HomeMy WebLinkAbout4I - Refuse Hauler Permit
AGENDA #:
PREPARED BY:
SUBJECT:
DATE:
INTRODUCTION:
BACKGROUND:
DISCUSSION:
ISSUES:
ALTERNATIVES:
STAFF AGENDA REPORT
(4)1
LAURIE DAVIS -FRIEDGES
APPLICATION FOR REFUSE HAULING BY JME OF MONTICELLO
APRIL 15,1996
JME of Monticello, Inc. is applying for a Refuse Hauling License in order
to operate in the City of Prior Lake.
JME has submitted all of the necessary forms, applications, insurance,
bonds and fees for a Refuse Hauling License.
The Prior Lake Police Department is currently running a background
check on JME of Monticello, Inc. and will submit that information to me
before license approval.
JME of Monticello, Inc. will be operating rolloffs only for commercial and
residential projects.
1.
Prior Lake City Council approve JME of Monticello, Inc.'s Refuse
Hauling License pending Police Department background check.
Prior Lake City Council may table this application for a later date.
Prior Lake City Council may deny this application.
2.
3.
RECOMMENDATION: St recommends the Prior Lake City Council approve this application
p nding Police Department Check.
ACTI otion and second to approve as part of the Consent Agenda.
AG41
-1-
16200 Eagle Creek Ave. S.E., Prior Lake. Minnesota 55372-1714 1 Ph. (612) 447-4230 1 Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
G-i)
Capitol Indemnity Corporation
Bond No. LP 606182
License and Permit Bond
For County, City, Town or Village Only - Not valid for bonds required by the state. ~ot valid for Contract, per-
formance. ~laintenance, Subdivision, .\gent to sell Hunting and Fishing Licenses or Utility Guarantee Bond.
Surety:
Capitol" Indemnity Corporation
P.O. Box 5900
Madison. WI 53705-0900
Principal: (Full name and address)
JME of Monticello, Inc.
Obligee: (Principals customer)
City of Prior Lake
4629 Dakota St. PO Box 359
Prior Lake, MN 55372
PO Box 477
Monticello, MN 55362
Agency Name/Address/Code:
Kelly Agency, Inc.
PO Box 21128
St: Paul. MN SS121-01?R
Effective Date:
March 15, 1996
(Valid/or one year)
Expiration Date:
March 15, 1997
PE~.\L .\.\[OU~T OF BO~D (~ot valid for more than S25.()()()): $1,000.00 ,lawful
monev of the United States. to he paid to the said ohli~ee. tor which payment well and tmly to he madl;: we
bind (;ursdves and our le~al represencativc. jointly and severally.
Tlw condition of this obli~ation is such. that whereas. the principal has been licensed by the ohligee for
Disposal Hauling
NOW THEREFORE, if the principal shall faithfully perform the duties and comply with the laws and ordinances
(includin~ all amendments). pertainin~ to the license or permit. then this ohligation to he \'oid, otherwisc to
remain in full force for not more than 12 consecutin~ months. unless renewed by concinuation certit'icatc.
This bond may be ternlinarcd at any time by the Surety upon sendin~ notice; in writin~ co thc obligee and at
the expiration ot thirty-fh'c (35) days trom the mailing of notice or as soon there:.ltter as permitted by applica-
blc law. whichever is lacer. this bond shall terminate and the Surety shall be relien~d from any liability for any
subsequenc acts or omissions ot" the principal.
Signed with our hands and sealed with our seals this. the 15th day of
March
, .\D~j 1996
JME of Monticello, Inc.
Principal
\~~C.\PI~DI:\ITY CO~OR.\TIO:-;
'. Sl Tec\' /I 4
Countersigned " ~ ' y' ' ? /1(/";;:;-'
(Licensed Rt..":5ur;;;;c .-\gent. if applicable) President
:t",~~~~~~,I~~II/~~:O'''''l,./
~ .:)"'/ '(1"';'-
ff {I ,"s%
~ ~ I CORPORA TE)' = ~
~ 1\ SEAL ff
\~Jj
i/I//II """';CONS\.... \\\~
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On the 1st day of ~Iarch. A.D., 1995. hdore me personally came George .\. Fait. to me known, who being by
me duly sworn, did depose and say: that he resides in the County of Dane, State of Wisconsin; that he is the
President of C.\PITOL INDE~L'\ITY CORPOR.\TIO~, the corporation described in and which executed the
above instrument; that he knows the seal of the said corporation: that the seal affixed to said instrument is
such corporate seal: that it was so affixed hy order of the Board of Directors of said corporation and that he
signed his name thereto hy like order.
qLfk
~\\\\~ ~\~~ I ~~ ~~~,.' II/I,
~ y~.;'l
f!~ PETER \\ '\
\:1\ H:NS ) 1
. '
ST.\TE OF \\lSCO;\SI~
D.\XE COt :-:T"\"
Peter E. Hans. ~otary Public
.\1.\' Commissio/l is pcnmlTlcllC
PIIOOUC..
... .
"\CsFtO'3.;. DATE lMMIDDIYYI;
.................................. "''','':,:<,ALBU'''';l>>\'':'' 03/15/96 ..'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
AL TEA THE COVERAGE AFFORDED BY THE POUClES BELOW.
COMPANIES AFFORDING COVERAGE
::i[\;.~~~_tll~..::.!::~.~~~I:~:I:~.~!~:j:!:~:~:::~:~~:~~~I:~:~:
Kelly Agency, Inc.
2025 Cen~re PoiD~e Blvd. # 470
S~. Paul MH 55120
Judi 1:h A. Pekarek
Phone No. 612-452-5752 Fa No.
INaUND
COMPANY
A 1I0JaBBROOlt PROPERTY Ie CASUALTY
COMPANY
B SDD PURD MUTUAL
ALBXARDRIA CORCRBD PROD.,IIIC.
Ic JIIB OP IIOftICBLLO, DlC.
PO BOX 477
IIOtr.rI CELLO IlK 55362
COMPANY
C
COMPANY
D
%ill
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co
LTR
TYPE OfIINalMANCE
POUCY NUMaIl
POUCY &RC11VE POUCY EXPIRAnoN
DATE CMMIDOIYYl DATE CMMIDDIYYl
UMlTS
AUTOMOBILE UABlUTY
-
A X ANY AUTO
-
X ALL OWNED AUTOS
-
..-!.. SCHEDULED AUTOS
X HIRED AUTOS
-
X NON-oWNED AUTOS
-
CA 0053956
GENERAL AGGREGATE $ 2 I 000 , 000
03/01/96 03/01/97 PRODUCTS - COMP/OP AGG $ 2, 000 , 000
PERSONAL 8& ADV INJURY $ 1, 000 , 000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone firel $ 50,000
MED EXP IAny one peraonl $ 5,000
03/01/96 03/01/97 COMBINED SINGLE UMIT $ 1,000,000
BODILY INJURY $
(Per peraonl
BODILY INJURY $
(Per accidentl
PROPERTY DAMAGE $
GENIItAL UABlUTY
-
A X COMMERCIAL GENERAL UABIUTY BPP 0053955
22:=J CLAIMS MADE [!] OCCUR
OWNER'S 8& CONTRACTOR'S PAOT
-
-
-
INet. 002850.212
exet.
03/01/96
AUTO ONLY. EA ACCIDENT $
OTHER THAN AUTO ONLY: I> ..... .,., , ".., ..,..:..
.:.:.. :,:,..:::..:..:.:......:.:...: ..
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $2,000,000
03/01/97 AGGREGATE $2,000,000
$
X I STATUTORY UMITS ..,.....
EACH ACCIDENT $ 100,000
03/01/97 _. POUCY UMIT $ 500,000
DISEASE - EACH EMPLOYEE $ 100,000
'\.,
,
CIMAQE UABlUTY
-
ANY AUTO
-
~
~.. UMlUTY
~BRELLA FORM
"' THAN UMBRELLA FORM
'~noN AND
'ITY
UEL0515010
03/01/96
CA 0053956
03/01/96
03/01/97
COMP DED
COLL DED
500
1000
IXJIIRATION DATE THBBfI. THE I8SUING COMPANY WlU ENDEAVOR TO MAIL
..!9-- DAY. WIWTTBII NOncE TO THE CIRTIFK:ATE HOLDIR NAMED TO THE a.s:T.
I
...... >\
i
I
!
.~ ITEMS
.::<tmn{:nn::mm:u::u%{::~~~HJ:m:nnn::::u:nmu::::u:Jm:::m:W::::U:::U: ... ....... .. . . ... ... .. ". ... .
."RIORLA SHOULD MY 011 THE MOW DDCNUD POUClD lIE CANCB.LED BB=OM THE
Judi ~h A. PeJca
....... ....... .
. - . . . . . . . .
.. .
crry OF PBIOH Lt\KL
4G2~ Dakota StreeL SL *" PO L30x J)~
Pr ior Lake, t~innesoLd )) 372
(6)~'-$i~1J ti~..J )u~tA~ erdf
APPLICA T IOr~ FOR A ~ 'Wttl:.e[ & HEFUSE HAULING LICEt~SE
Ordinance 1172-2
nEW X
Rrt I[.JV~----
Applican t I IH'j C I "\OQ -" F LJ
r4a~ger 's n.ame it:-di ffer~nt than applicant
-1.)/ ~) I ~l'~ Cor,t )..~r .
Firm Nam~l.. 561cv\:h n ii Y1"; :~ VIe -
Address (J" n'-..J I l~~
l1cn+,~~<lgi'~ N~ I "5.~_3Ic7
Telephone Number /i;JZ - 2q5 -3IZ:c
Receipt Number
License Number
License Numbers
Truck Make
Trai.liM' t~ake
l.~
~
~
2.
3.
4.
5.
\
.J
o.
License Fee: First Truck $125.00:
Each Additional Truck 25.00 I ' , i
Roll Off Containers 25.00' ;_1(1.G.7"" ,(l~ _t.>'/I,.C.-'
residence per year for once a week pickup S J
residence per quarter for once a week pickup S
residence per month for once a week. pickup 5
commercial per year for twice a week pickup S
CharJe on a call basis only 5 to S
Other ~,ro.1\ Ct,j--.. (l:li hunt (~ <fit I ct~ ii1\.{'SI"11,~ OJ "7 ~ Ii- (I L~1t IA..fSS
PROPOSED CHANGES IN CHARGES DURING THE LIFE OF THIS APPLICATION MUST BE SUBNITTED TO THE CITY.
Charge per
Charge per
Charge per
Charge for
Contents of (Maximum Number) 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 refuse:
~
Days which 'your trucks will pick lJP in the City:-1rJrnDAL}
Number of cU,stomers: \00 +
,..-- --
--H\ llCt).ct~ ~ ~& r:t---
.~{Qr, ,
D~ -- ~~("",-( ~ ( ~
R.u~ LAliT
Time of day pickup will be made:
7: Of) AIL to i.' Dc)
/
INSURANCE POLICY (OK COpy) MUST UE ATTACHED TO THE APPLICATION. ~~
A CERTIFIED BOND IN THE SUM OF $1,000.00 FOR EACH VEHICLE MUST BE FILED WITH THIS APPLICATION.
. -
INSURANCE r.tUST aE PROViDED TO cn\'F.l\ ALL. VFHfCLES: tUnimum S 100,000.00 each person insure
300,000.00 each accident
2S.,OOO.OO property dclmayc
LICENSE QUESTIONNAIRE
NAME OF ESTABL I SlIMENT 0YIP (~ D::1co!-i CJ. c ~ D :J) fI.(/ J
TYPE OF LI CENSE
TYPE OF OWNERSHIP
NUMBER OF EMPLOYEES 7
BIRTH DATES
1]- ,C] -73
i -Zz. -4~
12 -9 - 7"=3
Lj - I 2 - /,,[f
i2-Z'-SD
{()-!{J-70
\
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~ifGER E5oLI-
NAMES OF OWNERS
Ja,~1 ~ N()r2Pi{)~
I
Please re turn to:
Ci ty of Prior Lake
4629 Dakota Street SI
P .0. Box 359
Prior Lake, Minnesota 55372
. .
-..
~ ~ r.w.f-~Y1f) ~ ~.erCJ-,J'..::.;t #6 ~ ,..., 7
1-v# &ter- H~ !;'/11
There sJ\dll be no hauling in the City for hire from residential dwelling units between
"'ole-the hours after 7:00 Pr.1 or before 7:00 AH 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 around 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
~/
POSITION
DATE r1 - / 4 - f 0
Approval by City Manager:
Approved
Approval of City Council
rorm SP::1
LICENSE APPLICANT:
Pursuant to Minneso~a Statute 270.72 lax Clearance; Issuance of Licenses.
the I icensing autnori~y is reouired to croviae to tne Minnesota
Commissioner of Revenue your Minnesota business tax identifica~ion numoer
and the social securi~y numoer of each I icense ac~l icant.
Under tne Minnesota Government Data Practices Act and the Federal Privacy
Act of 1974. we are reouired to advise you of tne fol lowing regarding the
use of this information:
1. This information may be used to deny the issuance, renewal or
transfer of your license in the event you owe the Minnesota
Oeear~ment of Revenue del inquent taxes, penalties or interest;
2. Ucon receiving this information, the I icensing authority wil I
sueely it only to the Minnesota Department of Revenue. However,
under the Federal Exchange of Information Agreement the .
Deoartment of Revenue may sucply t~is information to the Internal
Revenue Service:
3. Failure to supely this information may jeocardize or oelay tne
erocessing of your licensing insuance or renewal aeel ication.
Please suooly tne forlowing information and return along with your
aeol ication ~o the agency issuing tne li]2nse. DO NOT RE~URN T~HE I
DEPARTMENT OF REVENUE. NM 6JJJrn/d1~~ T ..t)~~6-;;f7C;f-J
LI CENSE BE I NG APPL. j ED FOR OR RENEwED: C~ '~ i 1"21'-4 () Q 61 i'i{ . hCl.i.L, f'~ /'CLil..~
LICENSING AUTHORITY: C 1~1 l~ r?i?~(W ACl/A J. ,
(name or city. county or state agency issuing I ic se)
LICENSE RENEWAL DA7E:
PERSONAL INFORMATION elf appllcable)'
Aooi ican~'s Name:
ADDl ican-:'s Accress: . ci))f4.~~
-14()\Lh U.t..Q l)
Ci-:y
Soe i a I Se:::.;:- i -:y N~:7:=e:"": L/ '1 / - t/g -l./9.S-0
BUSINESS INFOR~ATION (if applicable):
Business Name: ~. . L Ct-- tvtQ1cJj(~1 J.~~
Business Accress: ~ ~~ ~~-;
O)~ 0 Q.iu (Yl1r-- 55-3c....-Z-
City State
J~oqo /2-
L/ / - /5D7 / 1~7
.
~~~--lOJ --'
'i- ,__
\JVU..,-
c~5 ,?:io? --
S~a~e
Zie Cooe
Zie Cooe
Minnesota Tax Ioentification No.:
Federal Tax Identification No.:
if a Minnesota Tax Identification number is not reouirec. please explain
reverse sioe.
Posi-cicn
e-: c . )
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 ooerate 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 pol icy number, and dates of coverage or the pennit to sel f-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 this information is not provided and/or falsely
reported, it may result in a $1,000 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.
Ins urance Company Name: k )r:.?+i, f4Z..I'r-J~
(NOT the insurance agent~
Pol icy Number or Sel f- Insurance Pennit Number: ~ OO.~ 30 tJl&
Dates of Coverage: .3/ I /ql~ fz.,> 3/ / /e,-,
I { , I
(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
INFORMAT PROVIDED IS TRUE AND CORRECT.
JA/