City and County of Denver DEPARTMENT OF EXCISE AND LICENSES

201 West Colfax Avenue, Dept. 206 Denver, Colorado 80202

720-865-2740

Cannabis Consumption Special Event NEW LICENSE APPLICATION

*Annual Fee: $1,000 --- *Application Fee: $1,000

Business File Number (BFN): _____________________________(This will be filled in by a licensing technician upon application acceptance)

Event Address: ___________________________________________________________________________________________

City: ____________________________________ State: _______________________________ Zip Code: _________________

Business must have legal possession of the premises during all times that the designated consumption area will be active 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: ____________________________

Legal (Entity) Name of Applicant: ______________________________________________________________________________ (Must match Secretary of State Certificate of Good Standing - if applicable)

Event Location Information

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. Events also may not be held on public property. 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 Conforming Location

Statement of Possession of Premises

Contact Information

Responsible Party/Main Contact:

Name ________________________________ Phone _________________ E-mail ______________________________

Mailing Address:

City: State: Zip Code:

Event Organizer (if different from the applicant)

Name ________________________________ Phone _________________ E-mail ______________________________

Event Details

(Must match Secretary of State Statement of Trade Name, if a trade name is in use)

Trade Name (DBA): _________________________________________________________________________

Outdoor Outdoor Outdoor

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 Other: Indoor

Outdoor If you will permit any 'other' type of consumption, please describe: ____________________________________________________

Event Website: ___________________________________________________________________________________________ (If applicable)

Type of event: Festival or Community Event (music, art, neighborhood) Parade Assembly or Public Gathering

Market (produce, vendors, product sales)Run, Walk, Ride, RaceOther: __________________________________

Please describe the event: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

The event will be held: Indoors Outdoors Both Indoors & Outdoors

Will the event entail any of the items below? Please check all that apply:

Alcohol Served or Sold

Amplified music, sound - if yes, please describe equipment and expected noise levels: _______________________________

Food Sold

Generators smaller than 5KW

Generators 5KW or larger

Merchant/Security Guards

Pools or Water Features

Propane or Open Flame

Stages, Bleachers or other Structures

Tattoos or Body Piercing

Tents smaller than 200 sq ft

Tents 200 sq ft or larger

Vendors Selling Retail Goods

None of the above

Additional Information for Underlying Business or Event

Legal Entity Name of Underlying Business/Event: ________________________________________

Trade Name of Underlying Business/Event: _____________________________________________

Is liquor ever served at the proposed establishment/event? Yes No

If yes, please describe how the applicant intends to ensure that the designated consumption area (DCA) does not overlap with any

part of a liquor licensed premises, and how the applicant intends to ensure that liquor is not served while the DCA is operating.

_________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

BFN of Underlying Business/Event: ___________________

Proposed Event Days and Times

Cannabis consumption event permits may be granted for up to 10 days in a calendar year. All events must be held at the same location. No modifications to the approved permit event map, days, or times may occur after a permit is approved and issued unless these changes are occuring at the request of a city agency. Please list below the events proposed days and times of operation:

Neighborhood Support

Which Eligible Neighborhood Organization (ENO) is supporting your application: _________________________________________

ENO Contact Information

E-mail: ___________________________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: ___________

Will the event or any participating business rent, or make avaliable for use, any cannabis consumption accessories? Yes No

How many employees will the event employ: _____________

How many attendees are expected: _____________

(if applicable)

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 CONTACT

NAME

FIRST AND LAST

HOME ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH

(mm/dd/yy)

EMAIL ADDRESS PHONE # POSITION % OWNERSHIP

2NDCONTACT

NAME

FIRST AND LAST

HOME ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH

(mm/dd/yy)

EMAIL ADDRESS PHONE # POSITION % OWNERSHIP

3RD CONTACT

NAME

FIRST AND LAST

HOME ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH

(mm/dd/yy)

EMAIL ADDRESS PHONE # POSITION % OWNERSHIP

4TH CONTACT

NAME

FIRST AND LAST

HOME ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH

(mm/dd/yy)

EMAIL ADDRESS PHONE # POSITION % OWNERSHIP

5TH CONTACT

NAME

FIRST AND LAST

HOME ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH

(mm/dd/yy)

EMAIL ADDRESS PHONE # POSITION % OWNERSHIP

6TH CONTACT

NAME

FIRST AND LAST

HOME ADDRESS

STREET ADDRESS CITY STATE ZIP CODE

DATE OF BIRTH

(mm/dd/yy)

EMAIL ADDRESS PHONE # POSITION % OWNERSHIP

Required Documentation:

1.

6.

I N T E RNA L US E ONLY

A community engagement plan that contains the following items in a clearly delineated format:

• The name, telephone number, and email address of the person affiliated with the applicant who is responsible forneighborhood outreach and engagement.

• The names of all Registered Neighborhood Organizations whose boundaries encompass the location of the proposedlicensed premises, and a statement that the applicant shall contact the Registered Neighborhood Organizations priorto commencing operations.

• An outreach plan to contact and engage residents and businesses in the local neighborhoods where any license islocated.

• A detailed description of any plan to create positive impacts in the neighborhoods where the licensed premises arelocated, which may include by way of example, participation in community service, volunteer service, and activepromotion of any local neighborhood plans.

• Written policies and procedures to timely address any concerns or complaints expressed by residents and businesseswithin the neighborhood surrounding the licensed premises.

• Written policies and procedures designed to promote and encourage full participation in the regulated marijuanaindustry by people from communities that have previously been disproportionately harmed by marijuana prohibitionand enforcement in order to positively impact those communities.

A health and sanitation plan indicating how any cannabis consumption accessories that will be rented or madeavailable for use will be cleaned (if applicable)

13. Evidence that the establishment will comply with the Colorado Clean Indoor Air Act (if indoor smoking will be permitted)

5. An event map drawn to scale on 8-1/2" x 11” paper showing the layout of the event and the principal uses of eachsection of the event area. The location of the Designated Consumption Area within the event must becontinugous and outlined in red. Please include dimensions, and event boundaries, including external andinternal walls, doors, fences, gates and the like. Clearly indicate any entrances, exits, bathrooms, locations wherefood, drink, or ice will be stored or served, stages, structures, bleachers, tents, generators, pools or water features,locations of propane or any other liquified petroleum gases, amplified sound equipment and/or odor controltechnology will be located. Also, clearly indicate where the standardized placard, access restriction signage, andresponsible usage signage will be located and where the event will be locating its posting notice for the publichearing. Please provide a separate page for each floor level in the establishment (if event will be held indoors).

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

7.

8. A national criminal history records check conducted by the FBI within the last 60 days for each owner and manager

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

9. A responsible operations plan, along with an employee training manual, indicating, at a minimum:

An Affidavit of Lawful Presence for each owner10.

11. An Odor Control Plan (please visit Denver Environmental Quality's Odor webpage for guidelines)

12. Copies of government-issued identification for each owner and manager

• how employees will prevent the usage of any liquified gas torches on the premises if dabbing will be permitted

14. Evidence of support from an eligible neighborhood organization, including any additional restrictions on advertising and/or operational requirements that such support is dependent upon

Lease or Deed (if leased, include written consent from the property owner to use the property for cannabis consumption)15.

Secretary of State Certificate of Good Standing (if applicable)16.

Secretary of State Statement of Trade Name (if applicable)17.

2. A copy of the Certificate of Occupancy for the establishment (if event will occur indoors, otherwise a copy will berequired once the proposed business is established but before any consumption license if granted)

3. A copy of a valid zone use permit for the underlying business or event

4. Advisement and Acknowledgement Form for each owner and manager

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: Date:

Print Name: Title:

*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

*Applicants must be in compliance with all city and state laws, including the rules and regulations promulgated pursuant thereto, at all times.

Please note:

IINTERNAL ONLY - QCNTERNAL ONLY - QC

QC Completed By: ________________________ QC Completed Date: _____________________________

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 ☐

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What is the zone district of the proposed facility?

_______________

Is the zone district I-A or I-B, thereby necesitating 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 ☐

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-I did complete 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 ☐

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I have provided the customer with the "New Cannabis Consumption Special Event - Next Steps" handout - Yes ☐

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Form Last Revised on 01/14/19