SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A

Transcription

1 SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A ** APPLICANT INFORMATION ** NOTE: IF APPLICANT IS AN ORGANIZATION EXEMPT UNDER SECTION , OR IS APPLYING FOR A LICENSE AS A TRANSIENT MERCHANT OF ITINERANT VENDOR UNDER SECTION , OR IS APPLYING FOR A LICENSE AS A NONCOMMERCIAL SOLICITOR OR CANVASSER UNDER SECTION , PLEASE SEE THE CITY CLERK FOR THE APPROPRIATE FORM. DO NOT USE THIS FORM. IF THE APPLICANT IS AN INDIVIDUAL OR A SOLE PROPRIETORSHIP AND IS NOT A CORPORATION, A PARTNERSHIP, A LIMITED LIABILITY COMPANY, OR A LIMITED LIABILITY PARTNERSHIP PLEASE GO DIRECTLY TO PAGE 2. OTHERWISE, PLEASE COMPLETE THIS PAGE AND PROCEED TO PAGE 2. APPLICANT IS A: CORPORATION ( ) OR LIMITED LIABILITY CORPORATION ( ) PARTNERSHIP ( ) OR A LIMITED LIABLITY PARTNERSHIP ( ) APPLICANT S NAME: FEDERAL TAX ID NUMBER: 10 DIGIT NEW JERSEY STATE BUSINESS REGISTRATION NUMBER: A COPY OF THE NEW JERSEY SALES TAX CERTIFICATE IS ATTACHED ( ) BUSINESS ADDRESS: IF NOT A NEW JERSEY CORPORATION OR PARTNERSHIP, THE NAME AND ADDRESS OF THE REGISTERED AGENT IN NEW JERSEY FOR SERVICE OF PROCESS: NAME OF PRESIDENT OR MANAGING MEMBER: BUSINESS TELEPHONE # FAX # BUSINESS ADDRESS: BUSINESS HOURS AT PRINCIPAL BUSINESS ADDRESS: BUSINESS WEB SITE ADDRESS: APPLICATION IF FOR A LICENSE AS A: VENDOR ( ) SOLICITOR ( ) COMMERCIAL CANVASSER ( ) PEDDLER ( ) 1

2 SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A NOTE:THIS APPLICATION SHEET MUST BE COMPLETED FOR EACH PERSON WHO SHALL ENGAGE IN ANY SOLICITING, CANVASSING, PEDDLING OR VENDING WITHIN THE CITY OF SOMERS POINT TO COMPLY WITH SECTION OF THE SOMERS POINT MUNICIPAL CODE. APPLICANT S NAME: APPLICANT S PERMANENT HOME ADDRESS: APPLICANT S LOCAL ADDRESS IF DIFFERENT FROM ABOVE: APPLICANT S Phne # Age: Physical Descriptin: SEX ( ); EYE COLOR ( ) HAIR COLOR ( ) APPLICANT S SS# If ther than slely n behalf f Applicant, the name & address and telephne number f the rganizatin r persns fr whm canvassing, vending r sliciting is being made and the nature f the arrangement between Applicant and such ther persn r rganizatin: (IN RESPONDING TO THE NEXT QUESTIONS, PLEASE ATTACH SEPARATE SHEETS IF REQUIRED) Has the Applicant been cnvicted f a crime f the furth degree r higher, a disrderly persns ffense, a petty disrderly persns ffense, r a mving mtr vehicle ffense which resulted in damage r injury t persn(s) r prperty? YES ( ) NO ( ) If YES, the details theref including the ffense and the curt: A list f municipalities where the applicant has within the preceding three (3) years engaged in the activities f canvassing, peddling r sliciting, whether r nt a permit was applied fr r received in cnnectin therewith. A statement as t whether r nt the applicant has been denied a canvassing, peddling r sliciting permit and whether such permit r License has ever been revked r suspended; and if s, the details f the revcatin r suspensin. 2

3 SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A **Business Infrmatin** (PLEASE ATTTACH ADDITIONAL SHEETS IF REQUIRED) Descriptin f the nature f business r activity and the gds, services r wares t be sld: Days and dates upn which canvassing, peddling, sliciting r vending is t take place: Rute (s) t be taken: The make, mdel, year, clr and license plate number f such vehicle used by the applicant during the perid f canvassing r sliciting within the City and the number f applicant s driver s license and the State in which it is issued: **Insurance Requirements** The name and address f the insurance carrier and insurance plicy number with respect t such vehicle r vehicles; and a cpy f the current Certificate f Insurance Card issued by an insurance carrier licensed t d business in the State f New Jersey and evidencing prf f General Liability Insurance, Autmbile Liability Insurance fr each vehicle t be used, and Statutry Wrkers Cmpensatin if there are emplyees. INSURANCE COMPANY NAME(S) AND INSURANCE POLICY # (S): GENERAL LIABILITY: AUTOMOBILE: UMBRELLA (EXCESS): WORKERS COMPENSATION: All applicants selling fd items shall als submit a Certificate f Insurance demnstrating cverage with minimum amunts f $100,000 per persn Persnal injury; $300,000 per ccurrence; and $25,000 prperty damage (which shall be in additin t any insurance required fr peratin f a mtr vehicle as required by Sectin (10) and in which the City f Smers Pint shall be named as an additinal insured thrugh an endrsement t the plicy f 3

4 insurance and identified as such n the Certificate f Insurance which shall prvide fr nt less than thirty (30) days written ntice t the City f Smers Pint Clerk f cancellatin r terminatin. NOTE: NOTWITHSTANDING THE ABOVE REQUIREMENT, ALL APPLICANTS SELLING FOOD ITEMS USING A CART, WAGON OR OTHER VEHICLE USED IN OFFERING SUCH FOOD ITMES FOR SALE UPON A SIDEWALK SHALL COMPLY WITH THE INSURANCE REQUIREMENTS SET FORTH IN b) BELOW AND THE WRITTEN CONSENT REQUIREMENT SET FORTH IN a) BELOW. Each applicant shall be respnsible t maintain a current certificate f insurance during the term f the License and prvide same t the City Clerk. If a cart, wagn, r ther vehicle is t be used in ffering fr sale, sliciting, canvassing, r vending upn a sidewalk; a) The written cnsent f the abutting wner shall be filed with the License Applicatin setting frth any cnditins impsed by the prperty wner; and b) A certificate f Insurance demnstrating cverage with minimum amunts f $1,000,000 per persn Persnal injury; $1,000,000 per ccurrence; and $1,000,000 prperty damage (which shall be in additin t any insurance required fr peratin f a mtr vehicle as required by Sectin (10) and in which the City f Smers Pint shall be named as an additinal insured thrugh an endrsement t the plicy f insurance and identified as such n the Certificate f Insurance which shall prvide fr nt less than thirty (30) days written ntice t the City f Smers Pint Clerk f cancellatin r terminatin. **Required Attachments** Three (3) recent phtgraphs f the applicant (and each persn wh shall be engaged in the activity) which shall be apprximately tw and ne-half by tw and ne-half in size and shwing the head and shulders f the applicant in a clear and distinguishable manner. A cmpleted NJ State Bureau f Identificatin Frm authrizing release f any criminal histry recrd infrmatin (frmerly cmmnly as a Yellw Sheet ) accmpanied by a Mney Order in the amunt specified by the City Clerk t prcess each such Yellw Sheet payable as directed. Cpy f current Certificate f Insurance Card issued by an insurance carrier licensed t d business in the State f New Jersey and evidencing prf f General Liability Insurance, Autmbile Liability Insurance fr each vehicle t be used, and Statutry Wrkers Cmpensatin if there are emplyees. Applicatins f crpratins, partnerships r ther entities shall have attached t their applicatins individual statements cntaining all f the infrmatin required by Sectin fr each emplyee r agent wh shall engage in the licensed activity; said statements shall be signed and swrn t by each emplyee r agent and shall be treated, fr investigatin purpses, as separate applicatins t engage in a Licensed activity. 4

5 Applicatins by partnerships, crpratins r ther entities shall be signed by an authrized representative f the crpratin, partnership r entity. All applicants engaged in the sale r distributin f merchandise shall submit the riginal r a certified cpy f a valid certificate f authrity issued by the Directr f the New Jersey Divisin f Taxatin, pursuant t N.J.S.A.54:32B-15, empwering the vendr t cllect sales tax. Certificates shall nt be required fr the sale f prperty exempted frm sales and use taxatin pursuant t N.J.S.A.54:32B-8.2. Every applicant wh held a License issued under this Article during the year preceding the applicatin shall present prf f payment f New Jersey Sales Tax required pursuant t N.J.S.A.54:32B-1 et seq. All vendrs shall attach the riginal certificate t their cart, stand, truck, r ther merchandising device, as required by N.J.S.A. 54:32B-15. Each applicant fr a License under this Sectin shall present prf that he r she is a citizen f the United States r a persn satisfying all requirements f the Immigratin and Naturalizatin Laws, r ther applicable law, fr hlding gainful emplyment in the United States. All applicants selling fd items shall submit a cpy f the Atlantic Cunty Bard f Health License which shall be kept displayed t the public at all times when fd items are being ffered fr sale r being prepared n site fr sale. If a cart, wagn, r ther vehicle is t be used in ffering fr sale, sliciting, canvassing, r vending upn a sidewalk: (a) written cnsent f the abutting wner shall be filed with the License applicatin setting frth any cnditins impsed by the prperty wner; and (b) a Certificate f Insurance demnstrating cverage with minimum amunts f $1,000,000 per persn Persnal injury; $1,000,000 per ccurrence; and $1,000,000 prperty damage (which shall be in additin t any insurance required fr peratin f a mtr vehicle as required by Sectin (10) and in which the City f Smers Pint shall be named as an additinal insured thrugh an endrsement t the plicy f insurance and identified as such n the Certificate f Insurance which shall prvide fr nt less than thirty (30) days written ntice t the City f Smers Pint Clerk f cancellatin r terminatin. Applicatin Fee: Unless an exempt rganizatin described in Sectin f this Article, each applicatin shall be accmpanied by an applicatin fee f eighty dllars ($80.00) fr each individual cmmercial canvasser, slicitr, vendr, r peddler. Fees will nt be refunded if a License is nt issued. N cash will be accepted. A certified check r mney rder shall be made payable t The City f Smers Pint. Where an rganizatin has several agents peddling, sliciting, distributing merchandise r printed material r services, r canvassing, each such agent shall be identified within the License Applicatin, shall cmplete the applicatin, shall pay the applicable applicatin fee and shall be issued a separate License if apprved. 5

6 NOTE: The fee fr issuance f a duplicate License t replace a lst License r fr an amended License, shall be twenty-five dllars ($25.00). BY SUBMITTING THIS APPLICATION APPLICANT CERTIFIES THAT HE / SHE HAS READ THE GENERAL REGULATIONS CONTAINED IN SECTIONS AND OF THE SOMERS POINT MUNICIPAL CODE AND THE REQUIREMENTS OF SECTION (THE DO NOT SOLICIT LIST ) AND AGREES TO COMPLY WITH THOSE REGULATIONS AT ALL TIMES WHILE ENGAGED IN ANY LICENSED BUSINESS WITHIN THE CITY OF SOMERS POINT. I FUTHER CERTIFY THAT I HAVE COMPLETED THIS APPLICATION AND SUBMITTED ALL REQUIRED ATTACHMENTS. I hereby certify under penalty f law that the cntents f this applicatin are true and crrect, and that I have received a cpy f Ordinance N. 11 f Signature f Applicant Witness Date 6

7 APPLICATION FOR A LICENSE AS A: VENDOR ( ) SOLICITOR ( ) COMMERCIAL CANVASSER ( ) PEDDLER ( ) ***REQUIRED REVIEWS AND APPROVALS RECEIVED *** APPLICATION DEEMED COMPLETE SOMERS POINT POLICE DEPARTMENT SOMERS POINT CODE ENFORCEMENT OFFICER SOMERS POINT CITY ENGINEER (IF REQUIRED) OTHER DATE: DATE: DATE: 7