Pest Control Dealer License Application, DPR PML 041 20180612 145141 PCDBL Packet

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STATE OF CALIFORNIA

PEST CONTROL DEALER BUSINESS LICENSE PACKET

PR-PML-041 (REV. 8/17)

DEPARTMENT OF PESTICIDE REGULATION

PEST MANAGEMENT AND LICENSING BRANCH

LICENSING AND CERTIFICATION PROGRAM

1001 I STREET

SACRAMENTO, CALIFORNIA 95814-2828

(916) 445-4038

Web site: http://www.cdpr.ca.gov

PEST CONTROL DEALER

BUSINESS LICENSE

PACKET

Contains the following documents:

•Licensing Requirements and Fact Sheet

•Application and Instructions

•Visa/Mastercard Transaction Form

State of California

PEST CONTROL DEALER

LICENSING REQUIREMENTS

Rev. 8/17

DEPARTMENT OF PESTICIDE REGULATION

PEST MANAGEMENT AND LICENSING BRANCH

1001 I Street

P.O. Box 4015

Sacramento, California 95812-4015

Phone: (916) 445-4038 Fax: (916) 445-4033

Web site at <http://www.cdpr.ca.gov>

Do you need You must possess a pest control dealer license if you are a person, manufacturer, distributor,

this license? or retailer who does any of the following:

•Sells agricultural use* pesticides, methods, or devices for the control of agricultural

pests

•Solicits pest control sales through recommendations made by your field

representatives

•Sells restricted use pesticides to users

Note: Registrants who sell their own pesticide products and licensed pesticide brokers are

excluded from this license requirement if they do not sell directly to the end user.

*California’s definition of agricultural use includes but is not limited to commercial

production of animals or plants, golf courses, parks, cemeteries, roadsides, power line

rights-of-way, and nurseries.

Basic licensing You can obtain a pest control dealer license by submitting the application, appropriate fee,

requirements and supporting business information and documents. The following criteria must be met

prior to the issuance of this license:

•Qualified person

•Documents required to verify your business name and type

•Worker’s compensation insurance

Qualified

person According to the Food and Agricultural Code (FAC) section 12101.5, you must have at least

one person in a supervisory position at each principle and branch location who

•Is actively responsible for the operation of the dealership, and

•Holds a valid pest control dealer designated agent license, agricultural pest control

adviser license, pest control aircraft pilot certificate, or a qualified applicator license

Please state the name of the qualified person, their license or certificate number, and their

license or certificate category on the application form.

Continued on next page

Document Name

If you have a(n) …

Then you must …

Valid worker’s

compensation

insurance policy

•State the carrier’s name, policy number, and expiration date

on the application

•Write “not applicable” if your business has no employees

•Sign your application

Expired worker’s

compensation

insurance policy

Choose one of the following:

•Submit a certificate of insurance from your insurer stating

that the policy is valid, along with the expiration date

•Complete the Worker’s Compensation Insurance Verification

form (PR-PML-120), which can be found on DPR’s Web site

at <http://www.cdpr.ca.gov/docs/license/lcforms.htm>

Page 2 Pest Control Dealer

Licensing Requirements (Rev. 8/17)

Verifying your According to FAC section 11702(a), you must have the following documents to verify your

business name business name and type. If you are the sole proprietor (i.e., owner) and use your surname as

and type part of your business name, then no documents are required.

Details

Fictitious Business

Name Statement

•Obtainable from the County Clerk’s Office or County

Recorder’s Office

•Applies to any business operating under a fictitious name

Certificate of Good

Standing

•Obtainable from the California Secretary of State’s Office

•Applies to any domestic or foreign corporation operating in

California

•Must be registered with the California Secretary of State’s

Office

•See the Secretary of State’s Web site at

<www.ss.ca.gov/business/business.htm> for registration

information

Worker’s

compensation

insurance

Each applicant, who is an employer as defined in Section 3300 of

the Labor Code, is required

to carry worker’s compensation insurance. The Department of Pesticide Regulation’s (DPR)

policy on the worker’s compensation insurance requirement is listed in the table below.

Note: If you are interested in self-insurance to fulfill this requirement, please go to the

California Department of Industrial Relations’ Web site at

<http://www.dir.ca.gov/SIP/sip.html>.

Continued on next page

If your business name begins with …

Page 3 Pest Control Dealer

Licensing Requirements (Rev. 8/17)

Other

requirements Once you obtain your license, you must do all of the following:

•Maintain records of all purchases, sales, and distributions of pesticides at main and

branch offices for four years. You must report the total dollars of sales and total

pounds or gallons of agricultural use pesticides sold into or within California to

DPR’s director on a quarterly basis.

•Pay the quarterly mill assessment to the director if the registrant or pesticide broker

has not paid it (FAC section 12406[b]).

•Report purchases from other licensed dealers or registrants to the director on an

annual basis.

•Retain agricultural pest control adviser’s written recommendations for two years.

•Retain restricted material permits and operator identification statements records for

two years.

•Retain Qualified Applicator License, Qualified Applicator Certificate, and Private

Applicator Certificate numbers and pest control category(ies) received from

purchasers when the operator identification number certificate was not required.

•Obtain a copy of the ship vessel registration for tributyltin purchases.

Application fee The application fees are $160 (main) and $80 (branch) per calendar year (Title 3 of

California Code of Regulations [3 CCR], Code section 6502), which are based on the

following 2-year cycles:

Then your license will …

A through L Expire on December 31 of even-numbered

years (e.g., 2018, 2020, 2022, etc.)

M through Z (including businesses

starting with “The”) Expire on December 31 of odd-numbered

years (e.g., 2017, 2019, 2021, etc.)

For example, if you applied for a license under the name “Pest Control Dealer Corporation”

in January 2017, then your license would expire on December 31, 2017 and the fee would

be $160. If you applied for a license under the name “Best Pest Control Dealers” in January

2017, then your license would expire on December 31, 2018 and the fee would be $320.

Renewal fee The renewal fee is $320 (main) and $160 (branch) for the 2-year cycle (3 CCR section 6502).

We do not prorate your renewal fee if you renew your license late.

Late renewal A late fee of 50 percent of the total renewal fee will be assessed for each license postmarked

fee after December 31 of the expiration year.

Continued on next page

Type Amount

Page 4 Pest Control Dealer

Licensing Requirements (Rev. 8/17)

Miscellaneous The following chart lists the miscellaneous fees for this license. We charge a maximum fee

fees of $20 for all changes/requests that are submitted on a single application form.

Details

Name

change $20 •You must immediately notify the Licensing and

Certification Office in writing (3 CCR section 6508).

•You must submit legal documents certifying the name

change.

•A new license will be automatically issued for all name

changes.

•The Address and/or Name Change Form is available on

our Web site at

<www.cdpr.ca.gov/docs/license/lcforms.htm>.

Address

change $20 •You must immediately notify the Licensing and

Certification Office in writing (3 CCR section 6508).

•This fee is only required if you request a new license.

•The Address and/or Name Change Form is available on

our Web site at

<www.cdpr.ca.gov/docs/license/lcforms.htm>.

Duplicate $20

•This fee applies to requests for a duplicate or replacement

license.

Timelines for

processing

applications

DPR may take up to a hundred days to complete the processing of your application.

License

duration A new license may be issued for up to two years, depending on when you apply and your

license cycle. Each renewed license is valid for two years unless you renew late.

Most common

mistakes and

how to avoid

them

The most common application errors made are

•Incorrect fees

•No insurance documents, or the insurance documents submitted do not meet our

requirements

•No business type information provided

•No qualified person listed

You can avoid these errors by reading the application instructions carefully and by mailing

your renewal application before your license expires.

Continued on next page

Page 5 Pest Control Dealer

Licensing Requirements (Rev. 5/17)

Our physical Department of Pesticide Regulation

address Pest Management and Licensing Branch

Licensing and Certification Program

1001 I Street

Sacramento, CA 95814-2828

Our mailing Department of Pesticide Regulation

address Pest Management and Licensing Branch

Licensing and Certification Program

1001 I Street

P.O. Box 4015

Sacramento, CA 95812-4015

For more

information You can contact us between the hours of 8 a.m. to 5 p.m. at (916) 445-4038, or e-mail us

at <LicenseMail@cdpr.ca.gov>.

STATE OF CALIFORNIA

PEST CONTROL DEALER LICENSE APPLICATION

DPR-PML-041 (REV. 08/11)

Page 1 of 4

PLEASE READ INSTRUCTIONS ON PAGES 3 AND 4.

A. Application Type. Check the appropriate box(es).

DEPARTMENT OF PESTICIDE REGULATION

PEST MANAGEMENT AND LICENSING BRANCH

LICENSING AND CERTIFICATION PROGRAM

P.O. BOX 4015

SACRAMENTO, CALIFORNIA 95812-4015

(916) 445-4038

FAX - (916) 445-4033

Web site: http://www.cdpr.ca.gov/

B. Business Information (Main Location). Please print or type.

BUSINESS NAME

BUSINESS MAILING ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)

BUSINESS LOCATION ADDRESS (Number and Street) (City) (County) (State) (ZIP Code)

BUSINESS TYPE (Check only one box.) See instructions for documentation requirements.

CORPORATION INDIVIDUAL LIMITED LIABILITY COMPANY OTHER

C. Former Business Name. Enter former business name below.

FORMER BUSINESS NAME

D. Business Officers or Owners. Attach additional sheet if necessary.

MAILING ADDRESS (Number and Street or P.O. Box Number) (City) (State) (ZIP Code)

MAILING ADDRESS (Number and Street or P.O. Box Number) (City) (State) (ZIP Code)

E. Branch Locations. Attach additional sheet if necessary.

1) LOCATION ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)

2) LOCATION ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)

3) LOCATION ADDRESS (Number and Street or P.O. Box Number) (City) (County) (State) (ZIP Code)

F. Qualified Person. Each business location must have a qualified person, who possesses a valid license or certification in the

following: Pest Control Dealer Designated Agent License, Agricultural Pest Control Adviser License, Qualified Applicator License,

or Pest Control Aircraft Certificate. The qualified person is responsible for the operations of the pest control dealer business.

Attach additional sheet if necessary.

1) QUALIFIED PERSON'S NAME TYPE OF LICENSE/PILOT CERTIFICATE LICENSE/PILOT CERT. NUMBER EXPIRATION DATE

BUSINESS LOCATION ADDRESS (Number and Street) (City) (State) (ZIP Code)

2) QUALIFIED PERSON'S NAME TYPE OF LICENSE/PILOT CERTIFICATE LICENSE/PILOT CERT. NUMBER EXPIRATION DATE

BUSINESS LOCATION ADDRESS (Number and Street) (City) (State) (ZIP Code)

3) QUALIFIED PERSON'S NAME TYPE OF LICENSE/PILOT CERTIFICATE LICENSE/PILOT CERT. NUMBER EXPIRATION DATE

BUSINESS LOCATION ADDRESS (Number and Street) (City) (State) (ZIP Code)

Application Continued on Reverse Side

2) NAME

TITLE

1) NAME

TITLE

PARTNERSHIP

NON-PROFIT ASSOCIATION

LIMITED LIABILITY PARTNERSHIP

NEW APPLICATION

NAME / ADDRESS CHANGE

OTHER (Specify)

ADD BRANCH LOCATION

DUPLICATE / REPLACEMENT LICENSE

BUSINESS LICENSE #

EMAIL ADDRESS

FAX NUMBER

TELEPHONE NUMBER

(

(

)

STATE OF CALIFORNIA

PEST CONTROL DEALER LICENSE APPLICATION

DPR-PML-041 (REV. 08/11)

Page 2 of 4

G. Pest Control Dealer Type.

Indicate the type(s) of pest control methods/devices or pesticides your business will be selling by checking the appropriate box(es) below.

Agricultural Use Pesticides Only

Restricted Use Pesticides Only (Either California or Federal)

Both Agricultural Use and Restricted Use Pesticides

Tributyltin Other

Livestock/Poultry Pesticides

Biological Control Agents

H. Worker's Compensation Insurance. Each applicant who is an employer, as defined in Section 3300 of the Labor Code, is

required to carry worker's compensation insurance. If your business has no employees, write "Not Applicable" below.

WORKER'S COMPENSATION INSURANCE CARRIER NAME

POLICY NUMBER

EXPIRATION DATE

I. Fees. All fees are non-transferable and non-refundable.

1-Year 2-Year #Branches Total Fees

Main Location

Branch Location

Name/Address Change, Duplicate/Replacement Fee

Total Fee(s) Due/Enclosed $

Enclose a check, money order or credit card payment for the total amount due payable to: Cashier, Department of Pesticide

Regulation. Mail your completed application, required documentation, and fees to: Cashier, Department of Pesticide Regulation,

P.O. Box 4015, Sacramento, California 95812-4015.

J. Read Before Signing. During the last three years, have you had any administrative, civil, or criminal action taken against you

for violation of any State or federal laws or regulations relating to the application or use of pesticides that resulted in disciplinary

actions or in which any disciplinary action is pending?

YES (State explanation below or attach separate page.) NO

K. I declare under penalty of perjury, under laws of the State of California, that the above information is true and correct.

APPLICANT SIGNATURE

DATE SIGNED

FOR OFFICIAL

USE ONLY

BUSINESS LICENSE NUMBER PROBLEM COMPUTER ENTRY DATE

$160 or

$320 -- = $

$80 or $160 x = $

$20 x = $

STATE OF CALIFORNIA

PEST CONTROL DEALER LICENSE APPLICATION INSTRUCTIONS

DPR-PML-041 (REV. 08/11)

Page 3 of 4

A. Application Type.

New Application: If you are applying for the Pest Control Dealer License for the first time.

Add Branch Location: Adding a pest control dealer branch location to your license.

Duplicate/Replacement License: Requesting a duplicate or replacement license.

Name/Address Change: Requesting name/address changes. Submit a copy of the legal document

substantiating the name change. Address changes may be made directly on the application form with a $20

fee.

Other: Any other change, please specify the change.

B. Business Information (Main Location). Complete the information requested in this section. If you are changing

your business name, enter your former business name in Section “C”. If there is a change in business name or

address you must immediately notify the Director in writing. If your business is a:

Corporation, submit a current copy of the “Certificate of Good Standing” which may be obtained from the

Secretary of State, Certificate Department, 1500 11th Street, Sacramento, California 95814.

Limited Liability Company or Limited Liability Partnership, submit a current copy of the “Certificate of

Good Standing” which may be obtained from the Secretary of State, Certificate Department,

1500 11th Street, Sacramento, California 95814.

Partnership, submit a “Fictitious Business Name Statement” which may be obtained from the county clerk’s

office.

Individual, if the business name is different than your surname (last name), submit a “Fictitious Business

Name Statement” which may be obtained from the county clerk’s office.

Non-Profit Association, if the business is a corporation, submit a current copy of the “Certificate of Good

Standing” which may be obtained from the Secretary of State, Certificate Department, 1500 11th Street,

Sacramento, California 95814. If the business name is different than your surname (last name), submit a

“Fictitious Business Name Statement” which may be obtained from the county clerk’s office.

C. Former Business Name. If your business name has changed, enter the former name in this section of the

application.

D. Business Officers or Owners. List the name, title, and mailing address of the business officers and/or owners. If

necessary, use an additional sheet of paper. If there is a change in the business ownership or organization, notify

the Director immediately in writing. A new application and fee must be submitted for this change.

E. Branch Locations. Complete this section to add a branch location to your business. Enter the business location

address for each branch location added. If the branch name is different from the main business name, indicate the

branch name and submit a “Fictitious Business Name Statement” which may be obtained from the county clerk’s

office.

F. Qualified Person. Each principal and branch office must have a qualified person who possesses a valid Pest

Control Dealer Designated Agent License, Agricultural Pest Control Adviser License, Qualified Applicator License, or

Pest Control Aircraft Certificate. The qualified person is responsible for the operations of the pest control business.

Use an additional sheet of paper if necessary. If there is a change in the qualified person for the business, notify the

Director immediately. There is no fee required for this change.

G. Pest Control Dealer Type. Indicate the type of pesticides the business will be selling. Check all that apply.

H. Worker’s Compensation Insurance. Each applicant who is an employer as defined in Section 3300 of the Labor

Code is required to carry worker’s compensation insurance. If applicable, enter the name of the worker’s

compensation insurance carrier, the policy number, and the policy expiration date.

STATE OF CALIFORNIA

PEST CONTROL DEALER LICENSE APPLICATION INSTRUCTIONS

DPR-PML-041 (REV. 08/11)

Page 4 of 4

I. Fees.All fees are non-transferable and non-refundable.

One-Year* Two-Year*

Main Location: $160 $320

Branch Location: $ 80 $160

Name/Address Change Fee: $20 (See Note)

Duplicate/Replacement Fee: $20 (See Note)

NOTE: A fee for an address change is only required when the licensee requests a new license be issued (printed

and mailed). A maximum fee of $20 is due for all name/address changes and requests for a duplicate/replacement

licenses submitted on a single application.

* The following information and table will assist you in determining the appropriate application fee.

New Application Fee Schedule Example: Main License Branch License

Year Submitting License License Application Application

Application Name Expiration Year Fee Fee

2010 A-L 2010 $160 $80

M-Z 2011 $320 $160

2011 A-L 2012 $320 $160

M-Z 2011 $160 $80

2012 A-L 2012 $160 $80

M-Z 2013 $320 $160

If your business name begins with A - L, the expiration date of the business license is on even-numbered years.

If your business name begins with M - Z, the expiration date of the business license is on odd-numbered years.

J. Read Before Signing. Check appropriate box.

K. Declaration/Signature Block. Sign and date your application. Enclose a check, money order or credit card payable

to “Cashier, DPR” and mail to: Cashier, Department of Pesticide Regulation, P.O. Box 4015, Sacramento, California

95812-4015.

Failure to complete or provide the requested information may delay the processing of your application.

STATE OF CALIFORNIA

DEPARTMENT OF PESTICIDE REGULATION

1001 I STREET

SACRAMENTO, CA 95814-2828

Web site: http://www.cdpr.ca.gov

DPR-105 (Rev. 08/17)

Page 1 of 1

VISA/

M

ASTE

RC

A

RD

T

R

A

N

SA

C

TIO

N

Mail completed application with this payment form

to:

For Licensees: For Continuing Education Sponsors:

ATTN: Cashier Cashier

Department of Pesticide Regulation ATTN: CE

P.O. Box 4015 Department of Pesticide Regulation

Sacramento, CA 95812 P.O. Box 1379

Sacramento, CA 95812

ALL SECTIONS MUST BE COMPLETED. DO NOT E-MAIL OR FAX this form.

FAILURE TO COMPLETE ALL SECTIONS WILL RESULT IN YOUR APPLICATION BEING DELAYED OR REJECTED.

NAME OF CARDHOLDER (NAME APPEARING ON THE CARD)

VISA or MASTERCARD ONLY. No other cards are accepted.

VISA MASTERCARD

CHECK ONE:

CARD NUMBER

(16 DIGITS)

Expiration Date

Total Amount of Payment

SIGNATURE OF CARDHOLDER (NAME APPEARING ON THE CARD)

PAYMENT FOR:

MAILING ADDRESS (Street or P.O. Box Number)

City, State, and ZIP Code TELEPHONE NUMBER (include area code)

(DEPARTMENT USE ONLY) - ENTERED ON POS BY:

TODAY'S DATE

DATE MAILED

BY: