Anchorage at Jonathan’s Landing...
Transcript of Anchorage at Jonathan’s Landing...
1 | P a g e
Anchorage at Jonathan’s Landing Marina The Anchorage at Jonathan’s Landing
Condominium Association, Inc.
c/o Campbell Property Management
401 Maplewood Drive – Suite 23
Jupiter, FL 33458 PHONE 561-203-7910 FAX 561-277-2481
Thank you for your interest in The Anchorage at Jonathan’s Landing Marina. Please take time to review each
page and provide all requested information. Once complete, either fax back to Campbell Property Management at
561-277-2481 or email a scanned version to [email protected].. If you would like to hand deliver your
completed application, simply drop off at 401 Maplewood Drive, Suite 23, Jupiter, FL
Upon receipt, the application will be reviewed and you will be contacted with final billing information and slip
assignment. If you have any questions, please don’t hesi tate to contact me.
Please initial and return each page along with the full dockage payment, a security deposit equal to one month’s dockage,
pictures of three sides of the boat, copies of your insurance policy, and registration information.
Sincerely,
Debbie Ortiz
Enclosures: Bailment Application Slip Lease Rates, Bailment Agreement Rules and Regulations, Storm
Preparedness Plan
APPLICATION CHECKLIST: ALL REQUESTED DOCUMENTS TO BE SUBMITTED TOGETHER IN
ORDER FOR MANAGEMENT TO PROCESS FOR BOARD APPROVAL. NO BOATS CAN DOCK UNTIL
BOARD APPROVAL.
****APPLICATION TAKE APPROXIMATELY 14 DAY TO PROCESS.****
1) BAILMENT AGREEMENT COMPLETED
2) SCOTT ROBERTS BACKGROUND AUTHORIZATION FORM SIGNED
3) INSURANCE NAMING ANCHORAGE AS ADDITIONAL INSURED
4) REGISTRATION
5) PHOTO OF BOAT
6) CHECK FOR SLIP (PAYABLE TO ANCHORAGE @ JL)
7) CHECK FOR BACKGROUND ($50 PAYABLE TO CAMPBELL PROPERTY MANAGEMENT)
2 | P a g e
BAILMENT APPLICATION
The Anchorage at JL
Condominium Association, Inc. c/o Campbell Property Management 401 Maplewood Drive – Suite 23 Jupiter, FL 33458 PHONE 561-203-7910 FAX 561-277-2481
OWNER/APPLICANT: Signature Print Name
LOCAL ADDRESS: Street Apt. #
City State Zip
BILLING ADDRESS:
Street Apt. #
City State Zip
PHONE: FAX: EMAIL:
SPONSOR: _ TELEPHONE:
VESSEL NAME: VESSEL MAKE:
LENGTH (LOA): COLOR:
TYPE: INBOARD OUTBOARD I/O SAIL
INCLUDES: AIR COND. DEHUMID REFRIG BATTERY CHG
FL. REGISTRATION #: USCG DOC. #:
TOW PROVIDER NAME/PHONE #:_
INSURANCE NAME/PHONE #:_
INSURANCE POLICY #:_
ELECTRICITY CHARGE: 30A service
50A (or double 30A) 30A Non-standard service
BAILMENT PERIOD: SEASONAL ANNUAL
BAILMENT TERM: START DATE END DATE
DESIRED SLIP #:
------------------------------------------------------------------------------------------------------------------------------------------------
****** FOR INTERNAL OFFICE USE ONLY ******
APPROVED BY: ASSIGNED SLIP #:_ _
MONTHLY SLIP FEE (WITH ALL FEES/TAXES):_
SECURITY DEPOSIT REQUIRED: _ PREPAID SLIP FEE REQUIRED: _
3 | P a g e
STORM PREPAREDNESS PLAN
All slip renters are required to have and document a plan to secure their boats during a hurricane
or other major storm to prevent damage to the marina and other boats. The plan must identify the
methods used to secure the boat and who will be responsible (owner or captain) for making the
preparations described. Neither the Anchorage Association nor its employees or service
personnel are responsible for securing vessels in the marina. Any damage occurring to the owner’s
vessel, docks and the marina infrastructure, and other boats is the sole responsibility of the owner.
The Anchorage at Jonathan’s Landing will undertake actions necessary to recover repair or
replacements costs associated with damage created by the owner’s vessel. EMERGENCY CONTACT INFORMATION:
Emergency Contact Name:
Emergency Contact Phone No.:
Name of Insurance Co.:
Insurance Policy #:
Insurance Co. Phone No.:
PREPAREDNESS PLAN: How will you secure or remove the boat for impending hurricane or major storm?
Who will be responsible for removing or making sure the boat is secure?
Owner’s Signature:
Print Name:
Date:
4 | P a g e
SLIP LEASE RATES
ALL RATES ARE PER FOOT PER MONTH MEASURED LOA Up to 22 feet $9.50
23 – 30 feet $10.50
31 – 42 feet $11.00
43 – 48 feet $11.50
49 – 60 feet $12.00
Anchorage Owned Lifts: 33% Surcharge (Slip 45-49) Tenant Installed Lift: 25% Discount Minimum lease period is three (3) months. There is no refund for any unused portion of the
lease period.
Payment in full is required for a seasonal term and quarterly payment in advance is required for an
annual term. A security deposit equal to one month’s dockage will be included in the total payment
due upon approval of this Bailment Agreement. The security deposit less any assessments for
damages or unpaid balances will refunded if the lease is properly terminated and there are no fees
due for dockage or any other charges under this Bailment Agreement. There will be no rebate
of a month’s charges if a boat leaves earlier than the end of the month. Owner is required to
provide the Anchorage at least one month’s notice in writing on or before the first of the month to
terminate this Bailment Agreement. Any exception to this rule (i.e. “emergency situations or
repairs” will be determined on a case by case basis by the Dock Committee).
Monthly charge for electricity is as follows:
30A Service -- $35 per month 50A Service or double 30A Service -- $58 per month Non-standard 30A Service -- $17 per month (Standard charge for all boat lifts) Electricity charges are subject to change due to supplier cost increases or abnormal usage
Florida sales and use taxes will be added.
Lease rates are subject to change at the discretion of the Anchorage Association.
Slips will be assigned based on boat size determined as length overall (LOA). Length over
all is the length of the vessel from the most forward place to the most aft place inclusive of the
bow pulpit and swim platform. Over-sized vessels will not be allowed in slips of inadequate
size. The Association reserves the right to measure all vessels in determining length associated
with slip size and the Association's determination is final
5 | P a g e
BAILMENT AGREEMENT
The Bailment Agreement is entered into by the following bailer, hereinafter referred to as the
“Owner”, and Bailee, The Anchorage at Jonathan’s Landing Condominium Association, Inc.,
Marina, hereinafter referred to as the “Association”, whereby in return for certain monies to be paid
by the Owner, the Association grants to the Owner the right to store the following described boat
in an adequate space under the conditions described below. Anchorage residents shall have the
right of first refusal to any vacant slip in the Anchorage marina.
1. This Bailment Agreement shall be deemed a bailment for hire and shall be governed
exclusively by the terms and conditions stated herein. This Bailment Agreement and the
accompanying Bailment Application contain the entire understanding of the parties and
may not be modified except in writing signed by both parties. Every boat owner is
required to submit a new Bailment Application and Bailment Agreement yearly as of the
first of each year. Failure of any boat owner to pay the agreed upon dockage within 30 days
of any due date shall constitute an automatic termination of this Bailment Agreement
and the forfeiture of any last month’s rent and security deposit. The Anchorage
Association shall also be entitled to sue for and obtain all other damages including
attorney’s fees and costs due hereunder.
2. The Association makes no warranties or representations concerning security of the
premises, or about having an agent or employee on the premises.
3. It is expressly agreed by the Owner that the Association is not in any way an insurer of
the Owner's property or family, guests, employees, or agents. The Owner is responsible
for properly insuring the vessel. A certificate of current insurance accompanying this
Bailment Agreement is required naming the “The Anchorage at Jonathan’s
Landing Condominium Association, Inc.” at a minimum as a “certificate holder”.
4. The Association shall not be liable for personal injury, loss of life, property loss or
property damage to the Owner’s boat, motor, accessories or its contents due to fire, theft,
vandalism, collision, Marina equipment failure, windstorm, rain, hurricane, or other
casualty loss, or the ordinary negligence of the association, its employees, agents or third
parties. The Association shall not be liable for any acts beyond its control including any
failure of marina equipment that make it difficult or impossible for the owner to use the
boat.
5. The Owner for himself/herself, his/her family, guests, employees, agents, heirs, and
assigns hereby releases and agrees to indemnify and hold harmless the Association and
all of its employees and agents for any and all liability for personal injury, loss of life and
property damage:
a. arising out of the use of the storage space or negligence of Association personnel;
6 | P a g e
b. in connection with the Owners boat, motor and accessories while it is on the
premises or while it is being moved or while in the water moored to the
Association's docks; c. for loss or damage to the Owners boat, motor, accessories or contents thereof, or
Owner’s car or personal property in or around the dock area, due to fire, theft,
vandalism, collision, and marina equipment failure, windstorm, rain, a hurricane
or other casualty loss. The indemnification provided herein shall include all
costs, expenses and reasonable attorney's fees including appellate attorney’s fees
incurred by the Association and the defense of any action based on the foregoing,
including any action brought by the Owner, their family, guest, agents, or
assigns.
6. Slips will be assigned based on boat size determined as length overall (LOA). Over-sized
vessels will not be allowed in slips of inadequate size. The Association reserves the right
to measure all vessels in determining length associated with slip size and the
Association's determination is final.
7. The Owner agrees to comply with all the posted Rules and Regulations attached, as fully
as though they were set forth herein, and should breach of this agreement occur it will
terminate immediately, and the Association may remove the boat from the mooring space
at the Owner’s risk and expense and retake possession of the mooring space.
8. All charges must be paid in full before the boat will be permitted to leave the marina. To
secure payment of dockage fees and other services or materials rendered to or supplied to
the Owner, the Owner hereby grants to the Association a lien upon the boat, motor, or its
accessories. In the event that dockage fees have not been paid for a period of thirty (30)
days after becoming due, then it is hereby mutually agreed between the Owner and the
Association that the boat, motor and accessories may be sold by the Association at a non-
judicial sale as provided by applicable Florida statutes Chapter 677 or Chapter 85 to
satisfy the lien, in addition to any other remedy provided by law. This Agreement shall
also be deemed to be a warehouse receipt. In the event that a sale is made or other
collection procedures or legal action is required to collect any amount to this agreement,
the Owner agrees to pay all costs of sale or collection and reasonable attorney's fees. Notice
of the non-judicial sale will be mailed to the boat owner at the local address indicated in
this agreement. The security deposit provided by owner may be used by the Association
for any default under this Bailment Agreement and the Application thereto. Owner agrees
to pay all attorneys’ fees and costs incurred by Association hereunder as a result of Owner’s
breach of this Bailment Agreement and the Application.
9. The Bailment Agreement will be renewed yearly. Termination of this Bailment
Agreement is the sole responsibility of the owner by mailing written notice to
CAMPBELL PROPERTY MANAGEMENT 30 days prior to vacating the slip on or
before the first of the month prior to vacating the slip. The Owner and or the Association
may terminate this Agreement upon 30 days’ notice and after all charges against the boat
have been paid, the owner may remove the boat from the Association's premises. The
minimum term of this bailment agreement for dockage is THREE MONTHS and it is
mutually agreed that there will be no refund of any monthly dockage charges when this
Bailment Agreement is terminated by the Owner. Any notification to the owner pursuant
to any of the provisions of the Bailment Agreement will be sufficient if by mail to the
mailing address shown herein.
7 | P a g e
10. In the event any portion of this Agreement shall be deemed to be in violation of any law
of the United States or any law of the State of Florida, said portion, and said portion only,
shall be null and void and the balance of this Agreement shall remain in full force and
effect. This Agreement shall be interpreted in accordance laws of the State of Florida and
the laws of the United States.
11. Hurricane policy: In accordance with Section 59, Chapter 327 of the 2004 Florida
statutes, no vessel shall be required to vacate the Anchorage Marina following the
issuance of a hurricane watch or warning. However, Owners will be required to file a storm
/hurricane preparedness plan as part of this Bailment Agreement specifying details as to
how and by whom the vessel will be secured and the docks protected in the event of a storm
or hurricane. In the event of a hurricane or tropical storm, it is each owner’s express
responsibility to adequately secure their vessel using U.S. Coast Guard approved cleats,
ropes, lines, fasteners, fenders, etc. in accordance with their recorded Storm Preparedness
Plan, using double lines and adequate spring lines to allow for a 4ft. storm surge above
mean high tide. Vessel owners will be liable for any and all damages caused by their vessels
to The Anchorage Association marina, docks, and facilities and to other vessels moored in
the marina.
12. The wet storage charge entitles the Owner to a slip, storage locker, guest parking, and water
service. There will be an additional charge of $35 per month for standard 30A electrical
service or a charge of $58 per month for standard 50A or double standard 30A electrical
service. There will also be an additional charge of $17 per month for trickle charging up
to two batteries on an outboard boat, for powering any type of motorized boat lift or for
any other use on non-standard electrical service. 13. Seasonal tenants are billed in advance and payment is due in full before the first day of the
seasonal term. Annual tenants are billed quarterly in advance and payment is due on or before the first of the quarter and will be considered past due and delinquent after the 15th of the quarter. In addition to the initial billing of new tenants will be charged a security deposit equivalent to one month's lease rate based upon the current lease charges. The security deposit will be refunded after the final lease payment if there are no damages or other unpaid charges outstanding. If dockage is not paid within 15 days after becoming due, a late charge of
$50 per month will be applied to the next bill. Should payments to the Association
become delinquent by more than 15 days, the Association has the right to change the storage
location of the boat. Further, after delinquency of 30 days, the Association may begin to
pursue legal remedies available to it under existing Florida statutes, including the
attachment of a lien upon the boat as granted by the owner in item 8 above.
14. Owner is responsible for any damages to the Association’s property (including, but not
limited to, docks, finger piers, boat lifts and other marina facilities) as well as any damages
to other vessels within the marina caused in whole or in part by the negligence, omission
or intentional act of Owner, Owner’s guests or invitees.
15. The Association owns the lifts in 45 through 49. Tenants leasing these slips will be charged
a 33% surcharge of the total monthly lease ate, Upon prior approval of the Association,
tenants that install a lift in a currently leased will receive a 25% discount of the monthly
lease rate. This discount will cease upon non-renewal of the bailment agreement for that
slip. The lift becomes property of the Association upon competition of installation.
8 | P a g e
RULES AND REGULATIONS
In an effort to provide an inviting atmosphere for boat owners docking at The Anchorage Marina,
the following rules and regulations are provided for the protection of tenants and Anchorage
residents. When a boat enters the marina, the boat, crew, and guests must comply with all rules
set forth herein
1. Only pleasure boats in good condition and under their own power shall be admitted
to berthing areas. Each owner must make arrangements in advance for a third party
to check their vessel for any anomalies that may arise during the owners' absence,
and take appropriate and timely actions. If a problem is discovered that requires
immediate attention; for example, inoperable bilge pump, hull leaks, broken lines,
etc., the Association is authorized (but not required) to make the (or have made by
reputable service technician) emergency repairs, on a best efforts basis and as
economically as possible. Such repairs will be charged to the vessel owner. The
Association assumes no liability and shall be held harmless in the event of having made
any such emergency repairs it deems necessary.
2. Under no circumstances shall anyone be permitted to "live aboard" any vessel docked
at the Anchorage marina. However, on an exception basis only, permission for
Anchorage resident’s family members and/or guests to use vessel facilities overnight,
for a limited number of days, may be obtained from the Anchorage Association Dock
Committee. Vessels shall not anchor in the Marina basin except in rare and
emergency situations.
3. Boats leaving for an extended period of time will notify the Association. If
no advance notice has been given, and the slip is vacated by the vessel owner for more
than two weeks beyond the paid-up date, it will be assumed that the slip has been
abandoned and is therefore available for lease. Once the Bailment Agreement is
terminated, there is no guarantee that a returning vessel shall have the right to use the
same slip. Any returning vessel must submit a new Bailment Application and
Agreement and will be assigned the slip designated by the Owner.
4. The Rules of the Road and Navigation Laws of the United States will apply to all
vessels in or approaching the marina. Idle, no wake, speed limits will be strictly
enforced to protect the manatee population and to minimize excessive wake that
could damage other vessels and/or dock facilities.
5. Discharge of MSD holding tanks in the marina is a violation of federal laws and is
strictly prohibited.
6. Refuse shall not be thrown overboard. Garbage is to be maintained on board the
vessel and deposited in onshore waste disposal containers supplied for that purpose. No
person shall discharge oil, spirits, or other flammable liquids from vessels in the
marina. Charcoal fires are not permitted at the docks.
7. Owners shall notify the appropriate authorities in the event of any spill or leakage of
oil, gasoline or other flammable liquid into the waters of the marina. This notice
shall include immediate notification of the Anchorage Marina Committee.
9 | P a g e
8. Engine or generator operation, for the purpose of maintenance or performance checks, will be limited to 10 minutes per day between the hours of 9:00 a.m. and 4:00 pm. Upon re-entering its slip a vessel's engines will be shut down as promptly as practical to minimize exhaust fumes.
9. Monitoring and regulating the amount and volume of noise associated with boat
activities is of paramount concern in a marina that is directly adjacent to living
areas. The Anchorage Marina is a private facility and permits tenants to
perform only routine maintenance, repair and upkeep of their vessels and gear
between the hours of 9:00 am and 4:00 pm, October through May and 8:00 am
and 5:00 pm June through September. Such work includes the normally required
servicing, repair and maintenance of hulls, wood trim and bright work, engines
and power train components, air conditioning and refrigeration systems, electrical
and electronic systems, waste disposal and fresh water systems. The ONLY
exception to this rule is an emergency situation in which the vessel is in imminent
danger, when maintenance and upkeep requires the use of power tools these
shall not be operated except during the approved hours and are limited to small
power tools. Operators of power tools are expected to use discretion in
minimizing the noise they produce. At no time shall maintenance and upkeep
activities result in any damage or defacing of adjoining vessels or marina
property. At no time shall a Boat Owner permit overloud partying or use of its
boat and/or slip. If, in the discretion of the Dock Committee, a Boat Owner has
violated this policy, the Boat Owner shall be given a written warning. If the Boat
Owner violates this policy again after a written warning the Boat Owner shall be
subject to such penalties and fines as the Dock Committee imposes including
but not limited to the forfeiture of the security deposit and the requirement to
replenish the same or the termination of the Bailment Agreement.
10. More extensive repairs involving major rebuilding or reconstruction of any of the
systems described above are not permitted in the Anchorage Marina at any time.
11. Advertising or soliciting shall not be permitted on any boat within the marina. Neither the boat nor Marina address or phone numbers shall be used for business purposes.
12. Swimming or diving shall not be permitted from the docks, finger piers or boats.
13. Boat owners shall not store supplies, materials, accessories, or debris on piers or
walkways and shall not construct or install thereon any lockers, chests, cabinets or
similar structures except with the written approval of the Association. Painting,
scraping or repairing of gear shall not be permitted on the docks or finger piers.
Extent of repairs and maintenances shall be at the discretion of the association.
14. Boat owners shall not install satellite antennas, telecommunication or radio antennas,
nor any other television or radio reception devices on any piling, pier or dock.
15. Fish will not be cleaned on the docks or finger piers except for the fish cleaning
station located next to Slips 48-49.
10 | P a g e
16. Subleasing wet storage spaces and transfer of boats from the assigned space to
another space shall not be allowed. Owner agrees that in case of emergency, the
Association may move the boat from the particular space assigned to any other mooring
17. Laundry shall not be hung on boats, docks, or finger piers in the Marina, nor shall
"for sale" signs be put on boats.
18. Violation of the above rules and regulations, disorder, depredation, or indecorous
conduct by a tenant, their crew or guests, that might injure a person or cause damage
to property of the marina shall be cause for immediate removal from the marina of
the boat in question, the forfeiture of any security deposit and last month’s rent, the
imposition of fines for all of the above.
19. Leasing policy
a. All parties utilizing the docks must be 1) residents of Jonathan's Landing, or 2) sponsored by a resident of Jonathan’s Landing, or 3) invited guests of the above.
b. The appropriate Marina Committee official and/or the Management Company must be
notified on the docking of any vessel not currently allocated to a specific dock. Prompt
compliance with this policy will avoid unnecessary concern on the part of security
patrol.
c. Transient dockage is available only to Anchorage residents or their invited guests on an
availability basis. A daily transient leasing fee will be established by the Marina
Committee. All transient tenants are required to register their vessel with the Association
and to comply with the marina Rules and Regulations.
c. A non-resident tenant will not use Association facilities other than their leased dock space, the designated marina parking areas, and the docks and connecting paths thereto.
d. Any tenant, to remain eligible, must own 50% or greater share in the vessel involved unless approved by the Association.
I, the Owner, represent that the vessel is in compliance with current Federal and State of Florida registration laws. (Out of state vessels must register in Florida at the end of 90 days.)
I, the Owner, represent that the vessel is currently insured to cover damages to Association property,
other vessels, and Owner’s family and/or guests, employees, and agents. Proof of ownership and
proof of insurance are required to be attached to this completed Bailment Agreement.
I, the Owner, have read and fully understand the attached conditions, including Marina Rules and
Regulations, and agree to abide by each and every one of them, and do hereby voluntarily enter
into this Bailment Agreement with the Association, as of this
day of , 20
Owner: Signature Print Name
11 | P a g e
PLEASE NOTE: THIS IS A SAMPLE TEMPLATE DISCLOSURE/AUTHORIZATION PROCESS ONLY, AND IT SHOULD NOT BE CONSTRUED AS LEGAL ADVICE. ALL CLIENTS SHOULD CONSULT WITH COUNSEL TO
CONFIRM THAT THEIR DISCLOSURE AND AUTHORIZATION PROCESS COMPLIES WITH APPLICABLE FEDERAL, STATE, AND LOCAL LAWS.
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
The Anchorage at Jonathan’s Landing Condominium Association, Inc. (“the Company”) may obtain information about you
from a consumer reporting agency for tenant screening purposes. Thus, you may be the subject of a “consumer report” and/or
an “investigative consumer report” which may include information about your character, general reputation, personal
characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends or
associates. These reports may contain information regarding your criminal history, credit history, motor vehicle records (“driving
records”), verification of your education or employment history or other background checks. You have the right, upon written
request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative
consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained
with regard to applicants for residency is an investigation into your education and/or employment history conducted by Scott-
Roberts and Associates, LLC, 2290 10 Ave. N., Lake Worth, Florida 33461, (888) 605-4265,
www.scottrobertsassociates.com (“Agency”), or another outside organization. One person per application. You should
carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer
report. By signing this document you agree you have read and understand this disclosure.
_______________________________________________ _____________________________________________
Consumer’s Signature Print Consumer’s Name
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR
RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents.
I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after
receipt of this authorization and throughout my tenancy, if applicable. To this end, I hereby authorize, without reservation, any
law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information
service bureau, employer, insurance company, or other party to furnish any and all background information requested by Scott-
Roberts and Associates, LLC, 2290 10 Ave. N., Lake Worth, Florida 33461, (888)605-4265,
www.scottrobertsassociates.com, another outside organization acting on behalf of The Anchorage at Jonathan’s Landing
Condominium Association, Inc., and/or The Anchorage at Jonathan’s Landing Condominium Association, Inc. itself. I
agree that a facsimile (“fax”) or electronic or photographic copy of this Authorization shall be as valid as the original.
State of Washington applicants and/or residents only: You have the right to receive a complete and accurate disclosure of the
nature and scope of any investigative consumer report as well as a written summary of your rights and remedies under
Washington law.
New York applicants and/or residents only: You have the right to inspect and receive a copy of any investigative consumer
report requested by the Company by contacting the consumer reporting agency identified above directly.
California applicants and/or residents only: By signing below, you also acknowledge receipt of the NOTICE REGARDING
BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to
receive a copy of an investigative consumer report at no charge if one is obtained by the Company whenever you have a right
to receive such a copy under California law.
Signature: Date:
Sign
Here
Sign
Here
12 | P a g e
PLEASE NOTE: THIS IS A SAMPLE TEMPLATE DISCLOSURE/AUTHORIZATION PROCESS ONLY, AND IT SHOULD NOT BE CONSTRUED AS LEGAL ADVICE. ALL CLIENTS SHOULD CONSULT WITH COUNSEL TO
CONFIRM THAT THEIR DISCLOSURE AND AUTHORIZATION PROCESS COMPLIES WITH APPLICABLE FEDERAL, STATE, AND LOCAL LAWS.
Last Name: ______________________________ First Name: _________________________ Middle: ___________
Other Names Used (alias, maiden, nickname):________________________________________________________________
Email Address:
Current Address:
Street/P.O. Box City State Zip Code County Dates
Former Address:________________________________________________________________________________________
Street/P.O. Box City State Zip Code County Dates
Former Address: ________________________________________________________________________________________
Street/P.O. Box City State Zip Code County Dates
Current Employer:_______________________________________________________________________________________
Company Name City State Zip Code
________________________________________________________________________________________
Hire Date Supervisor Name/phone # Salary
Former Employer: _______________________________________________________________________________________
Company Name City State Zip Code
_______________________________________________________________________________________
Hire Date End Date Salary Supervisor Name/phone #
Education Information: __________________________________________________________________________________
Institution Name City State
__________________________________________________________________________________
Highest Degree Achieved Major Date Degree Awarded
Driver’s License #:________________________________State:________Gender_______Daytime Phone________________
Social Security Number: * Date of Birth: *
*This information will be used for background screening purposes only.
13 | P a g e
PLEASE NOTE: THIS IS A SAMPLE TEMPLATE DISCLOSURE/AUTHORIZATION PROCESS ONLY, AND IT SHOULD NOT BE CONSTRUED AS LEGAL ADVICE. ALL CLIENTS SHOULD CONSULT WITH COUNSEL TO
CONFIRM THAT THEIR DISCLOSURE AND AUTHORIZATION PROCESS COMPLIES WITH APPLICABLE FEDERAL, STATE, AND LOCAL LAWS.
NOTICE REGARDING BACKGROUND INVESTIGATION
PURSUANT TO CALIFORNIA LAW
The Anchorage at Jonathan’s Landing Condominium Association, Inc. (“the Company”) intends to obtain
information about you from an investigative consumer reporting agency and/or a consumer credit reporting
agency for tenant screening purposes. Thus, you can expect to be the subject of "investigative consumer reports"
and "consumer credit reports" obtained for tenant screening purposes. Such reports may include information
about your character, general reputation, personal characteristics, and mode of living. With respect to any
investigative consumer report from an investigative consumer reporting agency ("ICRA"), the Company may
investigate the information contained in your tenant application and other background information about you,
including but not limited to, obtaining a criminal record report, verifying references, work history, your
educational achievements, licensure, and certifications, obtaining your driving record and other information
about you, and interviewing people who are knowledgeable about you. The results of this report may be used
as a factor in making tenant application decisions. The source of any investigative consumer report (as that
term is defined under California law) will be Scott-Roberts and Associates, LLC, 2290 10 Ave. N., Lake Worth,
Florida 33461, (888)605-4265, www.scottrobertsassociates.com. The source of any credit report will be Scott-
Roberts and Associates, LLC, 2290 10 Ave. N., Lake Worth, Florida 33461, (888)605-4265,
www.scottrobertsassociates.com. Information regarding Scott-Roberts and Associates, LLC’s privacy practices
(including information about whether any consumer personal information will be sent outside the U.S. or its
territories) may be found at http://scottrobertsassociates.com.
The Company agrees to provide you with a copy of an investigative consumer report when required to do so
under California law.
Under California Civil Code section 1786.22, you are entitled to find out from an ICRA what is in the ICRA’s
file on you with proper identification, as follows:
In person, by visual inspection of your file during normal business hours and upon reasonable notice. You
also may request a copy of the information in person. The ICRA may not charge you more than the actual
copying costs for providing you with a copy of your file.
A summary of all information contained in the ICRA’s file on you which is required to be provided by the
California Civil Code will be provided to you via telephone, if you have made a written request with
proper identification for telephone disclosure and the toll charge, if any, for the telephone call is prepaid
by or charged directly to you.
By requesting a copy be sent to a specified addressee by certified mail. ICRAs complying with requests
for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after
such mailings leave the ICRAs.
"Proper Identification" includes documents such as a valid driver’s license, social security account number,
military identification card, and credit cards. Only if you cannot identify yourself with such information may
the ICRA require additional information concerning your employment and personal or family history in order
to verify your identity.
The ICRA will provide trained personnel to explain any information furnished to you and will provide a written
explanation of any coded information contained in files maintained on you. This written explanation will be
provided whenever a file is provided to you for visual inspection.
You may be accompanied by one other person of your choosing, who must furnish reasonable identification.
An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file
in such person’s presence.