CALIFORNIA BEER SHIPPER'S AGREEMENT day of On this Sacramento, California, the Department of Alcoholic Beverage Control and , at , whose address is and who is hereinafter referred to as the Vendor, have mutually agreed as follows: 1. This agreement shall be deemed to have been made and entered into at Sacramento, California, on the above date, and shall in all respects be governed by the Alcoholic Beverage Control Act and in particular Sec tion 23671 of the Business and Professions Code of the State of California, and regulations promulgated pursuant to such laws, in force on the said date and as thereafter amended, repealed, or modified. 2. The Vendor agrees that it and its agents and all agencies within this state controlled by it will comply with all laws of this state and all rules of the Depart ment with respect to the sale of alcoholic beverages, including, but not lim ited to, Section 25000 of th e California Business and Professions Code requiring the filing of price schedules with the Department. 3. In consideration of the privilege of shipping beer to purchasers within the State of California for sale within California, the Vendor agrees to furnish to th e State Board of Equalization, P.O. Box 942879, MIC 56, Sacram ento, California 94279-0001, or its successor in function, on or before the 10th day of each month a report on a form to be prescribed and furnished by the Board of Equalization, showing the quantity of beer shipped by the Vendor to purchasers within the State of California during the preceding month. It is necessary for a report to be filed even though no beer is shipped. 4. The Department of Alcoholic Beverage Control of the State of California agrees to furnish to the Vendor a Certificate of Compliance in acco rdance with Section 23671 of the Alcoholic Beverage Control Act of the Stat e of California, without fee. Such Certificate shall rem ain in effect until revoked. 5. It is understood and agreed that all reports furnished pursuant to the agreement shall become the property of the State of California when received and shall become public record. 6. The Vendor agrees that, upon failure to re nder the reports as herein provided, the Department of Alcoholic Beverage Control m ay suspend or revoke the Vendor's Certificate of Compliance in the manner provided by Section 23671 of the Alcoholic Beverage Control Act of the State of California. 7. If the Vendor ships beer into California from a point other than the address listed above, the Vendor will report by one of the following methods: Make one consolidated report for all shippi ng points outside Californi a. If this item is checked, a list of names and addresses of shipping points must be attached. ABC-410 (01/10) American LegalNet, Inc. www.FormsWorkFlow.com Separate report from each shipping point of Vendor. If this item is checked, a separate California Beer Shipper's Agreement must be executed by each of the Vendor's branches. 8. If the Vendor ships beer into California from more than one shipping point and has elected to make a single consolidated m onthly report, the Departm ent of Alcoholic Beverage Control will issue a single Cer tificate of Compliance. If the Vendor has elected to file separate reports from each shipping point, th e Department may issue to the Vendor a Certificate of Compliance for each shipping point for which a report will be filed. 9. The Vendor designates as its general agent/atto rney in fact for service of legal process within the State of California (name and street address - not P.O. Box) Phone: 10. The first report shall be due for the m onth in which the Certificate of Compliance is issued and each month thereafter until the Certificate of Compliance is surrendered or revoked. A. Do you expect to ship draught beer into California? If so, list the brand names below. If no brands of draught beer will be shipped into California, enter the word "None". B. Brands and types of canned or bottles beer to be shipped into California for which can flats or labels are enclosed: Recommend Approval ___________________________________ Diana Villanueva Program Technician III (916) 419-2571 For Lee Riegler Supervising Investigator, Trade Enforcement ________________________________ Name of Company ________________________________ Signature Title ________________________________ Contact Person & Phone Number ABC-410 (07/12) -2American LegalNet, Inc. www.FormsWorkFlow.com