HomeMy WebLinkAboutItem 06.dFebruary 22, 2011
Proposed Action
Staff recommends adoption of the following motion: Approve tree work license for
Premium Tree Protection, LLC.
Passage of this motion will result in issuing a tree work license for Premium Tree
Protection, LLC.
Overview
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching and injections) in the city.
Premium Tree Protection, LLC has submitted an application for a tree work license.
Staff is recommending approval of a tree work license for Premium Tree Protection,
LLC.
Primary Issues to Consider
a Applicant paid fee and submitted Certificate of Insurance.
o Staff contacted the applicant and verified they are knowledgeable about arbor
practices and proper tree care.
Supporting Information
n Hennen
rk Maintenance & Operations Mgr
Lakeville
APPROVAL OF TREE WORK LICENSE
FOR PREMIUM TREE PROTECTION, LLC
Financial Impact: $ Budgeted: YIN Source:
Related Documents (CIP, ERP, etc.):
Notes:
Item No.
o Copy of Application for Tree Work License submitted by Premium Tree Protection,
LLC.
APPLICATION FOR TREE WORK LICENSE
CITY OF LAKEVILLE
20195 Holyoke Avenue, Lakeville, MN 55044
Phone: 952 -985 -4400
1. Business name: Pr 1uM 6iko ke-vi LAC
?. Phone no: (02- ) 664-004 Fax:
3. Contact person: Adam G. ri, ( Title: K r IAri3 Or,S 1'
4. Mailing address: 5;15 3 - S . Ni one/ f c . 55417-
Street C1'ty Zip
5. P erson to be contacted in emergency: SI SeN { a � cc� �.
G. Business ownership: )Individual Partnership 0 Corporation
7. Number of employees: 9-- List names of employees, partners or officers below:
Acrvi 6erti rr
7;601 (..70 tic;
8. Minnesota Tax Identification No, of business
(or Social Security No. if applicant is an individual): 710 615 c i 0
9. Number of vehicles: 3
10. Type of equipment to be used in business: 5p1'it rr r�n e&/ .1; /;2_ ri
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. PIease 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): e( 1z ASm71/ 54-r6, -o r- Coimpr1/211
Policy number or self - insurance permit number: WC,' - - Di4 -00 5 co -
APPLICATION FOR TREE WORK LICENSE Page-2-
12. (CONTINUED)
Dates of coverage: 4/ is /10 to l}5 +r
(or)
1 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 comp a} }y licensed in any other city? If so, please list:
lVt #'mectpd.
s.f.
Ap lett
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.
C 4 1 tI 1
Authorized Signature
Title
TREEAPPL.doc(11122 /02)
34- --4 it, i 5 Pei. Y ��
Date:
if/
ANNUAL FEE: $25.00
All Licenses Expire December 31st
FOR CITY USE ONLY
Approved By Date Fe. e Paid;
Date: Amount Paid:
- Receipt No:
License No