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REVISED 5/10/2021 MARIJUANA BUSINESS LICENSE RENEWAL APPLICATION This application must be submitted to the City Clerk, along with the completed Colorado Marijuana Business License Renewal Application, no less than 45 days prior to the license expiration date. Applicant Trade Name (d/b/a) Address of Licensed Premise Mailing Address (if different) Contact Person Telephone E-mail address TYPE OF LICENSE / LICENSE NUMBER: Retail Marijuana Cultivation Medical Marijuana Cultivation Retail Marijuana Store Medical Marijuana Center Retail Marijuana Products Manufacturer Medical Marijuana Products Manufacture Testing Facility FEES AND SUPPLEMENTAL INFORMATION Application Fee $1,500 License Fee $2,000 Operating Fee $3,000 Late Renewal $750 Colorado Regulated Marijuana Business License Renewal Application Form DR 8529 Landlord Authorization to Use Property for a Marijuana Business Colorado Secretary of State Certificate of Good Standing Surety Bond Continuation Certificate (Store only) Marijuana Testing Facility Annual Certification AFFIRMATION AND CONSENT I affirm that I have reviewed this application and all associated documents and that the contents and statements made therein are true and correct to the best of my knowledge and belief. I understand that any misrepresentations or failure to disclose information requested or pertinent information may be deemed good cause to deny, withhold, or revoke a license. Date: Applicant Signature Date: Registered Agent (if applicable) DEPARTMENT APPROVALS Police report no incidents at this location See attached Police incident report Applicant is current on City Sales Tax (Center or Retail Store) Not applicable Applicant is current on utility payments Not applicable Applicant is current on excise tax payments (growers) Not applicable LOCAL LICENSING AUTHORITY Renewal Approved Renewal Denied (Attach explanation of denial) Lynnette Beck, City Clerk Date William Hayashi, City Attorney