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HomeMy WebLinkAboutdocuments distributedBCC -LIC -008 (Rev. 12/17) California Department of Consumer Affairs Bureau of Cannabis Control www.bcc.ca.gov State of California Edmund G. Brown Jr., Govemor CANNABIS MICROBUSINESS LICENSE APPLICATION APPLICATION FEE $1000 (NON-REFUNDABLE) To pay the application fee by cash, contact the Bureau to schedule an appointment. SECTION A - APPLICANTlBUSINESS INFORMATION Please provide the below business information for your cannabis license. 1. License Type Designation (Please check ONE): F] Adult -Use (A -license) Medicinal (M -license) 2. License Type: ❑X Microbusiness (Type 12) In order to hold a microbusiness license, a licensee must engage in at least three of the following cannabis business activities (Please check all that apply, THREE minimum): ❑ Retailer Non -Storefront Cultivation (less than 10,000 sq. ft.) ❑ Distributor Transport Only Manufacturer (Level 1, Type 6) 3. Business Organizational Structure (Please check ONE): ❑ Sole Proprietorship Limited Liability Company General Partnership ❑ Corporation (or foreign corporation) Limited Partnership Limited Liability Partnership 4. Name (sole proprietor first and last, all other business types legal business name) Doing Business As (DBA) 5. 6. 7 ... Business Premises Address City State Zip Code Mailing Address (if different from premises address) City State Zip Code Business Website Email Address Phone Number Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN); or Business's Federal Employer Identification Number (FEIN) SECTION B - PRIMARY CONTACT PERSON This will be the contact for any questions regarding this application, including the business's compliance with the track and trace program. 8. Name Title Phone Number Email Address SECTION C - DECLARATIONS 9. Is the proposed premises located within a 600 -foot radius of a school (K-12), day care center, or youth center. E] Yes ❑ No 10. Are you a federally recognized tribe or other sovereign entity? ❑ Yes ❑ No 11. Do you have evidence of California Environmental Quality Act (CEQA) compliance or exemption? ❑ Yes ❑ No 12. Applicant's Califomia Department of Tax and Fee Administration If no Seller's Permit, do you attest that you (applicant) are currently Seller's Permit Number, if applicable. applying for one? Yes 1:1 No 13. Does your company have 20 or more employees (not including supervisors) for the commercial cannabis business? El Yes ❑ No If "Yes", do you attest that you have entered into a labor peace agreement and will abide by the terms of the agreement? E] Yes ❑ No 14. The above listed business operated in compliance with the Compassionate Use Act of 1996 and its implementing laws before September 1, 2016. ElYes ❑ No SECTION D - LIST OF OWNERS An owner is defined as a person with an aggregate ownership Interest of 20% or more, chief executive officer, member of the board of directors of a nonprofit, or an individual participating in the direction, control, or management of the applicant. All business owners must be listed, including yourself. Attach additional pages if needed. Each owner is required to submit an Owner Submittal form. 15. Name Email Ownership % Title Mailing Address City State Zip Code Name Email Ownership % Title Mailing Address `City State Zip Code BCC -LIC -008 (Rev. 12/17) Page 1 of 3 SECTION E - NON -OWNERS WITH A FINANCIAL INTEREST IN THE BUSINESS (attach additional pages if needed) 16. Name Date of Birth Government ID Type Government ID Number Name Date of Birth Government ID Type Government ID Number 17. Business Name Address Business Name Address City State Zip Code City State Zip Code SECTION G - LICENSING FEE DETERMINATION What is the maximum dollar value of your planned annual microbusiness operation in terms of the value of product expected to be cultivated, manufactured, distributed, and/or sold as determined in assessing the 15% excise tax pursuant to Revenue and Taxation Code section 34011? ❑ Up to 0.5 million ($5,000) Greater than 0.5 million to 1.5 million ($15,000) ❑ Greater than 1.5 million to 4.5 million ($42,000) Greater than 4.5 million ($120,000) SECTION H - REQUIRED ATTACHMENTS/ DOCUMENTS Evidence of legal right to occupy and use the proposed premises location. ❑ Premises Diagram Form(s) ❑ Business formation documents, including all documents filed with the CA Secretary of State (SOS). Foreign corporations must include a copy of the Certificate of Qualification from the SOS. ❑ Evidence of premises compliance with local jurisdiction, if answered. "Yes" to question 9. Labor peace agreement or notarized statement indicating that you will enter into and abide by the terms of a labor peace agreement, if answered "Yes" to question 13. ❑ Limited waiver of sovereign immunity, if answered "Yes" to question 10. nEvidence of exemption from, or compliance with, the California Environmental Quality Act. ❑ Proof of commercial general liability insurance in the aggregate of no less than $2 million and no less than $1 million for each loss, if your license activities include distribution. Financial Information Form ❑ Proof of surety bond in the amount of $5,000, payable to the State of California. ❑ Transportation procedures Inventory procedures Non -Laboratory Quality Control procedures ❑ Security procedures ❑ Evidence of compliance with the Compassionate Use Act of 1996 and its implementing laws before September 1, 2016, if answered "Yes" to question 14. .AFFIRMATION AND CONSENT Under penalty of perjury, I hereby declare that the information contained within and submitted with the application is complete, true, and accurate. I understand that a misrepresentation of fact is cause for rejection of this application, denial of a license, or revocation of a license issued. -.... ............. Signature Printed Name Date Signed ice se n y CLEaR Application Record Number: See Disclosures on the Next Page BCC -LIC -008 (Rev. 12/17) Page 2 of 3 s SCAG REPORT Southern California Association of Governments 900 Wilshire Blvd., Suite 1700, Los Angeles, CA 90017 Agenda Item No. 7 April, 5, 2018 To: Transportation Committee (TC) Energy and Environment Committee (EEC) Community, Economic and Human Development (CEHD) From: Julia Lippe -Klein, Associate Planner, 213-236-1856 Subject: Go Human Active Transportation Safety and Encouragement Campaign Update RECOMMENDED ACTION: For Information Only - No Action Required EXECUTIVE DIRECTOR'S APPROVAL EXECUTIVE SUMMARY: SCAG, in coordination with its local and regional partners, will re -run the Go Human advertising campaign in May 2018 to coincide with National Bike Month. Staff will present an update on the status of the active transportation safety and encouragement campaign and highlight opportunities for participation. STRATEGIC PLAN: This item supports SCAG's Strategic Plan Goal 1: Improve Regional Decision Making by Providing Leadership and Consensus Building on Key Plans and Policies; Objective: c) Provide practical solutions for moving new ideas forward. BACKGROUND: People walking and bicycling are over -represented among traffic deaths compared to their total mode share in the Southern California region. Non -motorized trips comprise 12% of all daily trips, however, bicyclists and pedestrians comprise 32% of all fatalities and 20% of all serious injuries. Bicycle fatalities represented 4.5% of all traffic fatalities in 2015, whereas its mode share is 1.6% for all trips. Pedestrian fatalities represented 27.8% of all traffic fatalities in 2015, whereas its mode share is 10.7% for all trips. Moreover, in 2015 there were over 13,000 bicycle and pedestrian injuries accounting for 10% of the region's roadway injuries. To address the number of collisions occurring, the SCAG 2014 General Assembly passed a resolution to support a regional safety initiative aimed at improving roadway safety for bicyclists and pedestrians. To implement the resolution, SCAG secured $2.3 million in Caltrans grant funding from the statewide 2014 Active Transportation Program to coordinate a Southern California Active Transportation Safety and Encouragement Campaign. CEHD Packet 04.05.18 Page 19 of 42 Using these grant resources, SCAG successfully initiated the Go Human Campaign with the launch of a first round of advertising in September of 2015 as well as two additional rounds of advertising funded through the Office of Traffic Safety. The advertising campaign has secured over 555 million impressions to date (each time an ad is seen) region -wide through a combination of SCAG's initial investment, added value media secured through op-eds and press outlets, and donated media from local and county partners. Additionally, evaluation has shown that one in five respondents had recalled seeing any of the ads with an overall campaign awareness of 20%. Evaluation has shown that ads have been extremely relevant and motivating. To continue the Go Human Campaign's momentum, through funding from the Office of Traffic Safety, SCAG will re -run its advertising campaign, during the month of May to coincide with National Bike Month, and again in July to coincide with the typical rise in collisions involving pedestrians. Advertising includes billboards, transit shelters, digital, social and radio. To participate in the campaign, please use the Materials Request Form which can be found at http://gohumansocal.org/Pap,esIMoreToCome.asp . All materials will be resized, co -branded, printed and delivered to city partners. In addition to advertising efforts, SCAG will conduct local engagement strategies with community based organizations in each of the six SCAG counties to improve awareness around traffic safety through targeted outreach strategies during the summer of 2018. More information on the advertising campaign, as well as, other components of Go Human can be found at www.gohumansocal.org. FISCAL IMPACT: Funding is included in SCAG's FY 2017-18 Overall Work Program (OWP) Budget. Staff's work budget for the current fiscal year is included in the FY 2017-18 OWP (225-3564J3.12: Pedestrian and Bicycle Safety Program) ATTACHMENT/S: PowerPoint Presentation CEHD Packet 04.05.18 Page 20 of 42 .. - - -'-"-- -� -"-'--rte-•. _.r_._�._�-_._- ��. - . g(a Southern California Active Transportation Safety and Encouragement Campaign Update _ Julia Lippe -Klein Associate Regional Planner What is Go Human? 4 piece set. 4.0cle SCAG7 Matetiat Disbibution -_r L - ' .-'a. CEHD Packet 04.05.18 Page 21 of 42 Why Go Human? Safety Context k27%A OF ALL DEATHS INVOLVE PEOPLE WALKING OR BICYCLING i OF ALL PEDESTRIAN RELATED FATALITY VICTIMS ARE 26%(-)b GILDER 136000.0 rEoPLE SUISTAIPI INJURIES EVERY YEAR FROM COLLISIONS 270 COLLISIONS OCCUR PER DAY ON THE STREETS THAI IS ROUG -IL'f 991000 PER YEAR CEHD Packet 04.05.18 Page 22 of 42 Spring and Summer Advertising Campaign 2 flights of paid advertising across 6 counties • May 2018 (National Bike Month) • July & August (Back to School) • Goal: Achieve 250 million new impressions (1/2 billion to date!) • Seeking partners interested in participating Advertisements CEHD Packet 04.05.18 Page 23 of 42 r M &human 4I6human Oki Give even more room. Slow down. i; @! _ Switch lanes to pass safely. I She's going places. 11 X� ♦rim ©49 xlt .1" or A*human 0 F*human Reduce la velocidad. Life moves fast. llegarAn Iejos. Slow down to keep her safe. LAhEllos 1 � Ar _ J�+ 0 • f_ J l . r r A ` �+ � Lt's not just V 1 A 1' V I �i �_ a sign. _ ... ~ •...... , 1 Watch for aecpts • f at xitcrscc•�cxis • '' iViB�rch fCEith �, • � Yom" Why Participate? 1 in 5 residents in the SCAG region recognize ads • 85%+ found ads to be extremely or very motivating Request Materials From SCAG • Submit a materials request form for: • Banners • Lawn Signs • Bus Shelters • Billboards • SCAG will resize, co -brand, print & deliver materials to your City CEHD Packet 04.05.18 Page 25 of 42 MKgW MATERIALS REQUM MRM >L;. PaMrCA,'•yaecy: IhM.+y O.YRldr ssFIFAIAIb NfplEbl Neaae srlr�:rll:en'�!r+..8p aid e•raf.e aprons htbw to eeneFelc xw IMitS'.fil (lpvrp gssat I bids bclpw KI VEST U Ws.l N s...-. 4—... NEDIRST ",4, REDDESTi .rte. -w- f..wr r....ti . •.... RmvrsT 6, CQecmdny L,ao • ron•e Iha Pa'lr•s Ilp to bo Inehd" IJ d-Ndl — plmds-1, h'yh.yrsrtaYso Kslor Ne sM.h this rehuost subm�asen • i/bLCldF. DYC D31tl! n .' ymel!n. n••ti. De—ly Add—s EnNnhtcllmpyrsz:ar.;-i•trnaDte.m.xws Rm astmvlsd nurnbc.e+�mp:aae:ni+on.lhe rWW-ocs distrBaruaos-p•erflc any qc t.rarolw,.sl4a:�r+a m!twn nol sUtc'l abpvs Go Human open Streets Events & Demonstration Projects Upcoming Projects: Costa Mesa 4/21 Walnut Park 6/9 Culver City 6/15 West Covina 7/18 Ontario 8/8 Chino 9/22 San Jacinto 9/29 La Canada Flintridge 10/6 Arrow Highway 10/19-10/21 Lake Elsinore 10/27 Riverside TBD FUTURE Go Human Projects n, f y. i a n i3' (1 fie U tria n 5 o 1 Q CEHD Packet 04.05.18 Page 26 of 42