STATE OF ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD MONTGOMERY, ALABAMA LICENSE EXPIRES SEPTEMBER 30, 2019 RENEW LICENSE(S) BEFORE AUGUST 1, 2019 Confirmation Number: 20180725000010800 Renewal Period: June 1, 2019 Through July 31, 2019 License Number: 010788354 County: PICKENS Tobacco Business Type: 45 Vending Machines: 0 Effective Date: 10/01/2018 Printed Date: 07/25/2018 Trade Name: Licensee: MUN LLC Location: SUITE A Mailing Address: Alabama Sales Tax ID: R007900010 011 LOUNGE RETAIL LIQUOR - CLASS II (PACKAGE) These privileges have been issued under the provisions of Title 28, Code of Alabama (1975) effective on the date as shown above and continuing until expiration date set forth above unless sooner surrendered, suspended or revoked by the Board. These privileges are not assignable and are valid for use only by the licensee named hereon at the location hereon designated. Witness the hand and seal of the ABC Board. For questions or assistance go to our website www.alabcboard.gov click license and find the district contact number that services the county for this license. 100079 ADMINISTRATOR
License Renewal Receipt Receipt Confirmation Number: 20180725000010800 Payment Summary Payment Item County Fee State Fee Total Fee License: 011-010788354 011 - LOUNGE RETAIL LIQUOR - CLASS II (PACKAGE) 0.00 300.00 300.00 Total Amount to be Charged 0.00 300.00 300.00 Vendor License List Trade Name Type of Business: Liquor Package Tobacco Vending Machines: 0 RVP Certification: N Business Location Address SUITE A Liquor Liability Insurance in the amount of at least 100,000.00. Insurance Company: Hudson Specialty Insurance Co Insurance Policy Number: HSLL-35517 Insurance Coverage Begin: 07/09/2018 Insurance Coverage End: 07/09/2019 Renew License License Number License Type County County Fee State Fee RENEW 011-010788354 011 - LOUNGE RETAIL LIQUOR - CLASS II (PACKAGE) Business Information Business/Applicant Name: MUN LLC Business Mailing Address: Business Phone: 205-367-1691 Business Type: The business is a corporation, partnership, LLC or LLP Member Information Member Info Member DOB Member Address Mitulkumar Patel 03/28/1983 India 326 Turtle Bay Circle Northport, AL 35473 PICKENS 0.00 300.00 Affidavit I (Mitulkumar Patel) hereby certify that all other material facts set forth in my original application and subsequent renewal applications are true and correct. By checking the boxes above, I certify that I acknowledge and confirm the affirmations contained in each statement. If currently certified in the ABC Board Responsible Vendor Program (RVP), I attest that this location is in compliance with the ABC Board RVP Requirements. Administrative Comments License Number: 011-010788354 Date Added: 07/30/2018 11:50:41 AM
STATE OF ALABAMA ALCOHOLIC BEVERAGE CONTROL BOARD MONTGOMERY, ALABAMA LICENSE EXPIRES SEPTEMBER 30, 2019 RENEW LICENSE(S) BEFORE AUGUST 1, 2019 Confirmation Number: 20180725000010800 Renewal Period: June 1, 2019 Through July 31, 2019 License Number: 010010854 County: PICKENS Tobacco Business Type: 41 Vending Machines: 0 Effective Date: 10/01/2018 Printed Date: 07/25/2018 Trade Name: Licensee: MUN LLC Location: Mailing Address: Alabama Sales Tax ID: R007900010 050 RETAIL BEER (OFF PREMISES ONLY) 070 RETAIL TABLE WINE (OFF PREMISES ONLY) 990 TOBACCO AND ALTERNATIVE NICOTINE PRODUCTS These privileges have been issued under the provisions of Title 28, Code of Alabama (1975) effective on the date as shown above and continuing until expiration date set forth above unless sooner surrendered, suspended or revoked by the Board. These privileges are not assignable and are valid for use only by the licensee named hereon at the location hereon designated. Witness the hand and seal of the ABC Board. For questions or assistance go to our website www.alabcboard.gov click license and find the district contact number that services the county for this license. 100079 ADMINISTRATOR
License Renewal Receipt Receipt Confirmation Number: 20180725000010800 Payment Summary Payment Item County Fee State Fee Total Fee License: 050-010010854 050 - RETAIL BEER (OFF PREMISES ONLY) License: 070-010010854 070 - RETAIL TABLE WINE (OFF PREMISES ONLY) License: 990-010010854 990 - TOBACCO AND ALTERNATIVE NICOTINE PRODUCTS 0.00 150.00 150.00 0.00 150.00 150.00 0.00 0.00 0.00 Total Amount to be Charged 0.00 300.00 300.00 Vendor License List Trade Name Type of Business: Convenience Store Tobacco Vending Machines: 0 RVP Certification: N Business Location Address Liquor Liability Insurance in the amount of at least 100,000.00. Insurance Company: Hudson Specialty Insurance Co Insurance Policy Number: HSLL-35517 Insurance Coverage Begin: 07/09/2018 Insurance Coverage End: 07/09/2019 Renew License License Number License Type County County Fee State Fee RENEW 050-010010854 050 - RETAIL BEER (OFF PREMISES ONLY) RENEW 070-010010854 070 - RETAIL TABLE WINE (OFF PREMISES ONLY) RENEW 990-010010854 990 - TOBACCO AND ALTERNATIVE NICOTINE PRODUCTS Business Information Business/Applicant Name: MUN LLC Business Mailing Address: Business Phone: 205-367-1691 Business Type: The business is a corporation, partnership, LLC or LLP Member Information Member Info Member DOB Member Address Mitulkumar Patel 03/28/1983 India 326 Turtle Bay Circle Northport, AL 35473 PICKENS 0.00 150.00 PICKENS 0.00 150.00 PICKENS 0.00 0.00 Affidavit I (Mitulkumar Patel) hereby certify that all other material facts set forth in my original application and subsequent renewal applications are true and correct. By checking the boxes above, I certify that I acknowledge and confirm the affirmations contained in each statement. If currently certified in the ABC Board Responsible Vendor Program (RVP), I attest that this location is in compliance with the ABC Board RVP Requirements. Administrative Comments License Number: 050-010010854 Date Added: 07/30/2018 11:51:17 AM License Number: 990-010010854 Date Added: 07/30/2018 11:51:25 AM License Number: 070-010010854 Date Added: 07/30/2018 11:51:21 AM
UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below CERTIFICATE OF LIABILITY INSURANCE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG EACH OCCURRENCE AGGREGATE DATE (MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER INSURED THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (Ea occurrence) OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED HIRED SCHEDULED NON-OWNED Y / N N / A CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: NEW COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) PER STATUTE E.L. EACH ACCIDENT FAX (A/C, No): GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC OTH- ER E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Aggregate Limit---------------------- NAIC # DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) INS025 (201401) 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD