HomeMy WebLinkAboutItem 06.eApril 16, 2012
Proposed Action
Staff recommends adoption of the following motion: Approve tree work license for
Newtons Tree & Stump Service, LLC.
Passage of this motion will result in issuing a tree work license for Newtons Tree &
Stump Service, LLC.
Overview
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching, injections and stump removal) in the city.
Newtons Tree & Stump Service, LLC has submitted an application for a tree work
license.
Staff is recommending approval of a tree work license for Newtons Tree & Stump
Service, LLC.
Primary Issues to Consider
• Applicant paid fee and submitted Certificate of Insurance.
• Staff contacted the applicant and verified they are knowledgeable about arbor
practices and proper tree care.
Supporting Information
• Copy of Application for Tree Work License submitted by Newtons Tree & Stump
Service, LLC.
n Hennen
ark Maintenance & Operations Mgr
APPROVAL OF TREE WORK LICENSE
FOR NEWTONS TREE & STUMP SERVICE, LLC.
Item No.
Financial Impact: $ Budgeted: YIN Source:
Related Documents (CIP, ERP, etc.):
Notes:
APPLICATION FOR TREE WORK LICENSE
CITY OF LAKEVILLE
20195 Holyoke Avenue, Lakeville, MN 55044
952 -985 -4400
1. Business name: � � util 01 a k "dl). R Wi' e--,t L C.
2. Phone no: ( ) yY
3. Contact person: r •trly At - ."_ kv Title: Out_.)yy n,
4. Mailing address: ;oS 37 ,t3-c/ :S= 6 Mr,r �v 2
cit Zip
Street
5. Person to be contacted in emergency: a ny ,/F rii u
6. Business ownership: >c Individual Partnership Corporation
7. Number of employees: (L) List names of employees, partners or officers below:
8. Minnesota Tax Identification No. of business
(or Social Security No. if applicant is an individual):
9. Number of vehicles: — 160 c�
Fax:
10. Type of equipment to be used in business: --- z,t.`es , C . TpoJe s G{- 4 :5'A
11. Will you be using chemical substances 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 naive (NOT agent): 'I LOLL" ---s l TPc c Nli,�` c
Policy number or self-insurance permit number: A M St c) c� a C9
APPLICATION FOR TREE WORK LICENSE P age _2_
12. (CONTINUED)
Dates of coverage: a. i 51 to /j. /,, 3
(or) / '
I am not required to have workers' compensation liability coverage because:
( 1 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. Is your company licensed in any other city? If so, please list:
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. I further acknowledge that I have read and
understand the attached "Tree Preservation" and "Shoreland Impact" guidelines.
Authorized Signature
Title
TREEA PP L. d o c (11 /22/02)
Date:
ANNUAL FEE: $25.00
All Licenses Expire December 31st