Current through Register 2024 Notice Reg. No. 38, September 20, 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.
