Current through Register 2024 Notice Reg. No. 52, December 27, 2024
(a) The applicant shall submit a separate
application for each site, except for satellite sites, where services are to be
provided.
(b) Each application for
licensure shall include the following information:
(1) The name of the county and DUI program in
which the applicant will be providing services, and whether the applicant is
applying for licensure as a first offender, 18-month, or 30-month
program;
(2) The legal name of the
applicant and the name the DUI program will use to conduct business;
(3) The telephone number and mailing address
of the applicant, and the telephone number and address of the DUI program
location;
(4) The business status
(i.e., individual owner, partnership, nonprofit or for-profit corporation,
public agency, or another specified entity) under which the applicant will
operate the DUI program;
(5) The
name(s) and address(es) of any other licensed DUI program owned or operated by
the applicant(s) within the last five years;
(6) The name, address, and telephone number
of the program director;
(7) If the
applicant is a partnership, the name and principal business address of each
partner, and a copy of the partnership agreement as filed with the county or
state, as applicable;
(8) If the
applicant is a corporation or association, the name and address for the
corporation or association; the name and title of the officer or employee who
acts on behalf of the corporation or association; and a copy of the articles of
incorporation and bylaws;
(9) If
the applicant is a public agency, the type of agency (i.e. county, city, or
other specified), the name of the department, and address;
(10) The name(s), title, education and
experience of the program director in accordance with Section
9846 of this Chapter;
(11) Written assurance that the DUI program
will not discriminate in employment practices and in provision of benefits and
services on the basis of race, color, national origin, religion, sex, or mental
or physical disabilities pursuant to Title VI of the Civil Rights Act of 1964,
section 504 of the Rehabilitation Act of 1973, California Government Code
section
11135, et
seq., and other applicable state and federal laws;
(12) A statement, signed and dated by the
applicant or the authorized representative of the applicant, declaring under
penalty of perjury that all information submitted to the Department is true and
correct to the best of the applicant's knowledge;
(13) A signed and dated financial statement
with an itemized listing of the DUI program's assets, liabilities, and
equity;
(14) A line item budget
which includes fiscal information in the categories of personal services,
operating expenses, equipment, equipment and facility depreciation schedules,
revenue, and profit or surplus; and
(15) The signature of the applicant as
follows:
(A) For partnerships, each partner
shall sign the application.
(B) If
the applicant is a firm, association, corporation, county, city, public agency,
or other governmental entity, the application shall be signed by the chief
executive officer or the individual legally responsible for representing the
firm, association, corporation, county, city, public agency, or other
governmental entity.
1. Change
without regulatory effect amending section filed 4-15-91 pursuant to section
100, title 1, California Code of Regulations (Register 91, No. 20). For prior
history, see Register 82, No. 47.
2. Amendment of section and NOTE
filed 12-6-2004; operative 1-5-2005 (Register 2004, No. 50).
3.
Amendment filed 3-22-2012; operative 4-21-2012 (Register 2012, No. 12).
Note: Authority cited: Sections
11755,
11835,
and
11836.15,
Health and Safety Code. Reference: Sections
11836.12,
11836.15
and
11837.4,
Health and Safety Code.
