Waste Hauler Permit Application

Waste Hauler Permit Application

City of Westlake Village
Please review the Hauler Permit Application Requirements in full before completing this application. Multiple documents must be prepared and uploaded with the application. This application must be completed in one session. You will not be able to save and return at a later time.
Business Entity Information
Business Entity Name*
DBA (if applicable)
CorporationLimited Liability CompanyGeneral PartnershipLimited PartnershipLimited Liability PartnershipSole ProprietorshipOther
Mailing Address*

Street Address

Street Address Line 2

CityState

ZIP Code
Email*
Phone Number*
Format: (000) 000-0000.
Primary Contact Name*

First NameLast Name
Primary Contact Email*
Primary Contact Phone Number*
Format: (000) 000-0000.

Vehicle Fleet

Number of vehicles currently used within the City of Westlake Village:*

Rows	Number of Vehicles
Front Loaders
Side Loaders
Rear Loaders
Roll-Offs
Other
TOTAL

Vehicle Inventory*

Upload an inventory of all vehicles currently used for collection service within the City of Westlake Village. Include 1) license plate number, 2) vehicle number, 3) make and model, 4) year, 5) type (front/rear/side loader or roll-off), and 6) VIN.
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Vehicle Certification*
Fleet Storage Location*

Street Address

Street Address Line 2

CityState

ZIP Code

Customer Service
The permit holder is required to maintain a local phone number, email address, and website form to answer customer inquiries and receive complaints. The permit holder is also required to maintain a 24-hour telephone number for use by City staff in the event of an emergency.
Customer Service Number*
Format: (000) 000-0000.
24-Hour Emergency Number*
Emergency contact not for public useFormat: (000) 000-0000.
Customer Service Email*
Customer Service Website*

Indemnification and Insurance
Indemnification*
Insurance Certification*
Insurance Certificates*

Upload Certificates of Insurance for automobile liability, general liability, and workers' compensation policies, including all required endorsements and waivers.
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Route Review & Diversion Plan
Route Review Certification*
Diversion Plan*

Upload your diversion plan meeting the requirements provided in the Hauler Permit Application Requirements document.
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Convictions & Judgments
Has the applicant, a manager, a financial officer, a partner, a corporate officer, a major stockholder, a parent company, or a subsidiary company:
- Been convicted of a criminal offense within the past 5 years, or
- Had a criminal or civil ruling or judgment in excess of $5,000 within the past 5 years?
YesNo
YesNo
Conviction/Ruling/Judgment List

If the answer is yes to either question above, upload a document that provides the following information for each conviction/judgment/ruling: 1) name of person or company, 2) type of conviction/judgment/ruling, 3) date, and 4) brief description.
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Financial Resources
Applicants must provide satisfactory proof of adequate financial resources to provide waste collection services. Examples of satisfactory proof include an Audited Financial Statement or Irrevocable Letter of Credit.
Proof of Adequate Financial Resources*

Upload document(s) to demonstrate proof of adequate financial resources
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Certification
By signing below, I understand, certify, and agree to the following:
1. A waste hauler permit issued by the City of Westlake Village is required to collect or haul waste from commercial/industrial premises within the City of Westlake Village.
2. The permit holder undertsands and will comply with all provisions of Westlake Village Municipal Code Chapter 5.3.
3. The permit holder must provide each service location with recyclable material and organic material collection services, unless the City grants a waiver to the commercial/industrial premises pursuant to Westlake Village Municipal Code Section 5.3.275.
4. All waste collection services must be provided by the permit holder. The permit holder may not subcontract or otherwise transfer any obligations or responsibilities under the permit.
5. The permit holder grants the City of Westlake Village and its contracted agents the right to inspect any and all equipment and/or facilities and/or records during reasonable hours and with reasonable notice to ensure compliance with the Westlake Village Municipal Code.
6. All waste collection and hauling will be conducted consistent with the information contained in this application and the attachments hereto. Any change in the information must be reported to the City of Westlake Village within 48 hours of such change.
7. The permit is valid for one year from the approval date. If the permit holder wishes to renew the permit, it is the permit holder's responsibility to submit a completed permit application and all required attachments thereto prior to the expiration of the permit.
8. All information provided in this application and the attachments hereto is true, complete, and correct to the best of my knowledge.
Signature*

Clear
Name*

First NameLast Name
Title*
Should be Empty:

Waste Hauler Permit Application

Business Entity Information

Services Provided

Vehicle Fleet

Customer Service

Indemnification and Insurance

Route Review & Diversion Plan

Convictions & Judgments

Financial Resources

Certification