HomeMy WebLinkAbout(0014) ELG Waste Removal Application.pdfFORT WORTH. APPLICATION FOR
NON-EXCLUSIVE PRIVILEGE AGREEMENT
(Collection and Transportation of Municipal Solid Waste)
INSTRUCTIONS: Complete form and return to City of Fort Worth, Solid Waste Management Division
4100 Columbus Trail, Fort Worth, TX 76133
Trade Name of Applicant
ELG Waste Removal
Physical Address
Contact Name
Celeste Herrera-
Contact
tq17 141216
Mailing Address
3512 Baldwin Ave FTW TX
Telephone Number
Fax Number
1. Briefly describe the nature and character of the service the applicant proposes to
rl o1Fr0ff Dumpster Rental
2. Estimated Number of Vehicles Operating Under this Agreement. A list
of all vehicles must be attached to this application. The list shall 1
include make, model, year and license plate number of all vehicles to
operate under this Agreement.
3. Do each of the vehicles listed in question 2 above have a current City No
of Fort Worth Hauling Permit?
4. Applicant has attached Certificated of Liability Insurance as required in le One
the Non -Exclusive Privilege Agreement, section 13. rYE3
NO
5. Signature of person authorized by the Company to sign this Application
Signature Celeste Herrera
Title Owner. Date March 19 2021
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For City Use Only
Privilege Agreement Number: Date Approved:
Period Covered: to Approved MSC Number:
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Distribution: City Secretary, Solid Waste Division, Applicant