Limited Liability Company Automotive Repair Dealer Registration Application

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LIMITED LIABILITY COMPANY (LLC)

AUTOMOTIVE REPAIR DEALER REGISTRATION APPLICATION

INSTRUCTIONS

Complete this application in accordance with the instructions below and include additional pages and documents as

necessary. The Bureau of Automotive Repair (BAR) cannot consider an application for registration unless all requested

information is provided. If not applicable, indicate N/A.

• Submit completed application with all required information and fees to the BAR Licensing Program at the above

address. Send a separate completed application and $200.00 fee to the above address for each business

location.

• Remit fees by check or money order made payable to the Bureau of Automotive Repair.

• FEES ARE NON-REFUNDABLE PURSUANT TO BUSINESS AND PROFESSIONS CODE SECTION 158.

• A registration will be mailed to the address of record after your application is approved and processed, provided the

application does not have any deciencies.

SECTION 1 - 13

1. NAME OF BUSINESS: Provide the exact name under which the business will be conducted. This same name should

be shown on all invoices and advertisements. NOTE: The motor vehicle license plate number, if provided in

section 12, item (c), will be included as part of the registered business name.

2. NAME OF LIMITED LIABILITY COMPANY: Provide the name of the LLC as led with the California Secretary of State.

3. FEDERAL EMPLOYER IDENTIFICATION NUMBER: Provide the Federal Employer Identication Number (FEIN)

assigned by the Internal Revenue Service. The FEIN must be in an active status.

4. BUSINESS ADDRESS: Provide the physical address where business is conducted and/or records will be maintained.

P.O. Boxes are not permitted. If your business is located at an address that has multiple shops, you must provide the

unit/suite number since each business must have a unique address. All licenses are mailed to the business address.

The business address must be shown on invoices and advertisements. The business address will be disclosed on

BAR’s website as the address of record.

5. MAILING ADDRESS: Complete only if you wish to receive correspondence at an address other than the business

address. If you provide a mailing address, renewal notices will be sent only to this address.

6. BUSINESS AREA CODE AND TELEPHONE NUMBER: Provide the area code and telephone number.

7. EMAIL ADDRESS: Complete only if you wish to receive correspondence from BAR by email.

8. LIST ALL MEMBERS OF THE LIMITED LIABILITY COMPANY: Pursuant to Business and Professions Code

section 9884, an automotive repair dealer shall identify the owners, directors, ocers, partners, members, trustees,

responsible managing employee, and other persons who directly or indirectly control or conduct the business.

• Partnership: If the business is a partnership (two or more individuals), list the full name, title (i.e., partner), Social

Security Number (SSN) or Individual Taxpayer Identication Number (ITIN), government-issued photo identication

(ID), area code and telephone number, and home address for each partner of the business.

• Corporation: If the business is a corporation, list the full name, title (i.e., president, secretary, treasurer, etc.), SSN/

ITIN, government-issued photo identication (ID), area code and telephone number, and home address for each

ocer and director of the business. If the same person holds all corporate oces, you must state so on the

application.

• Trust: If the business is a trust, list the full name, title (i.e., trustee), SSN/ITIN, government-issued photo

identication (ID), area code and telephone number, and home address for each trustee.

BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR

BUREAU OF AUTOMOTIVE REPAIR | LICENSING PROGRAM

PO Box 989001, West Sacramento, CA 95798-9001

P (855) 735-0462 F (855) 641-9981 | www.bar.ca.gov

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9. APPLICANT’S BACKGROUND: This section must be completed in its entirety. Check “yes” or “no” for questions a

through j. Any applicable information not provided may result in denial of this application or legal action later to revoke

this licensure.

Expedited application assistance is available for current or former United States military personnel and spouses or

domestic partners of active duty or reserve military personnel. A waiver of renewal requirements is available for active

duty or reserve military personnel. To apply for expedited application assistance or a renewal requirement(s) waiver,

you must submit required documentation as specied at www.bar.ca.gov. (See Health and Safety Code section

44031.5(d) and Business and Professions Code sections 114.3 and 115.5.)

Expedited application assistance is available for applicants who were admitted to the United States as a refugee

under Section 1157 of Title 8 of the United States Code, applicants who have been granted asylum by the Secretary

of Homeland Security or the Attorney General of the United States pursuant to Section 1158 of Title 8 of the United

States Code, or applicants who have a special immigrant visa (SIV) that has been granted status under Section 1244

of Public Law 110-181, under Public Law 109-163, or under Section 602(b) of Title VI of Division F of Public Law 111-8.

(Business and Professions Code section 135.4)

Acceptable refugee, asylee, and immigration documentation includes:

• Form I-94, Arrival/Departure Record, with an admission class code such as “RE” (Refugee) or “AY” (Asylee) or

other information designating the person a refugee or asylee.

• Special immigrant visa that includes the designators “SI” or “SQ.”

• Permanent Resident Card (Form I-551), commonly known as a “Green Card,” with a category designation

indicating that the person was admitted as a refugee or asylee.

• An order from a court of competent jurisdiction or other documentary evidence that provides reasonable assurance

that the applicant qualies for expedited licensure.

10. SELLER PERMIT, CITY/COUNTY BUSINESS LICENSE, HAZARDOUS WASTE IDENTIFICATION NUMBER: If not

applicable, indicate N/A or Exempt.

• Seller Permit Number: Provide the seller permit number as assigned by the California Board of Equalization.

• City/County Business License Number: Provide the business license number as assigned by the local city or

county ocial of that jurisdiction. If the oce or jurisdiction does not require a business license, attach a detailed

statement dated and signed by a person listed in section 8 of the application.

• Hazardous Waste Identication Number: Provide the hazardous waste identication number as assigned by the

United States or California Environmental Protection Agency.

11. DOMESTIC/FOREIGN LIMITED LIABILITY COMPANY NUMBER: Provide the domestic or foreign limited liability

company number as assigned by the California Secretary of State and attach a copy of the following supporting

documents:

• Domestic Limited Liability Company: Articles of Organization and Charter, Statement of Information, Operating

Agreement, and Trust Agreement (if a member of the LLC is a trust).

• Foreign Limited Liability Company: Application to Register and Charter (issued by the state where the foreign LLC

was formed), Statement of Information, Certicate Registration, Operating Agreement, and Trust Agreement (if a

member of the LLC is a trust).

12. TYPE OF BUSINESS:

• Using the list provided, identify the primary and secondary services performed by the business and provide the

corresponding number(s) in items (a) and (b).

• Select YES or NO for item (c). If YES, provide the license plate number for the motor vehicle used to perform

mobile automotive repairs in item (c). The motor vehicle license plate number will be included as part of the

registered business name that must be shown on all invoices and advertisements. (California Code of Regulations

title 16, section 3351.7.3.)

• Select YES or NO for item (d).

• If required, provide the spray booth permit number as assigned by the local Air Quality Management or Air Pollution

Control District in item (e) and attach a copy of the supporting documents.

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13. CERTIFICATION: The appropriate person(s) must read, sign, and date section 13 of this application. Signatures arm

that all statements are true and correct. Any false statements made on this application may result in denial of this

application or legal action later to revoke the registration.

ADDITIONAL INFORMATION

TYPE OF REPAIR BUSINESS REQUIRED TO REGISTER

A valid registration is required for any business that, for compensation, performs tests or repairs to, maintenance of, or

diagnosis of malfunctions of any of the following automotive or motorcycle components:

• AIR CONDITIONING SYSTEM

• BODY AND FRAME

• BRAKES

• CLUTCH

• DRIVE TRAIN ASSEMBLY

• ELECTRICAL SYSTEM

• ENGINE

• SUSPENSION

• TRANSMISSION

• STEERING GEAR

• EMISSION CONTROL SYSTEM

• FUEL SYSTEM

• HEATER SYSTEM

• GLASS COMPONENTS

• OTHER AUTOMOTIVE MOTORCYCLE COMPONENTS

(not specically excluded)

TYPE OF REPAIR BUSINESS NOT REQUIRED TO REGISTER

No registration is required for the following:

• A business that services only vehicles other than passenger vehicles.

• A eet owner repairing only eet vehicles.

• Machine shops that meet all of the following criteria:

1. Primary business is the wholesale supply of new or rebuilt automotive parts; and

2. Solely engages in the remanufacturing of individual automotive parts without compensation for warranty

adjustments; and

3. Does not engage in repairing or diagnosing malfunctions of motor vehicles or motorcycles.

CHANGE OF BUSINESS NAME, ADDRESS, OR CORPORATE OFFICERS OR DIRECTORS

If there is a change to your business name, address, or corporate ocers or directors, please call (855) 735-0462 to request

a Change of Name/Address/Corporate Ocers or Directors form or access the form on BAR’s website. BAR must be notied

within 14 days of the change of business name, address, or corporate ocers or directors per California Code of Regulations,

title 16, section 3351.1(d).

CHANGE IN OWNERSHIP

An ownership change consists of any change in legal ownership of the licensed business, including the purchase of an

existing business, addition or deletion of a partner, the transfer of any ownership interest between members of family, change

of the business entity by incorporation of the business, or any other change in the corporate status that requires a new

corporate number as issued by the Secretary of State. When a change in the business ownership takes place, you must

cease operating as an automotive repair dealer and the new owner must submit a new application with the applicable fee.

RENEWAL OF REGISTRATION

An automotive repair dealer registration must be renewed annually by submitting a renewal notice and the applicable fee. The

Department of Consumer Aairs mails a courtesy notice approximately 90 days before expiration of a registration. However, if

a renewal notice is not received, owners are still responsible for renewing the registration. If a registration is renewed

after the date of expiration, the registrant will be charged a late fee of $50.00.

APPLICATION FOR SOLE PROPRIETORSHIP, PARTNERSHIP, OR CORPORATION

If the business is a sole proprietorship, partnership, or corporation (not LLC), you must apply on a separate Automotive Repair

Dealer Registration Application. To obtain an application, please visit www.bar.ca.gov or call (855) 735-0462.

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NOTICE ON COLLECTION OF PERSONAL INFORMATION

COLLECTION AND USE OF PERSONAL INFORMATION

The Bureau of Automotive Repair of the Department of Consumer Aairs collects the personal information requested on this

form as authorized by Business and Professions Code sections 30, 9884, and 9887.2, Labor Code section 432.7, Civil Code

section 1798 et seq. (Information Practices Act), and California Code of Regulations, title 16, section 3306. The Bureau of

Automotive Repair uses this information principally to identify and evaluate applicants for licensure, issue and renew licenses,

and enforce licensing standards set by law and regulation.

Pursuant to Business and Professions Code section 27, the licensee’s address of record is a public record and will be posted

on BAR’s website.

MANDATORY SUBMISSION

Submission of the requested information is mandatory. The Bureau of Automotive Repair cannot consider your application for

licensure or renewal unless you provide all requested information.

ACCESS TO PERSONAL INFORMATION

You may review the records maintained by the Bureau of Automotive Repair that contain your personal information, as

permitted by the Information Practices Act. See below for contact information.

POSSIBLE DISCLOSURE OF PERSONAL INFORMATION

The Bureau of Automotive Repair makes every eort to protect the personal information you provide us. The information you

provide, however, may be disclosed in the following circumstances:

• In response to a Public Records Act (PRA) request (Government Code section 6250 et seq.), as allowed by the

Information Practices Act (Civil Code section 1798 et seq.);

• To another government agency as required by State or Federal law; or

• In response to a court or administrative order, a subpoena, or a search warrant

Eective July 1, 2012, the California Department of Tax and Fee Administration and the Franchise Tax Board may share

taxpayer information with this agency.

Your license may be suspended by BAR if your state tax obligation is not paid.

CONTACT INFORMATION

For questions about this notice or access to your records, you may contact the Bureau of Automotive Repair PRA Unit at

10949 North Mather Boulevard, Rancho Cordova, CA 95670, by phone at (855) 735-0465, or by email at bar[email protected].

For questions about the Department’s Privacy Policy, you may contact the Department of Consumer Aairs at 1625 North

Market Boulevard, Sacramento, CA 95834, by phone at (800) 952-5210, or by email at [email protected].

For questions about the Information Practices Act, you may contact the Attorney General’s Oce, California Department of

Justice - Attention: Public Inquiry Unit, PO Box 944255, Sacramento, CA 94244, by phone at (800) 952-5225, or online at

www.oag.ca.gov.

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1. NAME OF BUSINESS (DBA/TO BE SHOWN ON INVOICES AND ADVERTISEMENTS)

Please type or print legibly in ink. If not applicable, indicate N/A. Do not leave any question blank.

FOR DEPARTMENT USE ONLY

ARD #:

Issue Date:

Business Type:

Receipt #:

ATS #:

2. NAME OF LIMITED LIABILITY COMPANY

(AS FILED WITH THE CALIFORNIA SECRETARY OF STATE)

3. FEDERAL EMPLOYER IDENTIFICATION NUMBER

4. BUSINESS ADDRESS

Number and Street Suite or Unit # City State Zip Code

5. MAILING ADDRESS

Number and Street or PO Box Suite or Unit # City State Zip Code

6. BUSINESS AREA CODE AND TELEPHONE NUMBER

8. LIST ALL MEMBERS OF THE LIMITED LIABILITY COMPANY: Pursuant to Business and Professions Code section 9884, an automotive repair

dealer shall identify the owners, directors, ocers, partners, members, trustees, responsible managing employee, and other persons who

directly or indirectly control or conduct the business. If a PARTNERSHIP, list all partners. If a CORPORATION, list all ocers and directors,

(i.e., president, secretary, and treasurer). If a TRUST, list all trustees. Enter full legal names (NO INITIALS). If a legal name contains initials only,

so state. Attach additional pages if necessary.

FULL NAME

Last

First Middle

TITLE

GOVERNMENT PHOTO ID ISSUING AUTHORITY, DOCUMENT TITLE, AND NUMBER

(EXAMPLE: CALIFORNIA DRIVER LICENSE A123456)

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER/INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER

HOME ADDRESS

Number and Street or PO Box Suite or Unit # City State Zip Code

FULL NAME

Last First Middle

TITLE

GOVERNMENT PHOTO ID ISSUING AUTHORITY, DOCUMENT TITLE, AND NUMBER

(EXAMPLE: CALIFORNIA DRIVER LICENSE A123456)

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER/INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER

HOME ADDRESS

Number and Street or PO Box Suite or Unit # City State Zip Code

FULL NAME

Last First Middle

TITLE

GOVERNMENT PHOTO ID ISSUING AUTHORITY, DOCUMENT TITLE, AND NUMBER

(EXAMPLE: CALIFORNIA DRIVER LICENSE A123456)

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER/INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER

HOME ADDRESS

Number and Street or PO Box Suite or Unit # City State Zip Code

LIMITED LIABILITY COMPANY (LLC)

AUTOMOTIVE REPAIR DEALER REGISTRATION

APPLICATION

FEE $200

BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR

BUREAU OF AUTOMOTIVE REPAIR | LICENSING PROGRAM

PO Box 989001, West Sacramento, CA 95798-9001

P (855) 735-0462 F (855) 641-9981 | www.bar.ca.gov

7. EMAIL ADDRESS

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9. APPLICANT’S BACKGROUND

Has any person listed in section 8 ever served in the United States military?

Is any person listed in section 8 married to or in a domestic partnership or other legal union with an active duty

member of the U.S. military assigned to a duty station in California under ocial active duty military orders?

YES NO

Has any person listed in section 8, or any business the person is or was directly or indirectly in control of, ever

been convicted of any oense or entered a plea of nolo contendere in this or any other state in the United States

or a foreign country?

This includes every citation, infraction, misdemeanor and/or felony, including trac violations. Note: Convictions that were

adjudicated in the juvenile court or convictions two years or older under California Health and Safety Code sections

11357(b), (c), (d), (e), or section 11360(b) should not be reported. Convictions that were later dismissed by the court or

set aside pursuant to section 1203.4, 1203.4(a), 1203.41, or 1203.42 of the California Penal Code or equivalent

non-California law MUST be disclosed.

Exclusive of juvenile court adjudications and criminal charges dismissed under section 1000.3 of the California

Penal Code or equivalent non-California laws, or convictions two years or older under California Health and

Safety Code sections 11357(b), (c), (d), (e), or section 11360(b), has any person listed in section 8 had a

conviction that was later dismissed or set aside by the court?

f. Does any person listed in section 8, or any business the person is directly or indirectly in control of, have any

criminal action pending against them/it, or is currently awaiting judgment and sentencing following entry of a

plea or jury verdict?

YES NO

If YES, you must provide required documentation. Refer to instructions page.

If YES, provide a statement of explanation, including the crime for which there was a conviction, the approximate date

and location of the crime, and the sentence served, if any.

If YES, provide a statement of explanation.

Is any person listed in section 8 a refugee, asylee, or holder of a special immigrant visa?

YES NO

If YES, you must provide required documentation. Refer to instructions page.

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YES NO

10. SELLER PERMIT, CITY/COUNTY BUSINESS LICENSE, HAZARDOUS WASTE IDENTIFICATION NUMBER

(If not applicable, indicate N/A or exempt.)

YES NO

Has any person in section 8, or any business the person is or was directly or indirectly in control of, ever had

a registration, license, or certication that was denied, suspended, revoked, or placed on probation by BAR or

that was issued a citation by BAR?

Does any person listed in section 8, or any business the person is directly or indirectly in control of, have a

CURRENT registration, license, or certication issued by BAR?

Has any person listed in section 8, or any business the person was directly or indirectly in control of, ever had a

PRIOR registration, license, or certication issued by BAR?

YES NO

11. DOMESTIC/FOREIGN LIMITED LIABILITY COMPANY NUMBER

Under Corporations Code sections 17000 and 17450, all limited liability

companies must be registered as a domestic or foreign limited liability company in good standing with the California Secretary of State. Provide the

number assigned to the domestic or foreign limited liability company and attach a copy of the supporting documents.

12. TYPE OF BUSINESS (Provide the number(s) corresponding to the primary and secondary services performed by the business.)

10. General Repair

11. Preventative Maintenance Services

12. Smog Check Station

13. Auto Body and/or Paint Shop

14. New/Used Car Dealer

15. Used Cars Only Dealer

16. Chain Store

17. Motorcycle Repair Shop

18. Engine Rebuilding/Repair

19. Mobile Automotive Repair

20. Automotive Diagnostic Repair

21. Auto Wrecker/Dismantler

22. Glass Shop

23. Transmission Repair Shop

24. Brake/Front End Alignment Shop

25. Muer/Exhaust Repair Shop

26. Radiator Repair Shop

27. Machine Shop

28. Tire Shop

29. Auto Training School/College

30. Auto Air Conditioning Shop

31. Trailer Hitch Installation

32. Tune Up/Oil Lube Shop

33. Ignition Interlock Device Installer

34. Automotive Parts Retailer

40. Other:

Is this a change of ownership? If YES, provide proof of sale.

YES NO

Domestic Limited Liability Company Number

Foreign Limited Liability Company Number

Attach a copy of the following:

• Articles of Organization and Charter

•

Statement of Information

•

Operating Agreement

•

Trust Agreement (if a member of the LLC is a trust)

Attach a copy of the following:

•

Application to Register and Charter (issued by the

state where the foreign LLC was formed)

• Statement of Information

• Certicate of Registration

•

Operating Agreement

•

Trust Agreement (if a member of the LLC is a trust)

If YES, provide a statement of explanation that includes each registration, license, and/or certication disciplined and a

description of the discipline imposed on that registration, license, and/or certication.

If YES, list the name(s) and registration number(s), license number(s), and/or certication(s):

Seller Permit Number

City/County Business License Number

Hazardous Waste Identication Number

Primary Business Type

Secondary Business Type

Page 8 of 8BAR-102 (4/2021)

BAR-102 (2/2020)

Spray Booth Permit Number

Motor Vehicle License Plate Number

PLEASE NOTE:

The motor vehicle license plate number will be included as part of the registered business name

that must be shown on all invoices and advertisements.

13. CERTIFICATION (This section must be signed and dated by each person listed in section 8 of this application. Attach additional pages if necessary.)

PLEASE NOTE: Pursuant to Business and Professions Code section 9884.6(a), you may not perform any activities at this location

for which you are required to possess a valid automotive repair dealer (ARD) registration until an ARD registration is

issued. In addition, section 9884.4 states that an ARD registration shall cease to be valid when the Director nds that

any of the information provided by this form ceases to be current. Furthermore, California Code of Regulations, title 16,

section 3351 requires that the application shall be accompanied by the registration fee and any evidence, statements,

or documents required on the application.

I certify under penalty of perjury under the laws of the state of California that all the statements made in this application and all attached supporting

documents pertaining to this application are true and correct.

SIGNATURE

TITLE

DATE

YES

If the business is applying for registration as an Auto Body and/or Paint Shop, does the business have the

required permits, licenses, and equipment to operate an Auto Body and/or Paint Shop? (See California Code of

Regulations title 16, section 3351.1(a) and (b).)

Pursuant to Business and Professions Code section 9889.52, an application for registration as an Auto Body and/or Paint Shop may be

required by law to have a spray booth permit. If required, provide the permit number and attach a copy of the supporting documents.

Will the business be engaged solely in mobile automotive repairs and not operate a facility where the diagnosis

or repair of motor vehicles is performed? If YES, provide the license plate number for the motor vehicle used to

perform the mobile automotive repairs.

NOTE: Once submitted, your application for Automotive Repair Dealer registration and supporting documentation become the property of BAR and will be

kept as a matter of record. MAKE A COPY OF THIS COMPLETED AND SIGNED APPLICATION FOR YOUR RECORDS.