Legal Solicitor Permit Application

LEGAL SOLICITOR PERMIT APPLICATION

Applicant Name:    Business/Trade Name:    To: Issuing Authority:

Applicant Contact Information

Individual    Corporation    Partnership    Nonprofit/Charitable Organization

Recitals

WHEREAS, the Applicant seeks authorization to engage in solicitor activities, including, but not limited to, solicitation of sales, charitable contributions, or information collection within the jurisdiction of the Issuing Authority; and

WHEREAS, the Issuing Authority administers a permitting process to protect public safety, ensure consumer protection, and verify qualifications of individuals and entities engaged in solicitor activities; and

WHEREAS, the Applicant agrees to comply with all applicable municipal, state, and federal laws and the specific conditions imposed by any permit issued under this application;

NOW THEREFORE, in consideration of the issuance of a permit and the mutual covenants contained herein, Applicant submits this application to the Issuing Authority and agrees to the following terms and conditions.

1. Scope of Permit

The permit, if granted, shall authorize the Applicant to conduct solicitation activities described herein within the territorial limits of the Issuing Authority subject to limitations and conditions imposed by this application and any permit document. Proposed nature of solicitation:

2. Proposed Dates and Locations

Proposed start date:    Proposed end date:

3. Methods of Solicitation

Methods to be used (check all that apply):

Door-to-door solicitation    Street solicitation    Telephone solicitation    Online solicitation    Table/booth at events

4. Background Disclosure & Consent

Applicant certifies that the following disclosures are complete and accurate. Has the applicant or any principal, officer, or agent been convicted of a felony or misdemeanor involving fraud, dishonesty or sexual offense? Yes    No

Applicant hereby authorizes the Issuing Authority to conduct background checks, including criminal history and identity verification, as necessary to evaluate this application. Applicant agrees to submit fingerprints and other identifying information upon request.

5. Insurance and Bonding Requirements

Prior to issuance, Applicant shall furnish evidence of commercial general liability insurance with minimum limits of:

6. Fees

Application fee submitted with this application: $    Method of payment:

7. Grounds for Denial or Revocation

The Issuing Authority may deny, suspend, or revoke a permit for materially false statements on this application, failure to meet insurance or bonding requirements, convictions that bear on public safety, repeated complaints substantiated by the Issuing Authority, or violation of permit conditions. The Applicant shall be provided written notice of denial or revocation and may request administrative review in accordance with applicable procedures.

8. Records, Reports and Compliance

Applicant shall maintain complete records of solicitation activities, sales receipts, donor lists, and incident reports for a minimum of three years and shall produce such records upon reasonable request by the Issuing Authority. Applicant shall comply with all consumer protection, solicitation, and public safety laws and ordinances.

9. Indemnification

Applicant agrees to indemnify, defend, and hold harmless the Issuing Authority, its officers, employees and agents from and against any and all claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising out of or in connection with Applicant's solicitation activities, including claims for personal injury, property damage, or violations of law.

10. Notices

11. Amendments; Waiver; Counterparts

No amendment or waiver of any provision of this application or any permit issued pursuant to it shall be effective unless in writing and signed by the Issuing Authority. A waiver of any provision shall not be construed as a waiver of any other provision or of the same provision on another occasion. This application may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

12. Governing Law; Entire Agreement; Severability

This application and any permit issued hereunder shall be governed by and construed in accordance with the laws of the state in which the Issuing Authority is located. This application, together with any written permit issued by the Issuing Authority, constitutes the entire agreement between the parties regarding the subject matter hereof. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Applicant Certification

I hereby certify under penalty of perjury that the information contained in this application and any attachments is true, complete, and correct. I understand that submission of false, misleading or incomplete information is grounds for denial or revocation of any permit and may subject me to civil or criminal penalties. I agree to comply with all applicable laws, ordinances and permit conditions.

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