New Jersey Administrative Code › Title 13 - LAW AND PUBLIC SAFETY › Chapter 69A - APPLICATIONS › Subchapter 5 - FORMS › Section 13:69A-5.7 - Business Entity Disclosure Form-Casino Hotel Alcoholic Beverage Enterprise

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A Casino
				Hotel Alcoholic Beverage Enterprise Business Entity Disclosure Form (CHAB BED)
				shall be in a format prescribed by the Division and may require the applicant
				to provide the following information:
1. Any
				official or trade name used by the applicant for the last five years;
2. Whether the application is for initial
				licensure or submission for retention of the license and, if for retention, the
				license number of the current license;
3. The name, title and telephone number of a
				person to be contacted in reference to the application;
4. The current or former business addresses
				of the applicant enterprise for the last five years;
5. The current telephone and fax number of
				the applicant enterprise;
6. The
				business form of the enterprise, and a copy of the certificate of
				incorporation, charter, bylaws, partnership agreement, trust agreement or other
				basic documentation of the enterprise;
7. If the enterprise is a publicly traded
				corporation, the exchange its stock is traded on and its symbol;
8. The nature of the applicant's business,
				and the type of goods and services being provided to the casino
				industry;
9. The Federal Employer
				Identification Number or Social Security Number of the owner;
10. The following information regarding
				agreements with any casino licensee or applicant:
i. The number of written agreements entered
				into and a sample copy of such an agreement;
ii. The terms of any unwritten agreements or
				purchase order agreements with casino licensees or applicants, including the
				expected duration and compensation; and
iii. Whether any such agreements are in any
				way subject to or conditioned upon any other agreement between the casino
				licensee or applicant and the applicant or any other enterprise, or upon other
				agreements between the applicant and its suppliers, vendors or subcontractors,
				and the facts related thereto;
11. Any suppliers, vendors or subcontractors
				of the applicant which are also securities holders or creditors of the
				applicant;
12. The name and
				location of any government agency in this State or any other jurisdiction that
				regulates the applicant, and the nature and extent of regulation;
13. During the last five-year period, whether
				the applicant has had any license or certificate denied, suspended or revoked
				by any government agency in this State or any other jurisdiction, the nature of
				such license or certificate, the agency and its location, the date of such
				action, the reasons therefor and the facts related thereto;
14. The following financial information:
i. Two copies of the applicant's most recent
				financial statement whether audited or unaudited, the auditor's report and
				Federal and state tax returns;
ii.
				During the last five-year period, information regarding any judgments or
				petitions for bankruptcy or insolvency and any relief sought under any
				provision of the Federal Bankruptcy Act or any state insolvency law; and any
				receiver, fiscal agent, trustee or similar officer appointed for the
				applicant's property or business;
15. Civil, criminal, administrative and
				investigatory proceedings in this State, or any other jurisdiction, as follows:
i. Information regarding any indictment,
				charge or conviction for any criminal or disorderly persons offense;
ii. Any criminal proceeding in which the
				applicant has been a party or has been named as an unindicted
				co-conspirator;
iii. Any judgment,
				order, consent decree or consent order entered against the applicant pertaining
				to a violation or alleged violation of the Federal antitrust, trade regulation
				or securities laws or similar laws of any jurisdiction; and
iv. During the past 10 years, any judgment,
				order, consent decree or consent order entered against the applicant pertaining
				to a violation or alleged violation of any other state or Federal statute,
				regulation or code which resulted in the imposition of a fine or penalty of $
				50,000 or more;
16. The
				name, home address, date of birth, title or position and percent of ownership,
				where applicable, of each of the following persons or entities:
i. Any officer, inside director, trustee,
				partner or sole proprietor;
ii.
				Each enterprise or natural person that directly holds any beneficial or
				ownership interest of five percent or more of the applicant;
iii. Each sales representative or other
				person who regularly solicits business from a casino licensee or applicant,
				such person's immediate supervisors and all persons responsible for the office
				out of which such supervisors work; and
iv. Any person authorized to sign any
				agreement with a casino licensee or applicant; and
17. A copy of a business registration
				certificate or other proof of valid business registration with the Division of
				Revenue in the New Jersey Department of the Treasury.