Liquor License Transfer_Rotary Club_ARC GamesPage 1 of 2
Transfer Premise BW0092633, Rotary Club of Dubuque, Dubuque
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Licenses may be transferred from one location to another, but only within the boundaries of the current approving Local ~
Transfer Application and all supporting documentation shall be approved by the Local Official and forwarded to the Iowa
Beverages Division before the event takes place. All selling and serving of alcoholic beverages must cease at the original
location during the period of the transfer. NOTE: If requesting a permanent transfer, an amended license will be forwarder
Official. If requesting a temporary transfer, a letter of permission will be forwarded to the Local Official.
Name of Applicant: Rotary Club of Dubuque
Name of Business (D/B/A): Rotary Club of Dubuque
Address of Premise: 135 W. 8th St.
Address Line 2:
City: Dubuque
County: Dubuque Zip: 52001
~ew Premise Address: A. Y McDonald Park-Hawthorne Street
N w Premise Address Line 2:
City: Dubuque lowtate: i Zip: 52001
r Temporary Transfer (24 hours through 7 days)
Beginning Date: 06/11/2008 Ending Date: 06/12/2
C' Permanent Transfer
Beginning Date:
Phone: (866) 469-2223
Ter
https://eicensing.iowaabd.com/TransferPremise.aspx 05/22/2008
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Page 1 of 1
Applicant BW0092633, Rotary Club of Dubuque, Dubuque
Applicant
Transfer Premise After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen.
The navigation links on the top may also be used to move around the application.
~_ New Premise Location Information
A licant Si nature Name of Applicant: Rotary Club of Dubuque Sole Pro netorshi Partnershi Cor oration, etc.
Pp 9 ( p P. P~ P
~~ Dram Cert Name of Business (D/B/A): Rotary Club of Dubuque
Local Endorse Address of Premise: 135 W. 8th St.
Address Line 2:
City: Dubuque
County: Dubuque
Zip: 52001
Business Phone: (563) 5$9-2234 Cell /Home Phone: ~-
~ Same Address
Mailing Address: P.O. Box 813
Mailing Address Line 2:
City: Dubuque State: Iowa
Zip: 52004
Contact Name: Mike
Phone: (563) 584-9235 Email Address: mloveless~
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Phone: (866) 469-2223
FAX: (515) 281-7375
https://eicensing.iowaabd.com/Applicant.aspx 05/22/2008
Page 1 of 2
New Premise Location Information BW0092633, Rotary Club of
Dubuque, Dubuque
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screen.
The navigation links on the top may also be used to move around the application.
~- # of Bathrooms:
~` Number of floors where alcoholic beverages will be sold, served, consumed and stored.
Indicate how you have control of premises (Permanent Transfers Only):
~' Own
C` Lease
Submit to the Local Authority a signed copy of the lease/rental agreement for the license period or signed final sales
contract or warranty deed.
Submit to the Local Authority a sketch on 81/2 x 11"white paper of the proposed premises showing all areas and
floors where alcoholic beverages will be sold, served, consumed and stored. Indicate all entrances and exits, location
of bar, back bar and bathrooms. If Applicant has Outdoor Service Area Privilege, please include in the sketch its
relationship to the licensed premises.
Outdoor Service
Area Dates (if From: 06/12/2008 MM/DD/YYYY To: 06/11/2008 MM/DD/YYYY
applicable):
Dates shall correspond with requested outdoor service areas.
On-Premise
Applicant's Only:
Yes ~ Is the premise furnished with tables and seats to accomodate a minimum of 25 persons at one
time?
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https://eicensing.iowaabd.com/NewPremiseLocationInformation.aspx 05/22/2008
Applicant Signature BW0092633, Rotary Club of Dubuque,
Dubuque
Complete the information below and click Finish to complete the application
Note that the license fees will only be withdrawn from accounts after the ABD approves the license.
This application must be completed by a person listed in the Ownership Section.
I hereby declare that all information contained in the Application is true and correct. I understand that
misrepresentation of material facts in the Application is a crime and grounds for denial of the license or permit
under Iowa law. 1 further understand that, as a condition of recieving a license, the licensed premise is subject
to inspection during business hours by appropriate local, state and federal officials.
NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen.
Applicant's Name: Amy Weber Date: 05/20/2008 MMIDD/YYYY
Tentative effective date: 06/11!2008 r MM/DD/YYYY
Please print a copy of this page for your records before clicking the "FINISH" button.
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https://elicensing.iowaabd.com/ApplicantSignature.aspx 05/22/2008
Page 1 of 2
Dram Shop Liability Certificate of Insurance BW0092633, Rotary I
Club of Dubuque, Dubuque
Complete the information below and click SUBMIT to endorse this Renewal application.
POLICY INFORMATION
Reason for re-submittal:
This is to certify: American Home Assurance Co
Policy Number: GL7218114
Assured: Rotary Club of Dubuque
DBA: Rotary Club of Dubuque
Address: 135 W. 8th St.
Address Line 2:
City: Dubuque
State: Iowa ~
Zip: 52001
Policy Effective Date: 07/01/2007 MM/DDlYYYY
To: t' Ex iration Date: 07/01/2008
p MM/DDlYYYY
Thru: {'
CHECK LIST
Outdoor Service Endorsement
Policy Information Verified (if incorrect please contact the licensee)
TEMPORARY TRANSFER ENDORSEMENT
https://eicensing.iowaabd.com/DramShopCert.aspx 05/22/2008
ABD Licensing -Dram Shop Certification Page 2 of 2
Address: A. Y McDonald Park-Hawthorne Street
Address Line
2:
City: Dubuque _ State: Iowa ~ Zip; ~-
r Outdoor Service Endorsement
Policy Effective 06/11/2008 t:
Date: MMIDD/YYYY To: Expiration Date: 06/12/2008 MM/DD/YYYY
Thru: ~'
The above-mentioned policy of insurance (hereinafter policy) contains coverage to comply with the provisions of Iowa Code sect
123.92 and all regulations of the Iowa Department of Commerce, Alcoholic Beverages Division.
The policy may be canceled by the Company of the Assured giving 30 days notice in writing to the Alcoholic Beverages Division
its office, Ankeny, Iowa. The 30 days notice will commence from the date notice is actually received by the division. J
Signature: ~ Date: 05/21/2008 MM/DD/YYYY
Phone: (866) 469-2223
FAX: (515) 281-7375
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