,or if a registered legal entity for itself and its related parties,hereby swear or j I affirm that I am duly authorized to make the above and foregoing application end,as such,I hereby swear or r affirm that the attached sketch is a true and correct representation of the premises to be licensed and agree that the place of business,if licensed,may be inspected and searched during business hours or at any time l'business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic ! ;1 Beverages and Tobacco,the Sheriff,his Deputies,and Police Officers for the purposes of determining i compliance with the beverage and retail tobacco laws." il 4 1 swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791,562.45 and I! .837.06,Florida Statutes,that the foregoing information is true and that no other pekon or entity x ecetas ( indicated herein has an interest in the alcoholic beverage license and/or tobacco permit,and all of the above 1' listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic beverage license lj and/or tobacco permit." • CV STATE OF r { V � - . �' fit; /'� COUNTY OF--1 -1/1K1 OOP 4 v:....�� %I 4.• il ^ /i i •PPLI ANT IGNATURE . f i APPLICANT SIGNATURE The foregoin was r'1 g ( )Sworn to and Subscribed OR( )Acknowledged Before me this c Day I. r of, '.1(,,, 'I ,20 1 ( ,By -C2�.,.i` ;•E'1 ;t . .0 a C:c. S ;. �� i! who is( )personally 1; (print name(s)cf person sj making statement) known to me OR( )who produced_ I Z_ /) as identification. 1 V i 3, i(Y,��is.- }%`'�"�—j Commission Expires: �� .. ti t/ Notary Public f� '1 `*IV r:4„ T 1 ��; REBECCA J ACOSTA _ `- Notary Public-State of flortsa t 1.it,- ec Aty Comm.Exprres Aug 26,2015 • . Keith.61A•1.023 VS a.Safrs ,-PaL ----..—......_-- 9 1. I ,, 1 • SUBLEASE BETWEEN INDIAN RIVER SEAFOOD,INC., AND FISHERMAN'S LANDING RESTAURANT,LLC A SUBLEASE made this _1 day of August, 2011, between INDIAN RIVER SEAFOOD, INC.,a Florida corporation, whose address is 1540 Indian River Drive, Sebastian, FL 32958, hereinafter referred to as "SEAFOOD" and FISHERMAN'S LANDING RESTAURANT,LLC,a Florida limited liability company,whose address is 1540 Indian River Drive,Sebastian,FL 32958, hereinafter referred to as"LLC",provides WITNESSETH: WHEREAS, SEAFOOD holds a sublease under FISHERMAN'S LANDING SEBASTIAN, INC.,hereinafter referred to as"FLS", to certain real property owned by the City of Sebastian, hereinafter referred to as the"OWNER", and is authorized to sublease portions of such land to businesses for the purpose of promoting lawful business activity in accordance with the Stan Mayfield Working Waterfront program;and WHEREAS, LLC is a Florida company which offers food service that will complement the revitalization of Sebastian's Working Waterfront and those activities benefitting local commercial fishermen and aquaculture;and WHEREAS,the property is subject to a Declaration of Restrictive Covenants and a management plan under the requirements of the Stan Mayfield Working Waterfront Grant;and WHEREAS, LLC has applied to SEAFOOD for a sublease of certain portions of the upland real estate held by SEAFOOD;and WHEREAS, SEAFOOD has determined that the revitalization and preservation of the Sebastian Working Waterfront will be promoted by the business activities of LLC;and WHEREAS,SEAFOOD desires to sublease such property to LLC for these purposes; NOW THEREFORE, in consideration of the foregoing and in further consideration of the mutual covenants contained herein,the parties agree as follows: 1. PREMISES. SEAFOOD hereby subleases unto LLC the Leased Premises located at 1540 Indian River Drive as delineated in the site plan attached hereto as Exhibit "A", along with appurtenant use of the parking spaces shown on Exhibit"B". 2. PURPOSE. The LLC shall use the Leased Premises for limited food service, including beverage service of beer and wine,ancillary to and in furtherance of the Stan Mayfield Working Waterfront program. 3. TERM. SEAFOOD subleases to the LLC the above premises for an initial three year term commencing on the date first set forth above. LLC shall have the option to extend the Sublease upon the same terms for an additional three year term upon written notice to SEAFOOD of its intent to exercise said option no later than one hundred twenty (120)days prior to expiration of the initial three year term. 4. RENT. LLC shall pay a base rent of$2,000 per month to SEAFOOD. The first month rent shall be paid upon execution hereof, and thereafter payment shall be made on the first day of each month for said month. If the full amount of rent is not paid by the fifth day of the month,a late fee in the amount of twenty dollars ($20.00) shall be added as additional rent on the sixth and for each day thereafter until rent is paid in full. 5.IMPROVEMENTS. The Leased.Premises are accepted by the LLC"as is". A. As an Economic Development component of the Stan Mayfield Working Waterfront Grant, SEAFOOD may solicit and oversee additional ancillary business operations that will be located at 1540 Indian River Drive. B. LLC shall obtain the written approval of SEAFOOD and FLS prior to making any improvements to the Leased Premises and existing structures. LLC shall also obtain the written approval of SEAFOOD and FLS as to paint colors utilized prior to painting any existing or new structure on the Leased Premises,it being understood that existing natural wood surfaces that have not been painted before are not to be painted. At the end of the term of this Sublease, LLC shall deliver the premises to SEAFOOD in good repair and condition, reasonable wear and tear excepted. All installations and improvements on the Premises,except any privately-owned removable equipment shall become the property of FLS, and on termination of the Sublease Term shall be surrendered with the Leased Premises in good condition. C. All plans and specification for such renovations, improvements or construction shall be submitted in writing to SEAFOOD and FLS for approval which approval shall not be unreasonable withheld or delayed. LLC shall not install any compressor, satellite dish, air conditioning unit, or any other equipment or machinery, in or about the Leased Premises,or on the roof of the building, without the prior written consent of SEAFOOD and FLS. Any request for the same to SEAFOOD shall be accompanied by plans and specifications and the name and insurance information of the contractor who will perform the work. D. Unless otherwise expressly prohibited herein, it shall be LLC'S sole responsibility to obtain all necessary governmental approvals for its uses upon the Leased Premises, including, but not limited to all necessary development permits. It is expressly understood,and agreed by LLC,that SEAFOOD and FLS shall not be liable to LLC for any expense, loss or damage incurred by LLC resulting from the failure of any governmental entity to grant any or all necessary governmental approvals or permits required for the Leased Premises. LLC acknowledges that the Leased Premises are located within the Sebastian Community Redevelopment District and thus any change to the premises is subject to such District's authority as well as provision of Chapter 163, Florida Statutes and any future ordinances,statutes or other regulations applicable within the District. 6. OPERATIONAL ADHERENCE. In addition to the duties provided in this Sublease Agreement, LLC shall comply with all requirements of the Stan Mayfield Working Waterfront Grant Agreement, attached hereto as Exhibit "C", any State approved Management Plan and deed restrictions created pursuant to that grant agreement, and the terms of the underlying land leases between SEAFOOD, FLS and the OWNER. The intent and requirements of the Stan Mayfield Working Waterfront Grant Agreement and interpretations given that document by its administering agency shall take precedent over any conflict provision of this Sublease or other document. 7. BUILDING,UTILITIES,MAINTENANCE AND REPAIRS. A. The LLC shall be responsible for the cost of installation and connection of necessary potable water,sewer,electric,natural/propane or other gas,telephone,cable,grease traps, solid waste, and information technology services to the Leased Premises beyond those being provided at the time this Sublease is executed. B. LLC and SEAFOOD agree to mutually obtain an assessment for equipment usage and to utilize the usage estimates to establish a pro-rata share of the utility bills for each. In the event that either party disagrees with the usage estimates,that party may obtain a second estimate at its expense. If the pro-rata share of utilities for LLC calculated under this second estimate is within twenty percent of the initial estimate, the two figures shall be averaged. If the parties cannot otherwise agree, the final determination of pro-rata utility charges shall be informally arbitrated by FLS. Additionally, the parties shall each pay one half of the portion of the monthly bill for electrical service to the parking area on the west side of Indian River Drive delegated to 1540 Indian River Drive by the underlying lease with FLS. SEAFOOD shall promptly provide LLC with a copy of any utility bill and its calculation of the pro-rata share owed by LLC, and LLC shall pay the same to SEAFOOD as additional rent no less than five(5)days before the utility charge is due. C. LLC agrees that all portions of the Leased Premises shall be kept in good repair and condition by LLC. LLC shall maintain and make all necessary repairs and alterations with respect to the Leased Premises(including but not limited to necessary replacements) to keep it in good condition. LLC'S sole right of recovery shalt be against its insurers for losses or damage to stock, furniture and fixtures, equipment, improvements and betterment. LLC agrees to make or contract for emergency repairs and provide protective measures necessary to protect the Leased Premises from damage and to prevent injury to persons or loss of life. LLC agrees to use its best efforts to insure that the property is maintained in an attractive condition and in a good state of repair. D. The interior and exterior of the Leased Premises shall be kept clean. It shall be LLC'S responsibility to provide and pay for maintenance services for the Leased Premises as well as the interior Common Areas shown on Exhibit"A". SEFOOD shall be responsible for providing and paying for maintenance services for the exterior Common Areas shown on Exhibit"A" E. Upon issuance of a"Hurricane Warning"by the National Weather Service encompassing the Leased Premises, LLC shall promptly take protective measures including, but not limited to,putting hurricane shutters in place,and storing/securing movable items on the exterior of the Premises. I; 8. INSURANCE,INDEMNIFICATION AND DAMAGE BY CASUALTY. A. SEAFOOD and FLS are under contractual obligations with the OWNER as owner of the leased land for procurement and maintenance of public liability risk, fire and other casualty insurance adequate to protect against liability for any and all damage claims that may arise due to the activities on the premises during the term of this Sublease.FLS may obtain such reasonable reinsurance, additional or increased coverage as, in its sound business discretion,is necessary to adequately protect its interests. B. LLC shall pay one half of the portion of the insurance premiums as are charged to SEAFOOD by FLS and OWNER under the terms of the underlying leases,and as may be charged for any other coverage obtained under subparagraph 8(A), for the use of the Leased Premises. SEAFOOD shall annually bill and LLC shall reimburse these insurance costs as additional rent. C. It is anticipated that LLC may carry additional coverage amounts or may carry additional types of business-related insurance at its sole costs, including but not limited to business interruption coverage, coverage for service g � of alcohol raw and aw shell fish, and coverage loss from electrical outage. rage D. LLC agrees to take out and maintain, during the term of this Sublease, applicable worker's compensation insurance for all its employees employed in connection with the business operated under this Sublease. Such insurance shall fully comply with the Workers Compensation Law, Chapter 440,.Florida Statutes. The workers compensation I' insurance policy required by this Sublease shall also include Employers Liability. LLC shall provide proof of worker's compensation insurance as required by law, if applicable. E. Neither SEAFOOD, FLS nor the OWNER shall be liable for any loss, injury, death or damage to persons or property which at any time may be suffered or sustained by LLC or by any person whosoever may at any lime be using or occupying or visiting the Leased Premises,or be in,on or about the same,whether such loss,injury,death or damage shall be caused by or in any way result from or arise out of any act, omission or negligence of LLC or of any occupant,subtenant,visitor or user of any portion of the Leased Premises unless affirmatively and directly caused by the intentional acts of agents of SEAFOOD. F. LLC shall indemnify SEAFOOD, FLS and OWNER against all claims, liabilities, loss or damage whatsoever on account of any such loss, injury, death or damage. LLC hereby waives all claims against SEAFOOD for damages to the improvements that are now on or hereinafter placed or built on the premises and to the property of LLC in, on or about the premises, and for injuries to persons or property on the premises, from any cause arising at any time. LLC agrees to hold harmless SEAFOOD, FLS and OWNER from and against any and all claims, lawsuits,judgments, or similar causes of action,for any injuries to persons or property arising out of the activities conducted by the LLC on the property described herein. Further LLC agrees to defend SEAFOOD, FLS and OWNER against any and all such claims and suits as described above at the LLC'S sole cost and expense with no cost and expense to be incurred by SEAFOOD and FLS. 9. TAXES. LLC will be required to pay all taxes or other levies or assessments lawfully levied against the subject business during the term of the Sublease, if any, and to evenly divide any such levies or assessments that are imposed upon the property at 1540 Indian River Drive, Sebastian,with SEAFOOD. 10. LLC'S RESPONSIBILITIES. LLC, its agents, employees and invitees, when on the premises, agrees to follow and abide by all local, state and federal laws and regulations and to follow and abide by the rules and regulations of the City of Sebastian, Community Redevelopment Agency and the State of Florida as may be amended from time to time. 11. INSPECTION BY SEAFOOD. SEAFOOD, FLS, OWNER and their agents, upon reasonable prior notice, May make periodic inspections of the Leased Premises to determine whether LLC is operating in compliance with the terms of this Sublease. The LLC shall be required to make any and all changes required by SEAFOOD which are necessary to ensure compliance with the terms and conditions of this Sublease and/or any applicable law(s) or regulations(s). 12. RESTRICTIONS ON ENCUMBRANCES, SUBLETTING AND ASSIGNMENT. LLC shall not mortgage,pledge,or encumber this Sublease,in whole or in part,or the leasehold estate granted under this Sublease. Any attempted mortgage, pledge, or encumbrance of this Sublease, or the leasehold estate granted under this Sublease, shall be void and may,at the sole option of SEAFOOD,be deemed an event of default under this Sublease. This covenant shall be binding on the successors in interest of LLC. LLC shall not pledge SEAFOOD'S credit or make it a guarantor for payment or surety for any contract debt, obligation, judgment, lien or any form of indebtedness. LLC warrants and represents that it has no obligation or indebtedness, which would impair its ability to fulfill the terms of this Sublease. LLC may not assign its interest in this Sublease, nor sublet any portion of the Leased Premises without the written consent of SEAFOOD, FLS and OWNER. If there shall occur any change in the ownership of and/or controlling interest in LLC, whether such change of ownership is by sale, assignment, bequest, inheritance,operation of law or otherwise,LLC shall promptly notify SEAFOOD. If SEAFOOD,FLS and OWNER do not consent in writing to such change within thirty(30)days(which consent may be withheld for any reason),SEAFOOD may terminate this Sublease upon thirty(30)days notice to LLC. 13. MISCELLANEOUS CONDITIONS. A. LLC agrees that its employees,agents, officers,and vendors engaged in activities on the Leased Premises shall be at all times subject to the LLC'S sole direction,supervision and control and shall not be considered employees,agents or servants of SEAFOOD,FLS or the OWNER. B. LLC agrees to park its vehicles and those of its employees in places specifically designated in writing from time to time by SEAFOOD and further agrees that no parking will occur in landscaped areas or blocking any sidewalk or street. LLC shall prohibit commercial truck parking on the premises for any duration other than what is reasonable for loading or unloading purposes. The parties recognize that the ongoing redevelopment efforts within the Sebastian CRA may result in changes in parking as well as the configuration of vehicle parking on or adjacent to the Leased Premises. Accordingly, G. LLC shall cooperate with SEAFOOD, FLS and OWNER in providing information and documentation as it relates to providing the Florida Communities Trust with an annual report relating to the Stan Mayfield Working Waterfront program. H. The Smoke House and cut-room, which remain under the control and use of FLS, and shall be made available for use by LLC when not needed for FLS's operations. I. SIGNS: LLC shall not place any additional signage on the exterior of the Leased Premises. LLC shall submit a drawing of any proposed interior signage within or viewable from the Common Areas to SEAFOOD for approval, and such signs shall comply with applicable governmental requirements. 14. TERMINATION. A. SEAFOOD may have the right to terminate this Sublease upon the occurrence of any of the following,hereinafter referred to as"Event of Default". (1) Institution of proceedings in voluntary bankruptcy by the LLC. (2) Institution of proceedings in involuntary bankruptcy against the LLC if such proceedings continue for a period of ninety (90) calendar days and are not dismissed. (3) Assignment of this Sublease for the benefit of creditors. it (4) Abandonment by LLC of the Leased Premises or discontinuance of operation of the Leased Premises for the permitted uses for more than thirty (30) calendar days. (5) Dissolution whether voluntary or involuntary of LLC business organization. (6) Default, non-performance or other noncompliance with any covenant, requirement or other provision of any nature whatsoever under this Sublease. (7) Failure to pay rent for fifteen calendar days after it is due. B. Upon the occurrence of an Event of Default, SEAFOOD shall send a written notice to LLC setting forth the Event of Default in specific detail and the date this Sublease shall terminate in the event LLC does not cure the default. C. Except for default under subparagraphs 14.A. (4)or(7)above, within thirty(30)calendar days following receipt of a default notice, LLC shall have cured the default to the reasonable satisfaction of SEAFOOD. D. In the event LLC fails to cure the Event of Default within thirty(30)calendar days, this Sublease shall be deemed to be terminated with no further action by SEAFOOD. However, there is no requirement that SEAFOOD provide said period for cure of a default under subparagraphs 14.A.(4)or(7)above. E. In no event,however, shall such termination relieve LLC of its obligation to pay any and all remaining rent due and owing to SEAFOOD for the period up to and including the date of termination, the remainder of that month and for up to three full months thereafter. • 15. INTEGRATION. The drafting, execution and delivery of this Sublease by the parties has been induced by no representations, statements, warranties or agreements other than those expressed in it. This Sublease contains the entire agreement between the parties and there are no further or other agreements or understandings written or oral in effect between the parties relating to its subject matter. This Sublease cannot be changed or modified except by written instrument executed by all parties hereto. This Sublease and the terms and conditions hereto apply to and are binding upon the heirs, legal representatives, successors and assigns of both parties. 16. SEVERABILITY. If any term of this Sublease or the application thereof to any e FP y p rson or circumstances shall be determined by a court of competent jurisdiction to be invalid or unenforceable, the remainder of this Sublease, or the application of such term to persons or circumstances other than those as to which it is invalid or unenforceable, shall not be affected thereby, and each term of this Sublease shall be valid and enforceable to the fullest extent permitted by law. 17. PROPERTY INTERESTS. Nothing contained in this Sublease shall be deemed to create or be construed as creating in LLC any property interest in or to the Leased Premises. 18. NOTICES. All notices required under this Sublease shall be sent by certified mails as follows: SEAFOOD: Indian River Seafood,Inc., 1 540 Indian River Drive Sebastian,FL 32958 LLC: Fisherman's Landing Restaurant,LLC 1540 Indian River Drive Sebastian,FL 32958 19. GOVERNING LAW/VENUE. This Sublease shall be governed and construed in accordance with Florida law. In the event that litigation arises involving the parties to this Agreement, venue for such litigation shall be in Indian River County, Florida. The parties hereto expressly waive trial by jury in any action to enforce or otherwise resolve any dispute arising hereunder. IN WITNESS WHEREOF,the Parties have executed this Sublease on the dates set forth above. SEAFOOD LLC Indian River Seafood,Inc., Fisherman's Landing Restaurant,LLC, a Florida corporation. a Florida limited liability company. M y f By: Susan Andrews,President By: Debbie McManus,Managing Member Donna Cyr From: Dorri Bosworth Sent: Tuesday, November 01, 2011 1:58 PM To: Donna Cyr Cc: Alfred Minner Subject: FW: Fishermans landing AB application Attachments: 201111O111O238061.pdf 2011110111023806 1.pdf(1 MB) Hi Donna - Attached is the public record requested for Fisherman's Landing (Liquor License) . We sign off on the zoning (page 5) only, and we usually don't keep a copy of the application, since it still needs to be submitted and issued by ATF. I requested this from Mr. Stanton at the Ft. Pierce ATF office. Hope this is what you need. Dorri Bosworth, Planner Community Development Department City of Sebastian 1225 Main Street, Sebastian, Florida 32958 (772) 589-5518 (772) 388-8248 fax dbosworth @cityofsebastian.org Original Message From: Stanton, Kent [mailto:Kent.Stanton @dbpr.state.fl.us] Sent: Tuesday, November 01, 2011 12:10 PM To: Dorri Bosworth Subject: FW: Fishermans landing AB application Original Message From: Stanton, Kent Sent: Tuesday, November 01, 2011 12:09 PM To: 'dbosworth @cityofsebastian.ord' Subject: Fishermans landing AB application Original Message From: Kent Stanton [mailto:kent.stanton @dbpr.state.fl.us] Sent: Tuesday, November 01, 2011 7:03 AM To: Stanton, Kent Subject: This E-mail was sent from "RNPFD65BE" (Aficio MP 2500) . Scan Date: 11.01.2011 11:02:37 (+0000) Queries to: dbpr.copier @dbpr.state.fl.us 1