California Code of Regulations
Title 16 - Professional and Vocational Regulations
Division 33.1 - Arbitration Certification Program
Article 4 - Certification Procedure
Appendix A - Arbitration Certification Program Department of Consumer Affairs

Application for Certification

Pursuant to Title 16, California Code of Regulations, Section 3399.1, the undersigned submit(s) to the Arbitration Certification Program of the California Department of Consumer Affairs, this application for certification of the arbitration program described below, accompanied by the materials described in Title 16, California Code of Regulations, Section 3399.2.

1.0. GENERAL INFORMATION

1.1 Please provide the names or titles, with the addresses and telephone numbers, of:

1.11 The manufacturer's principal administrator in charge of the arbitration program.

1.12 The administrator in charge of each area or office of the arbitration program located within California.

1.13 The manufacturer's and the arbitration program's agent to whom all communications and notices from the Arbitration Certification Program may be directed.

1.14 The arbitration program's principal place of business, and all other places of business of the arbitration program within California.

1.15 The custodian or custodians of the records which are required to be maintained under Section 3398.13 of this subchapter.

1.2 Please provide the names or titles, with addresses and telephone numbers, of the person or persons to whom consumers should give notice of a dispute when consumers are required to directly notify the manufacturer of a dispute, if the manufacturer elects to require that notice under Civil Code Section 1793.22(b)(1).

2.0. ARBITRATION PROGRAM

2.1 Please indicate where, in the written operating procedures (Section 3399.2(a) (1)) or other materials accompanying this application (Section 3399.2(a) (2)), the applicant has set forth the policies and procedures that will implement each of the requirements of this subchapter respectively. Please organize the response to this question by section and subdivision numbers that correspond to each of the sections and subdivisions in Articles 2 and 3 of this subchapter.

2.2 Please describe the steps the applicant has taken and will take to reasonably assure that the policies and procedures to which reference is made in the response to question 2.1 will be implemented.

2.3 Please describe the factors that the applicant requests the Arbitration Certification Program to consider in determining whether the arbitration program is competently staffed at a level sufficient to ensure fair and expeditious resolution of disputes.

2.4 Please describe any methods or amounts of payment by the manufacturer to the arbitration program that are affected by the method by which the dispute is resolved (for instance, by mediation, arbitration, or voluntary settlement) or by the nature of the decision (for instance, payment of money, further repair, or replacement or restitution). Specific dollar amounts need not be provided.

2.5 Please describe how arbitrators are selected and trained.

2.6 Please describe the procedure and criteria for the selection of independent automobile experts so as to ensure their independence.

2.7 Please state the date of your most recent application, and indicate in what respects this application is identical with, or differs from, that application.

2.8 Please identify any other applications submitted by the same sponsor and please indicate in what respects this application is identical with, or differs from those applications.

Dated:

(NAME OF APPLICANT)

________________________________________

(Signature)

Dated:

(NAME OF APPLICANT)

________________________________________

(Signature)