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Home My WebLink About4G - Refuse Permit R&W Roll Off CONSENT: PREPARED BY: SUBJECT: DATE: tI- (g) f!RANK BOYLES, CITY MANAGER CONSIDER APPROVAL OF REFUSE HAULER'S LICENSE FOR R & W ROLL OFF SERVICE, INC. FEBRUARY 22, 1994 BACKGROUND: Prior Lake City Codes provides that refuse haulers in the community are to apply for and receive their license annually. The attached applicant is a new applicant. therefore did not apply in June with the other applicants. DISCUSSION: License materials have been reviewed and submitted along with the fees and are attached to this consent agenda. ALTERNATIVES: The City Council has the following alternatives: 1 . Remove this item from the consent agenda for discussion. 2. Adopt a motion as part of the consent agenda approving this Refuse Hauler's license for 1993/1994 on the condition that all fees be paid and all application materials supplied. ACTION REQUIRED: A motion approving the Refuse Hauler's license as part of the consent agenda would be in order. CONAGG.wRT 4629 Dakota St. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (612) 447-4230 / Fax (612) 447-4245 AN EQUAL OPPORTUNITY EMPLOYER T T ,', . , " C (TV or PfUOn L^KI: 4629 Oakota Strc(: t SL · PO Uox j~~ Prior Lake, Minnesota ~~j7Z II[W__--K__. _ R[lllW^L ( APPLlCATlOU FOR A CARtMG[ & nEFUSE HAULlI~G LICEUSE Ordinance 1172-2 . Applicant Russ & Wendy Leistiko license Numbers T ruck Make I I TratW t1ake .~ '.. Manager's name if different than applicant Firm Name R & W Roll-Off Service. Inc. Address 5525 Co. Rd. 50 Carver. MN 55315 1. YM79778 2 . YX98330 1990 Mack 1980 Mack 3. YX98265 1970 White 4. Telephone Number 448-7833 Receipt Number ,U cense Number 5. j 6. First Truck $125.001 Each Additional Truck 25.00 Roll Off Containers 25.00 Charge per residence per year for once a week pickup $ Charge per residence per quarter for once a week pickup $ Charge per residence per month for once a week, pickup $ Charge for commercial per year for twice a week pickup $ Charge on a call basis only $ to S Other 10 - 40 Yard Roll-Off Containers - Charge. varies with size License Fee: of container PROPOSED CHANGES IN CHARGES DURING THE LIFE OF THIS APPLICATION MUST BE SUBMITTED TO THE CITY. Contents of (Maximum Number) j( dumpsters 1 cubic yard or larger will be picked up per stop at each commercial establishment or apartment house.' Amount of materials to be picked up at residence once a week in terms of number of garbage receptacles and refu~e: /,. 4~8/~ ~ "It ~ Days which your trucks will pick l-IP in the City: /1'1()A.J, - ~ Number of customers: J, ------ Time of day pickup will be made: ~"., to jpi1'/ / INSURANCE POLICY (O~ COpy) MUST ~E ATTACHED TO THE APPLICATION. ~. '.. .'.-.~-.'''~'''_. .-., - ...... -., --:-...- ""~"""'~~_.'''''''-'''''~.1:"-'_..~''--~-'-''-: . .''';"' ",~~f'!.;., . ~_~!!f.1.~I)~Q~l?J~ . ~HE SUM OF. _$t~O~O.og c fo.R . fACH VEHIClE MUST BE FILED WITH THIS APPLICA T~ON L INSURANCE I.IUST aE PROVIDED TO COVER All. VfH:fCLES: tHnimum $ 100,000.00 each person insured - 300,000.00 each accident 25',000.00 property damage .~.:-_..", " - ~':,:!.-;_..;-. :,. ~. -"~'.'" . I " . . -"',.".>>-..-,"'-..-..,,--........--."'.--. -", ,~"-.......'~^'~._---- ,.'it" . .. f orll $P:C I llCENSt APPLICANT; ~ursUlnt to "Inn.sot. St.tute 270.72 l.x Clear.nce; Issuance of Licenses, the licensing authority Is reQuired to provide to the "Innesotl Commissioner of Revenue your "Innesot. buslnes, t.~ Identlflc.tlon numoer .nd the socl.1 security numoer of eaCh license aDDllcant. Under tne "lnnesota Government Data Practices Act .nd the reder.I Privacy Act of 1974. we are reQuired to advise you of the following repardlng the use of this Information: . I. This Information may be used to deny the Issuance, renew. I or transfer of your license In the event you owe the "Innesot. Deoartment of Revenue oellnQuent taxes. penalties or Interest; 2. Upon receiving this Information. the licensing authority wtll supply It only to the "Inn.sota Department of Revenue. However. under the FeOeral Exchange of Information Agreement the Department of Revenue may supply this Information to the'lnternal Revenue Service: 3. failure to supply this Information may Jeopardize or delay the processing of your licensing Insuence or renewal application. Please SUPPly the fotlowlng Information and return along with your application to the agency Issuing the license. 00 NOT RETURN TO THE OEPARTI'ENT r:s REVENUE. LICENSE BEING APPLIED FOR OR RENEWED: Rpfll~P R. Ro:>ryrl; ng LICENSING AUTHORITY: City of Prior Lake (name of city. county or state agency Issuing license) LICENSE RENEWAL DATEI PERSONAL I NfORKA TI ON (I f .pp 11 cab 1 e) I ApDltcant's Name: Applicant's Aooress: Russell W. Leistiko 5525 Countv Road 50. Carver. MN 55315 City Soel.l, Sec~~Ity NU~~e~1 472-62-6004 BUSINESS INfORKATION (If eppl lcable) I Business Name: R & W Roll-Off Service. Inc. Business Aooress: 5525 Co. Rd. 50 Sute Zlo Cooe Carver MN State 55315 Zip Coce City "Innesota Tax Identification No.: 3370872 Federal Tax Identification No.1 41-1524898 If a "fnnesota Tax Identification number Is not reQuired. please explaIn on tne reverse side. .,/~~ /A'-€'=4'~r StQnatur. Posttlon (Officer. Partner. etc.) Date ,..<-.' ,u<"__,.__"~"""_'_"""""""""__,'~,__..~,wo..,,,_,-'"~...,,,,,.,...,~~"'"'",,=,~~.____.., If' ...... l' ...-...._*"""".~"""_'''~_~_....-... ..... . PROOF OF WORKERS' COMPENSATION INSURANCE COVERAGE Minnesota Statute Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Section 176.181, Subd. 2. The information reQuired is: The name of the insurance company, the policy number, and dates of coverage or the permit to self-insure. This information will be collected by the licensing agency and put in their company file. It will be furnished, upon request, to the Department of Labor and Industry to check for compliance with Minnesota Statute Sec. 176.181, Subd. 2. This information is required by law, and licenses and permits to operate a business may not be issued or renewed if it is not provided and/or is falsely reported. Furthermore, if thi s i nformat i on is not provided and/or fal sely reported, it may result in a SI,OOO penalty assessed against the applicant by the Commissioner of the Department lof labor and Industry payable to the Special Compensation Fund. Provide the information specified above in the spaces provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation. Insurance Company Name: Minnesota Workers' Compensation Assigned Risk Plan (NOT the insurance agent) ~erKley Admlnlstrators Policy Number or Self-Insurance Permit Number: 04-1?n~n Dates of Coverage: 04-08-93 to 04-08-94 (or) I am not required to have workers' compensation liability coverage because: ( ) I have no employees covered by the law. ( ) Other (Specify) I HAVE READ AND UNDERSTAND MY RIGHTS AND OBLIGATIONS WITH REGARDS TO BUSINESS LICENSES, PERMITS AND WORKERS' COMPENSATION COVERAGE, AND I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. 4~~~ JA/lc (J) 1181 _.,,_....'^""'-~..._-~"~.~~_..,,~ ' "., '"-""""'"",-,~"",-"".~-~-,,,,--~-~"-~,,,,,,,,,-,,,,,,,,,,,,,,~,,,,,,",,,'<-"-'~."-'-~"~'"''''''~~'-''"~'''''''''''''''''''''''-''-'';'.'."''"-'" .. .. .... T' LICENSE QUESTIONNAIRE NAME or ISTAlLISKHENT R & W Roll-Off Service. Inc./R & W Sanitation, INc. tyPI or LICENSI Refuse and RecvclinR TYPE OF OWNERSHIP 1MB! R OF EHPLOYEIS Corporation 5 NAHES OF EMPLOYEIS Rllq~~11 lJ T 9; ot-;1rn Wpnrly ~ TO;Q~;1r0 Kenneth n M~rkh~m Steven J. Balster Sharon 1. Hatch ~ OF MANAGER twCES OF OWNERS Russell & Wendy Leistiko . ~- _""~_""'_''''''''''_d_.' "'_"""~'~~~"""_""'~'_ '.' ..,.. T' '~"",,",''''''..'' ,....,.~_._...._Ah~._.,_A~,._~__.4..""_...._~. IIRTH DATES . 1 1_1 5n ij-15 5') ?-R-C;R 8-2-')7 11 - 11 -lL 1 Pleaae re tUrD to: Clt7 of Pnor Lab 4629 Dakota Street 51 P.O. loa 3S9 Prior take, K1nnesota SS372 . . ~. + .. There shall be no hauling in the City for hire from residential dwelling units between the hours after 7:00 PM or before 7:00 AM on any day. There shall be no garbage or refuse pickup from residential dwelling unit residences on Sunday. Refuse and garbage from residential areas may be picked up from one place at ground level adjacent to the street or alley, but deposited off the traveled roadway. . I (we) hereby agree to operate such business in accordance with the laws of Minnesota and the ordinances of the City of Prior Lake. The foregoing statements are true and correct to the best of my knowledge and belief. FIRM NAME R & W Roll-Off Service, Inc./R & W Sanitation. Inc. YOUR AUTHORIZED SIGNATURE -#~ ~ POSITION President DATE 2/3/94 Approval by City Manager: Approved Approval of City Council ........." ";_'~"~""'_~'''''''''''''''-'_'~' "_'.'~,.'_.".A_. "'_ ~,._.....~_ " .