Form 2601--General Information (Automobile Club Application for Certificate of Authority) The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney. Commentary Automobile Clubs are governed by Chapter 722 of the Texas Transportation Code and the secretary of state's administrative rules found in 1 Texas Administrative Code Chapter 75. Complete this form to obtain a new or renewed automobile club certificate of authority. Automobile club certificates of authority expire annually on August 31st and must be renewed. Instructions for Form · Preliminary Information: Select the appropriate box indicating whether this is a new application or an application for renewal. If it is a renewal, you should provide the registration number assigned by the secretary of state to facilitate processing of the document. Applicant Information: Include the name, principal business address, and office address of the automobile club applying for the certificate. You should also include the requested contact information. An email address is requested to facilitate communication with the secretary of state. Any email address provided is confidential pursuant to § 552.137 of the Texas Government Code. The secretary of state will redact the email address prior to providing a copy of this form in response to a public information request. Owner/Officer Information: If the automobile club is not a corporation, the application must list all of club's owners and officers. If the automobile club has more than three owners and officers, use an additional sheet. A document on file with the secretary of state is a public record subject to public access and disclosure. When providing address information, use a business or post office box address rather than a residence address if privacy concerns are an issue. · Operating/Management Agreement: If the automobile club is not a corporation, the application must include a list of all parties to any operating or management agreement governing the club. Attachments: The following items must be included with the application: 1. Annual fee of $150. 2. If the applicant is a corporation, a certificate status from the secretary of state showing the corporation is "in existence." A certificate of status may be ordered in one of the following ways: a. Via SOSDirect, our web-based system; b. By telephone at (512) 475-0775 c. By fax at (512) 475-2815; d. By email to corpcert@sos.texas.gov; or e. By mail to the Secretary of State Corporations Section Records Department, P.O. Box 13697, Austin, TX 78711-3697. 3. If the applicant is not a corporation, a copy of any operating agreement or management agreement affecting the club and a list of each party to the agreement. Form 2601 1 American LegalNet, Inc. www.FormsWorkFlow.com · · · 4. Proof of a $25,000 security deposit. The security may be in the form of (1) a certified check or money order made payable to the secretary of state; (2) a bond payable to the state, executed by a corporate surety licensed to do business in Texas, and meeting the conditions set forth in Section 722.005(a)(3), Texas Transportation Code; or (3) a certificate of deposit with assignment to the secretary of state. 5. A certified copy of each service contract plan that the automobile club is offering to its members. 6. If the automobile club provides participation in a group accidental injury or death policy, a copy of the certificate of participation. Note: Automobile clubs are also required to file changes to service contracts with the secretary of state. · Execution: A person who is authorized to sign on behalf of the person or entity applying for the automobile club certificate of authority must sign and date the application before a notary public or other official who has authority to administer an oath. Payment and Delivery Instructions: The annual fee for the Automobile Club Certificate of Authority is $150. Fees may be paid by personal checks, money orders, LegalEase debit cards or American Express, Discover, MasterCard, and Visa credit cards. Checks or money orders must be payable through a U.S. bank or financial institution and made payable to the secretary of state. Fees paid by credit card are subject to a statutorily authorized convenience fee of 2.7 percent of the total fees. The completed form along with the fee, certificate of status or operating/management agreement, if required, proof of security, service contract plan, and certificate of participation, if required, may be mailed to Registrations Unit, P.O. Box 13550, Austin, Texas 78711-3550 or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin, Texas 78701. The secretary of state will issue a certificate of authority upon filing of a completed application. Revised 02/2012 Form 2601 2 American LegalNet, Inc. www.FormsWorkFlow.com Form #2601 Rev. 02/2012 This space reserved for office use Submit to: SECRETARY OF STATE Registrations Unit P O Box 13550 Austin, TX 78711-3550 512-475-0775 512-475-2815 - Fax Filing Fee: $150 AUTOMOBILE CLUB CERTIFICATE OF AUTHORITY APPLICATION / RENEWAL Registration Number: Application for New Registration Application for Renewal of Registration Applicant Information Automobile Club Name: Contact Name: Phone: Principal Business Address: Street City State Zip Email Address: Fax: Office Address (if different from above): Street City State Zip Is the automobile club a corporation? Does the club provide participation in a group accidental injury or death policy? Yes Yes No No Owner/Officer Information Complete this section only if the automobile club is not a corporation. List each person who holds an ownership interest in the automobile club and each person who is an officer of the club. For "Position," write "owner" if the person holds an ownership interest and write the office held if the person is an officer. Name: Mailing Address: Street Position: City State Zip Name: Mailing Address: Street Position: City State Zip Name: Mailing Address: Street Position: City State Zip LIST ANY OTHER OWNERS AND OFFICERS ON A SEPARATE SHEET Form 2601 3 American LegalNet, Inc. www.FormsWorkFlow.com Operating/Management Agreement Complete this section only if the automobile club is not a corporation. If the automobile club is governed by an operating agreement or management agreement, list each part