HomeMy WebLinkAboutItem 06.cFebruary 22, 2011
Proposed Action
Overview
Primary Issues to Consider
Supporting Information
'f hn Hennen
ark Maintenance & Operations Mgr
APPROVAL OF TREE WORK LICENSE
FOR CARR'S TREE SERVICE INC.
Item No.
Staff recommends adoption of the following motion: Approve tree work license for
Carr's Tree Service Inc.
Passage of this motion will result in issuing a tree work license for Carr's Tree Service
Inc.
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching and injections) in the city.
Carr's Tree Service Inc. has submitted an application for a tree work license.
Staff is recommending approval of a tree work license for Carr's Tree Service Inc.
O 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.
• Copy of Application for Tree Work License submitted by Carr's Tree Service Inc.
Financial Impact: $ Budgeted: YIN Source:
Related Documents (CIP, ERP, etc.):
Notes:
iAN/31 /2011/M0N 01:41 PM
01/30/2011 23:37 3202551635
3202551635
1. Business name: ( * 17f-P., Se L LL c
2. Phone no: 6;1 ) 30- 35 .5
3. Contact person: rod IA
4. Mailing address: 0
9. Number of vehicles:
APPLICATION VOR TREE WOE: LICENSE
CITY OF LAI EVILLE
20195 Holyoke Avenue, Lakeville, MN 55044
Phone: 952 - 985.4400
Street
FAX No, 218
PERNAROERS
01/31/2011 01:38 RECEIVED FROM: 2183673358
P. 002
04615 P.002 /011
Fax: Cg � 8 314 '"
Title:
{4er L l
aky , City Z ip isvirLhoLkD
8. Minnesota Tax Identification No. of business
(or Social Security No. if applicant is an individual): 1 ( O
5. Person to be contacted in emergency;
6. Business ownership: Individual Partnership )( Corporation
7. Number of employees: ) ( - ) List names of employees, partners or officers below:
bn.
10, T • e of equipment to be used in business: (
11. Will you be using chemical substances in any activity related to treatment or disease
control? YES )( NO (IT 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,
l n o
Insurance company name (NOT agent): v \„ e G 1, (,. -
Ind.
Policy nun3ber or self-insurance permit number: £.-L) C -300ti 0 3a L13
#4616 -002
JAN /31 /2011 /MON 01:41 PM
01/30/2n11 23;37 3202551635
3202551635
APPLICATXON I?OR TREE WORK LICENSE
12. (CONTINUED)
Dates of coverage: -- li
(or)
FAX No. 218 - 367 - 3358
PERNARoERS
to 14
P. 003
#4615 P.003 /011
Page-2-
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? I F o u lease list:
0 ►�1rr LPL
Title
uthori ed Signature
_moo
TREEAPPL.doc(11/22 /02)
01/31/2011 01:39
RECEIVED FROM: 2183673356
a t4
If hot licensed in other cities, p lease se the spaces above to list references and phones numbers.
1, the undarsigped, hereby certify that the above information, furnished by me, is true and
con.e(to the' best of my knowledge. 1 further acknowledge that have read and
'alder : ad the attacl ed "Tree Preservation" and "Shoreland Impact" guidelines,
Date:
ANNUAL CIE: $25,00
All Licenses )re December 31st
4.4 3�Y ' F n { � ri r ;
c rr.r G, F 9 Jr
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