California Code of Regulations
Title 11 - Law
Division 5 - Firearms Regulations
Chapter 6 - Certified Firearm Safety Device Laboratories, Firearm Safety Device Standards and Testing, and Standards for Gun Safes
Article 3 - Certified Firearm Safety Device Laboratories
Section 4084 - Application for Firearms Safety Device Laboratory Certification

(a) Laboratory information: name of applicant laboratory; physical and mailing addresses; telephone and fax numbers; local licensing authority, business license number, and expiration date; the name of the local law enforcement agency with jurisdiction over the laboratory; state corporation/partnership number and expiration date; federal firearms license number, type, and expiration date (if licensed); business hours; e-mail address (if applicable); and copies of licenses and/or certificates identified on the application.

(b) COE holder information: name, title, COE number, and COE expiration date of any owner, chief executive officer, or person who possesses or has applied for a COE and who is authorized to sign compliance test reports.

(c) Ownership information: ownership structure; the name, title/relation to laboratory/percentage owned and/or controlled, address, telephone and fax numbers, state corporation/partnership number and expiration date, and local business license number and expiration date of any owner that is not a natural person; and the name, title/relation to laboratory/percentage owned and/or controlled, address, and telephone number of each owner, partner, officer, director and any person who owns and/or exercises control of five percent or more of outstanding common stock; and if a corporation or partnership either original certified copies of the articles of incorporation or a current roster of general and limited partners.

(d) Facility management and testing supervision information: name and title of the manager or director of the laboratory and/or unit of the laboratory that will conduct FSD tests, the person(s) supervising FSD tests (if different from the manager or director), and person(s) participating and/or performing FSD tests (if different); a copy of the laboratory's security procedures; the name, address, and telephone number of any 24-hour security service or monitored alarm system that is employed by the laboratory, and a copy of the contract for services; and a copy of the procedures for ensuring that persons prohibited from possessing firearms will not have access to firearms, and a description of the method to be used to identify any such persons.

(e) A signed certification regarding: possession of the required equipment (whether the laboratory will obtain the required equipment at the time the application is submitted or at a later date); the maintenance and calibration of that equipment; compliance with safety, design, operation, and licensing and approval requirements; the signature of the authorized representative; and the county, state, and date of signature.

(f) Off-site location information, if applicable: name of the owner; telephone number; physical address; and the testing to be performed and/or equipment to be used at the off-site location (if more than one off-site location is desired, the applicant must also complete a Request to Utilize an Additional Off-site Location Form BOF 020A (Rev. 01/2012).

(g) Authorized representative information: name and title of the person who has the legal authority to sign the application and attest to the required matters on behalf of the applicant laboratory, signed certification of the authorized representative, the county, state, and date of signature, and statements of certification that the laboratory agrees to give complete and truthful answers to questions that are pertinent to the laboratory's ability to perform FSD tests and to comply with all applicable federal, state, and/or local laws and/or regulations that relate to laboratory certification or FSD testing.

(h) A signed certification stating that the laboratory and/or owner is free from any conflicts of interest as defined by section 4090 of these regulations; the signature of the authorized representative; and the county, state, and date of signature.

(i) A signed certification ensuring: the notification to staff of laws relating to prohibitions against firearms possession, ensuring that prohibited persons do not have access to, come into contact with, and/or possess firearms; the laboratory obtaining and maintaining any required federal, state, and/or local licenses; and the laboratory complying with all applicable federal, state, and/or local laws and/or regulations; the signature of the authorized representative; and the county, state, and date of signature.