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CITYOFNEWPORT,OREGON APPLICATIONFORMedicalMARIJUANAFACILITYENDORSEMENT BusinessName: WebAddress (City of Newport)

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Recreational Marijuana Dispensary Endorsement – Rev. 1/16

CITYOFNEWPORT,OREGON

APPLICATIONFORMedicalMARIJUANAFACILITYENDORSEMENT

BusinessName: WebAddress

CorporationName: Phone:

PhysicalAddress:

MailingAddress:

NameofPersonResponsibleforRecreationalMarijuanaFacility:

PhoneofPersonResponsibleforRecreationalMarijuanaFacility:

E‐MailAddressofPersonResponsibleforRecreationalMarijuanaFacility:

Owner(ifdifferentfromabove): BusinessManager:

1CompleteaNewportPoliceDepartmentcrimi nalbackgroundcheckrequestform(enclosed)for

employeesoftherecreationalmarijuanafacilityandforownersworkingatthefacility(otherthanthe

principalperson)andattachthecompletedformstothisendorsementapplication.Acriminalbackground

requestformisnotrequiredforthepersonresponsibleforth

erecreationalmarijuanafacilityasthatwas

performedbytheOregonLiquorControlCommission. 

2. AttachacopyofthelicenseissuedbytheOregonLiquorControlCommission.

3. Providepaymentintheamountof$35.00fortherecreationalmarijuanafacilityendorsementalongwith

$35.00foreachcriminalbackgroundcheckthatistobeperformed.

Iherebyconfirmthattheinformationcontainedinthisapplicationistrue,andunderstandthatanyfalse

informationmaybegroundsfordenialor

revocationoftheendorsement.

BusinessOwner BusinessManager(ifdifferentfromowner)

Date

Returnthecompletedformto:CityofNewport,FinanceDepartment,169SWCoastHighway,Newport,

Oregon97365.

Recreational Marijuana Dispensary Endorsement – Rev. 1/16



AGREEMENT



PursuanttoOrdinanceNo.2089,thecity willnotissueaRecreationalMarijuanaFacilityEndorsement

unlessanduntilthePersonResponsiblefortheRecreationalMarijuanaFacilityagreestothefollowing

conditions:



1. ThePersonResponsiblefortheRecreationalMarijuanaFacility,andanyemployeesworkingatthe

Recreational Marijuana Facility, will cooperate with the  city during an inspection authorized by

Chapter4.20.050oftheNewportMunicipalCode.



2. Toallowthecitythesameaccesstoanyandallvideosurveillancerecordsandrecordingsofthe

RecreationalMarijuana  Facility astheOregonLiquor ControlCommissiondoespursuant toOAR

845‐025‐

1430.



3. Toallowthecitythesameaccesstoanyandalldocumentationrequiredtobemaintainedunder

the rules adopted by the Oregon Liquor Control Commission as the Oregon Liquor Control

CommissiondoespursuanttoOAR845‐025‐1200.



4. The Person Responsible for the  Recreational Marijuana  Facility agrees

 to direct the security

companyrequiredbyOAR845‐025‐1420(2)(b)tonotifytheCityofNewportPoliceDepartmentany

timethealarmsystemrequiredbyOAR845‐025‐1420istriggeredattheRecreationalMarijuana

Facility.



5. ThePersonResponsiblefortheRecreationalMarijuanaFacilityunderstands andagreesthatneither

theissuanceofabusinesslicensenortheissuanceofaRecreationalMarijuana FacilityEndorsement

constitutes a permit to engage in any activity prohibited by law or as a waiver of any other

regulatoryorlicenserequirementimposedbythecityorbyafederal,state,orlocallaw.



6. The Person Responsible for the Recreational Marijuana Facility agrees to notify the city of any

employees hired by the Recreational Marijuana Facility after issuance of the Recreational

MarijuanaFacilityEndorsementandpriortotheirfirstdayofemployment;andagreestoprovide

thecitywithcriminalbackgroundcheckrequestsfromthenewemployeesonaformprovidedby

thecity.



7. The Recreational Marijuana Facility agrees to notify the city, concurrent with notification to the

Oregon Liquor Control Commission, if the Person Responsible  for the Recreational Marijuana

Facilitychanges.



I,asthePerson ResponsiblefortheRecreationalMarijuanaFacility,agree

totheabovetermsandany

othersimposedbycity,state,andfederallaw.



___________________________________________ ________________________

PersonResponsiblefortheRecreationalMarijuanaFacility Date

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