HomeMy WebLinkAboutResolution 37-25 Liquor License ApplicationDR 8404 (08/08/24)
COLORADO DEPARTMENT OF REVENUE
Uquor Enforcement Division
PO BOX 17087
Denver CO 80217-0087 .»».• i • . —.,....r3o3)2oM3oo """ Colorado Liquor Retail License Application
* Note that the Division will not accept cash d Pald bv Check Date Uploaded to Movelt
Paid Online
[I New License [Xl New-Concurrent II Transfer of Ownership || State Property Only || Master file
All answers must be printed in black ink or typewritten
Applicant must check the appropriate box(es)
Applicant should obtain a copy of the Colorado Liquor and Beer Code: SB^G_Colorado^gv/Uguor
Applicant is applying as a/an II Individual
Corporation
Limited Liability Company II Association or Other
Partnership (includes Limited Liability and Married
Couple Partnerships)
Applicant Name If an LLC, name of LLC; if partnership, at least 2 partner's names; if corporation, name of corporation
JWC Elevations, LLC
FEIN Number State Safes Tax Number
n-ade Name of Establishment (DBA)
Stanley Chocolate Factory
business Telephone
370-577-4000
Address of Premises (specify exact location of premises, include suite/unit numbers)
157 W. Elkhom Units 1-10 & 14
City County State ZIP Code
Estes Park Larimer co 80517
MaiingAdd-ess (Number and Street)City or Town State ZIP Code
1453 E. WonderviewAve., Unit 3 Estes Park co 80517
Email Address
mrios@stanleyhotel.com
If the premises currently has a liquor or beer license, you must answer the following questions.
Present Trade Name of Establishment (DBA)
|n/a
Present State License Number
|n/a
'resent Class of License
n/a
3resent Expiration Date
n/a
Page 1 of 16
ATTACHMENT 3
Section A Nonrefundable application fees*
m Application Fee for New License...................................................................................................................$1JOO.OO
fXl Application Fee for New License with Concurrent Review............................................................................$1 ,200.00
n Application Fee for Transfer...........................................................................................................................$1,10
Section B Liquor License Fees*
F~| Add Optional Premises to H & R ...............................................................$100.00 X Total
Add Sidewalk Service Area.................................................................................................................................$75.00
Q Arts License (City)..,......................................,.................................................................................
II Arts License (County).......................................................................................................................................$308
n Beer and Wine License (City)...........................................................................................................................$351.25
II Beer and Wine License (County)......................................................................................................................$436.25
II Brew Pub License (City).................................................................................................................................. $750.00
r~l Brew Pub License (County)..............................................................................................................................$750.00
II Campus Liquor Complex (City)........................................................................................................................$500.00
II Campus Liquor Complex (County)..................................................................................................................$500.00
II Campus Liquor Complex (State)......................................................................................................................$500.00
D Club License (City)..................................................................................................................................^
n Club License (County)...................................................................................................................................^
n Distitlery Pub License (City)....................................................................................................................
n Distillery Pub License (County)......................................................................................................................
Q Entertainment Facility License (City)................................................................................................................$
II Entertainment Facility License (County)...........................................................................................................$500.00
Hotel and Restaurant License (City).................................................................................................................$500.00
n Hotel and Restaurant License (County) ...........................................................................................................$500.00
II Hotel and Restaurant License with one optional premises (City).....................................................................$600.00
II Hotel and Restaurant License with one optional premises (County)................................................................$600.00
DR B404 (08/08/24) Page 2 of 16
Section B Liquor License Fees* (Continued)
r~] Liquor-Licensed Drugstore (City).....................................................................................................................$227.50
I] Liquor-Licensed Drugstore (County)................................................................................................................$312.50
I) Lodging Facility License (City)..........................................................................................................................$500.00
II Lodging Facility License (County) ....................................................................................................................$500.00
II Manager Registration - H & R............................................................................................................................$30.00
Manager Registration-Tavern...........................................................................................................................$30.00
I Manager Registration - Lodging & Entertainment..............................................................................................$30.00
II Manager Registration -Campus Liquor Complex..............................................................................................$30.00
II Optional Premises License (City).....................................................................................................................$500.00
Optional Premises License (County)................................................................................................................$500.00
II Racetrack License (City)..................................................................................................................................$500.^
Racetrack License (County).............................................................................................................................$500.00
Resort Complex License (City).........................................................................................................................$500.00
r~| Resort Complex License (County)...................................................................................................................$500.00
r~\ Related Facility - Campus Liquor Complex (City).............................................................................................$160.00
II Related Facility - Campus Liquor Complex (County) ..................,........................................................,...........$160.00
II Related Facility - Campus Liquor Complex (State) ..........................................................................................$160.00
II Retail Gaming Tavern License (City)................................................................................................................$500.00
II Retail Gaming Tavern License (County)...........................................................................................................$500.00
II Retail Liquor Store License-Additional (City)..................................................................................................$227.50
II Retail Liquor Store License -Additional (County).............................................................................................$312.50
II Retail Liquor Store (City)................................................................................................................................
DR 8404 (08/08/24) Page 3 of 16
Section B Liquor License Fees* (Continued)
II Retail Liquor Store (County).
II Tavern License (City).
II Tavern License (County).
Vintners Restaurant License (City)
Vintners Restaurant License (County).
Questions? Visit: SBG.Colorado.gov/Liquor for more information
Do not write in this space - For Department of Revenue use only
Liability Information
.$312.50
.$500.00
.$500.00
.$750.00
.$750.00
-icense Account Number -iability Date
License Issued Through (Expiration Date)Total
OR 8404 (08/08/24)Page 4 of 16
Application Documents Checklist and Worksheet
Instructions: This checklist should be utilized to assist applicants with filing all required
documents for licensure. All documents must be properly signed and correspond with the name
of the applicant exactly. All documents must be typed or legibly printed. Upon final State approval
the license will be mailed to the local licensing authority. Application fees are nonrefundable.
Questions? Visit: SBG^Colorado.gov/Ljquorfor more Information
Items submitted, please check all appropriate boxes completed or documents submitted
I. Applicant Information
[3 Applicant/Licensee identified
State sales tax license number listed or applied for at time of application
[3 License type or other transaction identified
[3 Return originals to local authority (additional items may be required by the local licensing authority)
fXl All sections of the application need to be completed
f5?I Master file applicants must include the Application for Master File form DR 8415 and applicable fees to this
Retail License Application
II. Diagram of the premises
No larger than ay/X 11"
Dimensions included (does not have to be to scale). Exterior areas should show
type of control (fences, walls, entry/exit points, etc.)
[?3 Separate diagram for each floor (if multiple levels)
Return originals to local authority (additional items may be required by the local licensing authority)
I XJ Kitchen - identified if Hotel and Restaurant
[3 Bold/Outlined Licensed Premises
III. Proof of property possession (One Year Needed)
[3 Deed in name of the applicant (or) (matching Applicant Name provided on page 1 ) date stamped / filed with
County Clerk
Lease in the name of the applicant (or) (matching Applicant Name provided on page 1)
II Lease assignment in the name of the applicant with proper consent from the landlord and acceptance
by the applicant
II Other agreement if not deed or lease. (matching Applicant Name provided on page 1)
DR 8404 (08/08/24) Page 5 of 16
IV. Background information (DR 8404-1) and financial documents
Complete DR 8404-1 for each principal (individuals with more than 10% ownership, officers,
directors, partners, members)
Fingerprints taken and submitted to the appropriate Local Licensing Authority through an approved State
Vendor. Master File applicants submit results to the State
Do not complete fingerprint cards prior to submitting your application.
The Vendors are as follows:
IdentoGO
Appointment Scheduling Website: https://uenroll.identogo.c:om/workflows/25yQHT
Phone: 844-539-5539 (toll-free)
IdentoGO FAQs: https://cbi.colorado,gov/sections/biometric-identification-and-records-unit/biometnc-
identificatiqn-and-records-unit-faqs
State Liquor Code for IdentoGO: 25YQHT
Colorado Fingerprinting
Appointment Scheduling Website: http://www.coloradofingerpi~inting.com/cabs/
Phone: 720-292-2722 833-224-2227 (toll free)
State Liquor Code for Colorado Fingerprinting: C030LIQI
n^APurchase agreement, stock transfer agreement, and/or authorization to transfer license
List of all notes and loans (Copies to also be attached)
V. Sole proprietor/husband and wife partnership (If applicable)
|N/(\ Form DR 4679 Lawful Presence Affidavit
^JA^opy of State issued Driver's License or Colorado Identification Card for each applicant
VI. Corporate applicant Information (if applicable)
[N^ Certificate of Incorporation
miACertificate of Good Standing
[]3IA3ertificate of Authorization if foreign corporation (out of state applicants only)
VII. Partnership applicant information (if applicable)
'artnership Agreement (general or limited).
[^A^ertificate of Good Standing
VIII. Limited Liability Company applicant information (if applicable)
Copy of articles of organization
Certificate of Good Standing
m^\ Copy of Operating Agreement (if applicable)
^y/tertificate of Authority if foreign LLC (out of state applicants only)
IX. Manager registration for Hotel and Restaurant, Tavern, Lodging & Entertainment, and
Campus Liquor Complex licenses when included with this application
).00 fee
If owner is managing, no fee required
DR 8404 (08/08/24) Page 6 of 16
1. Is the applicant (including any of the partners if a partnership; members or
managers if a limited liability company; or officers, stockholders or directors if a
corporation) or managers under the age oftwenty-one years?....,.....,...,,,..,.........,.... 0 Yes ® No
2. Has the applicant (including any of the partners if a partnership; members or managers if a limited
liability company; or officers, stockholders or directors if a corporation) or managers ever (in
Colorado or any other state):
a. Been denied an alcohol beverage license?........................................................... Q Yes
b. Had an alcohol beverage license suspended or revoked?................................. Q Yes
c. Had interest in another entity that had an alcohol beverage license
suspended or revoked?.........................,.........................................................,........ 0 Yes
If you answered yes to a, b ore above, explain in detail on a separate sheet.
3. Has a liquor license application (same license class), that was located within 500
feet of the proposed premises, been denied within the preceding two years?.............. 0 Yes
If "yes", explain in detail.
No
No
No
No
4. Are the premises to be licensed within 500 feet, of any public or private school
that meets compulsory education requirements of Colorado law, or the principal
campus of any college, university or seminary? ................................................... 0 Yes
or
Waiver by local ordinance? 0 Yes ®
Other
No
No
5. Is your Liquor Licensed Drugstore (LLDS) or Retail Liquor Store (RLS) within
1500 feet of another retail liquor license for off-premises sales in a jurisdiction
with a population of greater than (>) 10,0000? NOTE: The distance shall be
determined by a radius measurement that begins at the principal doorway of the
LLDS/RLS premises for which the application is being made and ends at the
principal doorway of the Licensed LLDS/RLS............................................................ 0 Yes No
DR 8404 (08/08/24)Page 7 of 16
6. Is your Liquor Licensed Drugstore (LLDS) or Retaii Liquor Store (RLS) within
3000 feet of another retail liquor license for off-premises sales in a jurisdiction
with a population of less than (<) 10,0000? NOTE: The distance shall be
determined by a radius measurement that begins at the principal doorway of the
LLDS/RLS premises for which the application is being made and ends at the
principal doorway of the Licensed LLDS/RLS............................................................ 0 Yes ® No
For additional Retail Liquor Store only.
a. Was your Retail Liquor Store License issued on or before January 1, 2016?.... Q Yes (•) No
b. Are you a Colorado resident?.......,,................,.....,..,.............................................., Q Yes (®) No
7. Has a liquor or beer license ever been issued to the applicant (including any
of the partners, if a partnership; members or manager if a Limited Liability
Company; or officers, stockholders or directors if a corporation)? If yes, identify
the name of the business and list any current financial interest in said business
including any loans to or from a licensee....................................................................... 0 Yes ® No
8. Does the applicant, as listed on line 2 of this application, have legal
possession of the premises by ownership, lease or other arrangement?.......... ® Yes 0 No
Ownership Q Lease Q other (Explain in detail)
a. If leased, list name of landlord and tenant, and date of expiration, exactly as they appear on
the lease:
Landlord Tenant Expires
n/a n/a n/a
b. Is a percentage of alcohol sales included as compensation to the landlord?
If yes, complete question on page 9...................................................................... 0 Yes ® No
c. Attach a diagram that designates the area to be licensed in black bold outline (including
dimensions) which shows the bars, brewery, walls, partitions, entrances, exits and what each
room shall be utilized for in this business. This diagram should be no larger than QVi" X 11".
DR 8404 (08/08/24) Page 8 of 16
9. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations,
limited liability companies) will loan or give money, inventory, furniture or equipment to or for use in this
business; or who will receive money from this business? Attach a separate sheet if necessary.
Last Name First Name
n/a n/a
Date of Birth (MM/DD/YY)FEIN or SSN Number Interest/Percentage
n/a I |n/a n/a
Last Name First Name
n/a n/a
Date of Birth (MM/DD/YY)FEIN or SSN Number Interest/Percentage
n/a n/a n/a
Last Name First Name
n/a n/a
Date of Birth (MM/DD/YY)FEIN or SSN Number Interest/Percentage
n/a n/a n/a
Attach copies of all notes and security instruments and any written agreement or details
of any oral agreement, by which any person (Including partnerships, corporations, limited
liability companies, etc.) will share in the profit or gross proceeds of this establishment, and
any agreement relating to the business which Is contingent or conditional in any way by
volume, profit, sales, giving of advice or consultation.
10. Optional Premises or Hotel and Restaurant Licenses with Optional Premises:
Has a local ordinance or resolution authorizing optional premises been adopted?.... 0 Yes ® ?
In/aNumber of additional Optional Premise areas requested. (See license fee chart)
For the addition of a Sidewalk Service Area per Regulation 47-302(A)(4), include a diagram of the
service area and documentation received from the local governing body authorizing use of the
sidewalk. Documentation may include but is not limited to a statement of use, permit, easement, or
other legal permissions.
11. Liquor Licensed Drugstore (LLDS) applicants, answer the following:
a. Is there a pharmacy, licensed by the Colorado Board of Pharmacy, located
within the applicant's LLDS premise?................................................................... 0 Yes
If "yes" a copy of license must be attached.
No
DR 8404 (08/08/24)Page 9 of 16
12. Club Liquor License applicants answer the following: Attach a copy of applicable documentation
a. Is the applicant organization operated solely for a national, social, fraternal,
patriotic, political or athletic purpose and not for pecuniary gain?................,..... 0 Yes (®) No
b. Is the applicant organization a regularly chartered branch, lodge or chapter
of a national organization which is operated solely for the object of a patriotic
or fraternal organization or society, but not for pecuniary gain?.......,................ ^ Yes ® No
|n/ac. How long has the club been incorporated?.
d. Has applicant occupied an establishment for three years (three years required)
that was operated solely for the reasons stated above?..................................... 0 Yes ® No
13. Brew-Pub, Distillery Pub orVintner's Restaurant applicants answer the following:
a. Has the applicant received or applied for a Federal Permit? (Copy of permit
orapplication must be attached).,...„.„...„„.„....„.„.„„„„.„„......„..„..„.„......„....„. 0 Yes ® No
14. Campus Liquor Complex applicants answer the following:
a. Is the applicant an institution of higher education?.............................................. Q Yes (®) No
b. Is the applicant a person who contracts with the institution of higher
education to provide food services?....................................................................... 0 Yes ® No
If "yes" please provide a copy of the contract with the institution of higher education
to provide food services.
15. For all on-premises applicants.
a. For all Liquor Licensed Drugstores (LLDS) the Permitted Manager must also submit an
Manager Permit Application - DR 8000 and fingerprints.
Last Name of Manager First Name of Manager
Cullen IV John
16. Does this manager act as the manager of, or have a financial interest in, any
other liquor licensed establishment in the State of Colorado? If yes, provide
name, type of license and account number.............................................................. ® Yes U ?
Name
|The Stanley Hotel
Type of License Account Nymber
Hotel & Restaurant
OR 8404 (08/08/24) Page 10 of 16
17. Related Facility - Campus Liquor Complex applicants answer the following:
a. Is the related facility located within the boundaries of the Campus
Liquor Complex?............,...,.................,.......................................,.............,,...,,....,.. 0 Yes ®No
If yes, please provide a map of the geographical location within the Campus Liquor Complex.
If no, this license type is not available for issues outside the geographical location of the
Campus Liquor Complex.
b. Designated Manager for Related Facility - Campus Liquor Complex
Last Name of Manager First Name of Manager
n/a n/a
18. Entertainment Facility License
If Applicant is applying for an Entertainment Facility License, you affirm that your
business model and aligns with the statutory privileges and requirements:Yes No
Pursuant to 44-3-103(15.5) C.R.S., an Entertainment Facility means an establishment in which
the primary business is to provide the public with sports or entertainment activities within
its licensed premises; and that, incidental to its primary business, sells and serves alcohol
beverages at retail for consumption on the licensed premises; and has sandwiches and light
snacks available for consumption on the licensed premises.
If Applicant is applying for a Lodging Facility License, you affirm that your
business model and aligns with the statutory privileges and requirements: ...........0 Yes
Pursuant to 44-3-103(29) C.R.S., a Lodging Facility means an establishment in which the
primary business is to provide the public with sleeping rooms and meeting facilities; and that
sells and serves alcohol beverages at retail for consumption on the licensed premises; and has
sandwiches and light snacks available for consumption on the licensed premises.
19. Tax Information.
a. Has the applicant, including its manager, partners, officer, directors,
stockholders, members (LLC), managing members (LLC), or any other
person with a 10% or greater financial interest in the applicant, been found
in final order of a tax agency to be delinquent in the payment of any state or
local taxes, penalties, or interest related to a business?..................................... 0 Yes
b. Has the applicant, including its manager, partners, officer, directors,
stockholders, members (LLC), managing members (LLC), or any other
person with a 10% or greater financial interest in the applicant failed to pay
any fees or surcharges imposed pursuant to section 44-3-503, C.R.S. ?......... Q Yes
No
No
No
DR 8404 (08/08/24)Page It of 16
If applicant is a corporation, partnership, association or limited liability company, applicant must list all
Officers, Directors, General Partners, and Managing Members. In addition, applicant must list any
stockholders, partners, or members with ownership of 10% or more in the applicant. All persons
listed below must also attach form DR 8404-1 (Individual History Record), and make an appointment
with an approved State Vendor through their website. See application checklist, Section IV, for details.
Name
Street Address
Date of Birth (MM/DD/YY)
John W. Cullen IV
210 Twin Owls Lane
3ity
Estes Park
State
co
71P Code
80517
:>osition
President
'/o Owned
100%
Name
Street Address
Date of Birth (MM/DD/YY)
n/a n/a
n/a
3ity
n/a
State
n/a
71P Code
n/a
::>osition
n/a
/o Owned
n/a
Name
Street Address
Date of Birth (MM/DDA/Y)
n/a n/a
n/a
3ity
n/a
State
n/a
71P Code
n/a
3osition
n/a
'/o Owned
n/a
Name
Street Address
Date of Birth (MM/DD/YY)
n/a n/a
n/a
3ity
n/a
3tate
n/a
71P Code
n/a
'osition
n/a
'/o Owned
n/a
Name
Street Address
Date of Birth (MM/DD/YY)
n/a n/a
n/a
3ity
n/a
3tate
n/a
71P Code
n/a
3osition
n/a
'/o Owned
n/a
OR 8404 (08/08/24)Page 12 of 16
** If applicant is owned 100% by a parent company, please list the designated principal
officer on above.
** Corporations - the President, Vice-President, Secretary and Treasurer must be accounted for
above (Include ownership percentage if applicable)
** If total ownership percentage disclosed here does not total 100%, applicant must check this box:
Applicant affirms that no individual other than these disclosed herein owns 10% or more of the applicant and does
not have financial interest in a prohibited liquor license pursuant to Article 3 or 5, C.R.S.
I would like to apply fora Two-Year Renewal..................................................................... Q Yes (•) No
Oath Of Applicant
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 also acknowledge that it is my responsibility and the
responsibility of my agents and employees to comply with the provisions of the Colorado Liquor or Beer
and Wine Code which affect my license.
Printed Name / Title
JohnW.C.UH^shlV/ y/President
Authorized Signature / ,•/'/, Date (MM/DD/YY)
_e_
7?.. -^^ H [:^^[^j..iyLReport and Approval of Local Licensing Authority (City/County)
Date q^plication filed with local authority Date of local authority hearing (for new
/ -2-1- i^. ._ _^ I license applicants; cannot be less than
\^ru^ _I 30 days from date of application)
For Transfer Applications Only - Is the license being transferred valid?......................... 0 Yes 0 No
The Local Licensing Authority Hereby Affirms that each person required to file DR 8404-1 (Individual
History Record) or a DR 8000 (Manager Permit) has been:
(3 Fingerprinted
II Subject to background investigation, including NCIC/CCIC check for outstanding warrants
That the local authority has conducted, or intends to conduct, an inspection of the proposed premises
to ensure that the applicant is in compliance with and aware of, liquor code provisions affecting their
class of license
(Check One)
0 Date of inspection or anticipated date
® Will conduct inspection upon approval of state licensing authority
Is the Liquor Licensed Drugstore (LLDS) or Retail Liquor Store (RLS)
within 1,500 feet of another retail liquor license for off-premises sates
in a jurisdiction with a population of > 10,0000? .................................. u Yes ® No
DR 8404 (08/08/24) Page 13 of 16
D Is the Liquor Licensed Drugstore (LLDS) or Retail Liquor Store (RLS)
within 3,000 feet of another retail liquor license for off-premises sales
in a jurisdiction with a population of < 10,0000? .................................. 0 Yes 0 No
NOTE: The distance shall be determined by a radius measurement that begins at the principal
doorway of the LLDS/RLS premises for which the application is being made and ends at the
principal doorway of the Licensed LLDS/RLS.
Q Does the Liquor-Licensed Drugstore (LLDS) have at least twenty
percent (20%) of the applicant's gross annual income derived from the
sale of food, during the prior twelve (12) month period?............................ 0 Yes 0 N(3
The foregoing application has been examined; and the premises, business to be conducted, and
character of the applicant are satisfactory. We do report that such license, if granted, will meet the
reasonable requirements of the neighborhood and the desires of the adult inhabitants, and will
comply with the provisions of Title 44, Article 4 or 3, C.R.S., and Liquor Rules. Therefore, this
application is approved.
Local Licensing Authority Approves this license fora t^/o-year renewal........................ Q Yes 0 No
If "No", please cite the law, regulation, local ordinance or resolution that gives the local licensing
authority the ability to deny the applicant and grounds for denial. Also, please provide any and all
investigative reports, and administrative or criminal action that relate or justify this denial.
Proof of Violation
.ocal Licensing Authority for
cs^ &&>'*'S-^> <^>pv<&<y_-
Felephone Number
^-To-^^- ^?/
J0<]^ City
0 County
=>rinted Name niie
Signature Date (MM/DD/YY)
3rinted Name Fitle
Signature )ate (MM/DDA'Y)
DR 8404 (08/00/24)Page 14 of 16
DR 8495 (02/16/24)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
PO BOX 17087
Denver CO 80217-0087
(303) 205-2300
Tax Check Authorization, Waiver, and Request to Release Information
I,John W. Cullen IV
am signing this Tax Check Authorization, Waiver and Request to Release Information (hereinafter
"Waiver") on behalf of
(the "Applicant/Licensee")
JWC Elevations, LLC
to permit the Colorado Department of Revenue and any other state or local taxing authority to release
information and documentation that may otherwise be confidential, as provided below. If I am signing
this Waiver for someone other than myself, including on behalf of a business entity, I certify that I have
the authority to execute this Waiver on behalf of the ApplicanVLicensee.
The Executive Director of the Colorado Department of Revenue is the State Licensing Authority, and
oversees the Colorado Liquor Enforcement Division as his or her agents, clerks, and employees. The
information and documentation obtained pursuant to this Waiver may be used in connection with the
Applicant/Licensee's liquor license application and ongoing licensure by the state and local licensing
authorities. The Colorado Liquor Code, section 44-3-101. etseq. ("Liquor Code"), and the Colorado
Liquor Rules, 1 CCR 203-2 ("Liquor Rules"), require compliance with certain tax obligations, and set
forth the investigative, disciplinary and licensure actions the state and local licensing authorities may
take for violations of the Liquor Code and Liquor Rules, including failure to meet tax reporting and
payment obligations.
The Waiver is made pursuant to section 39-21-113(4), C.R.S., and any other law, regulation, resolution
or ordinance concerning the confidentiality of tax information, or any document, report or return filed
in connection with state or local taxes. This Waiver shall be valid until the expiration or revocation
of a license, or until both the state and local licensing authorities take final action to approve or deny
any application(s) for the renewal of the license, whichever is later. ApplicanVLicensee agrees to
execute a new waiver for each subsequent licensing period in connection with the renewal of any
license, if requested.
By signing below, ApplicanVLicensee requests that the Colorado Department of Revenue and any
other state or local taxing authority or agency in the possession of tax documents or information,
release information and documentation to the Colorado Liquor Enforcement Division, and is duly
authorized employees, to act as theApplicant's/Licensee's duly authorized representative under
section 39-21-113(4), C.R.S., solely to allow the state and local licensing authorities, and their duly
authorized employees, to investigate compliance with the Liquor Code and Liquor Rules. ApplicanV
Licensee authorizes the state and local licensing authorities, their duly authorized employees, and
their legal representatives, to use the information and documentation obtained using this Waiver in any
administrative or judicial action regarding the application or license.
Page 15 of 16
Name (Individual/Business)
JWC Elevations, LLC
Social Security Number/Tax Identification Number •\ome Phone Number
n/a
iusiness/Work Phone Number
410-585-4300
Street Address
333 E. Wonderview Ave
3ity
Estes Park
state
co
;IP Code
80517
Printed name of person signing on behalf of the Applicant/Licensee
John W. Cull^n IV
Applicant/Liceps9fe'$f<Sign^rfur^$i&nature authorizing the disclosure of confidential tax information) Date Signed77: (^^7^.^ ^/ (^
Privacy /\^t Statement
Providing your Social Security Number is voluntary and no right, benefit or privilege provided by law will
be denied as a result of refusal to disclose it. § 7 of Privacy Act, 5 USCS § 552a (note).
DR 8495 (02/16/24)Page 16 o(16
JWC Elevations, LLC
d/b/a
Stanley Chocolate Factory
157 W. Elkhorn Ave.,
I EstesPark,C080S17
^
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•
WILD ROSE
21'-S'
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JWC Elevations, LLC
d/b/a
Stanley Chocolate Factory
157 W. Elkhorn Ave.,
Estes .Park, CO 80517
JWC Elevations, LLC
d/b/a
Stanley ChocolRte Factory
lS7W.EIkhornAvc.,
EstesPark,C080517
^
157 W ElkhomAvn, Eil.s Folk, CO 80517
JWC Elevations, LLC
d/b/a
Stanley Chocolate Factory
157 W. Elkhorn Avc.,
Estes Park, CO 80517
^
157 W EfkJrm Ava, Erisi fcA. OKWil 7
DR 8404-1 (12/05/24)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
PO Box 17087
Denver CO 80217-0087
(303) 205-2300
Individual History Record
To be completed by the following persons, as applicable: sole proprietors; general partners regardless
of percentage ownership, and limited partners owning 10% or more of the partnership; all principal
officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning
10% or more of the outstanding stock; managing members or officers of a limited liability company, and
members owning 10% or more of the company; and any intended registered manager of Hotel and
Restaurant, Tavern, Lodging Facility, and Entertainment Facility class of retail license
Notice: This individual history record requires information that is necessary for the licensing
investigation or inquiry. All questions must be answered in their entirety or the license application may
be delayed or denied. If a question is not applicable, please indicate so by "N/A". Any deliberate
misrepresentation or material omission may jeopardize the license application. (Please attach a
separate sheet if necessary to enable you to answer questions completely)
Name of Business
JWC Elevations, LLC
Home Phone Number Cellular Number
n/a
Your Full Name (last, first, middle)
Cullen, John Wesley
List any other names you have used
n/a
Mailing address (if different from residence)
453 E. Wonderview Ave Unit 3 PMB 257, Estes Park, CO
Email Address
JCullen@grandheritage.com
210 Twin Owl Lane EstesPark,C080517
1. List current residence address. Include any previous addresses within the last five years. (Attach
separate sheet if necessary)
Current Street and Number Current City, State, ZIP
1210 Twin Owl Lane I |Estes
From: To:
110/29/2019 I ICurrent
Previous Street and Number Previous City, State, ZIP
|n/a I |n/a
From: To:
10/29/2019 Current
n/a n/a
n/a n/a
Page 1 of 6
Individual History Record (Continued)
2. List all employment within the last five years. Include any self-employment. (Attach separate sheet
if necessary)
Name of Employer or Business
Grand Heritage Hotel Group
Address (Street, Number, City, State, ZIP)
333 E. WonderviewAve., Estes Park, CO 80517
Position Held
President
From:To:
1989 Current
Name of Employer or Business
n/a
Address (Street, Number, City, State, ZIP)
n/a
Position Held
n/a
From:To:
n/a n/a
Name of Employer or Business
n/a
Address (Street, Number, City, State, ZIP)
n/a
Position Held
n/a
From:To:
n/a n/a
3. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol
beverage industry.
Name of Relative Relationship to You:
n/a n/a
Position Held Name of Licensee
n/a n/a
Name of Relative Relationship to You:
n/a n/a
Position Held Name of Licensee
n/a n/a
DR 8404-1 (12/05/24)Page 2 of 6
Individual History Record (Continued)
Name of Relative Relationship to You:
n/a n/a
Position Held Name of Licensee
n/a n/a
Name of Relative Relationship to You:
n/a n/a
Position Held Name of Licensee
n/a n/a
4. Have you ever applied for, held, or had an interest in a Colorado Liquor or
Beer License, or loaned money, furniture, fixtures, equipment or inventory to
any licensee?
(If yes, answer in detail.)
Yes 0 No
currently hold the liquor license for The Stanley Hotel.
5.Have you ever received a violation notice, suspension, or revocation for a
liquor law violation, or have you applied for or been denied a liquor or beer
license anywhere in the United States?.......................................,..,............................. (-) yes
(If yes, answer in detail.)
7.
No
6. Have you ever been convicted of a crime or received a suspended sentence,
deferred sentence, or forfeited bail for any offense in criminal or military court
or do you have any charges pending?..,,...................................,.................................. ^ yes
(If yes, answer in detail.)
® No
Are you currently under probation (supervised or unsupervised), parole, or
completing the requirements of a deferred sentence?.
(If yes, answer in detail.)
0 Yes No
DR 8404-1 (12/05/24)Page 3 of 6
Individual History Record (Continued)
8. Have you ever had any professional license suspended, revoked, or denied?..... 0 Yes
(If yes, answer in detail.)
No
Personal and Financial Information
Unless otherwise provided by law, the personal information required in this section will be treated as
confidential. The personal information required in this section is solely for identification purposes.
Date of Birth Social Security Number Place of Birth
U.S. Citizen W Yes
Name of District Court
0 No
If Naturalized, state where When
n/a n/a
Naturalization Certificate Number Date of Certification
n/a n/a n/a
If an Alien, Give Alien's Registration Card Number
n/a
3ermanent Residence Card Number
n/a
Height
6'-03"
Afeight
200
4air Color
Brown
Eye Color
Brown
3ender
Male
Do you have a current Driver's License/ID? If so, give number and state.
Driver's License Number Driver's License State
® Yes 0 No
Financial Information
9. Total purchase price or investment being made by the applying entity,
corporation, partnership, limited liability company, other..$17,896,000
10. List the total amount of the personal investment, made by the person
listed on page 1 in this business including any notes, loans,cash,
services or equipment, operating capital, stock purchases or fees
paid.n/a
NOTE: If corporate investment only, please skip to and complete question 12
NOTE: Question 10 should reflect the total of questions 11 and 13
DR 8404-1 (12/05/24)Page 4 of 6
Personal and Financial Information (Continued)
11. Provide details of the personal investment described in question 10. You must account for all of
the sources of this investment. (Attach a separate sheet if needed)
type: Cash, Services or Equipment
n/a
account Type
n/a
Bank Name Amount
n/a n/a
Type: Cash, Services or Equipment Account Type
n/a n/a
Bank Name Amount
n/a n/al
Type: Cash, Services or Equipment Account Type
n/a n/a
Bank Name Amount
n/a n/a
rype: Cash, Services or Equipment
n/a
\ccount Type
n/a
Bank Name Amount
n/a n/a
12. Provide details of the corporate investment described in question 9. You must account for all of the
sources of this investment. (Attach a separate sheet if needed)
Fype: Cash, Services or
Cash
Bank Name
Key Bank
Fype: Cash, Services or
n/a
Bank Name
n/a
Fype: Cash, Services or
n/a
Sank Name
n/a
13. Loan Information
Mame of Lender
Bob Hedleston
Term
12/01/2027
Equipment
Equipment
Equipment
(Attach copies of all
Security
1 st Deed of Trust
.oans
n/a
Amount
Loans
n/a
Amount
Loans
n/a
Amount
notes or loans)
Address
3905 Beech St. Cincinnati,
Amount
\ccount Type
Equity Investment
Account Type
n/a
Account Type
n/a
OH 45227
$500,000
n/a
n/a
$4,200,000
OR 8404-1 (12/05/24)Page 5 of 6
^lame of Lender
Sortis Income Fund
Ferm
06/30/2025
^Jame of Lender
n/a
Ferm
n/a
Mame of Lender
n/a
Ferm
n/a
Personal and
REIT, INC.
Security
2nd Deed of Trust
Security
n/a
Security
n/a
Financial Information (Continued)
Address
240 SE. 2nd Ave, Portland OR, 97214
Amount
$13,196,000
Address
n/a
Amount
n/a
Address
n/a
Amount
n/a
Oath of Applicant
I declare unde/ penalty of perjury that this application and all attachments are true, correct, and
complete to ^ie best of my knowledge.
/ / f: . / .. /.' /Electronic ^fgftsiture js no^qdfepted, physical signature is required.-77T
Print Sigi^&ture
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Title /
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. x
Date (MM/DDA/Y)
y/."^: •,;,;•.
DR 8404-1 (12/05/24)Page 6 of 6