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Attachment A <br />Recycling Hauler LICenSai A pplication <br />Fee Due;- S125,0IO Year X11-- (License will be for January I to December 3 1.) <br />Business Name <br />Emergency Contact Information, <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recycling services will be provided to (check all that apply): <br />kesidential, VI-C'oniniercial l r u Iti family "�Industrial <br />Number of vehicles the a,pipllicant proposes to use in the collection of riecyclables ( <br />Name and address, of lelolm panies or materials recovery facility where recyclablies will be delivered: <br />Ye�vsprint* <br />AI 4 <br />\A <br />Offtice poperlBoxboord * <br />Ul <br />Glass* <br />MMMEWTOM <br />Corrugated Cardboapd* <br />Olher(please specify) <br />*Reqlulired items for residential and multifamily haulers <br />I hav,e beers provided with a copy of the City of Roseville Curbside Reicy . clin rdimance and that violation of any of the <br />provisions included in the ordinance Imay result jju.,uspension or revocation of the H nr5le. <br />I have attached a certificate of' liability InsLyfance, a certiNcate indicatj <br />a <br />- it?c 01 n <br />W; <br />C' <br />Corrugated Cardboapd* <br />Olher(please specify) <br />*Reqlulired items for residential and multifamily haulers <br />I hav,e beers provided with a copy of the City of Roseville Curbside Reicy . clin rdimance and that violation of any of the <br />provisions included in the ordinance Imay result jju.,uspension or revocation of the H nr5le. <br />I have attached a certificate of' liability InsLyfance, a certiNcate indicatj <br />a <br />- it?c 01 n <br />W; <br />