APPLICATION FOR SNOW REMOVALDUMPING LICENSE

Transcription

1 FEW: PAID: $20.00 per yearlper vehicle LICENSE # DATE ISSUED APPLICATION FOR SNOW REMOVALDUMPING LICENSE The undersigned, does hereby apply to the License Commissioner of the City of Syracuse, State of New York, for a license to engage in the business of Snow removal/dumping, pursuant to the General Ordinances of the City of Syracuse. PLEASE PRINT Business Name: Business Address Tax ID# Business Phone Driver Name of Birth S.S. - I Driver Address Home Phone Is the applicant a Partnership, Association, Firm or Corporation or conducts business under an assumed r~a-mle'!' If you list yes to the above fill out below: Name #1 Address of Birth...- Name #2 Address of Birth -, List any additional names on back Year & Make of vehicle (make & model) Lic # Vin # Has applicant/driver/member ever been convicted of a felony? Yes No Name of Insurance Company? - -- INDEMNIFICATION STATEMENT The applicant upon the issuance of a license herein agrees to indemnify and save harmless the City of Syracuse, its agents, officers and employees thereof from all claims, suits or actions of every name or for or on account of bodily injuries, including d~ath or damages to property, received or sustained, or alleged to be sustaiiled by any persons arising our of the license issued herein. Police approval DPW approval Signature of Applicant Dumping location License approval can take 2-8 weeks.

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3 To process your application for Snow Removal/Plowing/Dumping the following must be done by all applicants: 1. All applicants must provide proof of insurance (per vehicle) in the amount of $100,000 - $200,000 bodily injury and $50,000 property damage naming City of Syracuse as additionally insured (a copy of policy is acceptable). 2. All applicants must provide a copy of current New York State vehicle registration (per vehicle) and a current New York State driver's license. 3. All applicants are subject to a record check by the Syracuse Police Department (takes approximately 2 to 8 weeks). 4. Removal/Dumping applications will be forwarded to DPW for a dumping location.

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5 FEE: PAID: $20.00 per yeartper vehicle LICENSE # DATE ISSUED APPLICATION FOR SNOW REMOVALIPLOWING LICENSE The undersigned, does hereby apply to the License Commissioner of the City of Syracuse, State of New York, for a license to engage in the business of snow removal. /plowing, pursuant to the General Ordinances of the City of Syracuse. PLEASE PRINT Driver Name: Driver Address: of Birth Home Phone Business Name Tax ID # Business Address Business Phone Is the applicant a Partnership, Association, Firm or Corporation or conducts business under an assumed name? If you list yes to the above fill out below: Name #1 Address of Birth Name #2 Address of Birth List any additional names on back Year & Make of vehicle (make & model) Lic # Vin # Has applicant or member of the applicant ever been convicted of a felony? Yes No C] Name of Insurance Company? INDEMNIFICATION STATEMENT The applicant upon the issuance of a license herein agrees to indemnify and save harmless the City of Syracuse, its agents, officers and employees thereof from all claims, suits or actions of every name or for or on account of bodily injuries, including death or damages to property, received or sustained, or alleged to be sustained by any persons arising our of the lickse issued herein. Signature of DriverIApplicant Police approval License approval can take 2-8 weeks.

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7 To process your application for Snow Removal/Plowing/Dumping the following muse be done by all applicants: 1. All applicants must provide proof of insurance (per vehicle) in the amount of $100,000 - $200,000 bodily injury and $50,000 property damage naming City of Syracuse as additionally insured (a copy of policy is acceptable). 2. All applicants must provide a copy of current New York State vehicle registration (per vehicle) and a current New York State driver's license..3. All applicants are subject to a record check by the Syracuse Police Department (takes approximately 2 to 8 weeks). 4. Removal/Dumping applications will be forwarded to DPW for a dumping location.

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