For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - ALARM AGENT
MUNICIPAL CODE SECTION - 4-18.7 (SEE ALSO 12.1-12.6)
DEFINITION:
Alarm agent means any person or entity, whether an individual, partnership or corporation, who
conducts a business of monitoring alarm systems and whose actions would involve contacting
the South Bend Police Department or South Bend Fire Department for a response.
GENERAL INSTRUCTIONS AND APPLICATION PROCESS:
1. Print legibly and complete all sections to ensure efficient processing.
2. Assemble all required information and materials before filing the application.
3. Thoroughly review all applicable Municipal Code Sections listed above.
4. Licenses expire January 31.
5. Add 10% to license fee for renewal after January 31.
6. Include $5.00 application processing fee payable to the City of South Bend.
7. License fee payable to the City of South Bend due upon approval - $75.00 (if you choose,
you may submit the license fee with the application and processing fee).
8. Application is reviewed by the South Bend Police Department and facilities located within
the city limits will be inspected by the South Bend Fire Department.
9. License will be issued upon approval and payment of the license fee.
REQUIRED INFORMATION AND MATERIALS:
1. Maintain and provide immediately upon request to South Bend Police or Fire Departments:
records of current alarm users employing applicants services, including name, address, and
telephone number of location where alarm system is installed, as well as names, addresses,
and telephone numbers of primary, secondary, and any additional key holders of that alarm
user.
2. If facility has multiple alarm systems or sensors, maintain facility floor plans, blueprints, or
similar documents showing zone locations for each system or sensor.
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - ALARM AGENT
MUNICIPAL CODE SECTION - 4-18.7 (SEE ALSO 12.1)
I. APPLICATION TYPE Check One: New Renewal
II. BUSINESS DATA
A. Business Name:
B. Business Address:
City: State: Zip:
C. Mailing Address (If different from above):
City: State: Zip:
D. Business Telephone Number:
E. Business Fax Number:
F. E-Mail Address:
G. Number of Clients:
H. All-hours Telephone Number:
III. PERSONAL DATA
A. Applicant's Legal Name:
B. Residential Address:
City: State: Zip:
C. Residential Telephone Number:
D. Cellphone Number:
E. Social Security Number: F. Date of birth:
F. Position with the Organization
For Office Use Only
Application Filed Police Dept. Approval
Application Fee Paid ($5) Fire Dept. Approval
Sent to Dept. License Fee Paid ($75)
License Number
Not Approved
Reason
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR - ALARM AGENT
MUNICIPAL CODE SECTION - 4-18.7 (SEE ALSO 12.1-12.6)
IV. CONTACT PERSON
A. Contact Person's Legal Name:
B. Residential Address:
City: State: Zip:
C. Residential Telephone Number:
D. Cellphone Number:
E. Position with Organization:
V. DO NOT SEND THE FOLLOWING INFORMATION TO THE CITY OF SOUTH BEND UNTIL REQUESTED.
Applicant, by submission of this application, agrees to maintain the following records and to provide
them to the South Bend Police Department or South Bend Fire Department immediately upon request.
A. Maintain and provide immediately upon request to South Bend Police or Fire Departments:
records of current alarm users employing applicants services, including name, address, and
telephone number of location where alarm system is installed, as well as names, addresses,
and telephone numbers of primary, secondary, and any additional key holders of that alarm
user.
B. If facility has multiple alarm systems or sensors, maintain facility floor plans, blueprints, or
similar documents showing zone locations for each system or sensor.
VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VII. AFFIRMATION
I, hereby, certify and affirm that all of the information I have given in this application is true and
accurate to the best of my knowledge. I further certify that I have in no way attempted to
mislead the City in this application by omitting facts known to me. I have read and understand
the regulations of the Alarm Agents license found in the City of South Bend Municipal Code,
Sections 4-18.7, 12-1, 12-2, 12-3, 12-3.5, and 12-6.
Signature Date
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