HomeMy WebLinkAboutItem 06.fJune 20, 2011
Proposed Action
Staff recommends adoption of the following motion: Approve tree work license for
Bob's Stump Grinding.
Passage of this motion will result in issuing a tree work license for Bob's Stump
Grinding.
Overview
The City of Lakeville licenses companies that provide tree care (i.e. pruning, removal,
trenching, injections and stump removal) in the city.
Bob's Stump Grinding has submitted an application for a tree work license.
Staff is recommending approval of a tree work license for Bob's Stump Grinding.
Primary Issues to Consider
Supporting Information
APPROVAL OF TREE WORK LICENSE
FOR BOB'S STUMP GRINDING
Item No.
• Applicant paid fee and submitted Certificate of Insurance.
• 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 Bob's Stump Grinding.
hn -nnen
ark Maintenance & Operations Mgr
Financial Impact: $ Budgeted: Y/N Source:
Related Documents (CIP, ERP, etc.):
Notes:
APPLICATION FOR TREE WORK LICENSE
CITY OF LAKEVILLE
20195 Holyoke Avenue, Lakeville, MN 55044
952- 985 -4400
1. Business name: (?)'19.5 DTH) i
2. Phone no: ( G 1 ) 70 a - L O 3 Fax:
3. Contact person: ` s-"}^ S, Ouse, Title: 0 '■cr
4. Mailing address: C5 ikl /v we / - V t ic, 0 / / 0 s--_;---(2yii
Street Qjf City Zip
enc g Y� 5. Person to be contacted in emer : Qrf ,) ja^ 61 a -70- `i $ 3 a
6. Business ownership: K Individual Partnership Corporation
7. Number of employees: List names of employees, partners or officers below:
8. Minnesota Tax Identification No. of business
(or Social Security No. if applicant is an individual): L( 7 0- ! ^aa$
9. Number of vehicles:
10. Type of equipment to be used in business: 5 '^^e �r,�� ( X14 '� PkY +tack-,
L F �t �r �fPl` D�c�s, sL ve15 "� P L roc /0( ( .4
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' cpmpensation.
Insurance company name (NOT agent):
Policy number or self - insurance permit number:
0/',1
APPLICATION FOR TREE WORK LICENSE Page -2-
12. (CONTINUED) }
Dates of coverage: 7 to N ✓-
(or)
I am not required to have workers' compensation liability coverage because:
(V) 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:
� - GI -708_ f2E1 r (2 - I
‘55
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
understa
)3
d the attached "Tree Preservation" and "Shoreland Impact" guidelines.
I 0
144 4
OLAAer
Title
Autho zed Signature
TREEAPPL.doc(11 /22/02)
SO it Vrorie6F
Date:
:1_ LiA
ANNUAL FEE: $25.00
All Licenses Expire December 31st