Fillable ARD Reg LLC App FRM (California)

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ARD Reg LLC App FRM (California)

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Page 1 of 8
BAR-102 (2/2019)
BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR
BUREAU OF AUTOMOTIVE REPAIR | LICENSING UNIT
PO Box 989001, West Sacramento, CA 95798-9001
P (855) 735-0462 F (855) 641-9982 | www.bar.ca.gov
LIMITED LIABILITY COMPANY (LLC)
AUTOMOTIVE REPAIR DEALER REGISTRATION APPLICATION
INSTRUCTIONS
Complete this application in accordance with the instructions below and include additional pages and documents as
necessary. The Bureau of Automotive Repair (BAR) cannot consider an application for registration unless all requested
information is provided. If not applicable, indicate N/A.
• Submit completed application with all required information and fees to the BAR Licensing Unit at the above
address. Send a separate completed application and $200.00 fee to the above address for each business
location.
• Remit fees by check or money order made payable to the Bureau of Automotive Repair.
• FEES ARE NON-REFUNDABLE PURSUANT TO BUSINESS AND PROFESSIONS CODE SECTION 158.
• A registration will be mailed to the address of record after your application is approved and processed, provided the
application does not have any deciencies.
SECTION 1 - 13
1. NAME OF BUSINESS: Provide the exact name under which the business will be conducted. This same name should
be shown on all invoices and advertisements. NOTE: The motor vehicle license plate number, if provided in
section 13, item (c), will be included as part of the registered business name.
2. NAME OF LIMITED LIABILITY COMPANY: Provide the name of the corporation as led with the California Secretary of
State.
3. FEDERAL EMPLOYER IDENTIFICATION NUMBER: Provide the Federal Employer Identication Number (FEIN)
assigned by the Internal Revenue Service. The FEIN must be in an active status.
4. BUSINESS ADDRESS: Provide the physical address where business is conducted and/or records will be maintained.
PO Boxes are not permitted. If your business is located at an address that has multiple shops, you must provide the
unit/suite number since each business must have a unique address. All licenses are mailed to the business address.
The business address must be shown on invoices and advertisements. The business address will be disclosed on
BAR’s website as the address of record.
5. MAILING ADDRESS: Complete only if you wish to receive correspondence at an address other than the business
address. If you provide a mailing address, renewal notices will be sent only to this address.
6. BUSINESS AREA CODE AND TELEPHONE NUMBER: Provide the area code and telephone number.
7. LIST ALL MEMBERS OF THE LIMITED LIABILITY COMPANY: Pursuant to Business and Professions Code
section 9884, an automotive repair dealer shall identify the owners, directors, ocers, partners, members, trustees,
responsible managing employee, and other persons who directly or indirectly control or conduct the business.
• Partnership: If the business is a partnership (two or more individuals), list the full name, title (i.e. partner), SSN/
ITIN, driver license number, area code and telephone number, and home address for each partner of the business.
• Corporation: If the business is a corporation, list the full name, title (i.e. president, secretary, treasurer, etc.), SSN/
ITIN, driver license number, area code and telephone number, and home address for each ocer and director of
the business. If the same person holds all corporate oces, you must state so on the application.
• Trust: If the business is a trust, list the full name, title (i.e., trustee), SSN/ITIN, driver license number, area code
and telephone number, and home address for each trustee.
8. MILITARY VERIFICATION: Expedited application assistance is available for current or former United States military
personnel and spouses or domestic partners of active duty or reserve military personnel. A waiver of renewal
requirements is available for active duty or reserve military personnel. To apply for expedited application assistance or
a renewal requirement(s) waiver, you must submit required documentation as specied at www.bar.ca.gov. (See Health
and Safety Code section 44031.5(d) and Business and Professions Code sections 114.3 and 115.5.)
Page 2 of 8
BAR-101 (10/2019)
9. MILITARY VERIFICATION: Expedited application assistance is available for current or former United States military
personnel and spouses or domestic partners of active duty or reserve military personnel. A waiver of renewal
requirements is available for active duty or reserve military personnel. To apply for expedited application assistance or
a renewal requirement(s) waiver, you must submit required documentation as specied at www.bar.ca.gov. (See Health
and Safety Code section 44031.5(d) and Business and Professions Code sections 114.3 and 115.5.)
10. BACKGROUND: This section must be completed in its entirety. Select YES or NO for items (a) through (g). Any
relevant information not provided may result in denial of this application or legal action later to revoke the registration.
11. SELLER PERMIT NUMBER, CITY/COUNTY BUSINESS LICENSE, AND HAZARDOUS WASTE IDENTIFICATION
NUMBER. If not applicable, indicate N/A or Exempt.
• Seller Permit Number: Provide the seller permit number as assigned by the California Board of Equalization.
• City/County Business License: Provide the business license number as assigned by the local city or county ocial
of that jurisdiction. If the oce or jurisdiction does not require a business license, attach a detailed statement dated
and signed by a person listed in section 8 of the application.
• Hazardous Waste Identication Number: Provide the hazardous waste identication number as assigned by the
United States or California Environmental Protection Agency.
12. TYPE OF OWNERSHIP: Select only one type of ownership: sole proprietorship, partnership, or corporation. This
application is not be used by a limited liability corporation (LLC). Please visit www.bar.ca.gov or call (855) 735-0462 to
obtain the appropriate LLC application.
13. TYPE OF BUSINESS:
• Using the list provided, identify the primary and secondary services performed by the business and provide the
corresponding number(s) in items (a) and (b).
• Select YES or NO for item (c). If YES, provide the license plate number for the motor vehicle used to perform
mobile automotive repairs in item (e). The motor vehicle license plate number will be included as part of the
registered business name that must be shown on all invoices and advertisements. (See Title 16, Section 3351.7.3
of the California Code of Regulations.)
• Select YES or NO for item (d).
• If required, provide the spray booth permit number as assigned by the local Air Quality Management or Air Pollution
Control District in item (e) and attach a copy of the supporting documents.
14. CERTIFICATION: The appropriate person(s) must read, sign, and date section 14 of this application. Signatures arm
that all statements are true and correct. Any false statements made on this application may result in denial of this
application of legal action later to revoke the registration.
ADDITIONAL INFORMATION
TYPE OF REPAIR BUSINESS REQUIRED TO REGISTER
A valid registration is required for any business that performs, for compensation, tests or repairs to, maintenance of, or
diagnosis of malfunctions of any of the following automotive or motorcycle components:
• AIR CONDITIONING SYSTEM
• BODY AND FRAME
• BRAKES
• CLUTCH
• DRIVE TRAIN ASSEMBLY
• ELECTRICAL SYSTEM
• ENGINE
• SUSPENSION
• TRANSMISSION
• STEERING GEAR
• EMISSION CONTROL SYSTEM
• FUEL SYSTEM
• HEATER SYSTEM
• GLASS COMPONENTS
• OTHER AUTOMOTIVE MOTORCYCLE COMPONENTS
(not specically excluded)
Page 3 of 8
BAR-101 (10/2019)
TYPE OF REPAIR BUSINESS NOT REQUIRED TO REGISTER
No registration is required for the following:
• A business that services only vehicles other than passengers vehicles.
• A eet owner repairing only eet vehicles.
• Machine shops that meet all of the following criteria:
1. Primary business is the wholesale supply of new or rebuilt automotive parts; and
2. Solely engages in the remanufacturing of individual automotive parts without compensation for warranty
adjustments; and
3. Does not engage in repairing or diagnosing malfunctions of motor vehicles or motorcycles.
CHANGE OF BUSINESS NAME, ADDRESS, OR CORPORATE OFFICERS OR DIRECTORS
If there is a change to your business name, address, or corporate ocers or directors, please call (855) 735-0462 to request
a Change of Name/Address/Corporate Ocers or Directors form or access the form on BAR’s website. BAR must be notied
within 14 days of the change of business name, address, or corporate ocers or directors per California Code of Regulations,
title 16, section 3351.1(d).
CHANGE IN OWNERSHIP
An ownership change consists of any change in legal ownership of the licensed business, including the purchase of an
existing business, addition or deletion of a partner, the transfer of any ownership interest between members of family, change
of the business entity by incorporation of the business, or any other change in the corporate status that requires a new
corporate number as issued by the Secretary of State. When a change in the business ownership takes place, you must
cease operating as an automotive repair dealer and the new owner must submit a new application with the applicable fee.
RENEWAL OF REGISTRATION
An automotive repair dealer registration must be renewed annually by submitting a renewal notice and the applicable fees.
The Department of Consumer Aairs mails a courtesy notice approximately 90 days before expiration of a registration.
However, if a renewal notice is not received, owners are still responsible for renewing the registration. If a registration
is renewed after the date of expiration, the registrant will be charged a late fee of $50.00.
LIMITED LIABILITY COMPANY
If the business is a limited liability company (LLC), you must apply on a separate Automotive Repair Dealer Registration
Application for an LLC. To obtain an LLC application, please visit www.bar.ca.gov or call (855) 735-0462.
NOTICE ON COLLECTION OF PERSONAL INFORMATION
COLLECTION AND USE OF PERSONAL INFORMATION
The Bureau of Automotive Repair of the Department of Consumer Aairs collects the personal information requested on this
form as authorized by Business and Professions Code sections 30, 9884, and 9887.2, Labor Code section 432.7, Civil Code
section 1798 et seq. (Information Practices Act), and California Code of Regulations, title 16, section 3306. The Bureau of
Automotive Repair uses this information principally to identify and evaluate applicants for licensure, issue and renew licenses,
and enforce licensing standards set by law and regulation.
Pursuant to Business and Professions Code section 27, the licensee’s address of record is a public record and will be posted
on BAR’s website.
MANDATORY SUBMISSION
Submission of the requested information is mandatory. The Bureau of Automotive Repair cannot consider your application for
licensure or renewal unless you provide all requested information.
Page 4 of 8
BAR-101 (10/2019)
ACCESS TO PERSONAL INFORMATION
You may review the records maintained by the Bureau of Automotive Repair that contain your personal information, as
permitted by the Information Practices Act. See below for contact information.
POSSIBLE DISCLOSURE OF PERSONAL INFORMATION
The Bureau of Automotive Repair makes every eort to protect the personal information you provide us. The information you
provide, however, may be disclosed in the following circumstances:
• In response to a Public Records Act (PRA) request (Government Code section 6250 et seq.), as allowed by the
Information Practices Act (Civil Code section 1798 et seq.);
• To another government agency as required by State or Federal law; or,
• In response to a court or administrative order, a subpoena, or a search warrant.
Eective July 1, 2012, the California Department of Tax and Fee Administration and the Franchise Tax Board may share
taxpayer information with this agency:
• Your license may be suspended by BAR if your state tax obligation is not paid
CONTACT INFORMATION
For questions about this notice or access to your records, you may contact the Bureau of Automotive Repair PRA Unit at
10949 North Mather Boulevard, Rancho Cordova, CA 95670, by phone at (855) 735-0465, or by email at bar.pra@dca.ca.gov.
For questions about the Department’s Privacy Policy, you may contact the Department of Consumer Aairs at 1625 North
Market Boulevard, Sacramento, CA 95834, by phone at (800) 952-5210, or by email at dca@dca.ca.gov.
For questions about the Information Practices Act, you may contact the Oce of the Attorney General, California Department
of Justice - Attention: Public Inquiry Unit, PO Box 944255, Sacramento, CA 94244, by phone at (800) 952-5225, or online at
www.privacy.ca.gov.
Page 5 of 8
BAR-102 (2/2019)
BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR
BUREAU OF AUTOMOTIVE REPAIR | LICENSING UNIT
PO Box 989001, West Sacramento, CA 95798-9001
P (855) 735-0462 F (855) 641-9982 | www.bar.ca.gov
LIMITED LIABILITY COMPANY (LLC)
FEE $200
AUTOMOTIVE REPAIR DEALER REGISTRATION
FOR DEPARTMENT USE ONLY
ARD #:
Issue Date:
Business Type:
Receipt #:
ATS #:
Please type or print legibly in ink.
1. NAME OF BUSINESS (DBA/TO BE SHOWN ON INVOICES AND ADVERTISEMENTS)
2. NAME OF LIMITED LIABILITY COMPANY
(AS FILED WITH THE OFFICE OF THE CALIFORNIA SECRETARY OF STATE)
3. FEDERAL EMPLOYER IDENTIFICATION NUMBER
4. BUSINESS ADDRESS
Number and Street Suite or Unit # City State Zip Code
5. MAILING ADDRESS
Number and Street or PO Box Suite or Unit # City State Zip Code
6. BUSINESS AREA CODE AND TELEPHONE NUMBER
7. LIST ALL MEMBERS OF THE LIMITED LIABILITY COMPANY (Attach additional pages if necessary. If a PARTNERSHIP, list all partners. If a
CORPORATION, list all ocers and directors, (i.e., president, secretary, and treasurer). If a TRUST, list all trustees. Enter full legal names (NO
INITIALS). If a legal name contains initials only, so state.)
FULL NAME
Last First Middle
TITLE
SOCIAL SECURITY NUMBER/INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER
DRIVER LICENSE NUMBER TELEPHONE NUMBER
HOME ADDRESS
Number and Street or PO Box Suite or Unit # City State Zip Code
FULL NAME
Last First Middle
TITLE
SOCIAL SECURITY NUMBER/INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER
DRIVER LICENSE NUMBER TELEPHONE NUMBER
HOME ADDRESS
Number and Street or PO Box Suite or Unit # City State Zip Code
FULL NAME
Last First Middle
TITLE:
SOCIAL SECURITY NUMBER/INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER
DRIVER LICENSE NUMBER TELEPHONE NUMBER
HOME ADDRESS
Number and Street or PO Box Suite or Unit # City State Zip Code
Page 6 of 8
8. MILITARY VERIFICATION:
a.
Has any person listed in section 7 ever served in the United States military?
If YES, refer to section 8 on instructions page.
YES
BAR-102 (2/2019)
NO
b.
Is any person listed in section 7 married to or in a domestic partnership or other legal union with an active duty
member of the U.S. military assigned to a duty station in California under ocial active duty military orders?
If YES, refer to section 8 on instructions page.
YES NO
9. BACKGROUND:
a.
Has any person listed in section 7, or any business the person is or was directly or indirectly in control of, ever
been convicted of any oense or entered a plea of nolo contendere in this or any other state in the United States
or a foreign country?
YES NO
This includes every citation, infraction, misdemeanor and/or felony, including trac violations. NOTE: Convictions that
were adjudicated in the juvenile court or convictions two years or older under California Health and Safety Code sections
1
1357(b), (c), (d), (e), or section 11360(b) should NOT be reported. Convictions that were later expunged from the re-
cords of the court or set aside pursuant to section 1203.4 of the California Penal Code or equivalent non-California
law MUST be disclosed.
If YES, provide a statement of explanation that includes the crime for which there was a conviction, the approximate date
and location of the crime, and sentence served, if any.
b.
Exclusive of juvenile court adjudications and criminal charges dismissed under section 1000.3 of the California
Penal Code or equivalent non-California laws, or convictions two years or older under California Health and
Safety Code sections 11357(b), (c), (d), (e), or section 1
1360(b), has any person listed in section 7, or any
business the person is or was directly or indirectly in control of, ever had a conviction that was set aside or
later expunged from the records of the court?
YES NO
If YES, provide a statement of explanation.
c. Does any person listed in section 7, or any business the person is directly or indirectly in control of, have any
criminal action pending against them/it, or is currently awaiting judgment and sentencing following entry of a
plea or jury verdict?
If YES, provide a statement of explanation.
YES NO
Page 7 of 8
d.
Has any person in section 7, or any business the person is or was directly or indirectly in control of, ever had
a registration, license, or certication that was denied, suspended, revoked, or placed on probation by BAR
or that was issued a citation by BAR?
BAR-102 (2/2019)
YES NO
If YES, provide a statement of explanation that includes each registration, license, and/or certication disciplined and
a description of the discipline imposed on that registration, license, and/or certication.
e.
Does any person listed in section 7, or any business the person is directly or indirectly in control of, have a
CURRENT registration, license, or certication issued by BAR?
YES NO
If YES, list the name(s) and registration number(s), license number(s), and/or certication(s):
f.
Has any person listed in section 7, or any business the person was directly or indirectly in control of, ever had a
PRIOR registration, license, or certication issued by BAR?
YES NO
If YES, list the name(s) and registration number(s), license number(s), and/or certication(s):
g.
Is this a change of ownership? If YES, provide proof of sale.
YES NO
10. SELLER PERMIT NUMBER, CITY/COUNTY BUSINESS LICENSE, AND HAZARDOUS WASTE NUMBER:
(If not applicable, indicate N/A or exempt.)
a.
Seller Permit Number
b.
Business License Number
c.
Hazardous Waste Identication Number
11. DOMESTIC/FOREIGN LIMITED LIABILITY COMPANY NUMBER
: (Under Corporations Code sections 17000 and 17450, all limited liability
companies must be registered as a domestic or foreign limited liability company in good standing with the California Secretary of State. Provide the
number assigned to the domestic or foreign limited liability company and attach a copy of the supporting documents.
a.
Domestic Limited Liability Company Number
Attach a copy of the following:
• Articles of Organization and Charter
•
Operating Agreement
•
Statement of Information
•
Trust Agreement (if a member of the LLC is a trust
b.
Foreign Limited Liability Company Number
Attach a copy of the following:
•
Articles of Organization and Charter (issued by the
• Certicate of Registration
state where the foreign LLC was formed.
•
Operating Agreement
• Statement of Information
•
Trust
Agreement (if a member of the LLC is a trust
12. TYPE OF BUSINESS
: (Provide the number(s) corresponding to the primary and secondary services performed by the business.)
a.
Primary Business Type
b.
Secondary Business Type
10. General Repair
11. Preventative Maintenance Services
12. Smog Check Station
13. Auto Body and/or Paint Shop
14. New/Used Car Dealer
15. Used Cars Only Dealer
16. Chain Store
17. Motorcycle Repair Shop
18. Engine Rebuilding/Repair
19. Mobile Automotive Repair
20. Automotive Diagnostic Repair
21. Auto Wrecker/Dismantler
22. Glass Shop
23. Transmission Repair Shop
24. Brake/Front End Alignment Shop
25. Muer/Exhaust Repair Shop
26. Radiator Repair Shop
27. Machine Shop
28. Tire Shop
29. Auto Training School/College
30. Auto Air Conditioning Shop
31. Trailer Hitch Installation
32. Tune UP/Oil Lube Shop
33. Ignition Interlock Device Installer
34. Automotive Parts Retailer
40. Other:
Page 8 of 8
BAR-102 (2/2019)
c.
Will the business be engaged solely in mobile automotive repairs and not operate a facility where the diagnosis
or repair of motor vehicles is performed? If YES, provide the license plate number for the motor vehicle used to
perform the mobile automotive repairs.
YES
NO
Motor Vehicle License Plate Number
PLEASE NOTE:
The motor vehicle license plate number will be included as part of the registered business name
that must be shown on all invoices and advertisements.
d.
If the business is applying for registration as an Auto Body and/or Paint Shop, does the business have the
required permits, licenses, and equipment to operate an Auto Body and/or Paint Shop? (See Title 16, Section
3351.1(a) and (b) of the California Code of Regulations for requirements.)
YES
NO
e.
Pursuant to Business and Professions Code section 9889.52, an application for registration as an Auto Body and/or Paint Shop may be
required by law to have a spray booth permit. If required, provide the permit number and attach a copy of the supporting documents.
Spray Booth Permit Number
13. CERTIFICATION (This section must be signed and dated by each person listed in section 7 of this application. Attach additional pages if necessary.)
PLEASE NOTE:
Pursuant to California Code of Regulations, title 16, section 3305, you may not perform any activities at this location
for which you are required to possess a valid automotive repair dealer (ARD) registration until an ARD registration is
issued. In addition, Section 9884.4 states that an ARD registration shall cease to be valid when the Director nds that
any of the information provided by this form ceases to be current. Furthermore, California Code of Regulations, title 16,
section 3351 requires that the application shall be accompanied by the registration fee and any evidence, statements,
or documents required on the application.
I certify under penalty of perjury under the laws of the State of California that all the statements made in this application and all attached supporting
documents pertaining to this application are true and correct.
SIGNATURE TITLE DATE
SIGNATURE TITLE DATE
SIGNATURE TITLE DATE
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ARD Reg LLC App FRM (California)

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Completed 21 July 2020

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