Form SFAA1 "Athlete Agent Amendment to Disclosure Statement" - California

What Is Form SFAA1?

This is a legal form that was released by the California Secretary of State - 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 April 1, 2015;
  • The latest edition provided by the California Secretary of State;
  • 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 SFAA1 by clicking the link below or browse more documents and templates provided by the California Secretary of State.

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Download Form SFAA1 "Athlete Agent Amendment to Disclosure Statement" - California

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File No. ______________________
State of California
Secretary of State
Athlete Agent Amendment to Disclosure Statement
A $20.00 filing fee must accompany this form.
IMPORTANT - Read instructions before completing this form.
Filing of false, misleading, or incomplete statements on this form may subject you to
criminal and civil penalties under the Miller-Ayala Athlete Agents Act, Chapter 2.5
(commencing with Section 18895) of Division 8 of the Business and Professions Code.
This Space For Filing Use Only
1. Name of Athlete Agent
File Number
Individual
Entity
FOR ITEMS 2 THROUGH 20, COMPLETE ONLY THE ITEMS THAT HAVE CHANGED.
2. Name of Athlete Agent
3. Street address of all locations where business is to be conducted, including City, State, and Zip Code (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
4. Name of designated agent for service of process in California
5. Street address of designated agent for service of process in California
City
State
Zip Code
CA
6. List all businesses and/or occupations engaged in for the two years preceding the date of this filing (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
CHECK YES OR NO TO QUESTIONS 7 THROUGH 11
YES
NO
7. Has the athlete agent ever been convicted of a felony?
8. Has the athlete agent ever been convicted of a misdemeanor involving a violation of Chapter 2.5 of
Division 8 of the Business and Professions Code, or Chapter 1 (commencing with Section 1500) of
Part 6 of Division 2 of the Labor Code as repealed by Chapter 857 of the Statutes of 1996, or the
law of any other state governing athlete agents?
9. Has the athlete agent ever been convicted of fraud, theft, embezzlement, fraudulent conversion,
or misappropriation of property?
10. Has the athlete agent ever made any appearances before any disciplinary or professional board,
association, secretary, committee, or other entity as a result of disciplinary charges or other
allegations of misconduct against the athlete agent? If yes, explain the outcome of those
proceedings (attach additional pages if necessary).
11. Has any student athlete or any educational institution been sanctioned, suspended, or declared
ineligible to participate in one or more interscholastic or intercollegiate athletic events in any
proceeding arising from, or related to, the actions of this athlete agent?
COMPLETE EITHER 12 OR 13 OR BOTH, WHICHEVER IS APPROPRIATE:
12. Name the insurer and amount of coverage for the security required by Business and Professions Code section 18897.87(a)
13. Specify the type, value and specific location of security consistent with the requirements of Business and Professions Code section 18897.87(b)
SEC/STATE SFAA1 Rev 04/2015
(Page 1 of 2)
FILING FEE: $20.00
File No. ______________________
State of California
Secretary of State
Athlete Agent Amendment to Disclosure Statement
A $20.00 filing fee must accompany this form.
IMPORTANT - Read instructions before completing this form.
Filing of false, misleading, or incomplete statements on this form may subject you to
criminal and civil penalties under the Miller-Ayala Athlete Agents Act, Chapter 2.5
(commencing with Section 18895) of Division 8 of the Business and Professions Code.
This Space For Filing Use Only
1. Name of Athlete Agent
File Number
Individual
Entity
FOR ITEMS 2 THROUGH 20, COMPLETE ONLY THE ITEMS THAT HAVE CHANGED.
2. Name of Athlete Agent
3. Street address of all locations where business is to be conducted, including City, State, and Zip Code (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
4. Name of designated agent for service of process in California
5. Street address of designated agent for service of process in California
City
State
Zip Code
CA
6. List all businesses and/or occupations engaged in for the two years preceding the date of this filing (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
CHECK YES OR NO TO QUESTIONS 7 THROUGH 11
YES
NO
7. Has the athlete agent ever been convicted of a felony?
8. Has the athlete agent ever been convicted of a misdemeanor involving a violation of Chapter 2.5 of
Division 8 of the Business and Professions Code, or Chapter 1 (commencing with Section 1500) of
Part 6 of Division 2 of the Labor Code as repealed by Chapter 857 of the Statutes of 1996, or the
law of any other state governing athlete agents?
9. Has the athlete agent ever been convicted of fraud, theft, embezzlement, fraudulent conversion,
or misappropriation of property?
10. Has the athlete agent ever made any appearances before any disciplinary or professional board,
association, secretary, committee, or other entity as a result of disciplinary charges or other
allegations of misconduct against the athlete agent? If yes, explain the outcome of those
proceedings (attach additional pages if necessary).
11. Has any student athlete or any educational institution been sanctioned, suspended, or declared
ineligible to participate in one or more interscholastic or intercollegiate athletic events in any
proceeding arising from, or related to, the actions of this athlete agent?
COMPLETE EITHER 12 OR 13 OR BOTH, WHICHEVER IS APPROPRIATE:
12. Name the insurer and amount of coverage for the security required by Business and Professions Code section 18897.87(a)
13. Specify the type, value and specific location of security consistent with the requirements of Business and Professions Code section 18897.87(b)
SEC/STATE SFAA1 Rev 04/2015
(Page 1 of 2)
FILING FEE: $20.00
14. List all past and present persons on behalf of whom the athlete agent has acted as an athlete agent (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
15. List the names of any players’ associations with whom the athlete agent is registered (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
16. List at least three references with complete addresses and phone numbers (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
17. List all affidavits or certificates of completion of any and all formal training or practical experience in any of the following specific areas: contracts, contract
negotiation, complaint resolution, arbitration, or civil resolution of contract disputes (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
18. List the name and residential address of all persons financially interested in the operation of the business of the athlete agent, whether as employees,
partners, investors, associates, or profit sharers, or in any other manner (attach additional pages if necessary)
A._____________________________________________________________________________________________________________________
B._____________________________________________________________________________________________________________________
C._____________________________________________________________________________________________________________________
19. Attach a schedule of fees to be charged and collected in the conduct of the athlete agent business.
SECTION 20A THROUGH 20C APPLICABLE ONLY IF THE ATHLETE AGENT IS AN INDIVIDUAL
20. A. Residence address of Athlete Agent
City
State
Zip Code
B. Social Security Number of Athlete Agent
C. Driver’s License Number of Athlete Agent
21. I declare that this disclosure statement is true, correct and complete.
Signature
Date
Type or print name and title
SEC/STATE SFAA1 Rev 04/2015
(Page 2 of 2)
FILING FEE: $20.00
Clear Form
Print Form
Instructions for Completing the Athlete Agent Amendment to Disclosure Statement
This form is available on the Secretary of State’s website at www.sos.ca.gov/business-programs/special-filings and
can be viewed and printed from your computer. Mail the completed form to Secretary of State, Special Filings Unit,
P.O. Box 942870, Sacramento, CA 94277-2870. Type or legibly print in black or blue ink. This form should not
be altered. This form is filed only in the Sacramento office.
Each athlete agent company, corporation, association, partnership or limited liability company must file an athlete agent
disclosure statement with the Secretary of State. In addition, each individual acting individually and/or as an athlete agent
within a company, corporation, association, partnership or limited liability company must file an athlete agent disclosure
statement with the Secretary of State. (Business and Professions Code section 18896.)
Within seven days of the time any information in the filing required by Business and Professions Code section 18896
changes, the athlete agent shall file revised information on an Athlete Agent Amendment to Disclosure Statement. No
revision of a fee schedule shall be effective until it is filed with the Secretary of State.
Along with the completed amended disclosure statement, it is necessary to submit the following items:
$20.00 filing fee made payable to the Secretary of State.
Schedule of fees to be charged and collected in the conduct of this athlete agent business (Item 19).
Complete the Athlete Agent Amendment to Disclosure Statement as follows (for Items 2 through 20, complete only
the items that have changed):
Item 1.
Enter the name of the athlete agent as filed on the original Athlete Agent Disclosure Statement and the file
number. Check whether the athlete agent is an individual or an entity.
Item 2.
Enter the new or amended name of the athlete agent.
Item 3.
Enter the street address of all locations where the athlete agent’s business is to be conducted. Attach additional
pages if necessary.
Item 4.
Enter the name of the athlete agent’s designated agent for service of process in California. An agent for service
of process is an individual who resides in California designated to accept any legal documents that may be
served upon the athlete agent.
Item 5.
Enter the street address of the designated agent for service of process in California. Do not enter “in care of”
(c/o) or abbreviate the name of the city. A post office box is not acceptable.
Item 6.
List all businesses and/or occupations which the athlete agent has engaged in for the two years preceding the
date of this filing. Attach additional pages if necessary.
Item 7-11.
Check “yes” or “no” for questions 7-11 and if #10 is checked “yes”, explain the outcome of any appearances
before any disciplinary or professional board, association, secretary, committee, or other entity as a result of
disciplinary charges or other allegations of misconduct against the athlete agent on additional pages.
Item 12.
Every athlete agent must provide security for claims against the athlete agent or the athlete agent’s
representatives or employees based upon acts, errors, or omissions arising out of the business of the athlete
agent. List the name of the insurer providing that security and specify the amount of the insurance coverage
consistent with Business and Professions Code section 18897.87(a).
Item 13.
If security is provided consistent with Business and Professions Code section 18897.87(b), specify the type,
value and location of the security. If security is being provided with a combination of the options in #12
and #13, complete both items in full.
Item 14.
List all past and present persons on behalf of whom the athlete agent has acted as an athlete agent. Attach
additional pages if necessary.
Item 15.
List the names of all players’ associations with whom the athlete agent is registered. Attach additional pages if
necessary.
Item 16.
Provide at least three references and include complete addresses and phone numbers. Attach additional pages
if necessary.
Item 17.
List any and all affidavits or certificates of completion of any and all formal training or practical experience in any
of the following specific areas: contracts, contract negotiation, complaint resolution, arbitration, or civil resolution
of contract disputes. Attach additional pages if necessary.
Item 18.
List the names and residential addresses of all persons financially interested in the operation of the business of
the athlete agent, whether as employees, partners, investors, associates, or profit sharers, or in any other
manner. Attach additional pages if necessary.
Item 19.
Attach a schedule of fees to be charged and collected in the conduct of the athlete agent business.
Item 20.
In boxes 20A-C, if the athlete agent is an individual, enter the athlete agent’s residential address, social
security number and driver’s license number.
Item 21.
The application must be signed with an original signature.
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