HomeMy WebLinkAboutItem 06.lMarch 19, 2012
Proposed Action
Overview
Primary Issues to Consider
Supporting Information
n Hennen
ark Maintenance & Operations Mgr
APPROVAL OF TREE WORK LICENSE
FOR MIDWEST TREE EXPERTS
Item No.
Staff recommends adoption of the following motion: Approve tree work license for
Midwest Tree Experts.
Passage of this motion will result in issuing a tree work license for Midwest Tree
Experts.
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching, injections and stump removal) in the city.
Midwest Tree Experts has submitted an application for a tree work license.
Staff is recommending approval of a tree work license for Midwest Tree Experts.
0 Applicant paid fee and submitted Certificate of Insurance.
Staff contacted the applicant and verified they are knowledgeable about arbor
practices and proper tree care.
a Copy of Application for Tree Work License submitted by Midwest Tree Experts.
Financial Impact: $ Budgeted: YIN Source:
Related Documents (CIP, ERP, etc.):
Notes:
1. Business name: 1 es\ \ct-v Ck +t r\
APPLICATION FOR TREE WORK LICENSE
CITY OF LAKEVILLE
20195 Holyoke Avenue, Lakeville, MN 55044
952- 985 -4400
Phone no: ((9 ) 11' is k Fax:
3. Contact person: ANC yr, Title:SWur
4. Mailing address: \ `„t_ \A tAg
Street City Zip
5. Person to be contacted in emergency: .13 h;, 1X:1 - i
6. Business ownership: Individual Partnership Corporation
7. Number of employees: d List names of employees, partners or officers below:
J S�
8. Minnesota Tax Identification No. of business
(or Social Security No. if applicant is an individual): 1 )7- 8 k7 )15
9. Number of vehicles: f )
10. Type of equipment to be used in business: 41h 4r, \ - ; cA.La, A r e t,i
11. Will you be using chemical subs races in any activity related to treatment or disease
control.? YES NO (If YES, certification by the Agronomy Division of the
Minnesota Department of Agriculture as a "commercial pesticide applicator" must be attached.)
12. Please provide the following information related to workers' compensation insurance,
or certify the precise reason your business is excluded from compliance with the
insurance coverage requirement for workers' compensation.
Insurance company name (NOT agent):
Policy number or self- insurance permit number:
APPLICATION FOR TREE WORK LICENSE Page -2-
12. (CONTINUED)
Dates of coverage: to
(or)
I am not required to have workers' compensation liability coverage because:
( ) l have no employees covered by the law.
( ) Other (Specify)
13. Proof of public liability insurance, covering all operations, for the sum of $300,000
combined single limit coverage must be attached.
14. Ip your company licensed in any other city? If so, please Iist:
1
If not licensed in other cities. please use the spaces above to list references and phone numbers.
1, the undersigned, hereby certify that the above information, furnished by me, is true and
correct to the best of my knowledge. 1 further acknowledge that 1 have read and
understand the attached "Tre- Preservation" and "Shoreland Impact" guidelines.
Authorized Signatur
O ' \Q (
Title
Date: 3- .
ANNUAL FEE: $25.00
All Licenses Expire December 31st
TREEAPPL.doc(11 /22/02)