Fillable Restoration Services License Application Restoration Services License Application

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Restoration Services License Application Restoration Services License Application

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DEPARTMENT OF PUBLIC SAFETY
BENSALEM FIRE RESCUE
RESTORATION SERVICES LICENSE APPLICATION
Page 1 of 3
BTFR 06/2014
TO SUBMIT YOUR APPLICATION AND/OR CONTACT US FOR INFORMATION:
BENSALEM FIRE RESCUE Phone: 215-633-3617 FAX: 215-633-3662
2400 Byberry Road Website: www.bensalempa.gov
Bensalem, PA 19020
License #
BUSINESS INFORMATION
All information must be included. Incomplete applications will be rejected.
Business Name:
Address:
City State ZIP
Phone #: Fax #:
Type of Business:
(i.e. Sole Proprietorship, Partnership, Corporation, etc.)
State Tax #: Federal Tax #:
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 that follows. In the case of a corporation, include the
name(s), address and phone numbers of responsible parties.
Owner’s Signature Date
APPLICANT INFORMATION
(if different from owner)
Name:
Address:
City State ZIP
Phone #: 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.
! Bensalem Township must be listed as a certificate holder.
! License fee of $100 shall be submitted with application (check or money order, made payable to Bensalem Township)
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 miles of Township boundaries
Business carries insurance coverage as outline in ordinance.
All vehicles are equipped with a two-way radio or mobile phones.
Owner or Agent’s Signature Date
DEPARTMENT OF PUBLIC SAFETY
BENSALEM FIRE RESCUE
RESTORATION SERVICES LICENSE APPLICATION
Page 2 of 3
BTFR 06/2014
INFORMATION OF RECORD
Certificate of liability insurance must contain a clause stating the policy will not be cancelled until the Township
of Bensalem is provided 30 day notice prior to cancellation.
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 three along with license number:
4. List all convictions within last two 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:
DEPARTMENT OF PUBLIC SAFETY
BENSALEM FIRE RESCUE
RESTORATION SERVICES LICENSE APPLICATION
Page 3 of 3
BTFR 06/2014
The Director shall revoke any license issued within the provisions of the Township of Bensalem Ordinance
90-23 s/s 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 in 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 Township of Bensalem. Any such suspension shall continue,
without rebate of any application or license fee until such time as the Township determines 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 any suspension
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 ten days in which to correct
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 on 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 omissions of
fact, and in this even, 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 the allocated time as
provided by subsections 90-33(A)(2) a. and b.
(6) The licensee’s license had been suspended three 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 th
e applicant in writing of the decision with 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 applicant may be entitled.
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
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Restoration Services License Application Restoration Services License Application

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Completed 11 July 2020

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