Arborist License Application

License Application for - Arborist

MUNICIPAL CODE SECTION – 4-19
Is this application pertaining to a new business or are you renewing your existing permit?*

New PermitRenew Permit
South Bend Municipal Code: Section 4-19

Definition:

Arborist activities include: any persons engaging in the business of planting, removing, trimming or spraying trees or shrubs.

General Instructions and Application Process:
1. Assemble all required information and materials before filing application.
2. Thoroughly review all applicable Municipal Code Sections listed above.
3. Licenses expire January 31.
4. Add 10% to license fee for renewal after January 31.
5. You are responsible for $5.00 license application fee payable to City of South Bend for this application to be valid. You may pay in-person at City Hall or by calling the Business Licensing Manager to pay over the phone at 574-235-5912
6. License fee payable to City of South Bend due at issuance - $60.00.
7. Per-Plate fee payable to City of South Bend due at issuance - $3.50 per vehicle.
8. First time applicants must pass a test administered by the South Bend Parks Forester or provide International Society of Arboriculture certification.
Required Information and Materials:
1. Certificate of Insurance per Municipal Code Section 4-19 with the city listed as an additional certificate holder.
2. Current certificate of insurance required for each annual license renewal.
Application Process:
1. Review Municipal Code Section 4-19 thoroughly.
2. Submit application with $5.00 processing fee.
3. Review by South Bend Board of Park Commissioners.
4. License issued upon approval and payment of the license fee.
Questions?

For all municipal business license questions, contact:

City of South Bend

Department of Community Investment

215 S. Dr. Martin Luther King Jr. Blvd.

Suite 500
South Bend, Indiana 46601

Phone: 574.235.5912

Fax: 574.235.9021

Application Type
Business Data
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Mailing address differ from Property Address?

Yes, different addressNo, Same address
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address*
example@example.com
Number of Employees*
Number of Vehicle Plates Needed*
List Equipment for planting, removing, trimming, spraying, and care of trees and shrubs*
Do you propagate your own stock?*

YesNo
If no, where is your stock purchased?*
In what type of zoning is your business located?*
Determine your business's zoning using the City Zoning Map
Insurance Information
Insurance Carrier*
Insurance Agency*
Amount of Liability Insurance*
Include Certificate of Insurance with the City of South Bend listed as an additional Certificate Holder*

Cancelof
Personal Data
Applicant's Legal Name*

First NameMiddle NameLast Name
Applicant's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant's Email*
example@example.com
Position with Organization*
Is the applicant also the business owner?*

YesNo
Owner's Legal Name*

First NameMiddle NameLast Name
Owner's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner's Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Email*
example@example.com
Experience and References
Are you familiar with prevalent tree and shrub diseases and competent to prescribe and apply control measures?*

YesNo
Explain Fully*
What experience or training in tree surgery have you had?*

List below the names and addresses of not less than four (4) clients where you have recently performed work (include dates)*

Rows	Client	Address	Dates
Client 1
Client 2
Client 3
Client 4

List all previous employment for three years prior to the date of this application*

Rows	Company	Address	Dates
Company 1
Company 2
Company 3
Company 4

Do you have an International Society of Arboriculture certification?*

YesNo
Submit a copy of the certification*

Cancelof
Signature
I, hereby, certify and affirm that all the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I agree to permit periodic inspection of my equipment by the Board of Park Commissioners or their agent. I have read and understand the regulations of the Arborist license found in the City of South Bend Municipal Code, Section 4-19.
Electronic Signature*

First NameLast Name
Date*

MonthDayYear
Should be Empty:

License Application for - Arborist

Definition:

General Instructions and Application Process:

Required Information and Materials:

Application Process:

Questions?

Application Type

Business Data

Insurance Information

Personal Data

Experience and References

Signature