Cannabis Consumption Establishment

Transcription

1 City and County of Denver DEPARTMENT OF EXCISE AND LICENSES 201 West Colfax Avenue, Dept. 206 Denver, Colorado Cannabis Consumption Establishment NEW LICENSE APPLICATION *Annual Fee: $1, *Application Fee: $1,000 Business File Number (BFN): (This will be filled in by a licensing technician upon application acceptance) Legal Entity Name of Applicant: (Must match Secretary of State Certificate of Good Standing - if applicable) Property Information Establishment Address: City: State: Zip Code Statement of Conforming Location Cannabis Consumption Permit locations may not be within 1,000 feet of any school, child care establishment, alcohol or drug treatment facility, or city-owned recreation center or outdoor pool. You can visit the Denver Business Licensing Center webpage for more information about these locations. It is the applicant's reponsibility to ensure that their proposed permit location meets all location requirements. Applications that do not conform with these location requirements will be denied. As the applicant, I confirm that the proposed location conforms with the proximity requirements listed above Statement of Possession of Premises Business must have legal possession of the premises for the entire term of the permit in order to apply. Please fill out below: Name of Property Owner: Address of Property Owner: Date Lease Begins: Phone Number of Property Owner: City: State: Zip Code: Expiration date of lease: Contact Information Responsible Party/Main Contact: Name Phone Mailing Address: City: State: Zip Code:

2 Establishment Details Additional Information for Applicant Business Trade Name (DBA): (Must match Secretary of State Statement of Trade Name, if a trade name is in use) Please describe the methods of consumption that will be permitted at the establishment. Check all that apply: Smoking: Indoor Vaping: Indoor Edibles: Indoor Dabbing: Indoor Outdoor Outdoor Outdoor Outdoor Other: Indoor Outdoor If you will permit any 'other' type of consumption, please describe: How many employees will your business employ: Will the business rent, or make avaliable for use, any cannabis consumption accessories? Yes No Additional Information for Underlying Business Type of Underlying Business: BFN of Underlying Business: (if applicable) Legal Entity Name of Underlying Business: Trade Name of Underlying Business: Is liquor ever served at the proposed establishment? Yes No If yes, please describe how the business intends to ensure that the designated consumption area (DCA) does not overlap with any part of a liquor licensed premises, and how the business intends to ensure that liquor is not served while the DCA is operating. Neighborhood Support Which Eligible Neighborhood Organization (ENO) is supporting your application: ENO Contact Information Name: Type of Organization: RNO BID Phone: Other: The ENO provided: A letter of support A letter of non-opposition A good neighbor agreement Other: Hours of Operation Please provide the proposed hours that the DCA will be operating. If you update your hours of operation at any time, you must file for and have approved a Modification of Premises before the change takes place. \ If other, please explain:

3 OWNER & MANAGER INFORMATION You must list the name (including any trade name), address, and date of birth of all applicants, including any manager of the proposed designated consumption area. In the event of an entity applicant, the form shall also contain the name, address, and date of birth or all persons who own five (5%) percent or more of the entity or will receive five (5%) percent or more of the profits of the entity. Please attach additional pages if necessary. 1ST 2ND 3RD 4TH 5TH 6TH

4 I NTE RNA L US E ONLY Required Documentation: 1. A community engagement plan that contains the following items in a clearly delineated format: The name, telephone number, and address of the person affiliated with the applicant who is responsible for neighborhood outreach and engagement. The names of all Registered Neighborhood Organizations whose boundaries encompass the location of the proposed licensed premises, and a statement that the applicant shall contact the Registered Neighborhood Organizations prior to commencing operations. An outreach plan to contact and engage residents and businesses in the local neighborhoods where any license is located. A detailed description of any plan to create positive impacts in the neighborhoods where the licensed premises are located, which may include by way of example, participation in community service, volunteer service, and active promotion of any local neighborhood plans. Written policies and procedures to timely address any concerns or complaints expressed by residents and businesses within the neighborhood surrounding the licensed premises. Written policies and procedures designed to promote and encourage full participation in the regulated marijuana industry by people from communities that have previously been disproportionately harmed by marijuana prohibition and enforcement in order to positively impact those communities. 2. A copy of the Certificate of Occupancy for the establishment (if the underlying business is already operating, otherwise a copy will be required once the proposed business is established but before any consumption license is granted) 3. A copy of a valid zone use permit for the underlying business 4. Advisement and Acknowledgement Form for each owner and manager 5. A floor plan of the establishment drawn to scale on 8-1/2" x 11 paper, showing the layout of the establishment and the principal uses of each section of the floor area. The location of the Designated Consumption Area within the establishment must be contiguous and outlined in red. Please include dimensions, security cameras, and establishment boundaries, including external and internal walls, doors, fences, gates and the like. Also, clearly indicate where the standardized placard, access restriction signage, and responsible usage signage will be located and where the business will be locating its posting notice for the public hearing. Please provide a separate page for each floor level in the establishment A health and sanitation plan indicating how any cannabis consumption accessories that will be rented or made available for use will be cleaned (if applicable) A marijuana waste plan that includes a detailed description of how employees will dispose of any waste that is left, abandoned, or otherwise not consumed on the premises 8. A national criminal history records check conducted by the FBI within the last 60 days for each owner and manager 9 A responsible operations plan, along with an employee training manual, indicating, at a minimum: strategies and procedures for identifying and responding to potential over-intoxication how employees will prevent underage access to the designated consumption area how employees will prevent driving under the influence of marijuana how employees will prevent illegal distribution of marijuana and marijuana products how employees will prevent issues relating to dual consumption of marijuana and alcohol how employees will prevent the usage of any liquified gas torches on the premises if dabbing will be permitted 11. An Affidavit of Lawful Presence for each owner 12. An Odor Control Plan (please visit Denver Environmental Quality's Odor webpage for guidelines) 13. Copies of government-issued identification for each owner and manager 14. Evidence that the establishment will comply with the Colorado Clean Indoor Air Act (if indoor smoking will be permitted) 15. Evidence of support from an eligible neighborhood organization,including any additional restrictions on advertising and/or operational requirements that such support is dependent upon 16. Lease or Deed (if leased, include written consent from the property owner to use the property for cannabis consumption) 17. Secretary of State Certificate of Good Standing (if applicable) 18. Secretary of State Statement of Trade Name (if applicable)

5 Please note: *Applicants must be in compliance with all city and state laws, including the rules and regulations promulgated pursuant thereto, at all times. *Legal documents included as part of this application must be properly signed and executed *Applications will be administratively closed if the application process has not been completed within 12 months *All applicable inspections will need to be completed and approved before a license will be issued Oath of Application I hereby certify that I am an authorized representative of the Applicant, that I have read the above information, and that I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Denver Revised Municipal Code and all Rules and Regulations which govern my Application. Authorized Signature: Print Name: Date: Title: IINTERNAL ONLY - QCNTERNAL ONLY - QC All required documents have been provided: Yes All fields in the application are complete. Only the trade name fields, or non-applicable fields may be left blank: Yes What is the zone district of the proposed facility? Is the zone district I-A or I-B, thereby necessitating an RNO Notification? Yes No If you answered yes above, have you completed the RNO Notification? A copy of this notification must be scanned into Accela - Yes -I did completed the "application intake" and "notification" workflow tasks, and set the "quality control" workflow task to pending - Yes I did not issue an inspection notice today - Yes I I have provided the customer with the "New Cannabis Consumption Establishment - Next Steps" handout - Yes QC Completed By: QC Completed Date: Form Last Revised on 10/10/17