CITY OF OAKWOOD
CONTRACTOR’S APPLICATION FOR LICENSE
TO CONTRACT FOR SIDEWALK, CURB, GUTTER & OTHER CONCRETE, ASPHALT AND PAVER WORK
TO BE DONE WITHIN THE RIGHT-OF-WAY IN THE CITY OF OAKWOOD, OHIO
TO BE DONE WITHIN THE RIGHT-OF-WAY IN THE CITY OF OAKWOOD, OHIO
CONCRETE LICENSE FEE: $50.00
(MUST BE PRINTED OR TYPED CLEARLY)
1.
Name of Company
2.
Company Address
3.
Telephone Number
Email Address
4.
Principal Officer or Owner(s)
5.
Attach summary of previous work done if you have not successfully completed this type work in Oakwood during the past two years.
6.
Submit $10,000.00 bond to the Finance Director of Oakwood.
a)
Name of Bond Company:
b)
Name of Agent
7.
Property damage and liability insurance coverage. Submit Certificate of Insurance to the Finance Director of Oakwood. Minimum coverage required: $200,000 for personal injury and/or death to any one person and $300,000 for such injury and/or death to more than one person but occurring from any one accident, and not less than $100,000 for property damage from such accident, providing the permittee, any property owner(s) with whom the permittee may contract, and the city with indemnification against any claim, demand, lawsuit or judgment arising out of the exercise of any permit granted.
a)
Name of Insuring Company
b)
Name of Agent
8.
Any change of owner, address, phone number, etc., must be given immediately to the city or the license becomes void.
9.
Before permit will be issued, contractor must have the following correct information:
a)
Name and address of property owner.
b)
Square footage of sidewalk, driveway apron, curb or gutter for each separate job.
c)
Estimated cost of improvements.
10.
Applicant states he agrees to and will comply with all laws and specifications of the City of Oakwood, and will abide by all lawful instructions issued by the city inspector. Applicant further swears that all information submitted is factual and that he has submitted all relevant and applicable facts to the city for the purpose of this application.
By
(Print Name)
Witness
STATE OF OHIO
County of Montgomery; SS
The foregoing instrument was acknowledged before me this day of ,
20 By .
Notary Public