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3 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br /> <br /> <br />LICENSE APPLICATION FOR - ARBORIST <br />MUNICIPAL CODE SECTION - 4-19 <br /> <br />D. Please list all previous employment for three (3) years prior to the date of this application: <br />Company Address City, State, ZIP Dates <br /> <br /> <br /> <br />(Attach additional sheets if necessary) <br /> <br />E. Do you have an International Society of Arboriculture certification? <br />Yes: No: <br />If yes, submit a copy of the certification with the application. <br /> <br /> <br />VI. INCLUDE CERTIFICATE OF INSURANCE WITH APPLICATION WITH THE CITY OF SOUTH BEND <br />LISTED AS AN ADDITIONAL CERTIFICATE HOLDER <br /> <br />VII. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />VIII.AFFIRMATION <br />I, hereby, certify and affirm that all of the information I have given in this application is true and <br />accurate to the best of my knowledge. I further certify that I have in no way attempted to <br />mislead the City in this application by omitting facts known to me. I agree to permit periodic <br />inspection of my equipment by the Board of Park Commissioners or their agent. I have read and <br />understand the regulations of the Arborist license found in the City of South Bend Municipal <br />Code, Section 4-19. <br /> <br /> <br /> <br /> <br />Signature Date