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2. 

3. Arborist License Application

5. Business Owner Information
7. Last Name*
8. First Name*
9. Middle Initial*
11. Company Name*
13. Company Street Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Alternate Phone Number
21. E-Mail Address
23. How many years has the company been in business?*

25. Per Municipal Code 2.19.18 - Before any license shall be issued, each applicant shall first file evidence of possession of liability insurance in the minimum amounts of one hundred thousand dollars ($100,000.00) for bodily injury and one hundred thousand dollars ($100,000.00) property damage indemnifying the city or any person injured or damaged resulting from the pursuit of such endeavors as herein described.

27. Company Insurance Provider*
29. Liability Insurance Certificate*
31. Municipal Code 2.19 Acknowledgement*

    I have read and understand regulations pertaining to tree trimming, tree topping, tree planting & spacing, and stump removal of street and park trees as defined within Municipal Code Chapter 2.19 for the City of Valley Center, KS. 

    For other questions related to Municipal Code 2.19, please contact the Parks & Public Buildings Department at parks@valleycenterks.org

    1. I have read and understand regulations pertaining to tree trimming, tree topping, tree planting & spacing, and stump removal of street and park trees as defined within Municipal Code Chapter 2.19
33. Electronic Signature*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I Agree
35. Applicant's name & Title of Officer for Person, Firm or Corp.*
36. Date*
    Date

38. Once submitted, you will be contacted by city staff using the information provided above to secure payment for processing of this application.

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40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

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