Fillable Garbagecollection Town of Fishkill - Application for Garbage Collection License

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Garbagecollection Town of Fishkill - Application for Garbage Collection License

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Town of Fishkill Clerk's Office
Application for Garbage Collection License
page 1 of 2
1. Name of Applicant: ___________________________________________
2. Address:
_________________________________
_________________________________
3. If applicant is corporation:
a) Name and address of all stockholders:
Name:
________________________________
________________________________
________________________________
Address:
________________________________
________________________________
________________________________
b) Name and address of all officers:
Name:
_____________________
_____________________
_____________________
_____________________
Title:
_____________________
_____________________
_____________________
_____________________
Address:
_____________________
_____________________
_____________________
_____________________
4. Has the applicant, any stockholder of the applicant or any officer of the applicant been
convicter of a misdemeanor or felony in any state? ______________________
If so, list all particulars below:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Town of Fishkill - 807 Route 52 - Fishkill, NY - 845.831.7800
Town of Fishkill - Application for Garbage Collection License
Town of Fishkill Clerk's Office
Application for Garbage Collection License
page 2 of 2
5. How many collection vehicles will be
used to collect garbage and refuse in the Town?___________________________
6. Describe each vehicle:
Year Type Description (make and color)
6a. Number of loads generated per week: _____________________________
7. Does each vehicle have a water tight body equipped with a compaction unit? ______
8. Set forth below the proposed collection schedule within the Town:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
9. Enclose proof of Workman's Compensation Insurance.
10. Application Fee $750.00
11. Proof of Insurance for $1,000,000.00 - listing the Town as additionally insured.
Date: _______________
I, the undersigned, do certify that I have read and I am familiar with the "Ordinance for the
Regulation of Collection, Storage and Disposal of Refuse and Garbage" of the Town of Fishkill
and the "Regulations for the Collection, Storage and Disposal of Refuse and Garbage" of the
Town of Fishkill, and the foregoing information is accurate and complete to the best of my
knowledge, information and belief.
________________________________________________
Signature
Town of Fishkill - 807 Route 52 - Fishkill, NY - 845.831.7800
Town of Fishkill - Application for Garbage Collection License
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Garbagecollection Town of Fishkill - Application for Garbage Collection License

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Completed 12 July 2020

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