DIVISION OF COMMERCIAL LICENSING AND REGULATION LIQUOR SECTION 233 Richmond Street, Suite 230 Providence, Rhode Island 02903-4230 Telephone (401) 222-2562 Facsimile (401) 222-6654 www.dbr.state.ri.us APPLICATION FOR AND CERTIFICATE OF COMPLIANCE _________________________________________________________________________of_________________________________________________________________________ Name of Applicant Street Address ________________________________________________________________________ City of Town ________________________________________________________________________ State This Certificate of Compliance is for the purpose of transporting into the State of Rhode Island the following brands, blends, mixtures, varieties, types, kinds and classes of distilled spirits, malt beverages and vinous beverages: (If additional space needed, use blank paper and attach) Distilled Vinous Malt ____________________________________________________________________________________________________________________ DESIGNATION The applicant hereby states that it is the owner or authorized distributor of the above brands, and as such has the authority to appoint a Rhode Island licensed wholesale liquor dealer, namely, Rhode Island Wholesalers name_________________________________________________________________________________________________________________________ AFFIDAVIT Signed this_________________________________________________________day of _____________________________________________________20____________________ By________________________________________________________________________________________________________________________________________________ Signature Official Capacity NOTARY PUBLIC Sworn to before me this ______________________________________________day of_____________________________________________________20____________________ Signature of Notary Public_____________________________________________________________________________________________________________________________ Certificate of Compliance Approval (For LCA use only) Certificate No.___________________________________________________ No. of Labels____________________________________________________________ This certificate is issued to be effective from: Fee____________________________________________________________________ ______________________________ 20________to December 1, 20______ AUDIT No.____________________________________________________ Signed_________________________________________________________________ Rhode Island Liquor Control Administrator Date___________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com DIVISION OF COMMERCIAL LICENSING AND REGULATION LIQUOR SECTION 233 Richmond Street, Suite 230 Providence, Rhode Island 02903-4230 Telephone (401) 222-2562 Facsimile (401) 222-6654 www.dbr.state.ri.us GUIDELINES FOR REGISTERING LABELS IN THE STATE OF RHODE ISLAND • • • • • • • • • • • • • • The Application for and Certificate of Compliance must be filled out in its entirety. Labels must be listed under the proper column, distilled, vinous or malt. All different vintages of wine must be listed and the fee paid on each. Do not register different sizes of a label. The Wholesaler being used in Rhode Island must be identified in the designation section. The affidavit section must be signed and the certificate notarized. Federal Label approvals and samples of your labels must accompany the application. If the product is imported then the applicant must show it has the authority to handle the product producing an authorization letter from the product owner stating the applicant’s authority. Refer to the label registration fees chart for the month and correct fee to be used per label. Label renewals billings are sent out during the Fall and are due by December 1. The label renewal year is from December 1 to November 30 of the next year. The Affirmation Statement form must be signed for all distilled and vinous beverages (Not for malt products) and must be notarized. Copies of invoices must be filed every time you sell in Rhode Island along with price lists and all updates. If the applicant has a salesperson in Rhode Island that person must be licensed as an Agent. The application for an Agent license is located on this website. Checks for label registrations should be made payable to Rhode Island Liquor Control or State of Rhode Island General Treasurer. Any checks payable to any other department will be returned. This information is provided per the General Laws of Rhode Island, 1956, as amended, Title 3 Alcoholic Beverages. American LegalNet, Inc. www.FormsWorkflow.com DIVISION OF COMMERCIAL LICENSING AND REGULATION LIQUOR SECTION 233 Richmond Street, Suite 230 Providence, Rhode Island 02903-4230 Telephone (401) 222-2562 Facsimile (401) 222-6654 www.dbr.state.ri.us THE APPLICANT APPLYING FOR A CERTIFICATE OF COMPLIANCE PURSUANT TO SECTION 3-6-14 OF THE GENERAL LAWS OF RHODE ISLAND, 1956 AS AMENDED, SHALL COMPLY WITH ALLPROVISIONS OF TITLE 3 OF SAID GENERAL LAWS AND WITH ALL RULES, REGULATIONS AND ORDERS ISSUED AND PROMULGATED UNDER AUTHORITY OF SAID TITLE 3. INSTRUCTIONS 1. A Certificate of compliance issued by this office must be in your possession to entitle you to make shipments into Rhode Island. 2. This application must be typed, signed in ink and filed with the Liquor Control Administration. 3. Show proof and age of each type and class. List each label separately under the appropriate heading (distilled, vinous or malt). 4. If the brand name is used for more than one product, list each item separately: Example- Brand X wine, Chablis, Burgundy. 5. If label was never registered before in Rhode Island, 1st time only use the attached pro-rated fee chart. Renewal fee will be $40.00 for each label. Any old labels being reactivated will also be $40.00. 6. This application must be filled out in its entirety to cover all brands, blends, mixtures, varieties, types, flavors, kinds and classes, difference of alcoholic proof and color. All items must have the exact name and proof as on label of bottle or container, or on any special bottle or container in which the beverage is shipped into this state. 7. Submit with this application a copy of Federal Label Approval (new items only) and Affirmation of Price Compliance. 8. Importers (primary source) – Submit with this application a copy of basic contract with foreign suppliers. (See #2 below). 9. This Certificate is approved when signed by the Liquor Control Administration. This Certificate shall expire on December 1, of each year. CONDITIONS PRECEDENT TO TRANSPORTING ALCOHOLIC BEVERAGES INTO RHODE ISLAND Outlines below are the conditions precedent to transporting or causing to be transported distilled spirits, vinous and malt beverages in the State of Rhode Island. 1. At the time of each shipment, a copy of the shippers invoice must be mailed directly to this office. 2. Any change in designation of a Rhode Island wholesaler must be forwarded to this office at the time of change. 3. Primary Source – The holders of wholesale licenses in this State shall purchase only from the Distillery, Rectifier, Winery or Brewery manufacturing the same or from the importer holding the basic contract with a foreign supplier. 4. A holder of a Certificate of Compliance may ship only to wholesale licensees in Rhode Island. 5. This Certificate shall not relieve any person from liability for violation of the General Laws of Rhode Island, 1956, as amended or the rules and regulations issued under it. 6. Failure to comply with the above conditions shall result in a stop sale order on this merchandise and same shall be returned to you at your risk. American LegalNet, Inc. www.FormsWorkflow.com DIVISION OF COMMERCIAL LICENSING AND REGULATION LIQUOR SECTION 233 Richmond Street, Suite 230 Providence, Rhode Island 02903-4230 Telephone (401) 222-2562 Facsimile (401) 222-6654 www.dbr.state.ri.us RHODE ISLAND LIQUOR LABEL REGISTRATION FEES Label fees increased on July 15, 2004 in Rhode Island to $40.00 for each label. Following is the chart that reflects the monthly pro-rata figure to use when labels are registered in months, other than December for the first time only. Thereafter, at renewal time, the $40.00 fee shall apply for each label. Each label year begins December 1 and is effective until November 30 of the next year. Renewals bills are sent during September and October. Vendors should take this time to decide which labels will be renewed and paid for by December 1. All label registration checks must be made payable to Rhode Island Liquor Control or State of Rhode Island General Treasurer. Any checks payable to any other department will be returned. The pro-rata fees are as follows: December $40.00 (1st time registry and renewal fees) January 36.63 February 33.30 March 29.97 April 26.64 May 23.31 June 19.98 July 16.65 August 13.32 September 9.99 October 6.66 November 3.33 American LegalNet, Inc. www.FormsWorkflow.com DIVISION OF COMMERCIAL LICENSING AND REGULATION LIQUOR SECTION 233 Richmond Street, Suite 230 Providence, Rhode Island 02903-4230 Telephone (401) 222-2562 Facsimile (401) 222-6654 www.dbr.state.ri.us AFFIRMATION Pursuant to the provisions of Section 3-6-14.1 of the General Laws of Rhode Island, 1956, as amended, the undersigned, holder of a Certificate of Compliance, hereby affirms and does certify as follows: 1. The undersigned is the holder of a Certificate of Compliance for each of the brands of distilled spirits or vinous beverages (Not for malt beverages) set forth in the schedule of prices to wholesalers attached hereto. 2. The bottle or case price of distilled spirits or vinous beverages to the Rhode Island wholesaler set forth in the attached Schedule of Prices to Wholesalers is not higher than the lowest price at which such item of distilled spirits or vinous beverages are being sold, offered for sale, shipped, transported or delivered by such holder to any wholesaler in any other State in the United States or in the District of Columbia or to any State or agency of a State which owns and operated retail liquor outlets. 3. This Affirmation and the Schedule of Prices to Wholesalers attached hereto shall remain in full force And effect until amended by the undersigned. Such amendment shall be filed within ten (10) days of The date of change of any price of an item listed on the attached Schedule of Prices to Wholesalers. _____________________________________________________________ Name of Holder of Certificate of Compliance By__________________________________________________________ Signature and Title of Authorized Officer or Representative Date_________________________________________________________ Notary Public State of ______________________________________County of ___________________________________ Subscribed and sworn to before me on this______________day of ____________________________20____ Notary Public____________________________________________________________________________ My Commission expires on _________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com