Division of Professions and Occupations 1560 Broadway, Suite 1350 Denver, CO 80202 Office of Licensing—Outfitters (303) 894-7800 / Fax (303) 894-7693 www.colorado.gov/dora/Outfitters
OUTFITTERS Application to Update Existing Registration: Name/Address/Responsible individual
APPLICATION TO UPDATE EXISTING REGISTRATION—OUTFITTERS APPLICANT INSTRUCTIONS Use this application to: Change the Responsible Party, business name, trade name(s)/DBA or business address. Notify the Director of the transfer, sale or dissolution of an entity. Do not use this application to: Change the business entity if you are sole proprietor. A new Application must be filed.
Mandatory Practice Act. Colorado has a mandatory practice act, which means that you may not practice as an Outfitter in this state without a Colorado registration. Submission of this application does not guarantee registration. Therefore, do not make life or career decisions based on the probability that you may receive a registration. Plan ahead for the time it will take to receive all required documents and complete evaluation. Basic Requirements. Requirements for registration are outlined in the Colorado Revised Statutes, specifically 12-55.5-101118, and the rules of the Office of Outfitters Registration. Both are available online at www.dora.colorado.gov/professions/outfitters. About the Application. This application is to be completed by you and returned to the Office of Licensing. All questions on the application are mandatory, and all supporting documents must be submitted with the application. You may copy as many forms as needed; however, each form submitted must be completed in original ink or typed. Keep a copy of the completed application for your records. Application Expiration. Your application will be kept on file for one (1) year from date of receipt in the Division. Your file and all supporting documentation will be purged if you do not submit the required documents and complete your application process in one year. Disclosure of Addresses: Consistent with Colorado law, all addresses and phone numbers on record with the Division of Professions and Occupations (DPO) are public record and must be provided to the public when requested. It is your responsibility to keep your address and contact information current in our system. Your email address is not open to public record, but must be provided at the time you register an account. If your email address is not current, it is possible you will not receive important information from DPO. You can change your address, email address and other information online by using Online Services: apps.colorado.gov/dora/licensing/Default.
Applicant: Keep this page for your records.
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Division of Professions and Occupations 1560 Broadway, Suite 1350 Denver, CO 80202 Office of Licensing—Outfitters (303) 894-7800 / Fax (303) 894-7693 www.colorado.gov/dora/Outfitters
OUTFITTERS Application to Update Existing Registration: Name/Address/Responsible individual
APPLICANT CHECKLIST All Applicants: You may submit one application for multiple changes being made at the same time. Complete all parts of the application that are appropriate for your change(s), as listed below. Return the completed application to the Office of Licensing. A fee is not required. To change the Responsible Individual: Complete Parts 1, 2, and 5 of the application; and Complete the Outfitter Responsible Party and Agent Update (attached). To change the business name, business address, or trade name(s)/DBA: Complete Parts 1, 3, and 5 of the application. Do not complete Part 2 if the responsible individual is not changing. To indicate the dissolution of a company: Complete Parts 1 and 4 of the application. To indicate the transfer or sale: Complete Parts 1 and 4 of the application and complete a new application. Return your completed application packet and all supporting documentation to: Division of Professions and Occupations Office of Licensing—Outfitters Registration 1560 Broadway, Suite 1350 Denver, CO 80202
Applicant: Keep this page for your records.
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Business Name:_______________________________________________ The content of this application must not be changed. If the content is changed, the applicant may be referred to the Colorado State Attorney General’s Office for violation of Colorado law. PART 1—OUTFITTER INFORMATION I AM REPORTING CHANGE(S) TO AN EXISTING REGISTRATION AS FOLLOWS: (Check all that apply) Change of Responsible Party and Agent—In addition to this application, submit the attached Outfitter Responsible Party and Update Do you understand that the Outfitter must notify the Office of Licensing within ten (10) working days after appointing a new responsible individual?
YES
NO
YES
NO
Change of business management or ownership Do you understand that the Outfitter must notify the Office of Licensing within thirty (30) days after a change in business management or ownership? NOTE: Registration Numbers are NOT transferrable - A New application may be needed Change of business name (Enter new business name in #3 below) Effective date of new name: Previous business name: Provide copy of Certificate of Good Standing from Secretary of State. Change or addition of trade name(s) or DBA Effective date of new trade name(s): Previous trade name(s): Provide copy of Certificate of Good Standing from Secretary of State. NOTE: List all trade names or DBAs to be included on the registration Change of business address (Enter new business address in 6 below) Effective date of new address: Previous business address:
1. Colorado Registration Number:
2. Expiration Date:
3. Business Name: 4. Date Outfitter Began Doing Business:
5. Federal Employer Identification Number (FEIN):
6. Business Address: Street
City
7. Daytime Telephone Number: (
)
State
Zip Code
8. E-mail Address:
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Business Name:_______________________________________________ PART 2—RESPONSIBLE PARTY AND AGENT INFORMATION Printed Name
Title/Position
Effective Date
Outgoing: Incoming: Note: List any related change in contact information for the outfitter registration in Part 1—Outfitter Information
Outgoing Responsible Party Signature
Date
PART 3—TRADE NAME AND DBA INFORMATION List ALL trade names and DBAs associated with this license and verify the change(s) by submitting copies of the documents filed with the Secretary of State.
PART 4 – BUSINESS MANAGEMENT or OWNERSHIP INFORMATION This application serves as written notification that the identified company has been transferred or sold and the new owner shall be responsible for applying to register the business by filing a NEW application dissolved and no further business will be conducted under this license Effective date of transfer, sale or dissolution:
Responsible Party Signature
Date
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Business Name:_______________________________________________ PART 5 – SCREENING QUESTIONS – TO BE COMPLETED BY NEW RESPONSIBLE PARTY Provide the following for each “YES” response to the screening questions below: •
An explanation, signed and dated by you, of your behavior or practice that led to the occurrence, including: o
Date(s) of event/offense
o
Description of event/offense
o
Location/court
o
Current status/outcome
You may be required to provide the following: •
Copies of legal documents relating to the event/offense.
•
Copies of legal documents indicating your compliance with any requirements imposed upon you.
1. Within the last 10 years, have you been found guilty of or admitted guilt to a violation of the laws or rules and regulations pertaining to the Colorado Division of Wildlife, United States Forest Service, Bureau of Land Management, or any other local, state, or federal wildlife or land management agency in Colorado or any other state?
YES
NO
2. Within the last 10 years, have you received a deferred judgment or paid a collateral forfeiture as a result of any violations pertaining to any of the aforementioned agencies?
YES
NO
3. Are there any pending charges against you not yet resolved involving any of the aforementioned agencies?
YES
NO
4. Within the last 10 years, have you been found in violation of or admitted to violation of any of the laws or rules and regulations governing the practice of outfitting, guiding, hunting, or fishing in Colorado or any other state?
YES
NO
5. Are there any pending charges against you not yet resolved alleging violation of outfitting, guiding, hunting, or fishing laws or regulations?
YES
NO
6. Have you ever been convicted, pled nolo contendere or guilty to a felony?
YES
NO
ATTESTATION I state under penalty of perjury in the second degree, as defined in C.R.S. 18-8-503, that the information contained in this application is true and correct to the best of my knowledge. In accordance with C.R.S. 18-8501(2)(a)(I), false statements made herein are punishable by law and may constitute violation of the practice act. I understand that I must comply with all laws and rules and regulations governing outfitters and that failure to do so may result in denial, probation, suspension or revocation of registration, or fines as set forth in the law.
Responsible Individual Signature
Date
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Business Name:_______________________________________________ OUTFITTER RESPONSIBLE PARTY AND AGENT UPDATE
Business Name:
License Number: First:
Responsible Individual Name: Last: Address:
Middle:
Suffix:
PO Box, Street: City, State, Zip:
I,
, certify the following: (Print Name)
1. I am at least eighteen (18) years of age.
YES
NO
2. I am employed by the business designated above.
YES
NO
3. I have current First Aid Certification
YES
NO
4. Are you now or have you ever been licensed to practice as an outfitter or guide in any state, territory, or district?
YES
NO
If YES, list each jurisdiction, other than Colorado, in which you are or have been registered or licensed as an outfitter. If needed, attach an additional sheet using the same format.
State/Country
Registration/License Number
Year registration/license issued
Disciplinary action against registration/license?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
5. Are there any pending complaints against you in any other jurisdictions?
Is this registration/license current/active?
If YES, provide an explanation:
I state under penalty of perjury in the second degree, as defined in C.R.S. 18-8-503, that the information contained in this application is true and correct to the best of my knowledge. In accordance with C.R.S. 18-8-501(2)(a)(I), false statements made herein are punishable by law and may constitute violation of the practice act.
Signature of Responsible Individual
Date
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