City of Edina Form Center

2. Business Name*
4. Contact Person First Name*
5. Contact Person Last Name*
7. Contact Person Email*
8. Contact Person Phone Number*
10. Business Address*
12. City
13. State
14. Zip Code
16. Provide your Minnesota Tax ID Number. If a Minnesota Tax ID Number is not required, explain why.*
17. Provide a Federal Tax ID or Social Security Number.*
19. If application is made on behalf of a partnership, corporation or LLC, please furnish the following:
21. Name of Partner (or Officer) and Title
22. Business Address
24. Name of Partner (or Officer) and Title
25. Business Address
27. Name of Partner (or Officer) and Title
28. Business Address
32. Truck Information
34. All trucks to be licensed must be listed below.
36. Vehicle Year*
37. Vehicle Make and Model*
38. Minnesota License Number*
39. Edina License Number
41. Vehicle Year
42. Vehicle Make and Model
43. Minnesota License Number
44. Edina License Number
46. Vehicle Year
47. Vehicle Make and Model
48. Minnesota License Number
49. Edina License Number
51. For more vehicles, upload additional documents.

    Documentation should include the same information as the above entries.

53. Frequency of Service*
54. Type*

    1. Commercial
    2. Residential
55. Do you provide recycling service?*

    1. Yes
    2. No
59. Fees
    • First vehicle license fee: $365
    • Each extra vehicle: $115

    You will be contacted about how to pay the fees after your application has been submitted and reviewed.

61. Certificate of Insurance*

    ($1,000,000/$1,000,000/$1,000,000)

62. Copy of Rate Schedule*
64. Are You a New Hauler to Edina?*

    1. Yes
    2. No
66. Additional forms needed - You are required to mail in a
    Continuing Bond Form (PDF)

    Print and fill out the Continuing Bond Form. 

    Mail to:
    Edina City Hall
    Attention: Jeff Brown
    4801 W. 50th St.
    Edina, MN 55424

68. I agree to send the Continuing Bond Form to the City.*

    1. I agree.
72. Insurance Company Name

    Please do not provide the name of the insurance agent.

74. Policy Number
75. Expiration Date
77. I am not required to have workers' compensation liability coverage because:

    1. I have no employees.
    2. I am self-insured (include permit to self-insure below).
    3. I have no employees who are covered by the workers' compensation law (these include: Spouse, Parents, Children, and certain farm employees).
79. Upload a certificate of insurance or permit to self-insure.
81. I certify that I have provided proof of coverage or I am not required to have workers' compensation liability coverage.*

    1. I agree.
83. Data Practices Act*

    The Minnesota Data Practices Act requires that we inform you of your rights about the private data we are requesting on this form. Private data is available to you, but not to the public. We are requesting this data to determine your eligibility for a license from the City of Edina. Providing the data may disclose information that could cause your application to be denied. You are not legally required to provide the data, however, refusing to supply the data may cause your license to not be processed. Under M.S. 270.72, the City of Edina is required to provide the Minnesota Department of Revenue your MN Tax ID Number and Social Security Number. This information may be used to deny the issuance, renewal or transfer of your license if you owe the Minnesota Department of Revenue delinquent taxes, penalties or interest. The Department of Revenue may supply information with the Internal Revenue Service. In addition, this data can be shared by Edina City Staff, the State of Minnesota Driver License Section, Hennepin County Auditor, Bureau of Criminal Apprehension, Hennepin County Warrant Office and Ramsey County Warrant Office. By agreeing below, you indicate that you understand these rights.

    1. I agree.
85. Submission Information

    Please note that your submission is encrypted for data security, so you will not receive a copy of your submission by email. 

    You may choose to print a copy by selecting "Submit and Print" below. Your submission information will open in a new tab or window. The original tab/window will go to a confirmation page; scroll to see the confirmation message and contact information should you need that.

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87. Submit Submit and Print

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