Waste Hauler License Application A.,lbertville
Small'fivaauaG living.Big C`.utyu Life.
WASTE HAULER LICENSE
Fee: $150 (Annually) License Year:
I. APPLICANT INFORMATION
Business Name:
Street Address:
City: State: Zip:
Daytime Phone: Cell Phone:
Person completing materials: Email:
II. MANAGER/SERVICE COMPLAINTS
Name:
Street Address:
City: State: Zip:
Phone: Email:
Phone for resident complaints:
III. FLEET/VEHICLE INFORMATION
Year Make Model Plate#
IV. LICENSING REGULATIONS,TREMS AND CONDTIONS
Completion of the application and issuance of license,the applicant agrees the waste hauler will abide to the
following:
The applicant has sufficient equipment and personnel to render service to existing and prospective customers and
in accordance with the requirements of this section;and further,that the applicant has the capability to assure
completion of applicant's routes on schedule under any circumstances
Equipment:
Vehicle Backup Warning Device:All licensed vehicles shall be equipped with a backup device which complies with
Minnesota statutes and Minnesota highway regulations applicable thereto.
Sanitation and Appearance:
All licensed vehicles and equipment shall be kept clean and in good repair and appearance and shall be maintained
in a sanitary condition so as to prevent insect breeding therein or other nuisance characteristics.
CITY OF ALBERTVILLE 5959 MAIN AVENUE NE 763-496-6801
CITY CLERK'S OFFICE ALBERTVILLE,MN 55301 WWW.CI.ALBERTVILLE.MN.US
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Albertvillc
Small'lllown Living.Big Oty Life.
Inspection:
No license shall be issued or renewed until the vehicle to be licensed has passed a state approved inspection and
received a commercial vehicle(CV)inspection certificate from either the state or a CV dealer authorized by the
state of Minnesota to conduct CV inspections.The inspection certificate for the proposed licensed vehicle must be
dated within twelve(12) months from the date of the application or renewal.
Liability Insurance:
Every licensee shall carry bodily injury liability insurance in an amount not less than five hundred thousand
dollars($500,000.00) per person and not less than two million dollars($2,000,000.00)per occurrence and not
less than five hundred thousand dollars ($500,000.00) of property damage insurance on all licensed vehicles.
Every licensee shall also carry workers'compensation insurance for its employees.The licensee shall provide the
city with evidence that said insurance is in full force and effect and shall provide the city with ten(10) days'
written notice of cancellation of said insurance.
Cancellation or Revocation:
The parties hereunder may,if mutually agreeable,cancel such license. However,the city may revoke the license of
any collector as provided for in this code.
Identification:
The collector shall display its company name and telephone number in a conspicuous place on both sides of each
licensed vehicle in letters and numerals no less than four inches (4")in height.
Denial of License:
The city reserves the right to deny any applicant a license or a renewal thereof if any reasonable doubt exists as to
the applicant's compliance with the provisions of this section or any other provisions of this code.
Frequency of Service:
The collector shall provide residential garbage and refuse collection service only on Thursdays,except when:
(1)A legal holiday falls on a day Monday through Thursday,in which case the collector shall provide
garbage and refuse collection on the next day; or
(2) Extreme inclement weather prevents the collector from collecting the garbage and refuse on the
scheduled Thursday,in which case the collector shall provide garbage and refuse collection on the next
day that weather permits such collection.
The collector shall provide commercial garbage and refuse collection on any weekday,Monday through Friday.
Service Complaints:
Contact Person: Each collector shall have a telephone number listed in a telephone directory of general circulation
in the city or on a webpage accessible to the public,and shall provide telephone answering service between the
hours of nine o'clock(9:00)A.M.and four thirty o'clock(4:30) P.M.Monday through Friday,except on legal
holidays.
Service Failure Makeup: If the customer was not serviced because the waste containers were not accessible on the
scheduled collection day,the collection shall be made as soon as possible by agreement between the collector and
customer.
CITY OF ALBERTVILLE 5959 MAIN AVENUE NE 763-496-6801
CITY CLERK'S OFFICE ALBERTVILLE,MN 55301 WWW.CLALBERTVILLE.MN.US
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Albertvillc
Small'lllown Living.Big Oty Life.
Collector To Replace Damaged Waste Containers:The collector shall replace at its expense,containers which are
damaged by the collector's carelessness or the carelessness of collector's employees or agents.
Collector To Replace Covers And Cans To Their Original Locations:The collector shall,after servicing the customer,
replace all covers and cans to their original location.
Use Of Private Driveway Prohibited:The collector is prohibited from driving the collection vehicle upon the
private driveways of residents unless written approval is first obtained from such resident.
Transportation Of Waste:
Waste To Be Covered: No collector shall transport waste upon the public streets and highways or other public
property of the city unless such waste being transported is entirely and securely covered.
"Packer Type"Refuse Body For Transporting Garbage: No collector shall transport garbage upon the public streets
and highways or other public property of the city except in a leak proof,compaction type body commonly referred
to as a"packer type"refuse body,as approved by the city manager or the manager's designee.
Cleanup Of Spilled Waste:The collector shall immediately clean up in a neat and workmanlike manner any waste
that the collector may have caused to spill upon the streets and highways or other public or private property in the
city.
Prohibited Dumping:No collector shall dump,place or otherwise dispose of waste in violation of the laws of the
United States,this state and its counties,or the laws of any political subdivision thereof.
Storage Of Vehicles In The City: Collectors shall not store or keep their waste removal vehicles in the city when not
in use(after such vehicle is free from all waste)unless located within a properly zoned district and the site
complies with all zoning and city codes.
Noise Regulations: Each collector operating in the city shall comply with all other provisions of this code,including
the noise level and hour regulations in section 5-5-1 of this code.
Hours Of Operation: No licensed collector may operate between the hours of nine o'clock(9:00) P.M.and seven
o'clock(7:00)A.M.
Transfer Of License:Unless otherwise provided in this code,no license shall be transferable without the
authorization of the council.
V. APPLICANT STATEMENT
The answers and statements given by me are true and accurate to the best of my knowledge and belief. I
understand that providing false information in this application may result in revocation of any and all licenses.
Signature of Applicant Date
CITY OF ALBERTVILLE 5959 MAIN AVENUE NE 763-496-6801
CITY CLERK'S OFFICE ALBERTVILLE,MN 55301 WWW.CLALBERTVILLE.MN.US
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Form SP: C1
BUSINESS TAX IDENTIFICATION INFORMATION
Pursuant to Minnesota Statute 270C.72,the agency issuing you this license is required to provide to the
Minnesota Commissioner of Revenue your Minnesota business tax identification number and the Social
Security number of each license applicant. Under the Minnesota Government Data Practices Act and the
Federal Privacy Act of 1974,we must advise you that:
• This information may be used to deny the issuance,renewal or transfer of your license if you owe the
Minnesota Department of Revenue delinquent taxes,penalties or interest; and
• The licensing agency will supply it only to the Minnesota Department of Revenue.However,under
the Federal Exchange of Information Act,the Department of Revenue is allowed to supply this
information to the Internal Revenue Service;and
• Failure to supply this information may jeopardize or delay the issuance of your license or processing
your renewal application.
Please fill in the following information and return this form along with your application to the agency issuing
the license. Do not return this form to the Department of Revenue.
Licensing Authority: City of Albertville
VI. LICENSE INFORMATION
Name of license being applied for:
License application date:
VII. PERSONAL INFORMATION
Applicant's Name(Last,first,middle initial):
Applicant's Address:
VIII. BUSINESS INFORMATION
Business Name:
Business Address:
Minnesota Tax Identification Number:
Federal Tax Identification Number:
Signature: Date:
CITY OF ALBERTVILLE 5959 MAIN AVENUE NE 763-496-6801
CITY CLERK'S OFFICE ALBERTVILLE,MN 55301 WWW.CLALBERTVILLE.MN.US
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LIC 04(3/13)
Certificate of Compliance - Minnesota Workers' Compensation Law
THIS FORM MUST BE COMPLETED BY THE BUSINESS LICENSEAPPLICANT
PRINT IN INK or TYPE.
Minnesota Statutes,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 Minnesota Statutes,
Chapter 176.If the required information is not provided or is falsely stated,it shall result in a$2,000 penalty
assessed against the applicant by the Commissioner of the Department of Labor and Industry.
A valid workers'compensation policy must be kept in effect at all times by employers as required by law.
LICENSE or CERTIFICATE NO(if applicable) BUSINESS TELEPHONE NO. FAX TELEPHONE NO.
BUSINESS NAME(Use the person(s)name if business structure is sole proprietor or partnership(i.e.,John Doe,or John Doe and Jane Doe),
otherwise it is the legal name of the business entity.)
DBA("doing business as"or also known as an assumed name) (if applicable)
BUSINESS ADDRESS(must be physical street address,no PO boxes) CITY STATE ZIP CODE
COUNTY EMAIL ADDRESS
YOUR LICENSE OR CERTIFICATE WILL NOT BE ISSUED WITHOUT THE
FOLLOWING INFORMATION. You must complete number 1 or 2 below.
NUMBER 1 - Workers' compensation insurance policy information
INSURANCE COMPANY NAME(not the insurance agent) NAIC Number
POLICY NO. EFFECTIVE DATE EXPIRATION DATE
NUMBER 2 - Reason for exemption from workers' compensation insurance
If you have questions regarding the need to obtain workers'compensation coverage,including exemptions,
contact 651.284.5032 or 1-800-342-5354.
❑ I have no employees. (See Minn.Stat.§176.011,subd.9 for the definition of an employee.)
❑ I am self-insured for workers'compensation(attach a copy of the authorization to self-insure from the
Minnesota Department of Commerce).
❑ I have employees but they are not covered by the workers'compensation law. (See Minn.Stat.§ 176.041
for a list of excluded employees.) Explain why your employees are not covered:
❑ Other:
I certify that the information provided on this form is accurate and complete.If I am signing on behalf of a business,I certify
that I am authorized to sign on behalf of the business.
PRINT NAME
APPLICANT SIGNATURE(required) TITLE DATE
CITY OF ALBERTVILLE 5959 MAIN AVENUE NE 763-496-6801
CITY CLERK'S OFFICE ALBERTVILLE,MN 55301 WWW.CI.ALBERTVILLE.MN.US
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Small Tmaevn Living.Big c'Ay,u Life.
TENNESSEN WARNING
In connection with your request for a license,the City has asked that you provide information about
yourself which may be classified as private,confidential,nonpublic,or protected nonpublic under the
Minnesota Government Data Practices Act.This means that this data is not ordinarily available to the
general public.Accordingly,the City is required to inform you of the following:
1. The purpose and intended use of the information requested is to determine if you are eligible
for a license from the City.
2. You are not legally obligated to supply the requested information and may refuse to provide
some or all of the requested information.
3. The known consequence of supplying the requested information is that the information or
further investigation could disclose information which could cause your application to be
denied.
4. The known consequence of refusing to supply the requested information is that your request
for a license cannot be processed.
S. A criminal charge,arrest,or conviction will not necessarily bar you from obtaining a license
with the City,unless the conviction is related to the matter for which the license is sought,
according to Minnesota Statute 364.03.However,failure to reveal the requested criminal
information will be considered falsification of the application and may be used as grounds for
the denial of the application.
6. Some of the information you provide will be released to the Minnesota Department of
Revenue. Other governmental agencies necessary to process your application are authorized
by law to receive the information provided. The City may also release the information
provided if required by Court order,or if authorized by other state or federal law.
The undersigned,by signing this notice,acknowledges that he/she has read and understood the contents
of this notice and is in agreement of the Tennessen Warning and its application.
Signature of Applicant Date
CITY OF ALBERTVILLE 5959 MAIN AVENUE NE 763-496-6801
CITY CLERK'S OFFICE ALBERTVILLE,MN 55301 WWW.CLALBERTVILLE.MN.US
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