HomeMy WebLinkAbout#5209 Distribution/Sale/Medical Cannabis RESOLUTION NO. 5209
A RESOLUTION APPROVING A CONDITIONAL USE PERMIT FOR THE DISTRIBUTION
AND SALE OF MEDICAL AND RECREATIONAL CANNABIS IN THE CITY OF CANTON
BY EVERGREEN DISPENSARY, LLC, EFFECTIVE JANUARY 1, 2020.
WHEREAS, Section 10-9-11 of the City Code of the City of Canton authorizes the City
Council of the City of Canton to issue a conditional use permit for the sale and distribution of
recreational and medical cannabis; and
WHEREAS,Evergreen Dispensary,LLC(d/b/a RISE CANTON and SALVEO HEALTH
AND WELLNESS DISPENSARY) has submitted an Application for the Dispensing of Medical
and/or Recreational Cannabis, a copy of which is attached hereto and incorporated herein as
"Exhibit A";
WHEREAS, the City Council of the City of Canton has determined that it is necessary
and in the best interest of the City to approve a Conditional Use Permit for Evergreen Dispensary,
LLC (d/b/a RISE CANTON and SALVEO HEALTH AND WELLNESS DISPENSARY),
effective January 1, 2020, to sell and dispense recreational cannabis.
. NOW,THEREFORE,BE IT RESOLVED BY THE MAYOR AND CITY COUNCIL
OF THE CITY OF CANTON,ILLINOIS,AS FOLLOWS:
1. That the Application attached hereto and incorporated herein as "Exhibit A" is
hereby approved by the Canton City Council.
2. That the Mayor, or his designee; the City Clerk; and the Zoning Administrator of
the City of Canton,Illinois,are hereby authorized and directed to execute said the approval of said
Application on behalf of the City of Canton.
3. That, upon payment of the required permit fee of $10,000.00, the Mayor, City
Clerk, and Zoning Administrator shall issue the Conditional Use Permit to EVERGREEN
DISPENSARY, LLC for the purpose of being a recreational cannabis dispensary center.
4. That the permit issued by this Resolution shall not be effective until January 1,
2020, and no sale nor dispensing of recreational cannabis shall occur prior to said date.
5. That the Zoning Administrator of the City of Canton, Illinois, is hereby authorized
and directed to execute any and all necessary applications and forms for the EVERGREEN
DISPENSARY, LLC, on behalf of the City of Canton, in order for the Illinois Department of
Financial and Professional Regulation to be notified that EVERGREEN DISPENSENARY, LLC
has complied with the City of Canton's zoning ordinances.
3. That this Resolution shall be in full force and effect immediately upon its passage
by the City Council of the City of Canton,Illinois, and approval by the Mayor thereof.
PASSED by the City Council of the City of Canton, Illinois, at a regular meeting this 5th
day of November, 2019, upon a roll call vote as follows:
AYES:Aldermen Justin Nelson, Angela_ Lingenfelter, Jeff Fritz, Angela Hale, Quin
Mayhew, Ryan Mayhew
NAYS: None
ABSENT: Aldermen Craig West, John Lovell
ABSTAIN: None
AP ROV D:
i
K nt McDowell, a
ATT T:
Diana Pavley-Rock, City Clerk
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FOR CLERK'S USE ONLY: #
City of Canton PERMIT NO. 1
2 N. Main Street
Canton, Illinois 61520 APPROVAL DATE
APPLICATION FOR CONDITIONAL USE PERMIT
FOR THE DISPENSING OF MEDICAL AND/OR RECREATIONAL CANNIBIS
Directions:
All applicants seeking a conditional use permit for•the dispensing of medical and/or recreational
cannabis must complete this application form by typing or printing the, requested information.
Respond to all questions on the application and furnish all supporting documents. Incomplete
applications will not be considered.The application form MUST bear an original signature and be
notarized. Facsimile copies will not be accepted. Renewal applications must be received prior to
December 31st of the calendar year in which the applicant is seeking renewal. Return to the City
Clerk.
Definitions:
MEDICAL CANNABIS DISPENSING ORGANIZATION, OR DISPENSING
ORGANIZATION, OR DISPENSARY ORGANIZATION: Means a facility operated by an
organization or business that is registered by the Department of Financial and Professional
Regulation to acquire medical cannabis from a registered cultivation center for the purpose of
dispensing cannabis, paraphernalia, or related supplies and educational materials to registered
qualifying patients, individuals with a provisional registration for qualifying patient cardholder
status, or an Opioid Alternative Pilot Program participant.
RECREATIONAL CANNABIS DISPENSARY CENTER: Means a facility operated by an
organization or business that is licensed by the Department of Financial and Professional
Regulation to acquire cannabis from a cultivation center,craft grower,processing organization,or
another dispensary for the purpose of selling or dispensing cannabis, cannabis-infused products,
cannabis seeds,paraphernalia, or related supplies under the Cannabis Regulation and Tax Act to
purchasers or to qualified registered medical cannabis patients and caregivers.As used in this Act,
dispensary organization shall include a registered medical cannabis organization as defined in the
Compassionate Use of Medical Cannabis Pilot Program Act or its successor Act that has obtained
an early approval adult use dispensing organization license.
Conditional Use Permit Being Sought,(Check all that apply)
❑ MEDICAL CANNABIS DISPENSING ORGANIZATION, OR DISPENSING
ORGANIZATION, OR DISPENSARY ORGANIZATION
* RECREATIONAL CANNABIS DISPENSARY CENTER
ISI New Permit ❑ Renewal Permit
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Background Information
1. Enter the legal name of the sole proprietorship (assumed name),partnership,
Corporation(Illinois,National,or Foreign),or limited liability company(the"Applicant"). l
NOTE! This name must be consistent with the name printed on your Illinois Department
of Financial and Professional Regulation License.
NAME: Evergreen Dispensary,LLC
If Applicant intends on "doing business as" a different name, please provide the name of
said entity.This name must be consistent with the name printed on your Illinois Department
of Financial and Professional Regulation License.
D/B/A NAME: Rise Canton (Please see Exhibit A). ,
2. Enter the street address,City, State,and Zip Code of the Applicant.
ADDRESS: 3104 N.Main Street, Canton, IL 61520
If the Applicant's Principal Address is different than the physical address where Applicant
intends on dispensing medical or recreational cannabis,then also state the physical address
of Applicant's dispensary.
PHYSICAL ADDRESS: 325 W.Huron, Suite 412, Chicago, IL 60654
3. FEIN--Enter Applicant's Federal Employer Identification Number(FEIN).The FEIN is a
nine-digit number issued by the United States Internal Revenue Service. This number is
used for verification purposes only, if needed. If you do not have an FEIN, please enter
Applicant's social security number(SSN).
FEIN:_
SSN(if no FEIN):
4. Check Applicant's Business Formation Status:
❑ Sole Proprietorship Date filed with County Clerk
❑ Partnership Date of formation
X Corporation Date of incorporation 8/28/14
❑ Sole Proprietorship Date of organization
*All corporations and limited liability companies must provide a copy of their file-stamped,
Articles of Incorporation or Articles of Organization, unless otherwise excused.
(Please see Exhibit B.)
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5. Ownership Information: Please provide a copy of Applicant's Table of Organization,
Ownership and Control, as submitted to the Illinois Department of Financial and
Professional Regulation pursuant to 410 ILCS 705/15-50. Or, in the alternative, please
provide all information as set forth in said statute. (please see Exhibit C.)
6. Please provide the following information for any and all managers and assistant managers
of the Applicant: Full name, home address, city, state, zip code, social security number,
date of birth,title/position and home telephone number. (please see Exhibit D.)
General Business Ouestions
1. Projected Number of Employees: 15
2. Projected Gross Annual Sales Amounts in U.S. Dollars($): $12.000,000
3. Projected Number of Daily Customers: 350
4. Projected Percentage(%)of Outside of Canton Customers: 30%
Other Questions
1. Is the Applicant licensed by the Department of Financial and Professional Regulation
through the State of Illinois to dispense medical or recreational cannabis?
iXi Yes n No
If yes,please answer the following:
License number(s): AUDO.000005
Description of License(s): Registered Adult Use Dispensing Organization
Active Status? Sales may begin on January 1, 2020
First Effective Date(s): License issued on August 22, 2019
Effective Date(s): January 1,2020
Expiration Date(s): March 31,2021
Have you ever been disciplined? No
*If yes,you must provide a detailed written explanation of the discipline,
including dates and reasons for the discipline.
Page 3 of 8
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A COPY OF YOUR LICENSE MUST BE INCLUDED WITH THIS APPLICATION. IF
YOU DO NOT YET HAVE A LICENSE FOR AN EARLY APPROVAL ADULT USE
DISPENSING ORGANIZATION LICENSE OR CONDITIONAL ADULT USE
DISPENSING ORGANIZATION LICENSE, BUT YOU HAVE RECEIVED
DOCUMENTATION FROM THE ILLINOIS DEPARTMENT OF FINANCIAL AND
PROFESSIONAL REGULATION THAT EVIDENCES YOUR APPROVAL OF SAID
LICENSES, THEN YOU MUST PROVIDE THAT DOCUMENTATION WITH THIS
APPLICATION.
(Please see Exhibit E).
2. Is the location where you will be operating your business within one thousand feet
(1,000)of the property line of a pre-existing public or private preschool, or elementary or
secondary school or daycare center,daycare home, group daycare home,part day
childcare facility?
❑ Yes X No
3. Is your business located in a house,apartment or condominium?
❑ Yes X No
4. Is your business located within one thousand five hundred feet(1,500)of another
organization or center that sells or dispenses medical or recreational marijuana?
❑ Yes X No
5. Is your business located in the offices of a physician?
❑ Yes XNo
6. Will your business be open outside the hours of seven o'clock(7:00)A.M. and ten o'clock
(10:00)P.M. on any day of the week, including holidays?
❑ Yes X No
7. Will your business utilize amplified music outdoors?
❑ Yes K No
8. Will your business have appropriate security employed and security measures
implemented at all times, in accordance with State regulations,to deter and prevent theft
of cannabis and unauthorized entrance into areas containing cannabis,cannabis infused
products and cannabis concentrate?
X Yes ❑No
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9. Will your business permit cannabis, cannabis infused products and cannabis concentrate
to be displayed or stored in an area accessible to the public?
❑ Yes DCNo
10. If your business intends on dispensing medical cannabis,will your business allow Q
medical cannabis to be consumed on the site of the medical organization?
❑Yes X No
11. Will you at retail, shall sell, give or deliver cannabis to any person as to whom the
prohibition thereof any applicable law of the State would apply?
❑ Yes KNo
12. Will two separate restrooms be provided with hot and cold running water together with
clean towels?
X Yes ❑No
13. Will you familiarize yourself with all laws of the United States, State of Illinois, and
ordinances of the City of Canton,Illinois, pertaining to the sale and dispensing of
medical and recreational cannabis, including,but not limited to,the Illinois
Compassionate Use of Medical Cannabis Program Act and the Illinois Cannabis
Regulation and Tax Act, and abide by all of them?
XYes ❑No
14. If food service is offered,will you familiarize yourself with all laws of the United States,
State of Illinois, and ordinances of the City of Canton or County of Fulton, Illinois,
pertaining to service of food and abide by all of them?
XYes ❑No
15. Will you maintain the entire premises in a clean and sanitary manner free from
conditions,which might cause accidents?
X Yes ❑No
16. Will you attempt to prevent rowdiness,fights and disorderly conduct of any kind and
immediately notify the police department if any such events take place?
X Yes ❑No
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Permit Fee
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Pursuant to Section 10-9-11(A) of the City Code of the City of Canton, the cost of a recreational
cannabis dispensary conditional use permit shall total ten thousand dollars ($10,000.00)per year.
Said fee shall initially be due on January 1,2020, or whenever the conditional use permit is issued
initially to anyone granted and issued a conditional use permit, but shall then be due January 1 of 4
each subsequent year,regardless of the month and specific date an initial conditional use permit is
issued to anyone granted and issued a conditional use permit.
The Applicant acknowledges no permit will be issued until receipt of the Ten Thousand Dollars
and No/Cents($10,000.00). The fee hereunder shall be paid to the City of Canton and delivered to
the City of Canton, ATTN: City Clerk, 2 N. Main Street, P.O. Box 478, Canton, Illinois 61520.
The fee is not required at the time of the application; however, it must be paid prior to any permit
being issued.
Is your fee included with the submission of this Application?
ci Yes X No (Fee will be mailed separately to above mentioned address.)
[SIGNATURE PAGE TO FOLLOW]
Page 6 of 8
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Signature/Title/Date
Please sign and date the application and provide your title with the Applicant. The application
must be signed by an owner,an officer,a partner or an officially authorized agent of the
Applicant. The signature must be an original. Rubber stamps are not accepted.
1,THE UNDERSIGNED APPLICANT OF AUTHORIZED AGENT THEREOF, SWEAR OR
AFFIRM THAT: THE MATTERS STATED ON THE FOREGOING APPLICATION ARE
TRUE AND CORRECT; THEY ARE MADE UPON MY PERSONAL I'(NOWLEDGE AND
INFORMATION;THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE CITY
OF CANTON TO ISSUE THE CONDITIONAL USE PERMIT HEREIN APPLIED FOR;THE
APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE CONDITIONAL USE
PERMIT APPLIED FOR;AND THE APPLICANT WILL NOT VIOLATE ANY OF THE
LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS OR THE
CITY OF CANTON, IN PARTICULAR,THE ILLINOIS COMPASSIONATE USE OF
MEDICAL CANNABIS PROGRAM ACT AND THE ILLINOIS CANNABIS REGULATION
AND TAX ACT,REGULATIONS, AND THE CIVIL RIGHTS SECTIONS THEREOF,AND
CHAPTER 9 OF TITLE 10 OF THE CANTON MUNICIPAL CODE.
FURTHER, I AGREE TO NOTIFY THE CITY OF CANTON WITHIN 30 WORKING DAYS
OF CHANGES IN ANY OF THE ABOVE INFORMATION,
DATE: November 4,.2019 i'�Ixw
APPLICANT SIGNATURE
Benjamin Kovler
APPLICANT NAME(PRINT)
CEO
TITLE/POSITION
STATE OF ILLINOIS )
COOK )
COUNTY OFA )
Subscribed and sworn to before me this 4th day of
moveotvtbef' _,20 Iq
(SEAL) OTARY PUBLIC
OFFICIAL SEAL
JOETTA KING
NOTARY PUBLIC.STATE OF ILLINOIS
My Commission Expires 09/0612021
Page 7 of 8
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FOR OFFICIAL USE ONLY
PERMIT APPROVED ON: FEE PAID? ❑ Yes ❑No
PERMIT DENIED ON:
VOTES: Ayes Nays Absent/Abstentions
MAYOR:
CITY CLERK:
ZONING ADMINISTRATOR:
Page 8 of 8
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EXHIBIT A
4
From: Zpetta Klno
To: Bender,Bret
Cc: FPR.MedCanUnit;Keen.Ma ;McVev.Brandon.M;Lewis.Elizabeth J.;Cruz.Andrea;Brendan lume:StM
Mahgne;Greg Gossett;Kristin Tdzna
Subject; RE;[EXTERNAL]RE:GTI Dispensaries-Name Change to Rise
Date: Thursday,October 24,2019 5:34:00 PM
Attachments: Evergreen Dispensary,LLC-IL•Assumed Name-Filhm.odf
3C Compassionate Care Center,LLC-IL-Assumed Name-Filing.odf
innage004.ona
imageODI.pno
Thank you, Bret.
Attached are SOS filings received for
9
Evergreen Dispensary LLC dba Rise Canton
3C Compassionate Care Center LLC dba Rise Joliet
GTI would like to give its 30 days notice as of today for Rise Canton's name unveiling. Rise Joliet will
be around December 13th
When the SOS filings are completed for the other stores I will forward them to you.
Take care,
-Joetta
Joetta King
Compliance Manager—IL,NV,OH,Chicago Office
c.773-307-1171
Facebook I Instagram I Twitter I Linkedin
From: Bender, Bret<Bret.Bender@lllinois.gov>
Sent:Thursday,October 24, 2019 8:09 AM
To:Joetta King<jking@gtigrows.com>
Cc:FPR.MedCanUnit<FPR.MedCanUnit@lllinois.gov>; Keen,Mary<Mary.Keen @illinois.gov>;
McVey, Brandon.M<Brandon.M.McVey@illinois.gov>; Lewis,Elizabeth J.
<Elizabeth.J.Lewis@lllinois.gov>;Cruz,Andrea<Andrea.Cruz@i11inois.gov>; Brendan Blume
<bblume@gtigrows.com>;Stacey Mahone<Stacey.Mahone@GTIGrows.com>
Subject: [EXTERNAL] RE:GTI Dispensaries-Name Change to Rise
Joetta,
Though you won't be able to officially use"Rise"as the d/b/a in filings with the Secretary of State's
Office for each license holding entity below,we have asked dispensaries to submit official d/b/a's
with the SOS office that would provide reasonable notice to anyone doing a d/b/a search that Rise is
tied to"Evegreen Dispensary, LLC," "GTI Mundelein,LLC,"etc.As such,we have asked licensees to
file d/b/a's like"Rise 1;' "Rise 2,"or"Rise Mundelein," "Rise Joliet,"etc.for each entity.
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State of Illinois-CONFIDENTIALITY NOTICE:The information contained in this communication is I
confidential, may be attorney-client privileged or attorney work product, may constitute inside information
or internal deliberative staff communication,and is intended only for the use of the addressee.
Unauthorized use,disclosure or copying of this communication or any part thereof is strictly prohibited
and may be unlawful. If you have received this communication in error, please notify the sender
immediately by return e-mail and destroy this communication and all copies thereof, including all
attachments. Receipt by an unintended recipient does not waive attorney-client privilege, attorney work
product privilege,or any other exemption from disclosure.
R
Z
OFFICE OF THE SECRETARY OF STATE
JESSE WHITE-Secretary of State
04921658
OCTOBER 17, 2019
C T CORPORATION SYSTEM
208 SO LASALLE ST, SUITE 814
CHICAGO, IL 60604.1101
RE RISE CANTON
DEAR SIR OR MADAM:
APPLICATION TO ADOPT AN ASSUMED NAME HAS BEEN PLACED ON FILE AND THE
LIMITED LIABILITY COMPANY CREDITED WITH THE REQUIRED FEE.
SINCERELY YOURS,
JESSE WHITE
ILLINOIS SECRETARY OF STATE
DEPARTMENT OF BUSINESS SERVICES
LIMITED LIABILITY DIVISION
(217) 524-8008
i
Form LLC-1.20 Illinois FILE# 049216SS
July2817 Limited Liability Company Act Tt&Wwararuse byst aUgofState.
Secretary of state Application to Adopt,Change,Cancel
Department of Business Services or Renew an Assumed Name
Liability Division
501& PILED� I L E
501 S.Second St„Rm.351 = DUPLICATE
Springfield,IL 82758 Type or print clearly.
217-6624.8008
%wvwxyberdrivelilinols,com OCT 16 2019
Payment may be made by check Filing Fee(See Note): JESSE WHITE
payable to Secretary of State, If SECRETARY OF STATE
check Is returned for any reason this Approved:
filing will be void.
1. Limited Liability Company name: EVERGREEN DISPENSARY,LLC
2. State or country under the laws of which the company Is organized:(check one)
®Illinois(domestic) O Foreign(epedify):
3. Check this box O If it is a Series of the Limited Liability Company that Intends to adopt,change,cancel or renew an assumed
name.
Name of Series:
4. TO ADOPT: The Limited Liability Company or Series Intends to adopt and transact business under the
(see note) assumed name of: RiSE Canton
5, TO CHANGE: (a) The abova-named Limited Liability Company or Series intends to cease transacting business '
(see note) under the assumed name of:
(b) and to commence transacting business under the new assumed name of:
S. TO CANCEL: The above-named Limited Liability Company or Series Intends to cease transacting business under
(sae 0010) the assumed name of:
7. TO RENEW: The above-named Limited Liability Company or Series intends to renew the assumed name of:
(Sao note)
8. The undersigned affirms,under penalties of perjury,having authority to sign hereto,that this Application to Adopt,Change,
Cancel or Renew an Assumed Name Is to the best of my knowledge and belief,true,correct and complete.
Dated: October 4 2019
nihmay Year
Signature
Den Kovlor,Monagcr
Nome and Title(typo or prim)
GTI Clinic Illinois Holdings,LLC
If applicant Is signing for a company at olhor onllty,
state name of company or entity.
P►Inlad by authority of the Mate of Illinois.Oacembor 2017—1—LLC 16.14
II.OSS-Iy111301r Noltm Rluauanl(nn
}i}
For example,if you go to the SOS's_webstte and do a search for"Sunnyside"and go a couple of
pages deep,you'll find several Sunnyside 1,Sunnyside 2,etc,This helps give notice to anyone doing
a corporate search of your retail outlet of the layers behind which entity actually holds the license.
Please notify the division after you have filed such paperwork,provide proof that the SOS has
received the paperwork, and give the Division at least 30 days'notice of when you plan to unveil the
name change,so we may update our licensing software,online list,and BioTrackTHC.
From:Joetta King<ikiag@_gtierows com>
Sent:Wednesday,October 23, 2019 3:57 PM
To: Bender, Bret<l3ret.Bender(ZDlllinois,gov>
Cc: FPR.MedCanUnit<FPR.MedCanUnit@lllinoIs,gov>; Keen, Mary<Mary,Keen C@illinois.Pov>;
McVey, Brandon.M <Brandon.M.MQVeY0Dillinois.ROv>;Lewis, Elizabeth J.
<Elizabeth.J.Lewisna Illinois.eOv>;Cruz,Andrea<Andrea.Cruz(@illinois.gov>; Brendan Blume
<bblume(@gtlgrows.com>;Stacey Mahone<Stac y.MaboneC@GTIGrQws.com>
Subject: [External] GTI Dispensaries-Name Change to Rise
Dear Bret,
GTI would like to rebrand each of its five dispensaries as"Rise." License numbers for the stores are
as follows:
Dispensary's Legal Name Medical License# Adult-Use License#
Evergreen Dispensary LLC 14-001 AUDO.000005
3C Compassionate Care Center LLC(Joliet) 29-002 AUDO.000002
3C Compassionate Care Center LLC 24-001 AUDO.000003
(Naperville)
NH Medicinal Dispensaries, Inc. 12-001 AUDO.000004
GTI Mundelein, LLC 27-001 AUDO.000001
The legal name will remain the same;only the d/b/a will change to Rise. Attached is an example of
the new name and logo as it would appear on the Mundelein store's exterior sign.
Please let me know if you have any questions or need additional information. I look forward to your
approval.
Thanks,
-Joetta
Joetta King
Compliance Manager—IL, NV,OH,Chicago Office
c.773-307-1171
FacebQok I Instagram I Twitter I Unkedln
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EXHIBIT
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Department of finandaf and4ftfessiow[ftufation
Divisio
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Fes', 44gisteredAduft Vse
ensinDispg Oroanization
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EvffGreen Dispensary, LLC
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3104 9V.- Main St.
Canton, IL 61520
License Number:A` OO.000005 OTires: 03-31-2021
(De6orah Magan-Semetary
Cedrza,96uneu—Acting Oinctor
The dispensary name that appears on this certification has complied with the provisions of the Illinois Scarmes and/or rules and
re-uhitions and Is hereby authorized to engagge in the activity&-;indicated herein. The status of this license mav be verified at w%vv.idfPr.con-i
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EXHIBIT B '
gg rr/ 1 Illinois
Limited Liability Company Act
Articles of Organization FILE ft 04921668
Secretory of Slate Jesse White FILED
Deparlment of Business Services Filing Fee: 8750 AUG 20 2014
Limited Uability Division Expedited Fee; Sioo Jesse White
twnvcy6erdriveIDinois,cam Approved By; TLB Secretary of Stale
1. Limited Liability Company Name;EVERGREEN DISPENSARY,LLC
2, Address of Principal Place of Business where records of the company will be kept:
3104 N.MAIN STREET
CANTON,IL 61620
3. Articles of Organization effective on the filing date.
4. Registered Agent's Name and Registered Office Address:
ANDREWC W.JOHNSON
212 E CHESTNUT ST
CANTON,IL 61520.2731 FULTON
6, Purpose for which file Limited Liability Company is organized:
Tile transaction of any or all lawful business for which limited Liability Companies may be organized under this Act."
6, The LLC is to have perpetual existence,
7. The Limited Liability Company is managed by the manager(s).
MILLER,SCOTT J
1111 E.JUNIPER STREET
CANTON,IL 61520
8. Name and Address of Organizer
I affirm,under penalties of perjury,having authority to sign hereto,that these Articles of Organization are to the bast
of my knowledge and belief,true,correct and complete.
Dated:AUGUST 20,2014 SCOTT J.MILLER
1111 E JUNIPER STREET
CANTON,IL 61620
The operaling agreement provltles for Ilia esehenfunoelOf mw or more series canon the company has hied a certificate of ee.dgoation for oath
series,which Is to have limited liablay pursuant to Section 37.40 of Ilia Illinois Umitad Liability Company Act,the dobto.Ilabdidcs and obbgadons
inemred.comaolad for or olheAvLso existing wth respect to a panicuiar series shell ho enforceable against Ilio assets of such sellas only,and not
against(ho assols ai Ilio Limited Liability company goncrally or any other series Ihercof,and wness otlerwtse provided In the opemdng agreement.
none of Ilio debts,liabilities,abligaoons and expenses incurred,conlmcled for or otherwise oxtsflnn wilh fospecl to this company generally orany
other series thereof shall be enforceable against the ussals of such series
This dccumonl was generated etechanlcally alvnw xytlardrivelliinois.com
Exhibit C
Table of Ownership
Evergreen Dispensary, LLC
GTI Core,LLC -
(DE LLC)
(GCorp Election)
100%
GTI-Clinic Illinois Holdings,LLC
(IL LLC)
100%Manager-Managed by GTI-Clinic Illinois Holdings,LLC
-Evergreen
Dispensary,
LLC
Salveo.
Dispensary
License
t
CONFIDENTIAL
Evergreen Dispensary, LLC
Ownership Summary
The dispensary license is held by Evergreen Dispensary, LLC d/b/a Salveo ("Salveo").Salveo is owned 100%by GTI-Clinic Illinois Holdings, LLC.GTI-
Clinic Illinois Holdings, LLC is 100%owned by GTI Core, LLC,a Delaware limited liability company. GTI Core, LLC is a wholly owned subsidiary of Green
Thumb Industries, Inc.,which is a publicly traded company_Those individuals owning 5%or more of the voting shares of Salveo are listed below.
Green Thumb Industries Inc.Voting Shareholders(+5%) (as of lune 2019)
1. Benjamin Kovler(36.2%)
2. Peter Kadens(21.1%)
3. Anthony Georgiadis (8.9%)
4. Andrew Grossman(5.6%)
Principal Officers of Salveo(as of June 2019)
1. Benjamin Kovler
2. Peter Kadens
3. Anthony Georgiadis
4. Andrew Grossman
5. Dina Rollman
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EXHIBIT D
MANAGERS AND ASSISTANT MANAGERS
OF
EVERGREEN DISPENSARY,AC
Full Name: GREGORY GOSS,fTT
Home Address: 239 WEST CHESTNUT
City: CANTON
State: IL
Zip Code: 61520
Social Security Number: 344-40-6111
Date of Birth: 01/13/1963
Title/Position: STORE MANAGER
Home Telephone Number: 309-357-0649
Full Name: SCOTT J.MILLER
Home Address: 1111 EASTJUNIPER
City: CANTON
State: IL
Zip Code: 61520
Social Security Number: 331-70-9153
Date of Birth: 09/14/1969
Title/Position: GENERAL MANAGER
Home Telephone Number: 309-264-3199
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FOR THE DISTRIBUTION AND SALE OF MEDICAL AND RECREATIONAL CANNABIS
BY AUTHORITY OF THE CITY OF CANTON
��. PERMIT IS HEREBY GRANTED TO
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u 3:EO4 N 1 R'n Street Canton 116 11, 520
4 a 4 FOR THE DISTRIBUTION AND SALE OF MEDICAL AND a
:3 RECREATIONAL CANNABIS r
r Conditional Use Permit#1 in said City beginning 01-01-2020 until 12-31-2020 R
subject to he provisions of all ordinances now in force and that may hereafter b passed b said Cit
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W ess the and of the Mayor of said City and the Corporate Seal thereof,this 5th day of November 2019 { h
ATTEST:
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City Clerk
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F ATTEST: i
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Mayor a Zoning ministrator
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Illinois Department of Financial and Professional Regulation
=.. Division of Professional Regulation - Cannabis Control Section
28TH i91
NOTICE OF PROPER ZONING FORM
1. BUSINESS/LEGAL NAME OF APPLICANT:
2. STREET ADDRESS F THE PROPOSED DISP NSARY:
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3. CITY: 4. COUNTY: 5. ZIP CODE:
The applicant is solely responsible for ensuring the proposed location is within a region prescribed by Section 15-20(b)or the region identified in the
applicant's application for a Conditional Adult Use Dispensing Organization License.Applicants must not apply with a proposed dispensary address that
needs to be re-zoned.NOTE:If a proposed location is not in a zoning classification that allows for operation of an adult use cannabis dispensary,
then the location Is non-compliant and your application will be disqualified.
CHECK ALL THAT APPLY
6. Are there local zoning restrictions specific to an adult use cannabis dispensary at the proposed location? Yes No
7. Is the location of the proposed adult use cannabis dispensary in compliance with minimum local zoning
restrictions for adult use cannabis dispensaries? Yes No
8. If necessary, has the proposed dispensing organization filed a request with the local zoning authority for a
dispensary use permit/conditional or special use permit? 1:1 NIA 9 Yes ® No
9. If a zoning request was filed but has not been approved,the zoning determination is expected to be issued
in approximately DAYS WEEKS MONTHS
SECTION72 TO'�E COMPLETED„BYQN AUTHORIZED REPRESENTA7`!UE al( MEMOMAL",”, G,OF, -11
Please confirm the boxes 6 to 9 above are true and accurate under the local zoning ordinance.
Title of the Autho ' d Zoning Representative Name of the Cecal J diction
d./? 'S C)c)�� U4-1 SO-A
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Printed Name Tee one Numl5er
Signature/Q to
IL486-2359 8/19