Form ABC-410 "Certificate of Compliance Application" - California

What Is Form ABC-410?

This is a legal form that was released by the California Department of Alcoholic Beverage Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the California Department of Alcoholic Beverage Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ABC-410 by clicking the link below or browse more documents and templates provided by the California Department of Alcoholic Beverage Control.

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Download Form ABC-410 "Certificate of Compliance Application" - California

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State of California
Department of Alcoholic Beverage Control
CERTIFICATE OF COMPLIANCE APPLICATION
Complete and sign this form and return to:
Alcoholic Beverage Control
Attention: Price Posting
3927 Lennane Drive, Suite 100, Sacramento, CA 95834
Item 1: Enter the name of the applicant. For a general partnership, the names of the
individual partners. For a limited partnership, limited liability company, or a corporation,
the name of the entity. Complete and include an ABC-256 for a limited partnership, an
ABC-256-LLC for a limited liability company, or an ABC-243 for a corporation.
1. APPLICANT(S) NAME
2. DOING BUSINESS AS (DBA)
3. PREMISES LOCATION (Where business will be conducted)
4. MAILING ADDRESS
5. TELEPHONE NUMBER
6. EMAIL ADDRESS
7. CONDITIONS FOR QUALIFICATION
As a condition for qualification of the certificate applied for, the applicant agrees to the
following:
That it will make available, both in California and outside the state, for inspection and copying by the
department, all books, documents, and records, located both within and without this state, which are
pertinent to the activities of the applicant, its agents and agencies within this state controlled by it, in
connection with the sale and distribution of its products within this state.
Under penalty of perjury, each person whose signature appears below, certifies and says:
(1) He/She is the applicant, or one of the applicants, or an executive officer of the applicant corporation,
named in the foregoing application, duly authorized to make this application on its behalf;
(2) That he/she has read the foregoing application and knows the contents thereof and that each and all of the
statements therein made are true;
(3) That no person other than the applicant or applicants has any direct or indirect interest in the applicant's
or applicants' business to be conducted under the license(s) for which this application is made.
PRINTED NAME
SIGNATURE
DATE SIGNED
X
ABC-410 (rev. 08/2020)
State of California
Department of Alcoholic Beverage Control
CERTIFICATE OF COMPLIANCE APPLICATION
Complete and sign this form and return to:
Alcoholic Beverage Control
Attention: Price Posting
3927 Lennane Drive, Suite 100, Sacramento, CA 95834
Item 1: Enter the name of the applicant. For a general partnership, the names of the
individual partners. For a limited partnership, limited liability company, or a corporation,
the name of the entity. Complete and include an ABC-256 for a limited partnership, an
ABC-256-LLC for a limited liability company, or an ABC-243 for a corporation.
1. APPLICANT(S) NAME
2. DOING BUSINESS AS (DBA)
3. PREMISES LOCATION (Where business will be conducted)
4. MAILING ADDRESS
5. TELEPHONE NUMBER
6. EMAIL ADDRESS
7. CONDITIONS FOR QUALIFICATION
As a condition for qualification of the certificate applied for, the applicant agrees to the
following:
That it will make available, both in California and outside the state, for inspection and copying by the
department, all books, documents, and records, located both within and without this state, which are
pertinent to the activities of the applicant, its agents and agencies within this state controlled by it, in
connection with the sale and distribution of its products within this state.
Under penalty of perjury, each person whose signature appears below, certifies and says:
(1) He/She is the applicant, or one of the applicants, or an executive officer of the applicant corporation,
named in the foregoing application, duly authorized to make this application on its behalf;
(2) That he/she has read the foregoing application and knows the contents thereof and that each and all of the
statements therein made are true;
(3) That no person other than the applicant or applicants has any direct or indirect interest in the applicant's
or applicants' business to be conducted under the license(s) for which this application is made.
PRINTED NAME
SIGNATURE
DATE SIGNED
X
ABC-410 (rev. 08/2020)
CALIFORNIA BEER SHIPPER’S AGREEMENT
On this
day of
, at
Sacramento, California, the Department of Alcoholic Beverage Control and
, whose address is
and who is hereinafter referred to as the Vendor, have mutually agreed as follows:
1. This agreement shall be deemed to have been made and entered into at Sacramento,
California, on the above date, and shall in all respects be governed by the Alcoholic
Beverage Control Act and in particular Section 23671 of the Business and Professions Code
of the State of California, and regulations promulgated pursuant to such laws, in force on the
said date and as thereafter amended, repealed, or modified.
2. The Vendor agrees that it and its agents and all agencies within this state controlled by it will
comply with all laws of this state and all rules of the Department with respect to the sale of
alcoholic beverages, including, but not limited to, Section 25000 of the California Business
and Professions Code requiring the filing of price schedules with the Department.
3. In consideration of the privilege of shipping beer to purchasers within the State of California
for sale within California, the Vendor agrees to furnish to the State Board of Equalization,
P.O. Box 942879, MIC 56, Sacramento, California 94279-0001, or its successor in function,
on or before the 10th day of each month a report on a form to be prescribed and furnished by
the Board of Equalization, showing the quantity of beer shipped by the Vendor to purchasers
within the State of California during the preceding month. It is necessary for a report to be
filed even if no beer is shipped.
4. The Department of Alcoholic Beverage Control of the State of California agrees to furnish to
the Vendor a Certificate of Compliance in accordance with Section 23671 of the Alcoholic
Beverage Control Act of the State of California, without fee. Such Certificate shall remain
in effect until revoked.
5. It is understood and agreed that all reports furnished pursuant to the agreement shall become
the property of the State of California when received and shall become public record.
6. The Vendor agrees that, upon failure to render the reports as herein provided, the
Department of Alcoholic Beverage Control may suspend or revoke the Vendor’s Certificate
of Compliance in the manner provided by Section 23671 of the Business and Professions
Code.
7. If the Vendor ships beer into California from a point other than the address listed above, the
Vendor will report by one of the following methods:
Make one consolidated report for all shipping points outside California. If this item is
checked, a list of names and addresses of shipping points must be attached.
ABC-410 (08/2020)
Separate report from each shipping point of Vendor. If this item is checked, a separate
California Beer Shipper’s Agreement must be executed by each of the Vendor’s
branches.
8. If the Vendor ships beer into California from more than one shipping point and has elected
to make a single consolidated monthly report, the Department of Alcoholic Beverage
Control will issue a single Certificate of Compliance. If the Vendor has elected to file
separate reports from each shipping point, the Department may issue to the Vendor a
Certificate of Compliance for each shipping point for which a report will be filed.
9. The Vendor designates as its general agent/attorney in fact for service of legal process
within the State of California (name and street address - not P.O. Box)
Phone:
10. The first report shall be due for the month in which the Certificate of Compliance is issued
and each month thereafter until the Certificate of Compliance is surrendered or revoked.
A. Do you expect to ship draught beer into California? If so, list the brand names below. If no
brands of draught beer will be shipped into California, enter the word “None.”
B. List the brands and types of canned or bottled beer to be shipped into California.
Approval
Signature
Ana Buendia
Title
Program Technician II
(916) 419-2571
Contact Person
For: Lee Riegler
Supervising Agent in Charge
Phone Number
Trade Enforcement Unit
ABC-410 (08/2020)

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