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APPLICATION FOR REMOVAL OF TREES AND STUMPS AND THE TRIMMING OF TREES IN THE CITY OF PLATTSBURGH, NEW YORK

  1. APPLICATION FOR REMOVAL OF TREES AND STUMPS AND THE TRIMMING OF TREES IN THE CITY OF PLATTSBURGH, NEW YORK.

  2. MM-DD-YYYY

  3. First, MI, Last

  4. ADDRESS:

  5. ___________________________________________________________________

  6. CERTIFICATE OF INSURANCE:

    1) All certificates must be on the comprehensive accord form naming the city of Plattsburgh as additional insured. Must have 30 days written notice of cancellation.
    2) GENERAL LIABILITY
    PREMISES - OPERATIONS BI/PD $1,000,000.00 C.S.L./$2,000,000.00 AGGREGATE.
    3) WORKER'S COMPENSATION AND DISABILITY BENEFITS.

  7. LICENSE FEE $260.00 PER YEAR FROM JANUARY OF EACH YEAR TO DECEMBER OF SUCH YEAR. (Not Prorated)

    It is my understanding that if I violate any of the provisions of the Ordinance, a copy of which I have read, that I shall be fined not less than $25.00 nor more than $100.00 for each offense and a separate offense shall be deemed committed on each day during or on which a violation occurs or continues.


    ____________________________________________________________________________
    Signature

  8. INSURANCE CERTIFICATE REVIEWED AND ACCEPTED:______________________________

  9. PERMISSION TO ISSUE LICENSE GRANTED BY:

    ___________________________________________



    License Issued By:_________________________________________

    Date:____________________________________________________

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