Fillable Restoration Services License 2017 - Restoration Services License Application2

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Restoration Services License 2017 - Restoration Services License Application2

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BENSALEM TOWNSHIP
RESTORATION SERVICES LICENSE APPLICATION
APPLICANT INFORMATION (if different from owner)
Name:
Address:
City:
State: ZIP:
Phone No.:
Position/Title:
Applicant’s Signature Date
NOTE: Applicant shall provide an original certificate of insurance for the following:
Comprehensive General Liability: policy shall have a bodily injury and property damage combined with single limit of liability
of $1,000,000 minimum per occurrence.
Excess/Umbrella: The restoration services company shall obtain minimum coverage limits of $2,000,000 per occurrence.
The additional limits above the Comprehensive General Liability and Automobile Liability policies.
Bensalem Township must be listed as a certificate holder. License fee of $100 shall be submitted with application.
CERTIFICATION IN LIEU OF OATH:
As the owner of record or authorized agent for the owner, I hereby
certify that the items checked meet the requirements of Bensalem
Ordinance 90-23 for a restoration services license.
At least one light duty vehicle properly equipped.
Vehicle signage contains business contact information.
Vehicle(s) maintained to be safe and operable.
Business located within 10 mi of Township boundaries.
Business carries insurance coverage as outlined in ordinance.
All vehicles are equipped with a two-way radio or mobile phones.
Owner or Agent’s Signature Date
8/2011
License #
Pursuant to the code of the Township of Bensalem Ordinance 90-23 I hereby apply for a license with Bensalem Township
BUSINESS INFORMATION
All information must be included. Incomplete applications will be rejected.
Business/Firm Name:
Address:
City: State: ZIP:
Phone No.: Fax No.:
Type of Business:
(i.e. Sole Proprietorship, Partnership, Corporation, etc.)
State Tax No.: Federal Tax No.:
E-Mail Address:
Business Owner’s Name:
Business Owner’s Home Address:
Business Owner’s Home or Cell Phone:
If business has additional owners, include on page two (2) that follows. In the case of a corporation, include
the name(s), address and phone numbers of responsible parties.
Owner’s Signature Date
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF LICENSE
Building and Planning Department
2400 Byberry Road ▪ Bensalem, PA 19020
Office 215-633-3644 ▪ Fax 215-633-3753
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RESTORATION SERVICES LICENSE APPLICATION Part 2 of 3
BENSALEM TOWNSHIP
1. Names, addresses and telephone numbers of additional Owners, Partners, etc. & Business Trade Name:
2. Statements regarding any other municipalities having refused to issue a license within the last two years:
3. If licensed in other municipalities, please list at least three (3) along with license number:
4. List all convictions within the last two (2) years:
5. List all unsatisfied civil judgments in any jurisdiction against the applicant:
6. List all personnel working within the Township as required by Bensalem Township Code:
8/2011
License #
INFORMATION OF RECORD
Certificate of liability insurance must contain a clause stating the policy will not be cancelled until the
Townshi
p
of Bensalem is
p
rovided a thirt
y
(
30
)
da
y
notice
p
rior to cancellation.
BENSALEM TOWNSHIP
ACKNOWLEDGEMENT
A restorations services license is issued by the Township conditioned upon, and with the express agreement of
the licensee, that the licensee shall, at all times, act as an independent contractor, and not as an employee of the
Township or its Police Department or its Fire Department. The licensee shall, and by acceptance of the license
hereby agrees to hold the Township harmless from any and all claims, suits, damages, injuries or causes of
action whatsoever may arise out of any restoration service or other activity performed by the licensee. Payment
for services rendered pursuant to the license shall be the responsibility of the owner, tenant, possessor or
custodian of the condemned or fire damaged property and not by the Township.
Owner’s Signature
Date
Applicant’s Signature (if other than owner)
Date
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF LICENSE
8/2011
License #
Date
The Director shall revoke any license issued within the provisions of the Township of Bensalem Ordinance 90-23, § 90-32
Suspension and Revocation of License under the following circumstances:
(A) The Township reserves the right to suspend the license issued at any time if an inspection by a Township Official or
Police Officer determines that required equipment is missing, inoperable, unsafe or the owner or operator is otherwise in
violation of this article or the Code of the Township of Bensalem. Any such suspension shall continue, without rebate of any
application or license fee until such time as the Township determine applicant is in full compliance of all applicable
ordinances.
(1) The licensee agrees as condition of the license to hold the Township harmless for any and all claims, actions or
causes of action whatsoever, including alleged loss of profits arising from aby suspension of license.
(2) The Township shall give the licensee notice that the licensee is in violation of the provisions and terms of this article
prior to any formal action to suspend the license. The determination of whether a violation is safety related shall be
solely the determination of Bensalem Township. The Township shall permit the licensee to correct deficiencies as
follows:
a. In the case of any non-safety violation, the licensee shall have 10 days in which to correct the deficiencies.
b. In the case of safety related violations, the licensee shall have 48 hours in which to correct deficiencies.
(B) A restoration services license may be revoked upon a finding by the Township of any of the following grounds:
(1) The license was procured by fraudulent conduct or false statement or omission of a material fact, and in this event,
the license shall be null and void as if an application had never been filed.
(2) The licensee failed to perform or violated any of the duties of a licensee set forth hereinabove.
(3) The licensee no longer meets all the standards for issuance of a restoration services license.
(4) The licensee’s application is found to be defective in any way or contains misinformation or omission of fact, and in
this event, the license shall be null and void and as if an application had never been filed.
(5) The licensee failed to correct safety related or non-safety related deficiencies within the allocated time as provided
by subsections 33(A)(2)a. and b.
(6) The licensee’s license had been suspended three (3) times,
(C) Within 30 days of the date of any suspension or revocation of license, the applicant may appeal to the Bensalem
Township Code of Appeals Board, which shall, within 21 days after the appeal is received by the Township, hear such
appeal and evidence as may be offered by the applicant or Township. The Code Appeals Board may render an oral
opinion at the time of the hearing and shall notify the applicant in writing of the decision within 20 days of the hearing.
The decision of the Code of Appeals Board shall be considered the Township’s final administrative action for purposes
of any appeals to court to which the applicant may be entitled.
RESTORATION SERVICES LICENSE APPLICATION Part 3 of 3
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Completed 11 July 2020

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