Forms for Commercial Haulers Hauler License Application Step 1 of 5 20% Business Name * Required Owner's Name * Required First Last Phone * RequiredEmail * Required Mailing Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Are your mailing and business addresses the same? * Required Yes No Business Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Local Contact InformationLocal Contact Person * RequiredNote: This is the person authorized by the owner to receive all communications regarding the hauler’s license. First Last Email * Required Phone * RequiredNumber of Residential CustomersPlease enter a whole number.Number of Commercial CustomersPlease enter a whole number. Solid waste to be transported is generated in: * RequiredCheck all that apply Entire District Bolton Burlington Charlotte Colchester Essex Essex Jct. Hinesburg Huntington Jericho Milton Richmond Shelburne South Burlington St. George Underhill Westford Williston Winooski Outside of CSWD Specify solid waste districts served outside of CSWDPlease separate multiple districts with a comma. Vehicle Information 1. Complete the Vehicle Information Table below, or upload your own file containing the requested information. 2. Upload your proof of insurance.1. Vehicle Information TableClick the “+” button until all of your vehicles are added. License plate #MakeYearVINBody style Upload your own form.Accepted file types: xls, xlsx, doc, pdf, Max. file size: 5 MB.Maximum file size – 5 mega bytes. 2. Upload proof of insuranceIf not already on file, have your insurance company submit proof of insurance naming CSWD as an additional policy holder. Liability insurance must be maintained at or above the following levels: $100K per person and $300K per occurrence for personal injury or death, and $100K per occurrence for property damage. Accepted file types: xls, xlsx, doc, pdf, Max. file size: 5 MB.Maximum file size – 5 mega bytes. Select the waste services you provide * RequiredSelect all that apply Landfill-bound Trash Mandatory Recyclables Construction / Demolition (C&D) Waste Yard Trimmings / Food Scraps Tires Scrap Metal Other Special Wastes (banned from landfill) Select the facility or facilities you use for LANDFILL-BOUND TRASH Casella Transfer Station: Williston, VT Waste USA Landfill: Coventry, VT Other Enter facility name and location Select the facility or facilities you use for MANDATORY RECYCLABLES CSWD Materials Recovery Facility (MRF): Williston, VT Other (Private processor) Enter facility name and location Select the facility or facilities you use for C&D WASTE All Cycle Transfer Station: Williston, VT Burlington Area Transfer Station: Williston, VT Myers Recycling Facility: Colchester, VT Other Enter facility name and location Select the facility or facilities you use for YARD TRIMMINGS / FOOD SCRAPS Green Mountain Compost: Williston, VT Other Enter facility name and location Enter facility name and location you use for TIRES Enter the facility name and location you use for SCRAP METAL Other Special WastesCheck all that apply Appliances Electronic waste Confidential materials destruction Non-regulated hazardous waste Clean wood Other Enter additional materials Please separate multiple entries with a commaCustomer education * RequiredPursuant to Section 4.8 G of CSWD’s Solid Waste Management Ordinance, commercial haulers are required to provide instructions on the proper management of Mandatory Recyclables, Special Wastes, Unregulated Hazardous Waste, and Compostables to new customers when service commences and to all customers on an annual basis at a minimum. Please indicate the method(s) used for delivery of instructions (check all that apply). Hand delivery USPS Email Other If other, please specify Hauler License Certifications Please read all items below and certify your agreement. License Applicants: 1. Will obtain all other necessary state and local permits and licenses prior to commencing activities under this license. [NOTE: State of Vermont Waste Transportation Permit required for any person that transports solid waste for compensation.]2. Will comply with all rules, regulations, and ordinances pertaining to the management of solid waste as enacted by CSWD and all applicable federal, state and local laws, rules and regulations. The undersigned understands that failure to comply may result in suspension or revocation of the License and/or other penalties.3. Is not delinquent in payments owed to CSWD in excess of 60 days past the billing date, and the required License fee has been paid.4. Will ensure that employees and personnel have received the education and training necessary to safely and properly conduct the undersigned’s activities under the License.5. Will ensure financial resources are adequate to allow the undersigned to safely and properly conduct the undersigned’s activities under the License.6. Will not unduly pollute any element of the environment nor impose any undue burden upon any element of the community.7. Will maintain liability insurance coverage at or above the following levels for the term of the License: $100,000 per person and $300,000 per occurrence for personal injury or death, and $100,000 per occurrence for property damage.8. Indemnifies and holds harmless CSWD from any and all claims, damages, losses and expenses (including attorneys’ fees) to the extent caused by the undersigned’s performance under the License or the performance by any agents, officers, subcontractors, employees, or personnel of the undersigned at facilities owned, leased, or operated by CSWD.9. Will ensure that every vehicle used by the undersigned or on the undersigned’s behalf in the collection, transfer, transport, or disposal of solid waste will be prominently labeled with an identification number provided by the District. [NOTE: Decals must be visible on the right and left sides of the vehicle.]10. Will not deliver nor dispose of any solid waste generated within CSWD at any facility not designated in his or her Hauler’s License. [NOTE: Hauler must notify CSWD of any changes in destination of waste generated in the District.]11. Will not place or cause to be placed any solid waste on private property unless lawfully authorized by the owner of the property and such placement is lawfully permitted.12. Will not transport solid waste unless such vehicle securely contains the solid waste in a manner that, while in transit, will prevent any of the solid waste and related liquids from escaping or leaking from the vehicle.13. Will ensure that any solid waste destined for disposal be delivered to and deposited at a transfer or disposal facility within forty-eight (48) hours of collection.14. Will provide (independently or through duly licensed subcontractors) collection of mandatory recyclables at least once monthly to all customers for whom such Hauler provides collection of solid waste destined for disposal. The undersigned will not offer and his customers will not subscribe to trash only collection service unless recycling collection service is provided or subcontracted by CSWD or a member municipality or unless they obtain an exemption from CSWD.15. Will provide instructions on proper management of mandatory recyclables, special waste, unregulated hazardous waste, and compostables to new customers when service commences and to all customers on an annual basis at a minimum.16. Will not dispose of mandatory recyclables that are properly prepared and set out for collection.17. Will not knowingly accept landfill-bound waste set out for collection that contains mandatory recyclables, hazardous waste, special wastes, or yard trimmings. The Hauler will alert CSWD of customers not source-separating banned landfill materials from trash destined for disposal.18. Will comply with the container labeling requirements in CSWD’s Solid Waste Management Ordinance.19. Will weigh solid waste hauled that is destined for disposal that was generated in CSWD on a District-licensed scale.20. Will submit to CSWD on a quarterly basis the quantity of scrap tires hauled from Chittenden County by weight, volume or count on a form provided by the District, if not weighed on a District-licensed scale. I have read and agree to all of the terms listed above. * Required I agree By initialing below I attest, as a representative of the above Hauling company, the information provided on this application and all accompanying documents is true, accurate, and complete. * RequiredPlease enter your initials in the box below. Truck license fee Quantity * RequiredEnter the number of trucks you are licensing (should match the total number of trucks entered under “Vehicle Information”). Price: $15.00 Quantity Total due $0.00 How would you like to pay? * Required Check/Money Order (made payable to CSWD) Cash Please send a check for full payment to: Chittenden Solid Waste District ATTN: Hauler’s License 19 Gregory Dr., Suite 204 South Burlington, VT 05403 Δ
