California Code of Regulations › Title 9 - Rehabilitative and Developmental Services › Division 4 - Department of Alcohol and Drug Programs › Chapter 3 - Programs for Alcohol and Drug Impaired Drivers › Subchapter 2 - Licensure of DUI Programs › Article 2 - Initial License › Section 9804 - Content of Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 applicant shall submit a separate application for each site, except for satellite
					 sites, where services are to be provided.
(b) Each application for licensure shall include
					 the following information:
(1) The name of the
					 county and DUI program in which the applicant will be providing services, and
					 whether the applicant is applying for licensure as a first offender, 18-month, or
					 30-month program;
(2) The legal name of
					 the applicant and the name the DUI program will use to conduct business;
(3) The telephone number and mailing address of
					 the applicant, and the telephone number and address of the DUI program
					 location;
(4) The business status (i.e.,
					 individual owner, partnership, nonprofit or for-profit corporation, public agency,
					 or another specified entity) under which the applicant will operate the DUI
					 program;
(5) The name(s) and address(es)
					 of any other licensed DUI program owned or operated by the applicant(s) within the
					 last five years;
(6) The name, address,
					 and telephone number of the program director;
(7) If the applicant is a partnership, the name
					 and principal business address of each partner, and a copy of the partnership
					 agreement as filed with the county or state, as applicable;
(8) If the applicant is a corporation or
					 association, the name and address for the corporation or association; the name and
					 title of the officer or employee who acts on behalf of the corporation or
					 association; and a copy of the articles of incorporation and bylaws;
(9) If the applicant is a public agency, the type
					 of agency (i.e. county, city, or other specified), the name of the department, and
					 address;
(10) The name(s), title,
					 education and experience of the program director in accordance with Section
					 9846 of this Chapter;
(11) Written assurance that the DUI program will
					 not discriminate in employment practices and in provision of benefits and services
					 on the basis of race, color, national origin, religion, sex, or mental or physical
					 disabilities pursuant to Title VI of the Civil Rights Act of 1964, section
					 504 of the Rehabilitation Act of 1973,
					 California Government Code section
					 11135, et seq.,
					 and other applicable state and federal laws;
(12) A statement, signed and dated by the
					 applicant or the authorized representative of the applicant, declaring under penalty
					 of perjury that all information submitted to the Department is true and correct to
					 the best of the applicant's knowledge;
(13) A signed and dated financial statement with
					 an itemized listing of the DUI program's assets, liabilities, and equity;
(14) A line item budget which includes fiscal
					 information in the categories of personal services, operating expenses, equipment,
					 equipment and facility depreciation schedules, revenue, and profit or surplus;
					 and
(15) The signature of the applicant
					 as follows:
(A) For partnerships, each partner
					 shall sign the application.
(B) If the
					 applicant is a firm, association, corporation, county, city, public agency, or other
					 governmental entity, the application shall be signed by the chief executive officer
					 or the individual legally responsible for representing the firm, association,
					 corporation, county, city, public agency, or other governmental
					 entity.