memorandum - The City of Kenai
MEMORANDUM TO:
Mayor Brian Gabriel and Kenai City Council
THROUGH: FROM:
Jamie Heinz, Acting City Clerk
DATE:
August 8, 2017
SUBJECT:
Marijuana License Renewals
The Alcoholic & Marijuana Control Office has sent notification that the following applicants have requested license renewal: Applicant: Owners: D/B/A: License Type:
Red Run Cannabis Cultivators, LLC Eric Derleth, Marc Theiler and Roger Boyd Red Run Cannabis Cultivators, LLC Standard Marijuana Cultivation Facility
Applicant: Owners: D/B/A: License Type:
Red Run Cannabis Company, LLC Eric Derleth, Marc Theiler and Roger Boyd Red Run Cannabis Company, LLC Retail Marijuana Store
Pursuant to KMC 2.40.010, It is determined to be in the public interest that holders of or applicants for licenses issued by the Alcoholic Beverage Control Board or the Marijuana Control Board of the State of Alaska shall have all obligations to the City of Kenai on a satisfactory basis prior to the City Council approval of any activity of said license holder or applicant. A review of City accounts has been completed and the applicants have satisfied all obligations to the City. With the approval of Council, a letter of non-objection to the request for the renewal of a Standard Marijuana Cultivation Facility License and a Retail Marijuana Store will be forwarded to the Alcoholic & Marijuana Control Office and the applicant. Your consideration is appreciated.
"Vt1/llje with a Past, City with aFuture" 210 Fidalgo Avenue, Kenai, Alaska 99611-7794 Telephone: 907-283-7535 I FAX: 907-283-3014
'
1992
MEMORANDUM David Ross, Police Chief Terry Eubank, Finance Department Scott Bloom, Legal Department Willie Anderson, Lands Management Matt Kelley, City Planner
TO:
FROM :
~amie Heinz, Acting City Clerk
DATE:
July 27, 2017
RE:
Standard Marijuana Cultivation Facility License Renewal
The Alcoholic & Marijuana Control Office has sent notification that the following applicant has applied for renewal of their license: Applicant: Owners: D/B/A:
Red Run Cannabis Company, LLC Roger Boyd, Eric Derleth, and Marc Theiler Red Run Cannabis Company, LLC
Pursuant to KMC 2.40 .010 , It is determined to be in the public interest that holders of or applicants for licenses issued by the Alcoholic Beverage Control Board or the Marijuana Control Board of the State of Alaska shall have all obligations to the City of Kenai on a satisfactory basis prior to the City Council approval of any activity of said license holder or applicant. Please review records maintained by your department (i.e. water and sewer billings, lease/property payment history, citations, etc.) by the above reference applicant and advise if obligations have been met. Mark the appropriate box below. If obligations have not been met, attach information to this memorandum indicating what obligations are outstanding and how the obligations can be cured. Please let me know if you have any questions. Thanks. 1. Police Department "}. ~ •
0
initials
I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
0
The appo/...f:has outstanding obligations and an additional page has been attached. 2. Finance • initials
~ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
0
The applicant has outstanding obligations and an additional page has been attached. 3. Legal 5 ? initials
~ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
0
The applicant has outstanding obligations and an additional page has been attached.
4~ds Management w...t.r initials
~ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
Orhe applicant has outstl}l)~obligations and an additional page has been attached. 5:.f!;rhning and Zoning JYl "nitials
LiJ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist. Orhe applicant has outstanding obligations and an additional page has been attached. Returned to Clerk's office:
~ • '2 · 11 ~
Department of Commerce, Community, and Economic Development ALCOHOL & MARIJUANA CONTROL OFFICE
550 West 7th Avenue, Suite 1600 Anchorage, AK 99501 Main: 907.269.0350
July 24, 2017 City of Kenai Attn: Sandra Modigh, City Clerk VIA Email: [email protected]
License Number:
10052
License Type:
Standard Marijuana Cultivation Facility
Licensee:
Red Run Cannabis Cultivators, LLC
Doing Business As:
RED RUN CANNABIS CULTIVATORS, LLC
Physical Address:
5455 Kenai Spur Highway Kenai, AK 99611
Designated Licensee:
Marc Theiler
Phone Number:
907-953-9453
Email Address:
[email protected]
AMCO has received a complete renewal application for the above listed license (see attached application documents) within your jurisdiction. This is the notice required under 3 AAC 306.035(c)(2). To protest the approval of this application pursuant to 3 AAC 306.060, you must furnish the director and the applicant with a clear and concise written statement of reasons for the protest within 60 days of the date of this notice, and provide AMCO proof of service of the protest upon the applicant. 3 AAC 306.060 states that the board will uphold a local government protest and deny an application for a marijuana establishment license unless the board finds that a protest by a local government is arbitrary, capricious, and unreasonable. At the May 15, 2017, Marijuana Control Board meeting, the board delegated to me the authority to approve renewal applications with no protests, objections, or notices of violation. However, if a timely protest or objection is filed for this application, or if any notices of violation have been issued for this license, the board will consider the application. In those situations, a temporary license will be issued pending board consideration. If you have any questions, please email [email protected]. Sincerely, Erika McConnell Director
Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https:ljwww.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications What is this form? This renewal application certifications form is required for all marijuana establishment license renewal applications. Each person signing an application for a marijuana establishment license must declare that he/she has read and is familiar with AS 17.38 and 3 AAC 306. A person other than a licensee may not have direct or indirect financial interest (as defined in 3 AAC 306.0lS(e)(l)) in the business for which a marijuana establishment license is issued, per 3 AAC 306.0lS(a).
This form must be completed and submitted to AMCO's main office by each licensee (as defined in 3 AAC 306.020(b)(2)) before any license renewal application will be considered complete.
Section 1 - Establishment Information Enter information for the licensed establishment, as identified on the license application .
I
Licensee:
Red Run Cannabis Cultivators, LLC
License Type:
Standard Cultivation
Doing Business As:
Red Run Cannabis Cultivators, LLC
Premises Address:
5455 Kenai Spur Hwy, Suite A
City:
Kenai
I
License Number:
State:
IAK
I 10052
I
ZIP:
199611
Section 2 - Individual Information Enter information for the individual licensee who is completing this form.
I
Name:
IEric Derleth Section 3 - Changes to Licensed Marijuana Establishment
Read each line below, and then sign your initials in the box to the right of only the applicable statement:
Initials
I certify that no changes have been made, except for those that have been previously reported or requested on a form prescribed by the Board, to this licensed establishment's business name, ownership, licensed premises diagram, or operating plan, and (for marijuana product manufacturers) that I do not wish to request Board approval for production of any new proposed marijuana products. I certify that a change has been or will be made to one or more of the items listed above for this establishment, and I understand that an additional form(s) and fee(s) must be submitted to AMCO before any renewal application for this license can be considered complete.
D
I ou have selected the second certi 1cation, lease list an and all o the 1ve t
[Form MJ-20) (rev 05/01/2017)
1
JUN 2 7 2017 1 M.COt
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Page 1 of2
Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https://www.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications Section 4 - Certifications Read each line below, and then sign your initials in the box to the right of any applicable statements:
Initials
I certify that I have not been convicted of any criminal charge in the previous two calendar years.
I certify that I have not committed any civil violation of AS 04, AS 17.38, or 3 AAC 306 in the previous two calendar years.
Sign your initials to the following statement only if you are unable to certify one or both of the above statements:
Initials
I have attached a written explanation for why I cannot certify one or both of the above statements, which includes the type of offense, as required under 3 MC 306.035(b)(4).
D
Read each line below, and then sign your initials in the box to the right of each statement:
Initials
I certify that no person other than a licensee listed on my marijuana establishment license renewal application has a direct or indirect financial interest, as defined in 3 MC 306.0lS(e)(l), in the business for which the marijuana establishment license has been issued. I certify that this establishment complies with any applicable health, fire, safety, or tax statute, ordinance, regulation, or other law in the state. I certify that I have not violated any restrictions pertaining to this particular license type, and that this license has not been operated in violation of a condition or restriction imposed by the Marijuana Control Board. I certify that I understand that providing a false statement on this form, the online application, or any other form provided by or to AMCO is grounds for rejection or denial of this application or revocation of any license issued .
As an applicant for a marijuana establishment license renewal, l declare under penalty of unsworn falsification that I have read and am familiar with AS 17.38 and 3 MC 306, and that this application, including all accompanying schedules and statements, is true, correct, and complete. I agree to provide all Information required by the Marijuana Control Board in support of this application and understand that failure to do so by any deadline given to me by AMCO staff ~~Uhikl1additional fees or expiration of this license. ..,,,.,.......-"' -·-
-
---=-===-
SignatUre of licensee
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Printed name of licensee Subscribed and sworn to before me this
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Page 2 of 2
Alcohol and Marijuana Control Office 550 W 7t11 Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https:ljwww.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications What is this form? This renewal application certifications form is required for all marijuana establishment license renewal applications. Each person signing an application for a marijuana establishment license must declare that he/she has read and is familiar w ith AS 17.38 and 3 AAC 306. A person other than a licensee may not have direct or indirect financial interest (as defined in 3 AAC 306.0lS(e)(l)) in the business for which a marijuana establishment license is issued, per 3 AAC 306.0lS(a).
This form must be completed and submitted to AMCO's main office by each licensee (as defined in 3 AAC 306.020(b)(2)) before any license renewal application will be considered complete.
Section 1 - Establishment Information Enter information for the licensed establishment, as identified on the license application.
I
Licensee:
Red Run Cannabis Cultivators, LLC
License Type:
Standard Cultivation
Doing Business As:
Red Run Cannabis Cultivators, LLC
Premises Address:
5455 Kenai Spur Hwy, Suite A
City:
Kenai
I
license Number:
State:
IAK
110052
I ZIP: 199611
Section 2 - Individual Information Enter information for the individual licensee who is completing this form.
I
Name:
IMarc Theiler
Section 3 - Changes to Licensed Marijuana Establishment Read each line below, and then sign your initials in the box to the right of only the applicable statement: I certify that no changes have been made, except for those that have been previously reported or requested on a form prescribed by the Board, to this licensed establishment's business nam e, ownership, licensed premises diagram, or operating plan, and (for marijuana product manufacturers) that I do not wish to request Board approval for production of any new proposed mar ijuana products. I certify that a change has been or will be made t o one or more of the items listed above for this establishment, and I understand t hat an additional form(s) and fee(s) must be submitted to AMCO before any renewal application for this license can be considered complete.
[Form MJ·201(rev 05/01/2017)
Initials ~
~
D Page 1of2
Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https://w ww .commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications Section 4 - Certifications Read each line below, and then sign your initials In the box to the right of any applicable statements:
Initials
I certify that I have not been convicted of any criminal charge in the previous two calendar years.
I certify that I have not committed any civil violation of AS 04, AS 17.38, or 3 AAC 306 in t he previous two calendar years.
Sign your initials to the following statement only if you are unable to certify one or both of the above statements:
Initials
I have attached a written explanation for why I cannot certify one or both of t he above statements, which includes the type of offense, as required under 3 AAC 306.035(b)(4).
D
Read each line below, and then sign your initials in the box to the right of each statement:
Initials
I certify that no person other than a licensee listed on my marijuana establishment license renewal application has a direct or indirect financial interest, as defined in 3 AAC 306.0lS(e)(l), in the business for which the marijuana establishment license has been issued. I certify that t his establishment complies with any applicable health, fire, safety, or tax statute, ordinance, regulation, or other law in the state. I certify that I have not violated any restrictions pertaining to this particular license type, and that this license has not been operated in violation of a condition or restriction imposed by the Marijuana Control Board. I certify that I understand that providing a false statement on this form, the online application, or any other form provided by or to AMCO is grounds for rejection or denial of this application or revocation of any license issued.
As an applicant for a marijuana establishment license renewal, I declare under penalty of unsworn falsification that I have read and am familiar with AS 17.38 and 3 AAC 306, and that this application, inclu,~Jm~.~11), accompanying schedules and statements, is true, correct, and complete. I agree to provide all information required by th~~'riC'e~f~f1.tJ',~I Board in support of this application and understand that failure to do so by any deadline given to me by AMCO ~}~~..rEsal~·iQ~~'~al fees or expiration of this license.
~ / ~/C>-=Signa::-of licensee
Marc Theiler Printed name of licensee
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\ ~ :I _,o'1r .
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- ___ _:ATE Or Att,SKA ~ UFFICE
--
Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https:ljwww.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications Section 4 - Certifications Initials
Read each line below, and then sign your initials In the box to the right of anv applicable statements: I certify that I have not been convicted of any criminal charge in the previous two calendar years.
I certify that I have not committed any civil violation of AS 04, AS 17.38, or 3 AAC 306 in the previous two calendar years.
Sign your initials to the following statement onlv if you are unable to certify one or both of the above statements:
Initials
I have attached a written explanation for why I cannot certify one or both of the above statements, which includes the type of offense, as required under 3 AAC 306.03S{b)(4).
D Initials
Read each line below, and then sign your initials in the box to the right of each statement: I certify that no person other than a licensee listed on my marijuana establishment license renewal application has a direct or indirect financial interest, as defined in 3 AAC 306.0lS(e)(l), in the business for which the marijuana establishment license has been issued . I certify that this establishment complies w ith any applicable health, fire, safety, or tax statute, ordinance, regulation, or other law in the state. I certify that I have not violated any restrictions pertaining to this particular license type, and that this license has not been operated in violation of a condition or restriction imposed by the Marijuana Control Board. I certify that I understand that providing a false statement on this form, the online application, or any other form provided by or to AMCO is grounds for rejection or denial of this application or revocation of any license issued.
As an applicant for a marijuana establishment license renewal, I declare under penalty of unsworn falsification that I have read and am familiar with AS 17.38 and 3 AAC 306, and that this application, including all accompanying schedules and statements, is true, correct, and complete. I agree to provide all information required by the Marijuana Control Board in support of this application and understand that failure to do so by any deadline given to me by AMCO staff ~t'e~Urt1in,sidditional fees or expiration of this license.
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Marc Th el'I er
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Printed name of licensee
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STATE OF ALASKA
ul OFFICE
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Mayor Brian Gabriel and Kenai City Council
THROUGH: FROM:
Jamie Heinz, Acting City Clerk
DATE:
August 8, 2017
SUBJECT:
Marijuana License Renewals
The Alcoholic & Marijuana Control Office has sent notification that the following applicants have requested license renewal: Applicant: Owners: D/B/A: License Type:
Red Run Cannabis Cultivators, LLC Eric Derleth, Marc Theiler and Roger Boyd Red Run Cannabis Cultivators, LLC Standard Marijuana Cultivation Facility
Applicant: Owners: D/B/A: License Type:
Red Run Cannabis Company, LLC Eric Derleth, Marc Theiler and Roger Boyd Red Run Cannabis Company, LLC Retail Marijuana Store
Pursuant to KMC 2.40.010, It is determined to be in the public interest that holders of or applicants for licenses issued by the Alcoholic Beverage Control Board or the Marijuana Control Board of the State of Alaska shall have all obligations to the City of Kenai on a satisfactory basis prior to the City Council approval of any activity of said license holder or applicant. A review of City accounts has been completed and the applicants have satisfied all obligations to the City. With the approval of Council, a letter of non-objection to the request for the renewal of a Standard Marijuana Cultivation Facility License and a Retail Marijuana Store will be forwarded to the Alcoholic & Marijuana Control Office and the applicant. Your consideration is appreciated.
"Vt1/llje with a Past, City with aFuture" 210 Fidalgo Avenue, Kenai, Alaska 99611-7794 Telephone: 907-283-7535 I FAX: 907-283-3014
'
1992
MEMORANDUM David Ross, Police Chief Terry Eubank, Finance Department Scott Bloom, Legal Department Willie Anderson, Lands Management Matt Kelley, City Planner
TO:
FROM :
~amie Heinz, Acting City Clerk
DATE:
July 27, 2017
RE:
Standard Marijuana Cultivation Facility License Renewal
The Alcoholic & Marijuana Control Office has sent notification that the following applicant has applied for renewal of their license: Applicant: Owners: D/B/A:
Red Run Cannabis Company, LLC Roger Boyd, Eric Derleth, and Marc Theiler Red Run Cannabis Company, LLC
Pursuant to KMC 2.40 .010 , It is determined to be in the public interest that holders of or applicants for licenses issued by the Alcoholic Beverage Control Board or the Marijuana Control Board of the State of Alaska shall have all obligations to the City of Kenai on a satisfactory basis prior to the City Council approval of any activity of said license holder or applicant. Please review records maintained by your department (i.e. water and sewer billings, lease/property payment history, citations, etc.) by the above reference applicant and advise if obligations have been met. Mark the appropriate box below. If obligations have not been met, attach information to this memorandum indicating what obligations are outstanding and how the obligations can be cured. Please let me know if you have any questions. Thanks. 1. Police Department "}. ~ •
0
initials
I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
0
The appo/...f:has outstanding obligations and an additional page has been attached. 2. Finance • initials
~ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
0
The applicant has outstanding obligations and an additional page has been attached. 3. Legal 5 ? initials
~ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
0
The applicant has outstanding obligations and an additional page has been attached.
4~ds Management w...t.r initials
~ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist.
Orhe applicant has outstl}l)~obligations and an additional page has been attached. 5:.f!;rhning and Zoning JYl "nitials
LiJ I have reviewed all records for my department and the applicant is current on obligations or obligations do not exist. Orhe applicant has outstanding obligations and an additional page has been attached. Returned to Clerk's office:
~ • '2 · 11 ~
Department of Commerce, Community, and Economic Development ALCOHOL & MARIJUANA CONTROL OFFICE
550 West 7th Avenue, Suite 1600 Anchorage, AK 99501 Main: 907.269.0350
July 24, 2017 City of Kenai Attn: Sandra Modigh, City Clerk VIA Email: [email protected]
License Number:
10052
License Type:
Standard Marijuana Cultivation Facility
Licensee:
Red Run Cannabis Cultivators, LLC
Doing Business As:
RED RUN CANNABIS CULTIVATORS, LLC
Physical Address:
5455 Kenai Spur Highway Kenai, AK 99611
Designated Licensee:
Marc Theiler
Phone Number:
907-953-9453
Email Address:
[email protected]
AMCO has received a complete renewal application for the above listed license (see attached application documents) within your jurisdiction. This is the notice required under 3 AAC 306.035(c)(2). To protest the approval of this application pursuant to 3 AAC 306.060, you must furnish the director and the applicant with a clear and concise written statement of reasons for the protest within 60 days of the date of this notice, and provide AMCO proof of service of the protest upon the applicant. 3 AAC 306.060 states that the board will uphold a local government protest and deny an application for a marijuana establishment license unless the board finds that a protest by a local government is arbitrary, capricious, and unreasonable. At the May 15, 2017, Marijuana Control Board meeting, the board delegated to me the authority to approve renewal applications with no protests, objections, or notices of violation. However, if a timely protest or objection is filed for this application, or if any notices of violation have been issued for this license, the board will consider the application. In those situations, a temporary license will be issued pending board consideration. If you have any questions, please email [email protected]. Sincerely, Erika McConnell Director
Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https:ljwww.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications What is this form? This renewal application certifications form is required for all marijuana establishment license renewal applications. Each person signing an application for a marijuana establishment license must declare that he/she has read and is familiar with AS 17.38 and 3 AAC 306. A person other than a licensee may not have direct or indirect financial interest (as defined in 3 AAC 306.0lS(e)(l)) in the business for which a marijuana establishment license is issued, per 3 AAC 306.0lS(a).
This form must be completed and submitted to AMCO's main office by each licensee (as defined in 3 AAC 306.020(b)(2)) before any license renewal application will be considered complete.
Section 1 - Establishment Information Enter information for the licensed establishment, as identified on the license application .
I
Licensee:
Red Run Cannabis Cultivators, LLC
License Type:
Standard Cultivation
Doing Business As:
Red Run Cannabis Cultivators, LLC
Premises Address:
5455 Kenai Spur Hwy, Suite A
City:
Kenai
I
License Number:
State:
IAK
I 10052
I
ZIP:
199611
Section 2 - Individual Information Enter information for the individual licensee who is completing this form.
I
Name:
IEric Derleth Section 3 - Changes to Licensed Marijuana Establishment
Read each line below, and then sign your initials in the box to the right of only the applicable statement:
Initials
I certify that no changes have been made, except for those that have been previously reported or requested on a form prescribed by the Board, to this licensed establishment's business name, ownership, licensed premises diagram, or operating plan, and (for marijuana product manufacturers) that I do not wish to request Board approval for production of any new proposed marijuana products. I certify that a change has been or will be made to one or more of the items listed above for this establishment, and I understand that an additional form(s) and fee(s) must be submitted to AMCO before any renewal application for this license can be considered complete.
D
I ou have selected the second certi 1cation, lease list an and all o the 1ve t
[Form MJ-20) (rev 05/01/2017)
1
JUN 2 7 2017 1 M.COt
"" u;FICE STAl°EOF.ALASKA
Page 1 of2
Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https://www.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications Section 4 - Certifications Read each line below, and then sign your initials in the box to the right of any applicable statements:
Initials
I certify that I have not been convicted of any criminal charge in the previous two calendar years.
I certify that I have not committed any civil violation of AS 04, AS 17.38, or 3 AAC 306 in the previous two calendar years.
Sign your initials to the following statement only if you are unable to certify one or both of the above statements:
Initials
I have attached a written explanation for why I cannot certify one or both of the above statements, which includes the type of offense, as required under 3 MC 306.035(b)(4).
D
Read each line below, and then sign your initials in the box to the right of each statement:
Initials
I certify that no person other than a licensee listed on my marijuana establishment license renewal application has a direct or indirect financial interest, as defined in 3 MC 306.0lS(e)(l), in the business for which the marijuana establishment license has been issued. I certify that this establishment complies with any applicable health, fire, safety, or tax statute, ordinance, regulation, or other law in the state. I certify that I have not violated any restrictions pertaining to this particular license type, and that this license has not been operated in violation of a condition or restriction imposed by the Marijuana Control Board. I certify that I understand that providing a false statement on this form, the online application, or any other form provided by or to AMCO is grounds for rejection or denial of this application or revocation of any license issued .
As an applicant for a marijuana establishment license renewal, l declare under penalty of unsworn falsification that I have read and am familiar with AS 17.38 and 3 MC 306, and that this application, including all accompanying schedules and statements, is true, correct, and complete. I agree to provide all Information required by the Marijuana Control Board in support of this application and understand that failure to do so by any deadline given to me by AMCO staff ~~Uhikl1additional fees or expiration of this license. ..,,,.,.......-"' -·-
-
---=-===-
SignatUre of licensee
~
~
,,,•'' \E. EL1,s '•,, ...,•' ....~ ...··....................../2' ~,,,,~
~~@!ti
~ ~,..-
..,
f,'};,/ 0T11b ! ~ "''Ty"\7\ \ Q • _ _........,.._'-"'-~"""'-zg,.=-::...==-----€ -•\ rn ~ Notary Public in andfO theStat;of Alaska : : 'm: : ~\di ,()usuG f § ~
~
~ :;
Er.1c Derleth
\Jo
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~ I'll.
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f
My commission expires:c'YO ·()\ · C,)c}I~
e
-:.',,Cb0 "·..~................ OF jl.\.~/ ~ ~ "' .....
Printed name of licensee Subscribed and sworn to before me this
11 1
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rv day of
•••''
(
•
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f1ij f??Bff§iID} aji ~ [Form MJ-20) (rev 05/01/2017)
; JUN 2 7 2017 Al.COi
, •W•
SWE OF.ALASKA
l
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Page 2 of 2
Alcohol and Marijuana Control Office 550 W 7t11 Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https:ljwww.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications What is this form? This renewal application certifications form is required for all marijuana establishment license renewal applications. Each person signing an application for a marijuana establishment license must declare that he/she has read and is familiar w ith AS 17.38 and 3 AAC 306. A person other than a licensee may not have direct or indirect financial interest (as defined in 3 AAC 306.0lS(e)(l)) in the business for which a marijuana establishment license is issued, per 3 AAC 306.0lS(a).
This form must be completed and submitted to AMCO's main office by each licensee (as defined in 3 AAC 306.020(b)(2)) before any license renewal application will be considered complete.
Section 1 - Establishment Information Enter information for the licensed establishment, as identified on the license application.
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Licensee:
Red Run Cannabis Cultivators, LLC
License Type:
Standard Cultivation
Doing Business As:
Red Run Cannabis Cultivators, LLC
Premises Address:
5455 Kenai Spur Hwy, Suite A
City:
Kenai
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license Number:
State:
IAK
110052
I ZIP: 199611
Section 2 - Individual Information Enter information for the individual licensee who is completing this form.
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Name:
IMarc Theiler
Section 3 - Changes to Licensed Marijuana Establishment Read each line below, and then sign your initials in the box to the right of only the applicable statement: I certify that no changes have been made, except for those that have been previously reported or requested on a form prescribed by the Board, to this licensed establishment's business nam e, ownership, licensed premises diagram, or operating plan, and (for marijuana product manufacturers) that I do not wish to request Board approval for production of any new proposed mar ijuana products. I certify that a change has been or will be made t o one or more of the items listed above for this establishment, and I understand t hat an additional form(s) and fee(s) must be submitted to AMCO before any renewal application for this license can be considered complete.
[Form MJ·201(rev 05/01/2017)
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Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https://w ww .commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications Section 4 - Certifications Read each line below, and then sign your initials In the box to the right of any applicable statements:
Initials
I certify that I have not been convicted of any criminal charge in the previous two calendar years.
I certify that I have not committed any civil violation of AS 04, AS 17.38, or 3 AAC 306 in t he previous two calendar years.
Sign your initials to the following statement only if you are unable to certify one or both of the above statements:
Initials
I have attached a written explanation for why I cannot certify one or both of t he above statements, which includes the type of offense, as required under 3 AAC 306.035(b)(4).
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Read each line below, and then sign your initials in the box to the right of each statement:
Initials
I certify that no person other than a licensee listed on my marijuana establishment license renewal application has a direct or indirect financial interest, as defined in 3 AAC 306.0lS(e)(l), in the business for which the marijuana establishment license has been issued. I certify that t his establishment complies with any applicable health, fire, safety, or tax statute, ordinance, regulation, or other law in the state. I certify that I have not violated any restrictions pertaining to this particular license type, and that this license has not been operated in violation of a condition or restriction imposed by the Marijuana Control Board. I certify that I understand that providing a false statement on this form, the online application, or any other form provided by or to AMCO is grounds for rejection or denial of this application or revocation of any license issued.
As an applicant for a marijuana establishment license renewal, I declare under penalty of unsworn falsification that I have read and am familiar with AS 17.38 and 3 AAC 306, and that this application, inclu,~Jm~.~11), accompanying schedules and statements, is true, correct, and complete. I agree to provide all information required by th~~'riC'e~f~f1.tJ',~I Board in support of this application and understand that failure to do so by any deadline given to me by AMCO ~}~~..rEsal~·iQ~~'~al fees or expiration of this license.
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Marc Theiler Printed name of licensee
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Alcohol and Marijuana Control Office 550 W 7th Avenue, Suite 1600 Anchorage, AK 99501 [email protected] https:ljwww.commerce.alaska.gov/web/amco Phone: 907.269.0350
Alaska Marijuana Control Board
Form MJ-20: Renewal Application Certifications Section 4 - Certifications Initials
Read each line below, and then sign your initials In the box to the right of anv applicable statements: I certify that I have not been convicted of any criminal charge in the previous two calendar years.
I certify that I have not committed any civil violation of AS 04, AS 17.38, or 3 AAC 306 in the previous two calendar years.
Sign your initials to the following statement onlv if you are unable to certify one or both of the above statements:
Initials
I have attached a written explanation for why I cannot certify one or both of the above statements, which includes the type of offense, as required under 3 AAC 306.03S{b)(4).
D Initials
Read each line below, and then sign your initials in the box to the right of each statement: I certify that no person other than a licensee listed on my marijuana establishment license renewal application has a direct or indirect financial interest, as defined in 3 AAC 306.0lS(e)(l), in the business for which the marijuana establishment license has been issued . I certify that this establishment complies w ith any applicable health, fire, safety, or tax statute, ordinance, regulation, or other law in the state. I certify that I have not violated any restrictions pertaining to this particular license type, and that this license has not been operated in violation of a condition or restriction imposed by the Marijuana Control Board. I certify that I understand that providing a false statement on this form, the online application, or any other form provided by or to AMCO is grounds for rejection or denial of this application or revocation of any license issued.
As an applicant for a marijuana establishment license renewal, I declare under penalty of unsworn falsification that I have read and am familiar with AS 17.38 and 3 AAC 306, and that this application, including all accompanying schedules and statements, is true, correct, and complete. I agree to provide all information required by the Marijuana Control Board in support of this application and understand that failure to do so by any deadline given to me by AMCO staff ~t'e~Urt1in,sidditional fees or expiration of this license.
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