HomeMy WebLinkAboutItem 06.oAugust 30, 2012 0 Item No.
TREE WORK LICENSE FOR ISAAC'S TREE AND LAWN CARE
Proposed Action
Staff recommends adoption of the following motion: Move to approve tree work license for
Isaac's Tree and Lawn Care.
Passage of this motion will result in issuing a tree work license for Isaac's Tree and Lawn Care.
Overview
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching, injections and stump removal) in the City.
Isaac's Tree and Lawn Care has submitted an application for a tree work license.
Staff is recommending approval of a tree work license for Isaac's Tree and Lawn Care.
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 Isaac's Tree and Lawn Care
hn Hen nen
nterim Parks &Recreation Director
Financial Impact: $ Budgeted: Y/N Source:
Related Documents (CIP, ERP, etc.):
N otes:
APPLICATION FOR TREE WORK LICENSE
CITY OF LAKEVILLE
20195 Holyoke Avenue, Lakeville, MN 55044
952- 985 -4400
1. Business naive:
2. Phone no: (Q_) Fax:
3. Contact person:, � �0 Title: , c��
4. Mailing address: I/ q01 k 6 aA & �� v)l1e IJ�
Street City Zip
5. Person to be contacted in emergency: lcacyr INAson
6. Business ownership: t// Individual Partnership Corporation
7. Number of employees: _0 List names of employees, partners or officers below:
8. Minnesota Tax Identification No, of business
(or Social Security No. if applicant is an individual): !� - tJ� 2 22
9. Number of vehicles:
10. Type of equipment to be used in business: _�'��rc Lgder ( 5alr1 t;�ir���!
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 name (NOT agent): W �If .„ P fl �n�nv
Policy number or self - insurance pen number: N ! 9 f 0 2
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:
( I 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: IVO
Tot Wal s em q F2 H - 2
If not licensed in other cities, please use the spaces above to List references and phone numbers
I, 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.
': L-M 4/,7 Dater -2 7 1,2
Authorized Signature
0 wPe10
Title
ANNUAL FEE: $25.00
All Licenses Expire December 31st
TREEAPPLAoc(I I /22/02)