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GRAMA-Documents' ' 5/l5/'J3 ( • Park City Municipal APPLICATION FOR SPECIAL EVENT TEMPORARY l. ALCOHOLIC BEVERAGE LICENSE Organizational Information. Name of Organization: Vfp {'J<~t Mf\NI\CJE MtM' I LLC.. Address: ·lnS'"D tlvenuc oftvlt lr»1tafctts 't11JD NtW'yorz.t:-NY ID0\9_ Street Suite# 1 City State Zip Business License Number: -------Date Organization Founded: ------ Mailing Address (if different):--------------------- TYPe of organization: (check one) 0 Incorporated Association 0 Religious Organization 0 Corporation 0 Partnership 1J Limited Liability Company 0 Non-Profit Corporation 0 Political Organization 0 Clzeck if a local chapter or s11h-unit of any of the above. 0 Utah state agency or political subdivision of the state including a county or a municipality Please attach a Certificate of Existence and one additional document verifying the existence of business (check all that apply) t;4. Certificate of Existence (Required) f;l Partnership Agreement FEDERAL TAX# · Wr l16J.fb30 ?J Articles of Incorporation 0 Other:------------ STATE TAX# ______________ __ Names of all Owners, Officers, and Directors that have power to make decisions for the entity. Include partners, managers, managing agents, stockholders who hold at least 20% of the total issued and outstanding stock of Applicant Corporation, or members who own at least 20% of an applicant limited liability company (attach additional page if necessary).· Name Home Address 1 Date of Birth & City, State, Zip Driver's License# 2· . Liquor Liability Insurance Information. Insurance Company Name and Address: EIYPUf?A-NLE AtAW\tkN ll:JS\At?J\tJC f, (![J. PolicyNumber: P6UOOS'"lS1 ~01 Effective Date: _1.:..~./J..I L/lt..::f:__ ____ _ A:ra~h insurance certificate for insurance with a minimum amount of$1 million per occurrence, $2 mtlhon aggregate. · 3. Responsible Party. Please list the name of the person responsible for completing, signing, and·. submitting this application. · Name: Jame& 'Nl\liavr1 BonDr<&1: DateofBirth:-lo3'4-!ll.:...l.H.&.-.lllMtA,L_ __ _ Mailing Address: lt,S1) Avenue. Of 1itR Amtl?tLAS, NeVJmrz¥-, 1£L 10019 (Stn:cl Address) (City) !Swcl (Zip C~) Phone number: ZlJ. .... 3({'l-~ooo Fa"<: ·klz ... sgq .. b"2b3 E-mail: b\1\. Col1bfe st @i!J.os~. Cbro Driver's License Number: Issuing State: CttldoCnla 4. Local Agent Please list the name and Utah mailing address of a local agent authorized to receive service of process. Name: £tnabdh Bve.rnn c{o ~!,\\a w llmeg . Jrfe . Utah Mailing Address: rr Nest w. So!Atn Ttmpl<. ~~ Paff'~ . UT BUt 0/ (Sirffi Address) (City) {Zip Code:} Phone number: tb0\-151 -lglo Fa"<: ___________ _ E-mail: L bfer..ttm (! SN{ll.W · COM 5. Event Information. 5/15/U Nameofevent: TirO Pat-1< ~ Locationofevent: ThC 'rard P¥et1~ CetrftP.. -llSI llMrtN.S AVe. Unit# __ Date of this event: ~ 11 ""' I· '1':1· 1'/ and hours of event: 6 am ... .Sam Description of event: OD<!.¥:flti) p?4'h'f:S Type of alcohol being served:.---=.M_:__I ..;...;lr:.:..;l c.t':;..;;....;.h~o:.J.I ____________ _ Number of people at event: _ _.·Z~W~"'"'pt(!"'--_~~~g,_nt_· ------------ Admission policy (Admission Charge; Guest List, etc.):_· ·_,ro..u.z.:.u=es=t ..... L:;.o..i ...._84-_______ _ 2 S/15/U •eee y 4*¥4 6· Liquor License Information. Please list existing or prior beer or liquor licenses held (include special events licenses): ----'-- Have you or anyone claiming ownership or directorship ha<}Any beer or liquor licenses revoked by a government agency within the past 3 years? [ ] YES M NO 7. Criminal History. Please list aU criminal offenses, other than minor traffic offenses, of which you or any officers, partners, managers, managing agents, directors, stockholders who hold at least 20% of the total issued and outstanding stock of an applicant corporation, me~bers who own at least 20% of an applicant limited liability company, and any person employed in a supervisory or managerial capacity have ever been convicted (also include any pending criminal charges). If none, the undersigned applicant attests that the above persons have not been convicted of any disqualifYing criminal offense (attach additional page if necessary). Name Criminal Offense Date of Conviction By signing below, the above listed Responsible Party attests that: • The Responsible Party is authorized to act on behalf of the applicant; • The Responsible Party is responsible to ensure that all actions taken under a license derived from this application comply with state and local laws; • The Responsible Party may be held liable for any actions taken under a license derived from this application, including, but not limited to, any criminal or civil penalties arising from the misllSe of'a liquor license or the violation of state and/or local liquor laws; • The Responsible Party's acceptance of responsibility, including liability for any criminal or civil penalties stemming from the violation of state and/or local liquor laws, is separate from and in no way limits the duties and liabilities held by directors, officers, managers, or other agents of the above named organization to ensure compliance with state and local liquor laws; · • No one under the age of2 I is a partner or managing agent of the applicant partnership; a managing agent, officer, director, or stockholder who holds at least 20% of the total issued and outstanding stock of the applicant; o{ a manager or member who owns at least 20% of the applicant limited liability company; • The Applicant and all officers, partners, and/or directors meet the Licensee qualifications set forth under the Utah Code Annotated and the Park City Municipal Code; 3 5/lS/13 \ ' • No person in the alcoholic beverage industry (winery, brewery, distillery, importer, supplier, wh~lesaler, bottler, or warehouser) holds a partial interest in the ownership of the retail bUsmess or in the real or personal property owned, occupied, or used by the applicant in the conduct of the applicant's business. • No gambling or any other violation of law or ordinance will be allowed on the premises serviced by the single event pennittee; • The applicant does not and will not discriminate against persons on the basis of race, color, sex, religion, ancestry, or national origin at the event; • He/she has read and abides by the provisions of the relevant parts of Utah Code 32B-9 & 328-15, all Rules of the Commission and directives of the Department of Alcoholic Beverage Control; and understands that failure to comply with these provisions, including any ongoing eligibility requirements, may resutt in immediate suspension and/or revocation ofthe license; • The applicant gives consent that authorized representatives of the commission, department, or any law enforcement officers will have unrestricted right to enter the premises during the event; • Responsible Party authorizes the Local Agent listed in this application to accept service of process; and, • The Responsible Party attests under penalty of perjury that the infonnation contained in this application is true and correct. Datedthis_l_dayof O¢ernvuz Ul.f> Responsible Party's Signature Name/Title 4 County of_..L......lf'=--l.o<-"*"'"'~~--­t Subscribed & sworn to befi \ ob :.,......,::.......::....:;;;~~....;:__-' t:2D I fr / SEAL: JEANffiE A. Si'RANG Notary Public, State of New Yott No. 01516265311 Ouaiified in Nassau~ CcrlrJUon EIPresJJJt!l~ IJ Delaware Page 1 The First State I, .:JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF DELAWARE, DO HEREBY CERTIFY "VIP EVENT M1UfiAGEMENT LLC" IS DULY FORMED UNDER THE LAWS OF THE STATE OF DELAWARE AND IS IN GOOD STANDING AND HAS A LEGAL EXISTENCE SO FAR AS THE RECORDS OF THIS OFFICE SHOW, AS OF THE FIFTH DAY OF DECEMBER, A.D. 2016. AND I DO HEREBY FURTHER CERTIFY THAT THE SAID "VIP EVENT MANAGEMENT LLC" ,WAS FORMED ON THE 'l'WENTY-FOVRTH DAY OF APRIL, A.D. 2013. AND I DO HEREBY FURTHER CERTIFY THAT THE ANNUAL TAXES HAVE BEEN PAID TO DATE. 5324086 8300 SR# 20166904225 You may verify this certificate online at corp.delaware.gov/authver.shtml Authentication: 203445148 Date: 12-05-16 VIPEV-1 OPJD·SP ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE [MWDDIYYYY) t...........--12/08/2016 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(les) 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($). PRODUCER ~2AA~~cT E. B. Cohen & Associates E.B. Cohen & A.A.A., LLC r,vgN~o Ext\: 973·403-9500 I fffc Nol: 973·403-7755 Elias B. Cohen & Associates 1 01 Eisenhower Parkway E·MAIL ADDRESS: Roseland, NJ 07068 E.B. Cohen& Associates JNSURER(SJ AFFORDING COVERAGE NAICII INSURER A: Endurance American Ins. Co. 10641 INSURED VIP Event Management, LLC INSUReR e: Allied World Assurance Co. US 1350 6th Avenue, Suite 710 INSURERC: New York, NY 10019 INSURERO: INSURER!!: INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· 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 TYPE OF INSURANCE ~~~~; i~Jl POLICY NUMBER ~~~~hl~MVv, r~2hl~'fvWv, LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 j CLAIMS·MADE 0 OCCUR X PGL 10005237202 07/01/2016 07/01/2017 ~~~~~J?E~~'g~~onca\ $ 1,000,000 MED EXP (My one person) $ Excluded rx Liquor· $2m/$3m PERSONAL & ADV INJURY $ 1,000,000 '-- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAl AGGREGATE $ 2,000,000 =i POLICY 0 ~~8r [8] lOC PRODUCTS· COMP/01' AGG s 2,000,000 OTiiER: $ AUTOMOBILe liABILITY ~~~~~~~fl!>JGLE liMIT $ 1,000,000 -A #lYAUTO PGL 10005237202 07/01/2016 07/01/2017 BODILY INJURY (Per person) $ -AlL OWNED r-SCHEDULED BODILY INJURY (Per accidenl) $ x AUTOS 7 AUTOS HIRED AUTOS NON-OWNED Fp~~~~d'Z,t?AMAGE $ j--,..---.AUTOS $ ~ UMBRELLA UAB ~OCCUR EACH OCCURRENCE $ 25,000,000 8 EXCESSUAB CLAIMS·MAOE 0310-2180 07/01/2016 07/01/2017 AGGREGATE $ 25,000,000 OED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION I PER I I OTfi. STATIJTE ER AND EMPLOYERS' trABIUTY YIN ANY PROPRIETORJPARTNERIEXECUTIVE D N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory ln NH) , E.L. DISEASE· EA EMPLOYEE $ II ~as, describe under E.l. DISEASE ·POLICY LIMIT $ 0 SCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aUached If moro space Js required) !?ark City Munioipal Corp. is additional insured per form #CG20260704 when required by a written contract for Sundance Film Festival held on 1/19/17- 1/29/17. CERTIFICATE HOLDER I Park City Municipal Corp. Po Box 1480 Park City, UT 84050 PARKCIT CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED lN ACCORDANCE WITH THE POLICY PROVISIONS. ~ _..., ~ © 1988-2014 ACORD CORPORATION. All rights reserved. POLICY NUMBER: PGL 10005237201 COMMERCIAL GENERAL LIABILITY CG 2026 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY .. ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person{s) Or Organization(s) As required by written contract signed by both parties prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II -Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 2607 04 ©ISO Properties, Inc., 2004 Page 1 of1 · 0 S}lS/l3 Park City Municipal APPLICATION FOR SPECIAL EVENT TEMPORARY ALCOHOLIC BEVERAGE LICENSE I. Organizational Information. NrumeofO~ruli~tion: __ _:B~R~IL=L~~N~T~C~O~N~SU~L~T~IN~G~---------------------------- Ad~:~.--~1~18~2~7~AD~D~IS~O~N~S~T~R=EE~T~·~V~AL=L=E~Y~V~IL=LA~G~E~·~C~A~9~16~0~7 _________________ _ Street Suite# City State Zip Business License Number: _.:..:;NI:..:..A=----------Date Organi~tion Founded: 12/13/2007 Mailing Address {if different):---------------------------------- Type of organization: {check one) 0 Incorporated Association 0 Non-Profit Corporation 0 Religious Organization 0 Political O~anization 0 Clzeck if a local chapter or sub-unit of any of the above. 0 Corporation 0 Partnership 0 Limited Liability Company 0 Utah state agency or political subdivision of the state including a county or a municipality Please attach a Certificate of Existence and one additional document verifying the existence of business (check all that apply) t!'.1 Certificate of Existence (Required) ~ Articles of Incorporation 0 Partnership Agreement 0 Other:--------------------- FEDERAL TAX# ---:2:=..;6;_-1;.;:;5..:....7-..;;.07.;;..;:9:;.;:.5 _____ STATE TAX #_C:::::3:::.:::0:.::::69:::.:::9~03~---- Names of all Owners, Officers, and Directors that have power to make decisions for the entity. Include partners, managers, managing agents, stockholderS who hold at least 20% of the totaJ issued and outstanding stock of Applicant Corporation, or members who own at least 20% of an applicant limited liability company (attach additional page if necessary). Name Home Address DANIELLE PELLAND 1 2. Liquor Liability Insurance Information. · Insurance Company Name and Address: NEW HAMPSHIRE INSURANCE CO, 175 WATER ST, 18TH FL NY NY Policy Number: ---=U~S:::..7.:.:58:.:.7..:::85=----------Effective Date: --'1""'0/"'"'4_/2~0~16=--------- Attach insurance certificate for insurance with a minimum amount of$1 million per occurrence, $2 million aggregate. 3. Responsible Party. Please list the name of the person responsible for completing, signing, and submitting this application. Name: DANIELLE PELLAND Date ofBirth: 06/10/1978 Mailing Address: 11827 ADDISON STREET , VALLEY VILLAGE, CA 91607 (S~re:t Address) (Ciry) (State) (Zip Code) Phone number: 310-497-3747 Fax=----------------- E-mail: --~d==a::.:n.:.::ie:::;lle::..l@=bn:..:.:·l.:.:.:lia::.n:.::tco=ns:..:u::.lt::.:.in~g~.c:.;::o.:.:..m=--------------------- Driver's License Number: ....Jati?PIII !,.: --------Issuing State: ~C~A:!......_ ____ _ 4. Local Agent. Please list the name and Utah mailing address of a local agent authorized to receive service of process. Name: ___ ~D~AN~IE=L=L~E~P~E~L=LA~N~D=------------------------- Utah Mailing Address:-------------____________ ,UT ____ _ (Stmt Address) (City) (Zip Code) Phone number: 310-497-3747 Fax: __________________ _ E-mrul: ___ ~da~n~ie~l~le~@~b~ri~lli~an~t~co~n~s~u~lti~ng~.~co~m~-------------------- 5. Event Information. Name of event: ACURA LOUNGE Location of event: 825 MAIN ST, PARK CITY, UTAH & LOWER MAIN STREET Unit# ----- Date ofthis event: JAN 19TH-24TH and hours of event: QA!LY 9AM-3PM Description of event: Private dinners and cocktail parties Type of alcohol being served:.--'B!:!e5!5e2.!.;r·L..lW!.!l!.!in!S!.el...!. S~p~inw.!'t2.s -------------_;_--- Number of people at event: _.Q5.J.!.0!!.!.00!.!..Qov~ear:r..!il6ud!SlalY.Y..Llo~en~·ol.!.ldL.. ______________________________________ _ Admission policy (Admission Charge; Guest List, etc.): Private guest list only. not open to public 2 5/15/l3 .· 6. Liquor License Information. Please list existing or prior beer or liquor licenses held (include special events licenses): ___ _ Have you or anyone claiming ownership or directorship had any beer or liquor licenses revoked by a goveilliiient agency within the past 3 years? [ ] YES ~ NO 7. Criminal History. Please list all criminal offenses, other than minor traffic offenses, of which you or any officers, partners, managers, managing agents, directors, stockholders who hold at least 20% of the total issued and outstanding stock of an applicant cotparation, members who own at least 20% of an applicant limited liability company, and any person employed in a supervisory or managerial capacity have ever been convicted (also include any pending criminal charges). If none, S/l5/f3 the undersigned applicant attests that the above persons have not been convicted of any · disqualifying criminal offense (attach additional page if necessary). Name Criminal Offense Date of Conviction By signing below, the above listed Responsible Party attests that: • The Responsible Party is authorized to act on behalf of the applicant; • The Responsible Party is responsible to ensure that all actions taken under a license derived from this application comply with state and local laws; • The Responsible Party may be held liable for any actions taken under a license derived from this application, including, but not limited to, any criminal or civil penalties arising from the misuse of a liquor license or th~ violation of state and/or local liquor laws; • The Responsible Party's acceptance of responsibility, including liability for any criminal or civil penalties stemming from the violation of state and/or local liquor laws, is separate from and in no way limits the duties and liabilities held by directors, officers, managers, or other agents of the above named organization to ensure compliance with state and local liquor laws; · • No one under the age of21 is a partner or managing agent ofthe applicant partnership; a managing agent, officer, director, or stockholder who holds at least 20% of the total issued and outstanding stock of the applicant; or a manager or member who owns at least 20% of the applicant limited liability company; • The Applicant and all officers, partners, andlor directors meet the Licensee qualifications set forth under the Utah Code Annotated and the Park City Municipal Code; 3 S/15/13 I ' • No person in the alcoholic beverage industry (wJ.ry, brewery, distillery, importer, supplier, wholesaler, bottler, or warehouser) holds a partial! interest in the ovmership of the retail business or in the real or personal property owned, occupied, or used by the applicant in the conduct of the applicant's business. I · • No gambling or any other violation oflaw or ordinance will be allowed on the premises serviced by the single event permittee; I • The applicant does not and will not discriminate a'gainst persons on the basis of race, color, sex, religion, ancestry, or national origin at the event; I • He/she has read and abides by the provisions ofth:e relevant parts of Utah Code 32B-9 & 32B-15, all Rules of the Commission and directivbs of the Department of Alcoholic Beverage Control; and understands that failure to tom ply with these provisions, including any ongoing eligibility requirements, may result iA immediate suspension and/or revocation of the license; I • The applicant gives consent that authorized representatives of the commission, department. or any law enforcement officers will have unrestritted right to enter the premises during the event; I I • Responsible Party authorizes the Local Agent listed in this application to accept service of process; and, I I • The Responsible Party attests under penalty of peijury that the information contained in this application is true and correct. I . I I Dated this __g§L_ day of NOVEMBER ' 2016 Responsible Party's Signature Nbtary Public I I I SEAL: DANIELLE PELLAND I PRESIDENT I I Nameffitle . . ..-. -· ·-~ I 4 ENTITY W..,ME: stat~i .Citi:caUforhia . se6~~t~6/~ofgifate · CERTI!i'ICATE OF STJl_TUS . . .· . -. . . BRILLI~~:r CONSULTlllG GROUP FILE NlJ'brBER: FORMATION DATE: TYPE:·. JORISDIC'I'IOll: STATUS: C3069903 l'2/l3/2007 . . ... · ..• DOMESTIC CORPORA~ION q..~IFORNIA .. ·. . ACTIVE {GOOD. ST-¥iDiiTG} I, ALEX l?AD1LLA, Secretary ·.of State of the State .of California, hereny certify: · The records of this office iri.oicate the entity .is authorized to exercise all ·of its powers;-rights and privileges in the State of california. No information is ·avail,.ci.ble from this. office regarding: the financial condition; business activities or'pract:i.ces of the·entity . . IN WITNESS WHEREOF, I execute. this certificate and}affiX the (;reat Se.ai of the, State of . CQ.l~fqrzP.a this. .day of .Navi::niber 23, 2 016. · NP·25 (RE:V 0112015} ALEXPA1>ILLA sei!ret~ri pfState MAR ARTICLES OF INCORPORATION ARTICLE ONE The ruune of the corpcratiou is Brilliant Events and Mari:eting.luc.. ARTICLBTWO The pmpose of this corporation is to engage in any lawful act or activity fer whidJ a corporation may be organized Wider the Qencra] Corporation Law ot CalifcnU'a OUter than the banking business. the 1rust company business, or~ pmctice of a profession penniucd to be incorporated by the Ollifornia Cotporanoos Code. ARTICLE THREE The name and~ in this state of !his ~on.•s initial agent for sei'Vice ofprocess is; (a) (b) War.nro.Nemhoff' . ATI'ORNEY AT lAW 9935 S. SANTA MONICA BLVD. BEVERLY HILLS. CA 90212 ARTICLE FOUR. This Corporation is autboti:<:ed to issue only thn:e classes of shares,. wbleh shall be desisnated "Common Stoclc.", "Class A Prefemld Stock", and "Class B Preferred Stock''. respectively. Tbe total rusmbet of se4l shares that may be issued is 20,000,000 CommOn Stock shares. 1,000,000 Class A Preferred Srock shares and 2.000,000 Class B Prefem:d Stock shares. Tile board of directors may divide any class ofPtcfened Stock into any number of series. Tlle board shalJ fiX the designaUoa snd number of shares of ea:cb such series. The board may determine and alter the rig!us, pre~ privileges end restrictioos gnwted to and impOsed upon any whoU_y unissuo:f class or series ofibe Preferred Stock. The board of directoc:s (withm the limits and restrictions of any ~lution adcpled by it crigfnally fixing the number of share or any .series) may inctea'ie or decrease lhc ntlmberofslw'es of any such series after !he issue of shares of that series. but uot below the number of then outstanding sbanls or sueb series. ARTICLE FlVE Thl: liclliley of the Din:dor:i of the Corporation for monc:wy ~shall he eliminated to the fullest extent pemrissibfe under California Law. ARTICLESlX The Corpora&n is authorized to provide indcmnificatioa of iWf!ls (as defined in Section 3l7 oftbe Corpor.uioPS Code) for brc:ach of duty to the ~ralion and it's .stdholdets through bylaw provisions "or lhrough agreements wilh tbe agem.s. or ~loth in excess of the lndenmifitation otherwise •" .,. -;" ·peAniUed by Section 3 J7.o[the Corpomfions Code, subject lo 'lhe limits of such exce:;s :. .. ,,.·W"· indemDffkation il.':l for1li )n Section 2M of the Corparadons Code • .. ~:i:.: .,';:;;;~~: ·~~.:11: ~ohl:~>. . · a zc;r Warren Nemiroff. Esq. lneo.rpomtor : ·' ... . . • : i~. i I ! I I . --.. -·----.-----·· ·-------....-· -....-' ' Date=---------~ ~ILL.A, Seelelal}' of Slat& t I 1 I I ; I ! 1 ! ! I I I' I: , I . I I ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIODIYYYY) ~ 11/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO-RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTi'"ICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL0\11. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING !NSURER(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 tems and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certincate holder in lieu of such endorsement(s). PRODUCE::.! 22tl~~CT Mar:isa Mancini-Cavallo Shoff Darby Companies ~ (203) 354-6200 rr~ No\: (203)354-6480 488 M:2i.n Avenue avallom@shoffdarby.com 3rd FJoor INSURER($) AFFORDING COVERAGE NAIC# Norwa.:lk:. CT 06851 INSURER A :New Ham12_shire Insurance Co INSURED INSURER e :Hartford Ins. Co. of Midwest 37478 Brilljant Consulting Group· INSURERC :Hiscox Insurance Compa~ 11827 ~dd:i.son Street INSURERO: INSURERE: Valle;:y Village CA 91607 INSURERF: COVERAGES CERTIFICATE NUMBER·16/ 17 REVISION NUMBER· 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 CERTIRCATE 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 TYPE OF INSURANCE IAD!JL ~~.;' lr~~M~ 11.~37-6%~ LIMITS LTR """n POLICY NUMEER ~ COMMERCIAL GENERAL UAEIUTY EACH OCCURRENCE $ 2,000,000 f--tJ CLAIMS-MADE 0 OCCUR ~~t~~J?E~~~~ncel A $ 300,000 - SEL0l5502270 10/4/2016 10/4/2017 MED EXP (Any one person} $ 5,000 ', f-- ~ Host Liquor Liability US75S785 PERSONAL & ADV INJURY $ 2,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~ POLICY 0 ~&'8r 0 LOC PRODUCTS • COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY ~~~~~~INGLE LIMIT $ 1,000,000 1--BODILY INJURY (Per person) $ ANY AUTO A 1--ALL OWNED ~ ""''""' AUTOS AUTOS SEL015502270 10/4/2016 10/4/2017 BODILY INJURY {Per accident} $ 1--NON·OWNED rp~9~~~t?MIAGE $ ~ HIRED AUTOS AUTOS $ UMBRELLA LIAS HOCCUR EACH OCCURRENCE $ 1--EXCESSL!AB CLAIMS-MADE AGGREGATE $ OED I I REiENTION $ 1$ WORKERS COMPENSATION l~f~TUTE L j OTH-I AND EMPLOYERS' LIABILITY ER YIN ANY FROPRIETORIPARTNERIEXECUTIVE GJ E.L EACH ACCIDENT $ l 000 000 OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE • EA EMPLOYEE $ B {Mandatory In NH) 3lWECCU33SO 10/7/2016 10/7/2017 1 000,000 W yes. descnbe under DESCRIPTION OF OPERATIONS below E.L DISEASE ·POLICY UMIT $ 1.000 000 c Professional Liability MPLl622B36.l6 9/10/2016 9/10/2017 Umit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required} Dates: January 15 thru February 1, 2017 Mosaic Sales Solutions US Operating Co . .' LLC and its affiliates and Anheuser-Busch Companies, Inc. its parent, subsidiary and affiliated companies are included as Additional Insured in accordance w:i.th the policy provisions of the General Liability, Auto Liability and Employers' Liahil:i.ty policie CERTIFICATE HOLDER CANCELLATION Mosaic Sales Solutions US Operating.CO. LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 220 East Las Colinas Elvd Suit Irving, TX 75039 AUTHORIZED REPRESENTATIVE ·1\l"l"''~n ?'\ f2014/01l © 1988-2014ACORD CORPORATION. All rights reserve( The ACORD name and logo are registered marks of ACORD I i I ! I I 5/15/2 Park-City Municipal APPLICATION FOR SPECIAL EVENT TEMPORARY . ALCOHOLIC·BEVERAGELICENSK I. ::::~::~·60~-rD P SkL\f. . .. Address: &Y3~tzKB1A.~N9s PvtAK: Lbop pc_ £118~! St.-eet. % Su~te # City State Zip . , Business Li<:ense.Nurnber.: Lflfa_] Date Organization Founded: \ ~ -1-og Mailing Address (if different): ~ L-f 2/.o N , l21.1s 'p'\ '£SS P ~ I DO p Type oforganization: (check one) 0 Incorporated Association 0 Non-Profit Corporation 0 Religious Organ.ization 0 Po~itical Organization 0 Check if a iocnl chapter or sulJ..uniJof any of the abo11e. ~oration 0 Pa.rtriership 0 Limited Liability Company 0 Utah state agency or political subdivision of the state including a county or a municipality Please attach a Certificate of Existence and one additional documentverifying the existence of business (c~ all tbat apply) / !1( Certificate ofExistence (Required)· ~rticles ofincorporation 0 Partnership Agreement 0 Other:--'---'-----~-----'------ FEDERAL TAX# 2-0-:SJOJ 0 Sl ~STATE TAX# \ ~G l{3] C::fo ~ 0 0 ~ i O.ec: d ""= · "'""'-.... ~..._. k d. · · &: ·~~ • · $ TC t Names ofal1 OW'llers,, 1.ucers, a..11 · 'JJ!rectcrs:,tti& 'uave ,powerto mae e · ectSlO!lS':tOT·c,.uc entity~ Include partners, managers, managing agents-, stockholders who hold at least 20% of the total issued : and outstanding stock of Applicant Cor-poration, oqnemhers who own at least 20% of an applicant limited liability company (attach additional page if necessary). · Name Home Address C. S z· Date 1ty, tate, tp D . , nvers 1 I I 6. Liquor License Information. Please list existing or prior beer or liquor licenses held (include special events licenses):~---- S~()\£ wevcl---1 S~.coe 1 <;\ lb M.avlaf- Have you oranyone c~~ o'Wnersh..ip or directorsmy~er"Odiquorlicenses revoked by a government agency vnthln the past 3 years? t lYE~ 7: Criminal History. Please list all criminal offenses; other than minor: traffic offenses, of which you or any 'officers, pa..rtners,. nmnagers, managing -agents~ ·direetoi:s, stockhOlders who hold at least20% oftbetot~lisSt1e4 an4 outstanding sto<:;kofan applicant corporation) members "'110 own at least 20% of an apPliCahtJitnited liability comp&~y; and;anyperson employed in a supervisory or managerial capacity ha'<;e ever b,.,"'en convic!ed{a1so indme any pending crimlna1 cha:rge5). If none, the undersigned applicant attests that the above persons have not been convicted of any disqualifying erimiP,ai offense (attach ~ditional page. if necessary}~ 5/lS/1:3 . --. ' ' . Name CrirrJnal Offense Date of Conviction N/A:- .··.: By signfug below,. the above listed Responsible Party attests that; • 'the Responsible Party is authorized to act on behalf of the applicant; o The Responsible Party is responsible to ensure that all actions taken under a license derived from this application comply v.dth state and local laws; • The Responsible Party may be held liable for any actions taken under a license derived from this application, including, but nbt -limited to, any crin:iinal or civil penalties arising from the misuse of a liquor license or the violation of state and/or local liquor laws; tance of responsibility, including liability for any c:rimiilal o:r the viola:tion of state and/or local liquor laws, is separate from and liabilities held by directors, officers, managers, or other rganization to ensure compliance vlith state_ and local liquor is a partner or managing agent of the applicant partnership; a man~eting agent, officer, director, or stockholder who holds at least 20% of the total issued and outstanding stock of the applicant; or a manager or member who owns at least 20% of the applicant limited liability company; o The Applicant and all officers, partners, and/or directors meet the Licensee qualifications set forth under the Utah Code Annotated and the Park City Municipal Code; 3 Fire-Number: 72008.11 Profit Corporation ARTICLES OF lNCOF..PORA.'flON OF Top Shelf Services Inc. The undersigned persons, acting as incorporators under the Utah Revised Business Corporation Act, adopt the fofhrwing Articles ofincorporation for such Corporation; . Article I CorpQrateName The name of the corporatiun is 'fop Shelf Services fuc: Property Management ArtideU Purpose The corporation shall further 'have udlimited power to engage in an(ii do any :iawfu'l aCt concerning any and aU iawful business for which oorporations may he organized ooder the Utah Revised Business Corporation Act and any amendments thereto. Article III Capital Stock Ciass·ofS:hrures Number:: o.f Shm!es Common lOO Preferred 0 Aruere :rv Name and Address of Registered Agent ~he address OO~e COfjpOratimt'S in§;tiaJ. registered O:ffice Shall-/be: i 45 -(;ounuyside Circle Park City, UT 84098 The corporation's initial registered agent at such address shaU he: . Casey Bradeen Metzger I hereby acknowledge and accept appointment as corporation registered agent: Casey Brad'een Metzger Signature .ArticleV Names and Addresses of Incorporators State of Utah Department of Commerce Division of Corporations & Commercial Code This certifies that this registration has been filed and approved on 2, December 2008 in the office of the Division and here{ly issues this Certification thereof. ~«~. ~l~-----~-·~---(1 v KAm¥BERG Di'1isiomDfreetor Under G'RAMA {63-2-201}, an registration infonnation maintained by. the Division is ~lassi:lled. as public retoEd. .Ji'g.• coniidt!ilialliy purposes, the business entity physical address may be provided rather than tlle residential or private address of any individual affiliated with, the entity. Business RenMal Utah.gov Services Utah.gov Services Busines • Feedback • hlstructions e Fees e Contact Us Agencies Agencies Division of Corporations and Commercial Code :.;-The foiiowing renewals wiif oe upaatea m our system wnnm seven aays"' ..Please pri.n.t"the·'fo1lowing ·receipt for )'Otl'l" records Summary For: Business Name:· 1"0P·SHELF SERVICES INC. Entity Number: 72008if~l42 Business·:Renewed:',Q 1/0411015 Business Entity Jn:forma,ion Entity Number: Entity Name: 7200811-0142 TOP SHELF SERVICES INC. Renewal· c $15WO "'ee: Late Fee: $0.00 Total Fee Paid!. $15.00 Printer Frien~.IY. ForiTl. Back Home Feedback Form 12/5/16, 12:06 PM ATTENTION-New Utah Law HB 251 requires that aU businesses with 15 or more empfoyees must verify all new hires .for legal working status by JULY l, 2010. For more information go to ~...utah Dei2artment of Commerce Home I Division of Comorations Home I Contact ·us ~gov Home'! .!J.tab...gov Terms of Use;J Utah.goy Privacy Policy.'} !.lliill.gov Accessibility Policy, f Translate Utah.gov Copyright© 2014 State of Utah -All rights reserved. Utah.gov Home 1 Utah.gov Terms of Use I Utah.gov PrivacY. PolicY. I Utah.gov AccessibilitY. PoliCY.. I Translate Utah.gov · Copyright@ 2014 State of Utah -All rights reserved. file:{//Users{caseymetzgerfDropbox{1%20TOP%20SHELF%200FFlCE{DOCS{Business%20info{Department%20of%20Commerce%20Reg .. webarchive Page 1 of CERTIFICATE OF UABIUTY INSURANCE DATE (MM/OD!YYY'I 1112912016 -------·---·---·-------~-------·--·-----·-·--·-· ' TillS C[RTIFICI\T[ !S ISSUED AS A MATTER OFfNFORMI\TION ONl'f liND CONFERS NO RIGHTS UPON HIE CERTIFICATE BOLDER. TtHS C€P.Tif1CATE DOcS NOT ,\FFIP.MATI\'HY OR NEGI\11V , AMEND, EXTEND OR 1\LTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. TI;IS CERTIFIC,\TE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HIE ISSUING INSUREJ; : AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. iMPOinANT· Hthe Ct>rf!fic.Jt<.· holder is oml\DO!TIONAl iNSUlH:D, the polit:y(it.'!lo} musllhwe ADDtliONALINS!JR£.:0 provb~iun<:; or bt:~nt..h..tr'it:d. H 5USI?OGAnOrJ f5 '~~J;l!'i(D. >t:b-!L'C~ tG th(;' :..-. .,,~M~~,2:~~~~~~t .:::~ ~-~-~~-=~· :.=.~~~i~~~~~~ ~e.~.~~!~~:~~.':~~ ~~~~r-~~r:!=..t:~· fl. statem~nl on this certHk;Jte does not confer rights tC.:..~~~::'!~~~~~::~~-~~~~:~~-:.~':,:'_ ~-~-~~.:~.~-~~~.:~ent(~~: ..... ~ ---·· . . PRODUCER Haniey·s Farmers lnsuMnr;e Joe Hanley .l\gent PO Box 3068 Park Cily. Utah 84060 >"!SUR ED Top Shetf Services 5436 N Bu5iness P<'rk Loop Rd Unit C Park City. Utah 84098 COVERAGES CERTIFICATE NUM!lER: , Nfi!'_1E: _Joe -~"-11!ey ; PHONE FA.'<. ' (11/C, NO, EXT): 435.649.8656 : {A 'C, NO)· 435 645 7245 t~ .. ·----<0·--·-·-···~---·-· --·~----~·~····-·----~-·--·-·-~ ·-~ --·----···--·-·---· ·---·--···' , E-MAIL . ADDRESS· t.hanloy@farrnersagent.corn !NSURER(Sl AFFORDING COYERIIGE REVlSION NUMBEJ\: , . '<..L'· f1i , ~! l;;.i 1 ii:: ft.J~il. il "• ~ ;; t;·J'·!Ul~: .. NCI U') i UJ Uf Li ~·/;;' i!,'-,Vt :n.::~! :···~Uf.ll !0 i.t It, il·j<;Uf.!U) i-!~ ... \H. r .. i)fi'<li i {)!:: ;·: ![ ;·~ >L:C1 f.'Uflt'l;; -~~ ,J,i 'r'.. ~.:·: >.(: ~ • • : ... :. >.;;"'·;t_, .:;: l .• -f~.H;:;.,::_~/.L~-n i £ >.::-/; OP COi'-H)l :ION Of.\! h' r:ON i R.\C! t)f~ Oil !l k DOCtH.·H Ni V·!! fH ~!.SPt:C r IU \"lH!CI i fHI-I.l CfJ·!·! if!CAI'L ~.t:.y ~1[ ;~";!JLD OR'~.-\.~ ( P!. :t-i.:F-~ ! ' f.'!'.q.:CI! ~-!''( ';:'":!.!-!\f_!J ! ·~ ~-~nr--: 1-.::_ '::Un!rC t !() r.:.~. T!· t; T i i~;-;t:-; ! XClU\!<1HS N H.) C<-~t!DH iOt!'~ fH .~U(:f! P(;UOL'~ U:..-i! I:_; 5! HlVlN ~.\A'l: lf~v::. ;?.~U·i i~[fJUt":. f'J :)\ :•.:.I:'.· A TYPE OF INSURANCE I P!~f i_ll( ~ .i AUTOf·nOBil£ L!Ailll!TY ; AND EMPlOYeRS. LIABiliTY p;._!::N:: t~ : llf:f Ul n:t f•T i K~LI<it .. :ttMBll·; : i.'lC.i.UfJi n~·{M;mdatoryinN'Ii} 1 :!-.;•"-. ,f,·-..n~h·unr!l•rrH.!~CWl''Hlf-.11)[ ' jCPS2492050 POLICY E:(P (MM/DD/Y'IY:_'_.;l...;. _______ ~···--···-----·· · .. ~. ' ;., ,. . 05/26/2016 05/26/2017 ~ .l :'. ;;:::-;: .·} r '.:.:.: .• ;: :·--·---. ~-. ·---------~ --------.·~ ~~·! ,f_,\:l; ~.~! ;,~'1-,(:r .t ) '. _____ j __ __ ' DESCRIPTION OF OPERATfo'NS/ LOCATiONS/VEHtCt.ES (i\CORO t 0 t. Additional Remarks Scl1~dulu. may be Jtt.lched I!' more 'SPTJt:e i'.> rt..!quir~d) 1G;JtorcrtBarir.ndcrl!.. iqunr Li<lhilitv I -----------------I CGilT!FIC/ITE HOLDER AFCI's Beyond Cinema 305 Main Street P:Jrk City, U!ah I>IOGO ACORD 25 (2016/03) CANCElLJIT!ON .... r~T~~;~~:~~o~~:;~:;~~~~~~~::~~ff~~~~\;~-~iiif;~~~~~~~~E~7i~;~:~;;~ II ~-~~-;;~~;~~~;;;p~~~~;;~~~i-----~ -~~:-~-~~~~~-'-~ z~---~----- c, 1988-2015 ACORDf~RPORATION -~; Ri9hl I I nw ll\ORD n;:om0. and lo<Jo are r<:qistered marks of ACORD !