CITY OF RIVERSIDE 3900 MAIN STREET FINANCE DEPARTMENT RIVERSIDE, CA 92522

BINGO LICENSE APPLICATION (PHONE) (951) 826-5465 (FAX) (951) 826-2356

LIVE BINGO REMOTE CALLER BINGO

NEW RENEWAL

Municipal Code Chapter 5.60 License Required. It is unlawful for any organization to conduct any bingo game in the City unless such organization is an organization permitted to play bingo pursuant to the provisions of section 326.5 of the Penal Code of the State and has a valid City license issued pursuant to the provisions of this Chapter. It is unlawful for any person to conduct any bingo games in the City unless such person is a member of and is acting on behalf of an organization that has been issued a license as provided by this Chapter. It is unlawful to conduct remote caller bingo games in the City unless a valid City license has been issued pursuant to the provision of this Chapter.

The following documents must be submitted with your application: 1. Copy of Certificate of Determination of Exemption from the Franchise Tax Board. 2. For mobile home park associations, senior citizen organizations, or charitable organization affiliated with a school

district, please provide a copy of your founding documents establishing your status. 3. Organization chart or a listing of the names, titles, and addresses of trustees, directors, and officers. 4. Plan setting forth the proposed security measures with respect to bingo events (RMC 2.28 and 5.60.120). 5. Written verification shall be obtained from the Planning and Fire Departments that zoning and building code laws

of the City will not be violated; and that there is improved vehicular access to the premises wherein a bingo game is to be conducted, and that such premises contain off-street vehicle parking facilities on the basis of not less than one parking space for every thirty square feet of floor area within the assembly room wherein the bingo game is to be conducted.

SECTION 1 - ORGANIZATION INFORMATION Legal Name of Organization

Address of Organization

Name and Address of Agent for Service of Process

Name and Address of Officer or Person Designated as the Site Manager and having Primary Responsibility for the Game

Applicant Contact Person

Contact Phone Number

SECTION 2 - BINGO GAME INFORMATION

Address where Bingo games are to be held:

Is the property where the Bingo game is to be held:

Owned by the Organization Leased by the Organization Use Donated to the Organization

How Long? ___________

For property for which the use is donated to the organization, is the use for the performance of the charitable purpose for which the organization was formed? Yes No

Proposed day(s) of week game(s) to be conducted:

Will bingo game(s) be open to the public? Yes No

Has a special fund or account been established for bingo profits? Yes No

Will bingo games be operated and staffed only by members of the organization, who shall not receive a profit, wage or salary from any bingo game? Yes No

List the members of the organization who will be in any way connected with the operation of the bingo game(s). A separate Bingo Operator Application from must be submitted for each person connected with the operation of the bingo games: (List or attach document with the member’s names and addresses) Name Address ________________________________________ ____________________________________________________________ ________________________________________ ____________________________________________________________ ________________________________________ ____________________________________________________________

REMOTE CALLER BINGO GAME ONLY:

Does your organization have a valid and current license to conduct Remote Caller Bingo Games issued by the California Gambling Control Commission? Yes No License #: _____________________ Exp. Date:______________________

Licensed Fiduciary _________________________________________ License #: _______________ Exp. Date:___________________

Name of vendor and any person or entity maintaining the equipment used to operate and transmit the game: ____________________ State License #________________ Exp. Date:____________

Will your organization cosponsor a remote caller bingo game with any other organization(s)? Yes No If yes, please provide the name(s) of all organization(s) with whom you are cosponsoring: ___________________________________________________________________________________________________________________ If cosponsoring, is your organization Affiliated Unaffiliated to the other cosponsoring organization(s)?

If cosponsoring, please attach a copy of the written agreement filed with the Department of Justice per California Penal Code Section 326.3.

SECTION 3 – APPLICANT SIGNATURE – SIGNATURE BELOW CERTIFIES THAT:

• Applicant agrees to conduct Remote Caller Bingo Games and/or Live Bingo Games in strict accordance with the provisions of California Penal Code Section 326.3 and/or 326.5 and Chapter 5.60 of the Riverside Municipal Code, as they may be amended from time to time, and understands that the Finance Director and/or the Police Chief may revoke the license for a violation of any such provision.

• Applicant agrees to immediately report to the Finance Director any changes in the information provided.

• Pursuant to RMC 5.60.100H3, applicant will provide timely financial records to the Finance Director.

• Applicant has read and is familiar with the provisions of Chapter 5.60 of the Riverside Municipal Code and will require all persons who operate, conduct, or staff bingo games to read and be familiar with all provisions of this Chapter prior to operating, conducting, or staffing bingo games.

• Applicant is a person with authority to bind the applicant organization.

• Applicant declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct to the best of their knowledge.

________________________ _________________________ __________________ ___________ Applicant SIGNATURE Applicant PRINT CLEARLY Relationship to Organization Date

SECTION 4 – OFFICE USE ONLY

Planning Department – Organization’s facilities:

Meets Does Not Meet City requirements.

SIGNATURE________________________________ DATE _______________________ Planning Director /Designee

Fire Department – Organization’s facilities:

Meets Does Not Meet City requirements.

SIGNATURE________________________________ DATE _______________________ Fire Marshall/Designee

Police Department – Application

Approved

Denied Per RMC 5.60.090, any person who has had an application for a bingo license denied may appeal the decision by filing with the City Clerk, within fifteen (15) days after the date of such decision, a written notice of appeal.

SIGNATURE_______________________________ DATE _____________________ Chief of Police/Designee

REASON DENIED _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________.