SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A ** APPLICANT INFORMATION ** NOTE: IF APPLICANT IS AN ORGANIZATION EXEMPT UNDER SECTION 202-22, OR IS APPLYING FOR A LICENSE AS A TRANSIENT MERCHANT OF ITINERANT VENDOR UNDER SECTION 202-25, OR IS APPLYING FOR A LICENSE AS A NONCOMMERCIAL SOLICITOR OR CANVASSER UNDER SECTION 202-30, 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 EMAIL ADDRESS: BUSINESS HOURS AT PRINCIPAL BUSINESS ADDRESS: BUSINESS WEB SITE ADDRESS: APPLICATION IF FOR A LICENSE AS A: VENDOR ( ) SOLICITOR ( ) COMMERCIAL CANVASSER ( ) PEDDLER ( ) 1
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 202-16 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
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 202-16 (10) and in which the City f Smers Pint shall be named as an additinal insured thrugh an endrsement t the plicy f 3
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 202-16 (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 202-16 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
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 202-16 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 202-16 (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 202-22 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
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 202-23 AND 202 36 OF THE SOMERS POINT MUNICIPAL CODE AND THE REQUIREMENTS OF SECTION 202-37 (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 2013. Signature f Applicant Witness Date 6
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