HomeMy WebLinkAboutItem 06.oMarch 7, 2011
Proposed Action
Overview
Item No.
APPROVAL OF TREE WORK LICENSE
FOR BRANCH & BOUGH TREE SERVICE AND LANDSCAPE CARE
Staff recommends adoption of the following motion: Approve tree work license for
Branch & Bough Tree Service and Landscape Care.
Passage of this motion will result in issuing a tree work license for Branch & Bough Tree
Service and Landscape Care.
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching and injections) in the city.
Branch & Bough Tree Service and Landscape Care have submitted an application for a
tree work license.
Staff is recommending approval of a tree work license for Branch & Bough Tree Service
and Landscape 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 Branch & Bough Tree
Service and Landscape Care.
ohn nen
ark Maintenance & Operations Mgr
Financial Impact: $ Budgeted: Y/N Source:
Related Documents (CIP, ERP, etc.):
Notes:
APPLICATION FOR TREE WORK LICENSE
CITY OF LAKEVII LE
20195 Holyoke Avenue, Lakeville, MN 55044
Phone: 952-985-4400
1. Business n evetoe-,, 1.44,‘Lse,yri
2. Phone no: ( ) 335 -- 1) Fax:
3. Contact person: Ai"( M Title: Oyu
4. Mailing address: .5 c i (3/14.:0
Street City Zip
5. Person to be contacted in emergency: . &/ . ..i6t` 1/41-44. ,c.i fr... 57 33
6. Business ownership: X Individual Partnership Corporation
7. Number of employees: c...) List names of employees, partners or officers below:
/41
9. Number of vehicles:
10. Type of equipment to be used in business:
8. Minnesota Tax Identification No. of business
(or Social Security No. if applicant is an individual): 5 10-0
4/4
or
9 74 - 44 * 67
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):
Policy number or self-insurance permit number: ,
Npv49- or /5,7
APPLICATION FOR TREE WORK LICENSE
12. (CONTINUED)
Dates of coverage: 1(4 1 / 2 .
13. Proof of public liability insurance, covering all operations, for the sum of S3OOOOO
combined single limit coverage must be attached.
14. Is your company licensed in any other city? If so, please li.st:
aLA-4
Art
If not licensed in other cities, please use the spaces above to list references and phone numbers.
(or)
I am not required to have workers compensation liability coverage because:
( ) I have no employees covered by the law.
( ) Other (Specify)
I, the undersigned, hereby certify that the above information, furnished by me, is true and
correct to the best of my knowledge. 1 further acknowledge that 1 have read and
understa.nd the attached "Tree Preservation" and "Shoreland Impact" guidelines.
14 Date:
7 12-v / J
Authorized Signature
0 1Uite:---v-
Title
FOR CITY USE'ONLNi; •
Appro\ ed By: •
Date:
TREEAPPL.doc(11/22/02)
ANNUAL FEE: $25.00
All Licenses Expire December 31st
,L:icense
Page -2-
Date le Paid:
Ai11011111 Paid: S
Receipt No: