anchorage at jonathan’s landing...

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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)

mailto:[email protected]..

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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: _

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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:

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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

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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;

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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.

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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.

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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.

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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.

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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

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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

http://www.scottrobertsassociates.com/

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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:________________________________________________________________________________________


Former Address: ________________________________________________________________________________________


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.

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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.

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