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Applicant BW0092633, Rotary Club of Dubuque, Dubuque
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Name of Applicant: Rotary Club of Dubuque (Sole Proprietorship, Partnership, Corporation, etc.)
Name of Business (D/B/A): Rotary Club of Dubuque
Address of Premise: ~ 135 1,'~d. 8th St.
Address Line 2: '
City: Dubuque
County: ~L)ubuque
Zip: 52001
Business Phone: (563) 589-2234
Cell /Home Phone: ~~~~
~ Same Address
Mailing Address: '~ ~.0. C?o;; 813
Mailing Address Line 2:
City: Dubuque State: Iowa .,
Zip: 52004
Contact Name: Mike Loveless
Phone: (563) 584-9235 Email Address: mloveless@lovelessins.corr
Phone: (866) 469-2223
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ABD Licensing -Transfer Premise
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~ Applicant Transfer Premise BW0092633, Rotary Club of Dubuque, Dubuque
~ 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.
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? Applicant Signature Licenses may be transferred from one location to another, but only within the boundaries of the current approving Local Official.The
? Dram Cert Transfer Application and all supporting documentation shall be approved by the Local Official and forwarded to the Iowa Alcoholic
Beverages Division before the event takes place. All selling and serving of alcoholic beverages must cease at the original licensed
Local Endorse location during the period of the transfer. NOTE: If requesting a permanent transfer, an amended license will be forwarded to the Local
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
New Premise Address: A.Y. McDonald Park
New Premise Address Line 2: 1924 Volunteer Drive
State:
City: ~ub!~gue Iowa ~~ Zip: 52001
l: Temporary Transfer (24 hours through 7 days)
Beginning Date: 06/10/2009
~ Permanent Transfer
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Phone: (866) 469-2223
Beginning Date:
Ending Date: 06/10/2009
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~ Applicant
~ Transfer Premise New Premise Location Information BW0092633, Rotary Club of Dubuque,
Dubuque
} New Premise Location Information After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen.
~ Applicant Signature The navigation links on the top may also be used to move around the application.
a Dram Cert ~~ # of Bathrooms:
Local Endorse '~- Number of floors where alcoholic beverages will be sold, served, consumed and stored.
Indicate how you have control of premises (Permanent Transfers Only):
C' Own
f 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: 06/10/2009 MM/DD/YYYY To: 06/10/2009 MM/DD/YYYY
applicable):
Dates shall correspond with requested outdoor service areas.
On-Premise
Applicant's Onl
Yes ~ Is the premise furnished with tables and seats to accomodate a minimum of 25 persons at one time?
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ABD Licensing -Applicant Signature
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Local Endorse
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.
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This application must be completed by a person listed in the Ownership Section.
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. I 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: 04/23/2009 MM/DD/YYYY
Tentative effective date: ~ 06/10/2009 MM/DD/YYYY
Phone: (866) 469-2223
Please print a copy of this page for your records before clicking the °'EIRIISH" button.
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ABD Licensing -Dram Shop Certification
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Address Line 2: 1024 Volunteer Drive
City: Dubuque ~ State: ~' Iowa ~ Zip: ~~
~ Outdoor Service Endorsement
Policy Effective Date: 06/10/2009 MM/DD/YYYY To: ~' Expiration Date: 06/10/2009 MM/DD/YYYY
Thru: ~
The above-mentioned policy of insurance (hereinafter policy) contains coverage to comply with the provisions of Iowa Code section 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 3o days notice in writing to the Alcoholic Beverages Division at its office, Ankeny, to
The 30 days notice will commence from the date notice is actually received by the division.
Signature: ~ Date: ~ MM/DD/YYYY
Phone: (366) 469-2223 - c:. ,;s c.''c~: c,.
FAX: (515) 281-7375 i'rivacy F'oficy
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ABD Licensing -Dram Shop Certification
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Dram Shop Liability Certificate of Insurance BW0092633, Rotary Club of
Dubuque, Dubuque
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Complete the information below and click SUBMIT to endorse this Transfer application.
POLICY INFORMATION
Reason for re-submittal:
This is to certify: American Home Assurance Co
Policy Number: 721811!.
Assured: Rotan~ Club of Dubuque
DBA: Rofary Club of Dubuque
Address: Alliant Outdoor Amphitheater at the Siar Brewery Complex
Address Line 2:
City: rDubuque
State: Iowa Zip: 52001
Policy Effective Date: 08/23/2008 MM/DD/YYYY
To: r
Expiration Date: 08/24/2008 MM/DDIYYYY
Thru: r
CHECK LIST
~ Outdoor Service Endorsement
r Policy Information Verified (if incorrect please contact the licensee)
TEMPORARY TRANSFER ENDORSEMENT
Address: A.Y. McDonald Parlc
hops://eicensing.iowaabd.com/DramShopCert.aspx 05/05/2009