HomeMy WebLinkAboutapplicationMIAMI
DADE
Y A. A 9 EWa e T T APPLICATION FOR GENERAL HAULER PERMIT
vi4/10 Y ito ut; LOPMENr
DATE: E
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3. Name of Applicant/Business Name:
C.4S%rrn Was/e syslit iiS j t .
4.ContactPerson/Mailing Address:
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7. Type of Business:
❑ Sdle Ownership ^❑ Partnership El Corporation 0 Other (Specify): •
8. If partnership or corporation: List principal officers, stockholders and other persons having financial or
controlling interest. /fa publicly owned corpora#on having more than 25 stockholders: Provide only the names
and business addresses �jof the Ioc I managing officers. 11 ff
Name: Nei eAs Position:V. R e ce./Ge
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10. if the applicant has operated any of the following under a franchise, permit or license, check and complete the
information for all that'apply:
0 Solid waste collection State Permit/License If revoked, date
and/or removal business
0 Waste tire transport business State Permit/License If revoked, date,
❑ Tire business State Permit/License If revoked, date
Page 1
S.A. .54} •
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12. If other than a corporation and operating under a fictitious name, submit information that the fictitious name is
registered.
Fictitious Name:
...-ergEPS
15. insurance carrier providing Comprehensive General Liability insurance:
Name L 6e etc, $ Aniotintoo
Insurance carrier providingyehicle Liability insurance:
Name IA C014 .61Vt er
Page 2
GENERAL HAULER PERMIT AFFIDAVIT
16. THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO
ADMINISTER OATHS.
16.1 In compliance with Metro -Dade County Code Chapter 15, Section 15.17, I, /' ` eK AA 5'4 being
first duly sworn, state that I am the duty authorized representative of the establishment:
Eci.5Ief1 (A.AsiQ ' Cy sitfru.s
(Name of(incl4al, Partnership, Corporator)
submitting this application, and as such, have full authority to execute this General Hauler Permit affidavit.
16.2 The above name Affiant understands and certifies that the named establishment will comply with the following:
A. The General Hauler Permit Is for the applicant to engage in the business of solid waste and/or recyclable
materials collection, removal or transport for hire or salvage over the streets or public right-of-way within any
unincorporated area of the County.
B. Within the service area of the Department of Solid Waste Management, the applicant understands that it is
prohibited by the Code of Metropolitan Dade County from entering into or renewing any agreement or contract to
provide waste or recycling service to any property defined in the code as resrdentral.
C. For properties in the unincorporated Dade County service area, the applicant will submit an authorization form
to they Department of Solid Waste Management for approval before providing waste service, and before entering
into any agreement to provide waste service.
•
D. At least annually, but not more frequently than quarterly as determined by the Department of Solid Waste
Management, each Permitted General Hauler will report Information to the Department as stipulated by the County
Code.
BY:
E. Any change of information included in the application will be reported in writing to the Director of the
Department of Solid Waste Management within thirty (30) days of change.
F. The insurance requirements in section 13 of the application shall not be construed as imposing on Dade.
County or the Department of Solid Waste Management, or any official or employee of the County any liability or
responsibility for injury to any person or property damaged by the Permittee.
G. The applicant will abide by all ordinances, rules and regulations stipulated in the Dade County. Code and/or
the Department of Solid Waste Management.
H. Any misrepresentation of information provided in the application may cause revocation of the permit.
4/x(Sipnalta8 ofAlPiant) Me s4 J. Pep s,' et7L
(Printed Name of Agent) (idre ofAffrant)
70 15- t c /40014, t d • /c d► •13 yQ 7
S f s/o3
Sworn to
(Address of Applicant/Business) r
'bed before me, this / day of
NOTA,9Y ' BLIC, State of Honda at Large
Page 3
• (Date)
-6:741.5t ern (,)c4 i Sys Ms
Name ofApplicant/Business)
JACQUELINE YANES
�MMissioN a CC885325
ADVANTAGE NOTARY
17`
17. Provide check in the amount of the total fee made payable to the Metro -Dade Department of Solid Waste
Management.
18. Other Payments: Money Order in the amount of $15.00 per person listed in section 6 made payable to the State
of Florida Department of Law Enforcement for the processing of fingerprints.
Office Use OMIY. Ds Not Write Below ibis uue.
GENERAL PERMIT PROCESSING LOG
Date Rcv'd. Comments
Signed General Hauler Permit Affidavit
Proof of Comprehensive General Liability Insurance
Proof of Vehicle Liability Insurance
Permit fee payment _.--✓
Money order for fingerprint processing* —�
Proof on incorporation*
Complete set of fingerprints*
Complete list of equipment*
Complete fist of customers/accounts*
*Required only if information has changed, or is requested by the Department of Solid Waste Management
4,4
THIS BECOMES AN OFFICIAL PERMIT WHEN SIGNED BELOW:
Permit Number`T\ \
Fee : $__ v ./3Q
Expires: \\' \\ By:
F540-
A Date:
11
fir
red Signature)
�-G
Page 4
3/25/99