Form DBPR FSBC01 "Application for Amateur Sanctioning Organization" - Florida

What Is Form DBPR FSBC01?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2012;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • 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 printable version of Form DBPR FSBC01 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR FSBC01 "Application for Amateur Sanctioning Organization" - Florida

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State of Florida
Department of Business and Professional Regulation
Florida State Boxing Commission
Application for Amateur Sanctioning Organization
Form # DBPR-FSBC-01
APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your
application to ensure faster processing.
ALL Applicants must submit:
Application
Organization’s Set of Standards as set forth in Section 548.0065(2), Florida Statutes.
Application fee
• $100.00 for each license requested.
• Make check payable to the Florida State Boxing Commission
Letters of Good Standing from any state, territory, or country applicant or applicant’s officers, representatives, or
financial support is licensed in.
Certified documentation indicating criminal history for all officers, officials, trustees, partners, directors, owners,
authorized representatives, or persons with financial interest in the amateur sanctioning organization.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.488.8500.
1. Application Instructions (by section)
a. Section I- Application Type
i.
Check only one of the application types. Select only one sport. If your entity wishes to
apply for licensure as an amateur sanctioning organization for more than one sport, you
will need to submit a separate application for each sport.
b. Section II- Business Information
i.
Fill out each section completely.
ii.
In the Full Legal Name section provide your full legal name. Do not use any nicknames or
initials. Please list any aliases or prior names in the prior name information section.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
v.
Applicants are required to provide at least one physical address – i.e., not a P.O. Box. If
the mailing address is not also your physical address, please provide a physical address.
vi.
Applicant’s addresses are used only for Department purposes and will not be printed on
the license.
vii.
Additional contact information is optional and will be used when the applicant cannot be
reached using their primary contact information.
viii.
Sole proprietorship/individual ownership may not be required to obtain a Federal
Employer ID Number.
ix.
The “Doing Business As” Name will be the actual name of the entity reflected on the
license.
x.
Business ownership: Provide the name, Social Security number, address, and the
percentage of ownership for all persons holding greater than or equal to a ten percent
ownership interest in the business.
Fla. Stat. § 559.79.
DBPR FSBC 01
Eff. date: December 2012
Rule 61K1-4.001
1 of 14
State of Florida
Department of Business and Professional Regulation
Florida State Boxing Commission
Application for Amateur Sanctioning Organization
Form # DBPR-FSBC-01
APPLICATION CHECKLIST - IMPORTANT - Submit all items on the checklist below with your
application to ensure faster processing.
ALL Applicants must submit:
Application
Organization’s Set of Standards as set forth in Section 548.0065(2), Florida Statutes.
Application fee
• $100.00 for each license requested.
• Make check payable to the Florida State Boxing Commission
Letters of Good Standing from any state, territory, or country applicant or applicant’s officers, representatives, or
financial support is licensed in.
Certified documentation indicating criminal history for all officers, officials, trustees, partners, directors, owners,
authorized representatives, or persons with financial interest in the amateur sanctioning organization.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.488.8500.
1. Application Instructions (by section)
a. Section I- Application Type
i.
Check only one of the application types. Select only one sport. If your entity wishes to
apply for licensure as an amateur sanctioning organization for more than one sport, you
will need to submit a separate application for each sport.
b. Section II- Business Information
i.
Fill out each section completely.
ii.
In the Full Legal Name section provide your full legal name. Do not use any nicknames or
initials. Please list any aliases or prior names in the prior name information section.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
v.
Applicants are required to provide at least one physical address – i.e., not a P.O. Box. If
the mailing address is not also your physical address, please provide a physical address.
vi.
Applicant’s addresses are used only for Department purposes and will not be printed on
the license.
vii.
Additional contact information is optional and will be used when the applicant cannot be
reached using their primary contact information.
viii.
Sole proprietorship/individual ownership may not be required to obtain a Federal
Employer ID Number.
ix.
The “Doing Business As” Name will be the actual name of the entity reflected on the
license.
x.
Business ownership: Provide the name, Social Security number, address, and the
percentage of ownership for all persons holding greater than or equal to a ten percent
ownership interest in the business.
Fla. Stat. § 559.79.
DBPR FSBC 01
Eff. date: December 2012
Rule 61K1-4.001
2 of 14
xi.
If the business will be owned by a corporation, each Officer, Director, Chief Executive or
other person who is able to directly or indirectly control the operation of the business
must provide their name, title, Social Security number, and an address.
Fla. Stat. §
559.79.
c. Section III- Operation in Other States/Jurisdictions
i.
Applicants must provide information on operation as an amateur sanctioning organization
in any other state, territory, or jurisdiction of the United States or in any foreign national
jurisdiction.
d. Section IV- Current/Prior License Information in other States/Jurisdictions
i.
Applicants must provide information on current or prior licenses held in Florida or any
other state, territory, or jurisdiction of the United States or in any foreign national
jurisdiction.
e. Section V- Licensure of Officers/Representatives
i.
Applicants must provide information on any business or professional licenses or
registrations held by the organization’s trustees, partners, officers, directors, and owners
in which the applicant has a financial interest.
f.
Section VI- Prior Name
i.
Applicants must provide information on any prior names or aliases used by applicant. If
the name on supporting documentation does not match the applicant’s legal name, the
alias used in the supporting documentation must be provided in this section. Failure to do
so will result in a deficient application.
g. Section VII- Qualifications
i.
Pursuant to Section 548.0065(2), F.S., the commission must review the applicant
organization’s standards to ensure that the applicant can adequately demonstrate that
the principles of the organization have sufficient background, training, and experience in
sanctioning and supervising matches for which the organization is approved to protect
the health and safety of the amateurs participating in the matches and the public. These
standards shall not contradict Chapters 61K1-1 and 61K1-4, Florida Administrative Code.
If the Commission approves the applicant organization for licensure, the organization
shall adhere to the requirements of Rule 61K1-1 and 61K1-4, Florida Administrative
Code. These Standards are used by the Commission at the time of application to
determine whether the organization’s officers are qualified to operate an amateur
sanctioning organization in the particular sport, and are not, in any way, considered a
replacement for the Statutes or Rules as adopted by the legislature or Florida State
Boxing Commission.
ii.
Applicants must answer the listed questions in reference to their submitted standards. If
the answer to the question is “Yes”, the applicant must list the page number in which the
commission can locate the topic referenced in the question.
iii.
Applicants must agree to adopt and enforce all of the health and safety standards
established and adopted by the Commission.
iv.
Applicants must indicate whether any trustee, partner, director, or owner for the applicant
organization has ever held office or been a representative of an amateur sanctioning
organization whose license in Florida or any other jurisdiction has been revoked,
suspended, fined, placed on probation, or otherwise acted against. Applicants must
supply identifying information on the previous organization, the position held by the officer
or representative of the applicant organization, and the position held by the officer or
representative in the disciplined organization.
h. Section VIII (a), (b), and (c)- Background Questions
i.
Applicants must submit answers to each of the background questions.
ii.
Question 1:
(1)
If you answer “yes” to this question, you must complete Section IX [make additional
copies as necessary] of the application and provide a copy of the arrest report,
copies of the disposition or final order(s), and documentation proving all sanctions
have been served and satisfied. You must supply this documentation for each
occurrence. If you are unable to supply this documentation, a certified statement
from the clerk of court for the relevant jurisdiction stating the status of records is
required.
(2)
If you are still on probation, you must supply a letter from your probation officer, on
official letterhead, stating the status of your probation.
iii.
Question 2:
DBPR FSBC 01
Eff. date: December 2012
Rule 61K1-4.001
3 of 14
(1)
If you answer “yes” to this question, you must complete Section IX [make additional
copies as necessary] of the application and provide a copy of the judgment or
decree. You must also supply documentation proving all sanctions have been served
and satisfied, or if not, stating the current status of any proceedings.
iv.
Question 3:
(1)
If you answer “yes” to this question, you must complete Section X [make additional
copies as necessary] of the application and supply copies of documentation
explaining the denial or pending action.
i.
Section VI- Affirmation by Written Declaration
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
2. Other Documentation
a. Applicant Organization’s Standards
i.
Pursuant to Section 548.0065(2), F.S., the commission must review the applicant
organization’s standards to ensure that the applicant can adequately demonstrate that
the principles of the organization have sufficient background, training, and experience in
sanctioning and supervising matches for which the organization is approved to protect
the health and safety of the amateurs participating in the matches and the public. The
applicant organization must supply a copy of their standards with the initial application.
Failure to do so will result in the application process being delayed due to incomplete
information.
DBPR FSBC 01
Eff. date: December 2012
Rule 61K1-4.001
4 of 14
State of Florida
Department of Business and Professional Regulation
Florida State Boxing Commission
Application for Amateur Sanctioning Organization
Form # DBPR-FSBC-01
If you have any questions or need assistance in completing this application, please contact the Florida
State Boxing Commission, at 850.488.8500
For additional information see Instructions at the end of this application.
Section I – License Type
CHECK ONE OF THE LICENSURE TYPES
Amateur Sanctioning Organization License/Approval- select one of the company types below:
Amateur Boxing
Amateur Kickboxing
Amateur Mixed Martial Arts
Section II –Business Information
BUSINESS INFORMATION
Organization Name/Individual Name:
Doing Business As (D/B/A) Name (This name will be the “organization name” on the license):
Federal Employer ID Number or SSN:
Appointment of Agent (The organization must have an authorized agent who accepts service for the
organization and can be contacted for matters related to the organization):
 Sole Proprietor
 Corporation or LLC  Partnership
Business Type:(Select ONE only)
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Resident Agent Name:
Primary Phone Number
Primary E-Mail Address
BUSINESS LOCATION ADDRESS
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
DBPR FSBC 01
Eff. date: December 2012
Rule 61K1-4.001
5 of 14
Section II –Business Information (continued)
BUSINESS OWNERSHIP
Please list all persons with ownership greater than or equal to 10%. Ownership includes all persons who
provide financial support for the amateur sanctioning organization in an amount greater than or equal to
10% of the budget for the fiscal year.
Name
Social Security
Address
%
Number*
Ownership
1.
2.
3.
4.
5.
CORPORATIONS OR LLCs ONLY
Please provide the following information for each Trustee(s), Officer(s), Directors, and Owners, or other
person who is able to directly or indirectly control the operation of the organization.
Officer’s Name
Title
Social Security
Address
Number
1.
2.
3.
4.
5.
PARTNERSHIPS ONLY
Please provide the following information for each Partners, Officer(s), and Owners, or other person who is
able to directly or indirectly control the operation of the organization.
Partner’s Name
Title
Social Security
Address
Number
1.
2.
3.
4.
5.
DBPR FSBC 01
Eff. date: December 2012
Rule 61K1-4.001