Every advertiser shall prepare, retain, and make available to the administrative director upon request a written registration statement. The information in the statement shall be verified by a declaration under penalty of perjury signed by the advertiser (if an individual), or by each owner of the advertiser (if a business entity). Whenever a material change occurs in the information in the statement, the advertiser shall within 10 days of the change revise the statement.
The statement shall contain the following information:
(a) The full legal name of the advertiser, and any other name(s) under which the person will advertise or do business.
(b) The advertiser's business form and place of organization; if the advertiser is a corporation, a copy of its articles of incorporation and bylaws and any amendments to them; if the advertiser is a partnership, a copy of the partnership agreement and any amendments to it; if the advertiser is an unincorporated organization a copy of its written organizational documents and any amendments to them; if the advertiser has filed or uses a fictitious business name, a copy of each fictitious business name statement showing the place(s) of filing.
(c) The complete street address or addresses of all locations at which the advertiser does or proposes to do business, and a designation of one such location in California as its principal place of business in the state.
(d) A listing of all telephone numbers to be used by the advertiser and the address where each telephone using each of these telephone numbers is located.
(e) The name of, and the office held by, the advertiser's officers, directors, trustees, general and limited partners, sole proprietor, and owners, as the case may be, and the names of those persons who have management responsibilities in connection with the advertiser's business activities.
(f) For each person whose name is disclosed under subdivision (e): the complete address of his principal residence; his driver's license number and state of issuance; and the number, licensing agency, and status of each professional license (s)he holds.
(g) A statement identifying any person disclosed under subdivision (e) who:
(1) has been convicted of or has pleaded guilty or no contest to a felony or misdemeanor violation of any offense related to workers' compensation, or of fraud, theft, embezzlement, fraudulent conversion, or misappropriation of property; or
(2) is or has been the subject of any civil or administrative action alleging acts in violation of any workers' compensation law, or of fraud, theft, embezzlement, fraudulent conversion, or misappropriation of property, or of the use of unfair, unlawful, or deceptive business practices.
The statement shall identify the person, court or administrative agency in which the case was filed, the case number, title of the case, and the result of the case.
NOTE: Authority cited: Sections 59, 133, 139.43(b) and 5307.3, Labor Code. Reference: Sections 7, 139.43(a), (b), (d), 139.45 and 5430-5434, Labor Code.
1. New section filed 12-31-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 53).