HomeMy WebLinkAboutItem 06.eSeptember 20, 2010
Proposed Action
Overview
APPROVAL OF TREE WORK LICENSE
FOR ALL STATE CRANE, INC.
Item No.
Staff recommends adoption of the following motion: Move to Approve tree work license
for All State Crane, Inc.
Passage of this motion will result in issuing a tree work license for All State Crane, Inc.
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching and injections) in the city.
Ail State Crane, Inc. has submitted an application for a tree work license.
Staff is recommending approval of a tree work license for All State Crane, Inc.
All State Crane, Inc. does tree removal and land clearing but does not do pruning,
trenching or injections.
Primary Issues to Consider
• Applicant paid fee and submitted Certificate of Insurance.
o Staff contacted the applicant and verified they are knowledgeable about proper tree
care removal.
Supporting Information
• Copy of Application for Tree Work License submitted by All State Crane, Inc.
n Herinen
rk Maintenance & Operations Mgr
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
Phone: 952- 985 -4400
1. Business name: a7/ 2 f- 6 1.,N . °c� "V
2. Phone no: (`75 ?5 _ 3 IOC Fax: q5:2-9g37:1/4/ V
3. Contact person: ►' S Ofseo Title: t n � —
Pf �° S G L� -er�' t
4. Mailing address: /O5 9-02 ?d St t() Lke vI Pe �So t f /L
City Zip
5. Person to be contacted in emergency: 4b ea-a- o 9 r8 -71 a/
6. Business ownership: Individual Partnership Corporation
7. Number of employees: List names of employees, partners or officers below:
Street
8. Minnesota Tax Identification No. of business
(or Social Security No. if applicant is an individual): 6 a L(5 c 7 c
9. Number of vehicles:
10. Type of equipment to be used in business:
4
Will you be using chemical substances in any activity related to treatment or disease
control? YES NO _X_ (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):
qappi-e-■-tirtitc- 7
2 ca. ( ?to to ?0
Policy number or self - insurance permit number: (J o q- -3 3)
APPLICATION FOR TREE WORK LICENSE Page -2_
12 (CONTINUED)
q— 1 —x05 —� 1 01 1
Dates of coverage: q - ,A1 " aO I D to q — c \ ~ 0.0 1 1
(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:
1v0 Cu►rreN4-11 %�e-r + fni :? — ?5 - 91
! *J A w o/o pil `15 :2 -e/57-3575 DeAmit 6(2- — c
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 nle, 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.
Aut Tlorized Signatur
Title
(65/
TREEAPPL.doc(1 X/22/02)
Date: J HO
ANNUAL FEE: 525.00
All Licenses Expire December 31st
ate Fee Pat.
:Ainoutnt' Paid:
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