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Contractor Liabilty Insurance

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					                               TOWN OF IGNACIO
                                 540 GODDARD AVENUE                                    Licensing and Permitting
                             P.O. BOX 459 IGNACIO, CO 81137                                 Application
                                        970-563-9494

DATE OF APPLICATION                                                        PHONE                                 CELL
NAME OF BUSINESS OR DBA
MAILING ADDRESS                                                        PHYSICAL ADDRESS
CITY                                            STATE AND ZIP
TYPE OF LICENSE OR PERMIT APPLYING FOR
Town Business     Service Business   Commercial Vendor                                 Overweight              Excavation Permit
$30.00            $50.00             $75.00                                            $15.00-$25.00           $10.00
                                                          Solicitor/ Vendor
                                                          $5 / $20 / $40 / $75         check box applied for

TOWN BUSINESS                                           Start here
Business License expires December 31st
Addresses inside the Town Limits
License Fee: $30.00 for two or less employees. $5.00 for each additional full time employee. 2 part timers = 1 full timer.
DO NOT INCLUDE OWNERS
Number of employees                                 Total Due ________________
Food Establishments must attach a current Colorado Retail Food Service License.                  License #
I hereby acknowledge that when selling merchandice within the Town of Ignacio I am required BY LAW to collect 6.9%
sales tax and remit to the State of Colorado Department of Revenue. I further acknowledge that a sales tax
license number is required.          Retail Sales Tax ( ) yes ( ) no     Sales tax license
             Applicant Initials           Applicant received Town of Ignacio Municipal Code pertaining to this section
             Staff Initials               Gave applicant necessary information regarding this section
For Staff Only:                           Parking Requirements No. of Parking spaces required
Parking plan reviewed by ________________________Staff Initials & Date________________
Type of Occupancy _______________ Change in use?______yes _____no Inspection required ______yes ______no
Inspection date and initial ___________________ Outside Sign Application?___yes ___no Approval Date_____________
All new Business Licenses with change of use in the building MUST go through inspection before issuance.

SERVICE BUSINESS                               Start here                              If applicable continue to Excavation Permit
License expires one year after date of payment                                         Locate Ticket NO.
Business has no physical address in Town & working under contract                      UNCC 811 must be called 3 days prior to digging
                                                      Vehicle Description____________________________State_______
Type of service to be provided_________________________
Location of work_______________________________________ If applicable give Building permit #_______________________
             Applicant Initials           Applicant received Town of Ignacio Municipal Code pertaining to this section
             Staff Initials               Gave applicant necessary information regarding this section
OVERWEIGHT PERMIT                                  Start here
Any vehicle with or without material that is over TEN TONS is considered overweight (20,000 pounds)
Desription of material being hauled_________________________________________________________

Road or Alleys you plan to use___________________________________________________________________________
____________________________________________________________________________________________________
Proof of vehicle/trailer weight and load must be given to clerk at time of entry into Ignacio Town Limits.
Should the Contractor or Hauler pay on a load basis the fee shall be $15.00 per load + $5.00 for every axle over two.
Should the Contractor or Hauler get an annual permit the fee shall be $400.00 per Vehicle/Trailer
             Applicant Initials           Applicant received Town of Ignacio MTC information pertaining to this section
             Staff Initials               Gave applicant necessary information regarding this section
COMMERCIAL VENDOR                              Start here
Business with no physical address in Town Limits. Selling goods with out collecting tax.
Permit expires 1 year after date of payment.               Type of Merchandise

Name of Business(s) you are working with inside Town Limits
Please attach information if needed

               Applicant Initials        Applicant received Town of Ignacio Municipal Code pertaining to this section
               Staff Initials            Gave applicant necessary information regarding this section

EXCAVATION PERMIT                                     Start here           Locate Ticket NO.
                                                                           UNCC 811 must be called 3 days prior to digging
Any movement of dirt in operation for digging, building or replacing pipes requires a permit whether on private property or
town Right-of-Way and placement of equipment whether working or parked in right-of-way.
Dates Permit Valid From:_______________________ To: ___________________ (not to exceed project time)
Location of proposed excavation, placement and/or work in/use or ROW. Provide map if needed.
______________________________________________________________________________________

Reason for work ________________________________________________________________________

Estimated square yards of surface excavation or linear feet of curb excavation
Please provide a Bond and/or Certificate of Liabilty naming THE TOWN OF IGNACIO AS ADDITONALLY INSURED
Enter name of company
NOTE*** Any company/person working in the Town of Ignacio and/or right-of-way must have insurance not less than
$300,000.00 for a Handyman and $1,000,000.00 for Excavator, Roofer and Tree Cutter.


               Applicant Initials        Applicant received Town of Ignacio Municipal Code pertaining to this section
               Staff Initials            Gave applicant necessary information regarding this section

SOLICITOR VENDOR                               Start here
Permit expires 1 year after date of payment               Must have Food Handler's License from State to sell food items
Business with no physical address in Town, coming into town limits collecting tax for items sold
This permit does not include The Ignacio Bike Week                       Date(s) of operation______________________

What are you selling______________________________________
If selling from a vehicle please provide a description_________________________________________________
Location of vending spot__________________________________             Sales Tax License NO. __________________________
Retail Sales Tax ( ) yes ( ) no
***I hereby acknowledge that when selling merchandice within the Town of Ignacio I am required BY LAW to collect 6.9%
sales tax and remit to the State of Colorado Department of Revenue. I further acknowledge that a sales tax license number
is required.                 Attach a photo copy of picture identification
               Applicant Initials        Applicant received Town of Ignacio Municipal Code pertaining to this section
               Staff Initials            Gave applicant necessary information regarding this section

I agree to comply with all requirements set for in The Town of Ignacio Municipal Code

SIGNATURE_______________________________________DATE____________
PLEASE MAKE CHECK TO THE TOWN OF IGNACIO
We take credit cards for nominal fee of $4.00 in person or $6.00 over phone or key in.

***Office use only

Fees Paid
Date Paid
Staff Initials

				
DOCUMENT INFO
Description: Contractor Liabilty Insurance document sample