Alarm Agent License Application

License Application for - Alarm Agent

MUNICIPAL CODE SECTION – 4-18.7 (See also 12.1-12.6)
South Bend Municipal Code: Section 4-17.8 and 12.1-12.6

Definition:

Alarm agent means any person or entity, whether an individual, partnership, or corporation, who conducts a business of monitoring alarm systems and whos actions would involve contacting the South Bend Police Department or South Bend Fire Department for a Response.

General Instructions and Application Process:
1. Assemble all required information and materials before filing the application
2. Thoroughly review all applicable Municipal Code Sections listed above
3. Licenses expire January 31
4. Add 10% to license fee for renewal after January 31
5. After filing application, you will be responsible for paying the $5.00 processing fee, either over the phone at 574-235-5912 or by coming in person to City Hall.
6. License fee payable to the City of South Bend due upon approval - $75.00 (if you choose, you may submit the license fee with the processing fee).
7. Application is reviewed by the South Bend Police Department and facilities located within the city limits will be inspected by the South Bend Fire Department.
8. License will be issued upon approval and payment of the license fee.
Required Information and Materials:
1. Maintain and provide immediately upon request to South Bend Police or Fire Departments: records of current alarm users employing applicants services, including name, address, and telephone number of location where alarm system is installed, as well as names, addresses, and telephone numbers of primary, secondary, and any additional key holders of that alarm user.
2. If facility has multiple alarm systems or sensors, maintain facility floor plans, blueprints, or similar documents showing zone locations for each system or sensor.
Questions?

For all municipal business license questions, contact:

City of South Bend

Department of Community Investment

215 S. Dr. Martin Luther King Jr. Blvd.

Suite 500
South Bend, Indiana 46601

Phone: 574.235.5912

Fax: 574.235.9021

Application Type
Is this application pertaining to a new restaurant or are you renewing your existing permit?*

New PermitRenew Permit
Business Data
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Mailing address differ from Property Address?*

Yes, different addressNo, Same address
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address*
example@example.com
Number of Clients in South Bend*
All-Hours Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Personal Data

Required for a background check performed by the South Bend Police Department
Applicant's Legal Name*

First NameMiddle NameLast Name
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Last Four Digits of Applicant's Social Security Number*
Copy of Applicant's Driver's License or other Government-Issued ID*

Cancelof
Date of Birth*

MonthDayYear
Position with Organization*
DO NOT SEND THE FOLLOWING INFORMATION TO THE CITY OF SOUTH BEND UNTIL REQUESTED.

Applicant, by submission of this application, agrees to maintain the following records and to provide them to the South Bend Police Department or South Bend Fire Department immediately upon request.
1. Maintain and provide immediately upon request to South Bend Police or Fire Departments: records of current alarm users employing applicants services, including name, address, and telephone number of location where alarm system is installed, as well as names, addresses, and telephone numbers of primary, secondary, and any additional key holders of that alarm user.
2. If facility has multiple alarm systems or sensors, maintain facility floor plans, blueprints, or similar documents showing zone locations for each system or sensor.
Is there a contact person other than you?*

YesNo
Contact Person's Legal Name*

First NameLast Name
Contact Person's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person's Home Number*
Please enter a valid phone number.Format: (000) 000-0000.
Contact Person's Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Contact Person's Email*
example@example.com
Signature
I, hereby, certify and affirm that all of the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Alarm Agents license found in the City of South Bend Municipal Code, Sections 4-18.7, 12-1, 12-2, 12-3, 12-3.5, and 12-6.
Electronic Signature*

First NameLast Name
Date*

MonthDayYear
Should be Empty:

License Application for - Alarm Agent

Definition:

General Instructions and Application Process:

Required Information and Materials:

Questions?

Application Type

Business Data

Personal Data

Signature