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Permittee Information

Insurance Requirements*
Required Insurance for City of Modesto vendors. You are required to upload this information into our Insurance tracking system (PINS) prior to the issuance of this permit.
1. I have reviewed the Insurance requirements and understand upon issuance of this permit, the vendor must acquire and maintain required insurance.
Are you an Approved City of Modesto Tree Vendor?*
1. Yes
2. No (please submit Application first)
In order to apply for this permit, you must have an approved application to be a vendor on file. You must be listed as an Approved Tree Vendor and have current Insurance documents uploaded to our PINS system.
Permittee*
City of Modesto Business License Number*
Purpose of Permit*
City Street Tree Species*
Owner's Name*
Street Address*
City*
State*
Zip Code*
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Encroachment Permit*
Approved Vendor shall obtain an encroachment permit.
1. I understand that this is required prior to performing any work or staging in the right-of-way and shall have a copy on site of all encroachment permits while work is being performed.
Removal of All Debris*
Approved Vendor is responsible for removing all debris from job site. Debris may not be left in the street, public right-of-way, sidewalk, or alley. Small or fine debris material shall be cleaned up and or placed in a manner as to keep it from entering City storm drains.
1. I agree
Notice of Completion Requirement*
1. I will provide a copy of the final invoice indicating the work was completed within ten (10) days after the work is completed.
2. I shall notify the Forestry Division immediately upon completion of the maintenance on a public street tree.
City Issued Notice
If a Notice was issued to the Customer by the City, a copy of the Notice must be submitted with this Permit Application.
Estimate for Services to be Performed*
A copy of the estimate for the work to be performed must be submitted with the permit.
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ANSI Standards Required*
1. I understand that approved vendors shall comply with all standards contained in ANSI A300 and Z133. I agree to comply with these standards upon approval of this application.
Uniform Traffic Control Device Requirement*
1. I understand that an Approved Vendor shall comply with all requirements of the Manual of Uniform Traffic Control Devices.
Safety Device Requirement*
1. I understand that as an Approved Vendor, I will be required to install any safety devices deemed necessary for public safety in accordance with OSHA and ANSI standards.
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Acknowledgment*
Permittee hereby agrees to indemnify and hold harmless the City of Modesto, the City Council, any other officer, employee, or agent of said City, from all suits, claims or actions of every kind brought as a result of any injury or damage suffered, whether to persons or property, which was sustained as the result of any act or omission of the Permittee, their employees, contractors, agents, or anyone else acting on behalf of Permittee, in the maintenance of any public street tree under the terms of this permit.
1. I agree
Acceptance of Terms*
1. I hereby agree to the above conditions and further acknowledge that failure to comply with these requirements, as listed above, will result in the revocation of this permit.

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