Loading...
HomeMy WebLinkAboutItem 06.dOctober 28, 2010 Proposed Action RECEIVE APPLICATION OF NORTHERN TIER RETAIL, LLC FOR AN OFF -SALE 3.2 MALT LIQUOR LICENSE AT SUPERAMERICA Staff recommends adoption of the following motion: Receive application of Northern Tier Retail, LLC, for off -sale 3.2% malt liquor licenses for SuperAmerica #4337, #4490 and #4528 and call a public hearing to be held on November 15, 2010. Overview The SuperAmerica stores are being sold to a new company, Northern Tier Retail, LLC. Liquor licenses in Lakeville are not transferrable; therefore, the new owner must obtain licenses for its three establishments, which are located at 16161 Cedar Avenue, 21070 Glade Avenue and 16180 Kenrick Avenue. The Police Department has reviewed the application and completed background investigations on the three named officers. The investigations raised no concerns that would prohibit the issuance of the licenses requested. A public hearing is scheduled for the November 15, 2010 City Council meeting. Supporting Information • License applications • Report and recommendation by the Police Department Charlene Friedges, C G y Clerk Item No. Financial Impact: $ Budgeted: YIN Source: Related Documents (CIP, ERP, etc.): Notes: Northern Tier Retail LLC d /b /a Super America 16161 Cedar Avenue Lakeville, MN 55044 -7213 16180 Kenrick Avenue, Lakeville, MN 55044 -5420 21070 Glade Avenue, Lakeville, MN 55044 -7428 Investigative Summary Sgt. John Kornmann Applicant: Northern Tier Retail LLC License Applied For: 3.2% Malt Liquor: Off Sale Date: October 28, 2010 Background Investigation Process All parties listed on the 3.2% malt liquor license application as either an officer or a manager of the business are required to complete a part II application, which includes personal information and character references. On October 28, 2010, I was assigned to the liquor license background check for Northern Tier Retail LLC, D /B /A Super America. The following automated databases were checked to conduct this background; DVS, MNCIS, in -house records. criminal history files. As theses businesses have been in operation in the City of Lakeville for a long period of time and no changes in business practices are anticipated, interviews were not conducted as a part of this process. The application reports there will be no change in management so no application information was required of store managers. Persons Checked Butler, Rex Eric, Company President Criminal History The party listed above was clear as checked for this application purpose Narrative: Northern Tier LLC will operate 166 stores across the United States. The operation and business practices of the Lakeville stores have not changed. Due the change in ownership, this background is required by ordinance. The Lakeville Police Department found no reasons for denial of a Liquor License. To Whom It May Concern: F A EG R BENSON LP UNITED STATES [ ENGLAND 1 CHINA October 12, 2010 PEGGY L. PERRYMAN PPerryman@faegte.com (612) 766 -8506 On May 19, 2010, Marathon Petroleum Company LLC's parent company, Marathon Oil Corporation ( "Marathon "), announced that it had entered into a non - binding Letter of Intent with ACON Investments, L.L.C., NTR Partners LLC and TPG Capital, L.P. (collectively, the "Buyer ") for the sale of most of Marathon's Minnesota downstream assets. These assets include the 74,000 barrel per day St. Paul Park refinery and associated terminal, 166 SuperAmerica convenience stores, SuperMom's Bakery (a baked goods supply operation), SuperAmerica Franchising LLC, interests in pipeline assets in Minnesota and associated inventories (the "Transaction "). The Transaction is expected to close by year end ( "Closing "). The sale of these assets is subject to, among other things, conclusion of definitive agreements and Marathon board approval. As part of the Transaction, Marathon Petroleum Company LLC and its affiliated entities, Speedway SuperAmerica LLC ( "SSA ") and SuperMom's LLC, will be supplying its employees to perform transitional services following the Closing. This support will be both in the nature of day -to -day operational work and back office functions, thus, Marathon Petroleum Company LLC and Speedway SuperAmerica LLC are listed, where required in the attached application for a new permit /license, as providing evidence of workers' compensation insurance coverage. The Buyer's purchase of the convenience store and bakery assets described above is being partially financed pursuant to a sale - leaseback transaction with Realty Income Corporation or an affiliate thereof (the "SLB Party "). At Closing, most of the real property currently owned by SSA and used in the operation of the convenience stores subject to the Transaction will be sold to the SLB Party. Northern Tier Retail LLC ( "NTR "), an affiliate of the Buyer, will then lease back such parcels of real property from the SLB Party to conduct the convenience store operations following Closing. SSA also leases real property used in the operation of the convenience stores subject to the Transaction from various third parties and such leases will be assigned by SSA to NTR. The real property currently owned by SSA and used in the operation of the bakery will also be sold to the SLB Party and subsequently leased back to Northern Tier Bakery LLC, another affiliate of the Buyer. Attached to this letter is the Buyer's application for a new permit/license effective November 1, 2010. We will contact your office if the new permit /license should not be issued on November 1, 2010 and provide you with an updated effective date at such time. We kindly ask you to please notify us as soon as possible if it is unlikely that the new permit /license can be issued by November 30, 2010, as the parties will need to discuss operating alternatives. My client is in the process of obtaining the requisite certificate of liquor liability insurance, when necessary, and will forward the same to your attention upon receipt. Thank you for your time and attention to this matter. Should you have any questions, please feel free to contact Peggy Perryman at (612) 766 -8506 or pperryrnanCZDfaegre.com. Upon issuance, the final permit /license can be sent to NTR at 37 Danbury Rd., Suite 204, Ridgefield, CT 06877 -4079. txuly a rs, Pe •• �.. Perryman 2200 WELLS FARGO CENTER 1 90 SOUTH SEVENTH S REST 1 MINNEAPOLIS MINNESOTA 55402 -3901 TELEPHONE 612 -766 -7000 1 FACSIMILE 612 - 766 -1600 1 WWW.FAEGRE.COM CITY OF LAKEVILLE Case file: 20195 Holyoke Avenue Date received: Lakeville, MN 55044 License type: License fee: LIQUOR LICENSE APPLICATION Sunday fee: Investigation fee: Receipt number: Part 1 Insurance received General Information -OFFICE USE ONLY ********************************************************* * ** * * * * * * * * * * * * * * * * * * * ** * * * * * ** TYPE OF LICENSE ************************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Name of applicant (name of individual, partnership, corporation or association) Northern Tier Re tail LLC Business Name SuperAmerica #4337 Business Address 16161 Cedar Ave. , Lakeville, MN 55044 -7213 Phone (952) 432 -4585 Minnesota Tax ID # 1729670 Dakota County Property ID # 22-16300- 014 -01 IF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION, NAME OR STYLE OTHER THAN FULL INDIVIDUAL NAME OF THE APPLICANT, ATTACH COPY OF THE CERTIFICATE OF ASSUMED NAME, AS REQUIRED BY CHAPTER 333, MINNESOTA STATUTES, CERTIFIED BY THE OFFICE OF THE SECRETARY OF STATE. DESCRIPTION OF PREMISES: State the exact legal description of the premises to be licensed. (Applicants must also stbmit a plot plan showing dimensions, location of buildings, any outdoor seating areas, street access, parking facilities and the locations of and distances nearest church buildings and school grounds) The South 215.28 ft. of Lot 1, Block 1, Carroll 1st Addition, Dakota County, Minnesota. Liquor Sunday Liquor Wine 3.2% Malt Liquor: On -Sale 3.2% Malt Liquor: Off -Sale Temporary 3.2% Malt Liquor: On -Sale () () O () Special Club Liquor Consumption & Display Temporary Consumption & Display Temporary Liquor: On -Sale Federal Tax # 27- 3005319 How are the premises zoned under the Lakeville zoning ordinance? C -3 General Commercial District Liquor License Application Page 2 Full names, residences and business addresses and telephone numbers of the owner or owners of the building wherein the licensed business will be located. Full Name A Residence Address Business Address 5T31 3n -h Pimp 3 � Residence Address Business Address FINANCIAL INTEREST CRITERIA: Full Name Address Nature of Interest, etc. DESCRIPTION OF PROPOSED BUSINESS: Phone Phone Full Name Phone Phone Phone Where the building is owned by other than the applicant, state in summary the conditions of lease arranger nent, such as, term of lease, monthly rental, renewal privileges, etc. (Attach a copy of he lease ) 2-- Give full names, addresses and telephone numbers of all persons, other than the applicant, who have any financial interest in the business, buildings, premises, fixtures, furniture, or stock in trade. State the nature of the interest amount thereof, and the terms for payment or other reimbursement. (This shall include, but not be limited to, any lessees, lessors, mortgagors, lendors, lien holders, trustees, trustors and persons who have cosigned notes or otherwise loaned, pledged, or extended security for any indebtedness of de applicant.) Full Name e A Hr ( rin era E Phone Address Nature of Interest, etc. Provide a detailed narrative description of the proposed business for which the license is sought including, but rut limited to, type of clientele, type of entertainment including, but not limited to, outdoor entertainment, dancing, live music and amplified music (if any) andtype of food menu. What is the seating capacity of the restaurant? Indoor seating Outdoor seating Liquor License Application Page 3 IF THE APPLICATION IS FOR PREMISES EITHER PLANNED OR UNDER CONSTRUCTION OR UNDERGOING SUBSTANTIAL ALTERATION, THE APPLICATION SHALL BE ACCOMPANIED BY A SET OF PRELIMINARY PLANS SHOWING THE DESIGN OF THE PROPOSED PREMISES TO BE LICENSED. IF THE PLANS OR DESIGN ARE ON FILE WITH THE MANAGER OF THE BUILDING AND LAKEVILLE BUILDING INSPECTIONS DEPARTMENT, NO' ADDITIONAL PLANS NEED BE FILED WITH THIS APPLICATION. State the floor number, general area, and all rooms where intoxbating liquor is to be sold and consumed, including outdoor areas. (Applicant shall attach a floor plan showing dimensions and indicating number of persons intended to be served in said rooms.) Continuing store operations; general sales area, walk in cooler, reach in cooler. What permits or licenses required by the State of Minnesota have been applied for or issued for the premises? In what name were these applied for or issued and what is the nature of the permit or license? See Attachment 7 Are any real estate taxes, personal property taxes, special assessments, or other financial claims of the City of Lakeville delinquent or unpaid for the premises to be licensed? Yes No % If yes, give details. Liability Insurance must be provided in accordance with City Code 3- 1 -9 -2. ANY FALSIFICATION OF ANSWERS TO THE ABOVE QUESTIONS WILL RESULT IN DENIAL OF THE LIQUOR LICENSE. SUBSCRIBED AND SWORN TO BEFORE ME this CHRISTINE CARNICELLI NOTARY PUBLIC MY COMMISSION EXPIRES SEP. 30,2015 (Signature of Applicant) aki Q, day of ' ' T 20 1Q My Commission expires on: Vice President Full Name None - See Attachment 1 CITY OF LAKEVILLE LIQUOR LICENSE APPLICATION FOR A CORPORATION OR ASSOCIATION Please attach to Liquor License Application -Part 1 PLEASE INCLUDE COPIES OF THE FOLLOWING: 1) Certificate of Incorporation, 2) Articles of Incorporation or Association Agreement, 3) By -Laws to the application, 4) foreign corporations shall attach Certificate of Authority, as described in MS.A. Chapter 303. Name of corporation or association, address and phone number and home office address and phone number: Name Northern Tier Retail LLC Home Office Address 37 Danbury Rd., Suite 204, Ridgefield, CT 06877 -4079 Full names of all officers of said corporation or association: President Rex Eric Butcher, Prospective President eff. on or aboutt4M12.84& 1113017t Phone (203) 244 -6550 Oscar Ignacio Rodriguez (Prospective Secretary eff. on or about 1141/-3040) r '�OD SeCrL.tal � l rJo1 Treasurer Oscar Ignacio Rodriguez (Prospective Treasurer eff on or about 11/1(201-09 II 3E!zp(p Full names of all persons who singly or together with their spouse and his or her parents, brothers, sisters o children, own or control an interest in said corporation or association in excess of five percent: Interest Full Name Interest es 1:00 Name Interest Pull Name Interest Pull name of the manager. assistant manager, food manager, beverage manager and any other individual with management responsibilities for the corporation's or association's premises to be licensed: Full Name Stephen Warren Coker Full Name Full Name (A Part 11- `Personal Information force' must be filled out and attached for each of the individuals listed above) Part I General Information ******* * * * * * ** *t. * ** ** * ** * ** * * * * * * * * ** Liquor Sunday Liquor Wine 3.2% Malt Liquor: On -Sale 3.2% Malt Liquor. Off -Sale Temporary 3.2% Malt Liquor: On -Sale * * * * * * * * * * * * ** * * * *. * ** * * ** eat******************************** * * * * * ** * * * * * * ** * * * * ** *a * * ** ** ** Name of applicant (name of individual, partnership, corporation or association Northern Tier Retail TLC Business Name SuperAmerica #4528 Business Address 16180 Kenrick Ave. , Lakeville, MN 55044 -5420 Phone (952) 892 -7444 CITY OF LAKEVILLE 20195 Holyoke Avenue Lakeville, MN 55044 LIQUOR LICENSE APPLICATION Minnesota Tax ID #_x]29670 Federal Tax # 27- 3005319 Dakota County Property ID If 22-73502- 010 -01 IF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION, NAME OR STYLE OTHER THAN FULL INDIVIDUAL NAME OF THE APPLICANT, ATTACH COPY OF THE CERTIFICATE OF ASSUMED NAME, AS REQUIRED BY CHAPTER 333, MINNESOTA STATUTES, CERTIFIED BY THE OFFICE OF THE SECRETARY OF STATE. DESCRIPTION OF PREMISES: Case file: Date received: License type: License fee: Sunday fee: Investigation fee: Receipt number: Insurance received -OFFICE USE ONLY TYPE OF LICENSE () () ) O Special Club Liquor Consumption & Display Temporary Consumption & Display Temporary Liquor: On -Sale State the exact legal description of the premises to be licensed. (Applicants must also submit a plot plan showing dimensions, location of buildings, any outdoor seating areas, street access, parking facilities and the locations of and distances nearest church buildings and school grounds) Lot 1, Block 1, SUPERAMERICA 3RD ADDITION, Dakota County, Minnesota. How are the premises zoned under the Lakeville zoning ordinance? C -3 General Commercial District Liquor License Application Page 2 Full names, residences and business addresses and telephone numbers of the owner or owners of the building wherein the licensed business will be located. Full Name Realty Income Properties 3, LLC eff. on or Phone (760) 741 -2111 about 11/1/20f0 Residence Address Business Address 600 La Terraza Blvd. , Escondido, CA 92025 Phone Full Name Phone Residence Address Business Address Phone Where the building is owned by other than the applicant, state in summary the conditions of lease arrangement, such as, term of lease, monthly rental, renewal privileges, etc. (Attach a copy of he lease.) FINANCIAL INTEREST CRITERIA: Give full names, addresses and telephone numbers of all persons, other than the applicant, who have any financial interest in the business, buildings, premises, fixtures, furniture, or stock in trade. State the nature of the interest amomt thereof, and the terms for payment or other reimbursement. (This shall include, but not be limited to, any lessees, lessors, mortgagors, lendors, lien holders, trustees, trustors and persons who have co-signed notes or otherwise loaned, pledged, or extended security for any indebtedness of tle applicant.) Full Name Jee hi Phone Address Nature of Interest, etc. Full Name Address Nature of Interest, etc. DESCRIPTION OF PROPOSED BUSINESS: Phone Provide a detailed narrative description of the proposed business for which the license is sought including, but rot limited to, type of clientele, type of entertainment including, but not limited to, outdoor entertainment, dancing, live music and amplified music (if any) andtype of food menu. What is the seating capacity of the restaurant? Indoor seating Outdoor seating Liquor License Application Page 3 IF THE APPLICATION IS FOR PREMISES EITHER PLANNED OR UNDER CONSTRUCTION OR UNDERGOING SUBSTANTIAL ALTERATION, THE APPLICATION SHALL BE ACCOMPANIED BY A SET OF PRELIMINARY PLANS SHOWING THE DESIGN OF THE PROPOSED PREMISES TO BE LICENSED. IF THE PLANS OR DESIGN ARE ON FILE WITH THE MANAGER OF THE BUILDING AND LAKEVILLE BUILDING INSPECTIONS DEPARTMENT, NO ADDITIONAL PLANS NEED BE FILED WITH THIS APPLICATION. State the floor number, general area, and all rooms where intoxbating liquor is to be sold and consumed, including outdoor areas. (Applicant shall attach a floor plan showing dimensions and indicating number of persons intended to be served in said rooms.) Continuing store operations; general sales area, walk in cooler, reach in cooler. What permits or licenses required by the State of Minnesota have been applied for or issued for the premises? In what name were these applied for or issued and what is the nature of the permit or license? See Attachment 7 Are any real estate taxes, personal property taxes, special assessments, or other financial claims of the City of Lakeville delinquent or unpaid for the premises to be licensed? Yes No X If yes, give details. Liability Insurance must he provided in accordance with City Code 3- 1 -9 -2. ANY FALSIFICATION OF ANSWERS TO THE ABOVE QUESTIONS WELL RESULT IN DENIAL OF THE LIQUOR LICENSE. SUBSCRIBED AND SWORN TO BEFORE ME this cv ,A"\ l Signof Notary Public CHRISTINE CARNICELLI NOTARY PUBLIC MY COMMISSION EXPIRES SEP. 30, 2015 6 (Signature of Applicant) day of My Commission expires on 20 10 At. 301io - 4s5 CITY OF LAKEVILLE LIQUOR LICENSE APPLICATION FOR A CORPORATION OR ASSOCIATION Please attach to Liquor License Application -Part I PLEASE INCLUDE COPIES OF THE FOLLOWING 1) Certificate oflncorporatlon, 2) Articles of Incorporation or Association Agreement, 3) By -Laws to the application, 4) Foreign corporations shall attach Certificate of Authority, as described in ALSA. Chapter 303. Name of corporation or association, address and phone number and home office address and phone number: Name Northern Tier Retail LLC Home Office Address 37 Danbury Rd.. Suite 204, Ridgefield, CT 06877 -4079 Phone (203) 244 -6550 Full names or all officers of said corporation or association: president Rex Eric Butcher, Prospective President eff. on oraboutb+h1+itrit I/.I42": >t0 Vice President Secretary Oscar Ignacio Rodriguez (Prospective Secretary eft on or about 19/1/2019) IIj2,(f2D)t;1 Treasurer Oscar Ignacio Rodriguez (Prospective Treasurer eff. on or about 1 1 41 1204 9x- 11 /sry. //1)to) Full names of all persons who singly or together with their spouse and his or her parents, brothers, sisters children, own or control an interest in said corporation or association in excess of five percent: Full Name None - See Attachment 1 Interest Full Name Interest Full Name Interest 4/0 Full Name Interest Full name of the manager, assistant manager, rood manager, beverage manager and any other individual with management responsibilities for the corporation's or association's premises to be licensed: Full Name Ronald Mark Ebb Full Name Full Name (A Part T/ - `Personal Information form' must be filled out and attached for each of the individuals listed above) CITY OF LAKEVILLE 20195 Holyoke Avenue Lakeville, MN 55044 LIQUOR LICENSE APPLICATION Part 1 General Information Liquor Sunday Liquor Wine ( ) 3.2% Malt Liquor: On -Sale ( ) 3.2% Malt Liquor: Off -Sale ( ) Temporary 3.2% Malt Liquor: On -Sale ( ) ************************************************************* * * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** Name of applicant (name of individual, partnership, corporation or association) Northern 'Tier Retail LLC Business Name SuperAmerica 1/4490 Business Address 21070 Glade Ave. , Lakeville, MN 55044 -7428 Phone (952) 469 -6622 Minnesota Tax ID # 1729670 Dakota County Property ID # 22- 73501- 020 -02 IF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION, NAME OR STYLE OTHER THAN FULL INDIVIDUAL NAME OF THE APPLICANT, ATTACH COPY OF THE CERTIFICATE OF ASSUMED, NAME, AS REQUIRED BY CHAPTER 333, MINNESOTA STATUTES, CERTIFIED BY THE OFFICE OF THE SECRETARY OF STATE. DESCRIPTION OF PREMISES: TYPE OF LICENSE Case file: Date received: License type: License fee: Sunday fee: Investigation fee: Receipt number: Insurance received -OFFICE USE ONLY Special Club Liquor Consumption & Display Temporary Consumption & Display Temporary Liquor: On -Sale Federal Tax # 27- 3005319 State the exact legal description of the premises to be licensed. (Applicants must also arbmit a plot plan showing dimensions, location of buildings, any outdoor seating areas, street access, parking facilities and the locations of and distances nearest church buildings and school grounds) Lot 2, Block 2, SUPERAMERICA 2ND ADDITION, Dakota County, Minnesota. How are the premises zoned under the Lakeville zoning ordinance? C -2 Highway Commercial District Liquor Lice Application Page 2 Full names, residences and business addresses and telephone numbers of the owner or owners of the building wherein the licensed business will be located. Full Name Realty Income Properties LLC e about 11/1/2010 Residence Address Full Name Residence Address Business Address FINANCIAL INTEREST CRITERIA: Address Nature of Interest, etc. Full Name Address Nature of Interest, etc. DESCRIPTION OF PROPOSED BUSINESS: What is the seating capacity of the restaurant? Indoor seat! g . on or Phone Phone (760) 741 -2111 Business Address 600 La Terraza Blvd. , Escondido, CA 92025 Phone Phone Phone Where the building is owned by other than the applicant, state in summary the conditions of lease arrangement, such as, term of lease, monthly rental, renewal privileges, etc. (Attach a copy of he lease.) Give full names, addresses and telephone numbers of all persons, other than the applicant, who have any financial interest in the business, buildings, premises, fixtures, furniture, or stock in trade. State the nature of the interest amou t thereof, and the terms for payment or other reimbursement. (This shall include, but not he limited to, any lessees, lessors, mortgagors, lendors, lien holders, trustees, trustors and persons who have co-signed notes or otherwise loaned, pledged, or extended security for any indebtedness of tte applicant.) Full Name .See Attachunem-8 Phone Provide a detailed narrative description of the proposed business for which the license is sought including, but rot limited to, type of clientele, type of entertainment including, but not limited to, outdoor entertainment, dancing, live music and amplified music (if any) andtype of food menu. Outdoor seating Liquor License Application Page 3 IF THE APPLICATION IS FOR PREMISES EITHER PLANNED OR UNDER CONSTRUCTION OR UNDERGOING SUBSTANTIAL ALTERATION, THE APPLICATION SHALL BE ACCOMPANIED BY A SET OF PRELIMINARY PLANS SHOWING THE DESIGN OF THE PROPOSED PREMISES TO BE LICENSED. IF THE PLANS OR DESIGN ARE ON FILE WITH THE MANAGER OF THE BUILDING AND LAKEVILLE BUILDING INSPECTIONS DEPARTMENT, NO ADDITIONAL PLANS NEED BE FILED WITH THIS APPLICATION. State the floor number, general area, and all rooms where intoxbating liquor is to be sold and consumed, including outdoor areas. (Applicant shall attach a floor plan showing dimensions and indicating number of persons intended to be served in said rooms.) Continuing store operations; general sales area, walk in cooler, reach in cooler. What permits or licenses required by the State of Minnesota have been applied for or issued for the premises? In what name were these applied for or issued and what is the nature of the pennit or license? See Attachment 7 Are any real estate taxes, personal property taxes, special assessments, or other delinquent or unpaid for the premises to be licensed? Yes No X If yes, give details. Liability Insurance must be provided in accordance with City Code 3- 1 -9 -2. ANY FALSIFICATION OF ANSWERS TO THE ABOVE QUESTIONS WILL RESULT IN DENIAL OF THE LIQUOR LICENSE. SUBSCRIBED AND SWORN TO BEFORE ME this ' \ day of 'S`=ptomb&r 9 • 2010 Signatur- +f Notary Public CHRISTINE CARNICELLI NOTARY PUBLIC MY COMMISSION EXPIRES SEP. 30, 2015 (Signature of Applicant) My Commission expires on: ancial claims of the City of Lakeville CITY OF LAKEVILLE LIQUOR LICENSE APPLICATION FOR A CORPORATION OR ASSOCIATION Please attach to Liquor License Application -Part I PLEASE INCLUDE COPIES OF THE FOLLOWING: 1) Certificate of Incorporation, 2) Articles of Incorporation or Association Agreement, 3) By -Laws to the application, 4) Foreign corporations shall attach Certificate ("Authority, as described in AtS.A. Chapter 303. Name of corporation or association, address and phone number and home office address and phone number: Name Northern Tier Retail LLC Home Office Address 37 Danbury Rd., Suite 204, Ridgefield, CT 06577 -4079 Full names of all officers of said corporation or association: President Rex Eric Butcher, Prospective President eff. on or about14442B44 1 /302D)c Vice President Phone (203) 244 -6550 Secretary Oscar Ignacio Rodriguez (Prospective Secretary eff on or about 1111/209'3) li/ 0 Treasm e Oscar Ignacio Rodriguez (Prospective Treasurer eff on or about 11/1/201.0) f Full names of all persons who singly or together with their. spouse and his or her parents, brothels sisters or children, own or control an interest in said corporation or association in excess of live percent: Full Name None - See Attachment 1 Interest Full Name Interest Full Name Interest Full Name Interest Full name of the manager, assistant manager, Food manager, beverage manager and any other individual with management responsibilities for the corporation's or association's premises to be licensed: Full Name Melissa Ann Contrelia Full Name Full Name (A Part 17 - 'Personal /nfarmation form' must befitted out and attached for each of the individuals listed above)