MAINTENANCE GARDENER PEST CONTROL BUSINESS
LICENSE PACKET
STATE OF CALIFORNIA
(REV. 7/24)
DEPARTMENT OF PESTICIDE REGULATION
LICENSING AND CERTIFICATION
PO BOX 4015
SACRAMENTO, CALIFORNIA 95812-4015
(916) 445-4038
Email:
Web
site:
<www.cdpr.ca.gov>
MAINTENANCE GARDENER PEST
CONTROL BUSINESS LICENSE
PACKET
Contains the following documents:
•
Licensing Requirements and Fact Sheet
•
Application & Instructions
•
Supplemental Application Information
•
Financial Responsibility Information
•
Financial Responsibility Documents:
o
ACORD Certificate of Liability Insurance
(sample)
o
Certificate of Insurance
o
Pest Control Business Licensees Bond
o
Liability Certification Statement
o
Certificate of Deposit (no document is available,
proof from bank issuer is required)
•
Licensing Visa/Mastercard Transaction Form
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
(REV. 7/24)
MAINTENANCE GARDENER PEST CONTROL BUSINESS
LICENSING REQUIREMENTS
MAINTENANCE GARDENER PEST CONTROL BUSINESS LICENSING REQUIREMENTS
Do you need
this license?
You must possess a Maintenance Gardener Pest Control Business (MGB) License if you
are a maintenance gardener who occasionally engages in pest control in support of your
primary gardening business for hire
1
(Food and Agricultural Code [FAC] section 11704a).
•
You are a Maintenance Gardener if your maintenance gardening activities include
mowing lawns, engaging in general yard cleanup, and/or taking care of plants and
turf in:
o Outdoor ornamental and garden areas surrounding public structures, such
as buildings, brick walls, fountains, fences, statues;
o Outdoor ornamental and garden areas surrounding commercial parks, such
as, offices, restaurants, warehouses, factories, stores, shopping centers,
malls;
o Parks, golf courses, cemeteries, but only on ornamental or turf plantings near
buildings (clubhouses, pro shops, restrooms) that are distinct and separate
from the plantings that constitute open space landscaping in a park, golf
course or cemetery itself.
If the primary purpose of your business is pest control, you must obtain a Pest
Control Business License.
Licensing
exemption
Persons doing pest control incidental to new construction are not required to obtain this
business license. This includes construction work in establishing new landscapes.
Basic licensing
requirements
You may obtain a MGB license by submitting the following:
o Application;
o Appropriate fee;
o Supplemental application information (PR-PML-143);
o Qualified person’s identification;
o Proof of financial responsibility;
o Documents required to verify y our business name and type, if applicable; and
o Worker’s compensation insurance, if applicable.
Definitions and more information will follow.
Qualified
person
A qualified person is someone in a supervisory position that holds a valid Qualified
Applicator Certificate (with a subcategory Q-Maintenance Gardener or category B-
Landscape Maintenance) or a valid Qualified Applicator License (with a category B-
Landscape Maintenance). There must be at least one qualified person at each business
location at all times [FAC section 11704(a)].
Please state the name of the qualified applicator, their license or certificate number, and
their license or certificate category as indicated on the application form.
Continued on next page.
1
“For hire” refers to any person who advertises, solicits, or operates as a business.
Page 2
Maintenance Gardener Pest Control Business
Licensing Requirements (Rev. 7/24)
Financial
responsibility
You must demonstrate financial responsibility by choosing one of the options listed below
and completing the required form associated with your preferred option (FAC section
11702(c)(2) and Title 3 of the California Code of Regulations [3 CCR] section 6524). All
department forms are available in this packet. They are also available on the DPR website:
www.cdpr.ca.gov/docs/license/lcforms.htm.
Options
Required Forms
Minimum Amounts
1) Liability
Insurance
Submit one of the following:
•
ACORD Certificate
of
Liability
Insurance
Bodily
injury per
person
$5,000
Bodily
injury per
occurrence
$10,000
Property
damage
$5,000
•
Certificate of Insurance
(PR-PML-052)
2) Certificate
of
Deposit
Proof from bank issuer
$5,000 (need not exceed $300,000)
3) Surety Bond
Pest Control Business Licensees
Bond (PR-PML-053)
$5,000 (need not exceed $300,000)
4) Self-Insurance
Liability Certification Statement
(PR-PML-170)
Damages paid with personal
assets.
Verifying
your business
name and type
You must have the following documents to verify your business name and type (FAC
section 11702(a). If you are the owner of the business and use your surname as part of your
business name, then no documents are required.
Document Name
Details
Fictitious Business Name
Statement
(Sole Proprietorship or
Individual)
•
Obtain from the County Clerk’s Office or County
Record’s Office.
•
Applies to any business operating under a name other
than the owner’s surname.
Certificate of Good Standing
(Corporation, Partnership,
Limited Liability Corporation,
Limited Liability Partnership or
Non-Profit)
•
Applies to any domestic or foreign corporation
operating in California.
•
Must be obtained by registering with the California
Secretary of State’s Office.
Continued on next page.
Page 3
Maintenance Gardener Pest Control Business
Licensing Requirements (Rev. 7/24)
Worker’s
compensation
insurance
You must have worker’s compensation insurance if your business has employees (Labor
Code section 3300). See the table below for instructions on how to demonstrate that you
have met the requirements for worker’s compensation insurance.
If you have employees and
a
valid worker’s
compensation
insurance
policy:
State the carrier’s name, policy number, and
expiration date in section H of the application.
If you do not have employees:
Write “no employees’ in section H of the application.
NOTE: If you are interested in self-insurance to fulfill this requirement, please go to the California
Department of Industrial Relations for information.
Requirements
after license is
issued
Once you obtain your license, you must do all of the following:
•
Register with the County (see below);
• Retain pest control application notification records for two years (3 CCR section 6619);
• Retain records of pesticide use for two years (3 CCR section 6624);
• Submit pesticide use report records to County Agricultural Commissio
ner every 10
th of the
month (3 CCR section 6627);
• Possess valid permits from the County for restricted materials used (3 CCR section 6632);
• Provide proof of financial responsibility each year by submitting your renewed financial
resp
onsibility statement; and
• Provide proof of worker’s compensation insurance (if applicable) each year by submitting a
valid certificate of worker’s compensation insurance or by completing the Worker’s
Compensation Insurance Verification form (PR-PML-120), which can be found at
www.cdpr.ca.gov/docs/license/lcforms.htm
.
County
registration
Before you conduct any work, you must register the MGB license with the county
agricultural commissioner’s office in each county that your business intends to perform pest
control (FAC section 11732). Most counties require an annual fee for registration, which
covers one calendar year. For a list of county registration fees, please go to the DPR
website at www.cdpr.ca.gov/docs/license/liccert.htm.
To register your MGB license with the County, the qualified person must present the
following items to the county agricultural commissioner’s office.
•
Valid MGB license,
•
Valid QAL/QAC card – Landscape Maintenance (category B) or Maintenance
Gardener (subcategory Q), and
•
Inventory of pest control equipment, including number and kind of equipment.
Continued on next page.
Page 4
Maintenance Gardener Pest Control Business
Licensing Requirements (Rev. 7/24)
Application
fee
The application fee is $180 per calendar year for this license (3 CCR section 6502).
Depending on the name of your business, you may be required to pay a second year fee
o
f an additional $180. This distinction is based on the following second year cycles:
If your business name begins
with…
Then your license will…
A through L
Expire on December 31 of even-numbered years (e.g.
2024
, 2026, 2028, etc.)
M through Z (including
businesses starting with “The”)
Expire on December 31 of odd numbered years (e.g.
20
23, 2025, 2027, etc.)
For example, if you applied for a license under the name “The Best Landscaping Company”
in January 20
23, then your license expires on December 31, 2023 (in this case, the license
duration is one year) and the fee is $
180. If you applied for a license under the name “Best
Landscaping Company” in January 20
23, then your license expires on December 31, 2024
(
in this case, the license duration is two years) and the fee is $360.
Valid licenses A list of currently valid business licenses may be viewed at the DPR website at:
www.cdpr.ca.gov/docs/license/currlic.htm.
License
duration
A new license may be issued for up to two calendar years, depending on when you apply and
license cycle. Each renewed license is valid for two years unless you renew late.
Renewal fee The renewal fee is $360 for the 2-year cycle (3 CCR section 6502). We do not prorate your
fee if you renew your license late. Instead, a late fee is applied.
Late renewal
fee
A late fee of 50 percent of the total renewal fee will be charged for each license postmarked
after December 31 of the expiration year.
Continued on next page.
Page 5
Maintenance Gardener Pest Control Business
Licensing Requirements (Rev. 7/24)
Miscellaneous
fees
The following chart lists possible miscellaneous fees.
Type
Amount
Details
Name
change
$20
•
This option applies only if you are changing your business name.
o If you are changing your business status (corporation,
partnership, individual, or LLC), or if the owner is changing,
you need to apply and pay for a new business license.
•
You must immediately notify the Licensing and Certification
office in writing (3 CCR section 6508).
•
You must submit legal documents certifying the name change (i.e.
Fictitious Business Name Statement).
•
A new license will be issued for all name changes.
•
Name change requests can be submitted by completing the
Maintenance Gardener Pest Control Business License application
(PR-PML-004) and marking the “Name/Address Change” box.
Address
change
$20
(fee only
required if
requesting
a new
license)
•
You must immediately notify the Licensing and Certification
office in writing (3 CCR section 6508).
•
Address change requests can be submitted by completing the
Maintenance Gardener Pest Control Business License application
(PR-PML-004) and marking the “Name/Address Change” box.
Duplicate
$20
•
This fee applies to requests for a duplicate or replacement license.
•
Duplicate card requests can be submitted by completing the
Maintenance Gardener Pest Control Business License application
(PR-PML-004) and marking the “Duplicate/Replacement License”
box.
Name and/or address change fees are waived when a license is reprinted during renewal.
Common
mistakes
The most common application errors are:
•
Incorrect fees;
•
No insurance documents, or the insurance documents submitted do not meet our
requirements;
•
No business type information provided;
•
No qualified applicator listed, or the qualified applicator has the wrong license
type.
You can avoid these errors by reading the application instructions carefully.
Continued on next page.
Maintenance Gardener Pest Control Business
Licensing Requirements (Rev. 7/24)
Page 6
Our mailing
addres
s
Department of Pesticide Regulation
Licensing and Certification Program
P.O. Box 4015
Sacramento, CA 95812
For more
information
Please email us at [email protected].
Note: Your application and materials must be mailed to DPR. We cannot accept
electronic submittals.
This page intentionally left blank for double‐sided printing.
State of California
Maintenance Gardener Pest Control Business
License Application
LIC-004 (Rev. 07/24)
Page 1 of
4
Depar
tment
of Pesticide Regulation
Licensing and Cer
tification Program
PO Box 4015
Sacramento, CA 95812-4015
E-Mail: Lic
enseMail@cdpr.ca.gov
Web site
: http://www.cdpr.ca.gov/
For complete instructions, see pages 3 and 4.
A. Application Type.
Check the appropriate box(es).
New Application
(One location per business license)
Name / Address Change
Duplicate / Replacement License
Maintenance Gardener Business License #
B. Business Information.
Business Name
E-Mail Address
Phone Number
Business Mailing Address (Number and Street or PO Box Number)
(City)
(County)
(State)
(ZIP Code)
Business Location Address (Number and Street) (City) (County) (State) (ZIP Code)
Business Type (Check only one box.) See instructions for documentation requirements.
Corporation
Individual
Limited Liability Company
Partnership
Non-Profit Association
Limited Liability Partnership
C. Former Business Name.
Enter former business name and license number below.
Former Business Name
License Number (optional)
D. Business Officers or Owners.
Attach additional sheet if necessary.
1) Name
Title
Mailing Address
(Number and Street or PO Box Number)
(City)
(State)
(ZIP Code)
2) Name
Title
Mailing Address (Number and Street or PO Box Number)
(City)
(State)
(ZIP Code)
3) Name
Title
Mailing Address (Number and Street or PO Box Number)
(City)
(State)
(ZIP Code)
E. Qualified Applicator. Each business must
have a qualified applicator who possesses a valid Qualified Applicator Certificate
(QAC) or Qualified Applicator License (QAL) with the Landscape Maintenance category B or Maintenance Gardener
subcategory Q. The qualified applicator is responsible for supervising all pest control operations performed by the business.
1) Qualified Applicator Name
QAC or QAL Number
Expiration Date
Business Location Address (Number and Street or PO Box Number)
(City)
(State)
(ZIP Code)
State of California
Maintenance Gardener Pest Control Business License Application
LIC-004 (Rev. 07/24)
Page 2 of 4
F. Maintenance Gardener Pest Control Business Type.
Select the type(s) of pest control your business will engage in. Check all that apply.
Interior Plants or Landscape Maintenance
Exterior Landscape Maintenance Vertebrate Pest Control
Turf Pest Control
Ornamental Plant Pest Control Weed Control
G. Liability Insurance. Each applicant must show proof of financial responsibility that meets the requirements of Section 6524
of Title 3, of the California Code of Regulations. Proof of financial responsibility is demonstrated by having your insurance carrier
complete one of the two attached insurance certificates or some other method approved by the Department.
H. Worker’s Compensation Insurance. Each applicant who is an employer, as defined in Section 3300 of the California Labor
Code, is required to carry worker's compensation insurance. If your business has no employees, write "No Employees" below.
Worker’s Compensation Insurance Carrier Name
Policy Number
Expiration Date
I. Fees. All fees are non-transferable and non-refundable. (See “New License Fee Examples” in the instructions on page 4)
1- Year 2 -
Year Total Fees
Location
$180
or
$ 360 =
$
Name/Address Change, Duplicate/Replacement Fee
$20
=
$
Total Fee(s) Due
=
$
Enclose a check, money
order, or credit card information for the total amount due. Make payable to: "DPR Cashier."
Mailing Instructions: Mail your completed application, required documentation, and fees to:
Department of Pesticide Regulation
Att
n: Cashier MS-4A
PO Box 4015
Sacramento, CA 95812-4015
J. Re
ad Before Signing. During the last three years have you had any administrative, civil, or criminal action taken against you
for violation of any State or federal laws or regulations relating to the application or use of pesticides that resulted in disciplinary
actions or in which any disciplinary action is pending?
Yes (Attach explanation on a separate page.)
No
K. I declare under penalty of perjury, under laws of the State of California, that the above information is true and
correct.
Applicant Signature
Date Signed
State of California
Maintenance Gardener Pest Control Business License Application Instructions
LIC-004 (Rev. 07/24)
Page 3 of 4
Failure to complete or provide the requested information will delay the processing of your application.
A. Application Type:
New Application: If you are applying for the Maintenance Gardener Pest Control Business License for the first time.
A separate business license is required for each Maintenance Gardener business location (i.e., one license per
location).
Name/Address Change: Every business shall immediately notify DPR of any change. Submit a copy of the legal
document substantiating the name change. Address changes may be made directly on the application form. A new
license will only be mailed if you submit a $20 fee.
Duplicate/Replacement License: Requesting a duplicate or replacement license.
Maintenance Gardener Business License Number: Ent
er your cur
rent Department of Pesticide Regulation (DPR)
Maintenance Gardener Pest Control Business license number.
B.
Business
Information: You must immediately notify DPR, in writing, of any change in the business name. Enter your
former business name, and license number (optional), in Section C. Submit the following information with your new
application or name change according to your business type below:
Partne
rship: Submit a “Fictitious Business Name Statement” which may be obtained from the county clerk’s office.
Individual: If the business name is different than your surname (last name), submit a “Fictitious Business Name
Statement” which may be obtained from the county clerk’s office.
Corp
oration, Limited Liability Company, or Limited Liability Partnership: Submit a current copy of the “Certificate
of Good Standing” which may be obtained from the Secretary of State, Certificate Department.
Non-Profit Association: If the business
is
a corporation, submit a current copy of the “Certificate of Good Standing”
which may be obtained from the Secretary of State, Certificate Department, 1500 11
th
Street, Sacramento, California
95814. If the business name is different than your surname (last name), submit a “Fictitious Business Name
Statement” which may be obtained from the county clerk’s office.
C.
Former Busi
ness Name: Enter the former
name and license number (optional) in this section of the application.
D.
Busi
ness Officers or Owners: List the name, title, and mailing address of the business officers and/or owners. If
necessary, use an additional sheet of paper. Notify DPR immediately if there is a change in the business ownership or
organization. A new application and fee must be submitted for this change.
Each eligible employee must complete and submit the Statement of Verification (PR-PML-143) indicating he/she meets
the criteria to become a maintenance gardener.
E.
Qual
ified
Applicator: Each business must have a qualified applicator who possesses a valid Qualified Applicator
Certificate (QAC) or License (QAL) with the Landscape Maintenance category B, or QAC with Maintenance Gardener
subcategory Q. The qualified applicator is responsible for supervising all pest control operations performed by the
business. If there is a change in the qualified applicator for the business, notify DPR immediately. There is no fee required
for this change.
F.
Mainten
ance Gar
dener Pest Control Business Type: Indicate the type of pest control your business will be
performing or performs. Check all that apply.
G.
Liability
Insurance: Each applicant for a Maintenance Gardener Pest Control Business License must demonstrate
financial responsibility that meets the requirements in Title 3, California Code of Regulations (3 CCR) section 6524.
(Note: Coverage must include chemical liability.) Financial responsibility is demonstrated by one of the following
methods:
1. File with DPR an approved certificate of insurance certifying liability insurance coverage that meets the minimum
requirements. This can be achieved by having your insurance carrier complete the attached Certificate of
Insurance (DPR-PML-052, Rev. 8/11).
State of California
Maintenance Gardener Pest Control Business License Application Instructions
LIC-004 (Rev. 07/24)
Page 4 of 4
2. In lieu of insurance or a certificate of deposit, the maintenance gardener business may provide a “Liability Certification
Statement” (PR-PML-170) to DPR, under
penalty of perjury, that as to chemical property damage resulting from their
pest control operations, you are financially able to respond to damages using your own personal assets, etc.
3. A Certificate of D
eposit that meets the minimum requirements in 3 CCR section 6524.
4. A surety bond that meets the minimum requirements of 3 CCR section 6524.
See the Financial Responsibility Options chart in 3 CCR section 6524 for specific coverage requirements. If you have
questions, call DPR.
H. Worker’s Compensation Insurance: Each applicant
who is an employer, as defined in Section 3300 of the California
Labor Code, is r
equired to carry worker’s compensation insurance. If applicable, enter the name of the worker’s
compensation insurance carrier, the policy number, and the policy expiration date.
I. Fees: All fe
es are non-transferable and non-refundable.
Maintenance Gardener Pest
Control Business License
A-L business name submitting
in even calendar year*
or
M-Z business name submitting
in odd calendar year*
M-Z business name submitting
in even calendar year*
or
A-L business name submitting
in odd calendar year*
Location
$180
$360
Name/Address Change or Duplicate / Replacement Fee: $20
*Your license fee is based on whether you are applying in an ‘even’ or ‘odd’ calendar year and whether your business name begins with
the letters ‘A-L’ or ‘M-Z.’ This is because DPR has a set two-year renewal cycle based on the business’ name. See the following
examples to help determine the appropriate fee.
New License Fee Examples
:
Year Submitting Application
Business Name
Starts with…
License
Application Fee
License expires on December
31
st
of the:
Odd Calendar Year
(i.e., 2025, 2027…)
A-L
$360
next even calendar year
M-Z
$180
current calendar year
Even Calendar Year
(i.e., 2024, 2026…)
A-L
$180
current calendar year
M-Z
$360
next odd calendar year
J. Read Before Signing: Check appropriate box and provide ex
planation, if necessary.
K. Declaration/Signature Block: Sign and date your application.
Mailing Instructions: Enclose a check, money order, or credit card information payable to “Cashier, DPR” and mail to:
Department of Pesticide Regulation
Attn: Cashier
MS-4A
PO Box 4015
Sacramento, CA 95812-4015
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
SUPPLEMENTAL APPLICATION INFORMATION
LICENSING AND CERTIFICATION PROGRAM
Maintenance Gardener Pest Control
1001 I STREET
SACRAMENTO, CALIFORNIA 95814-2828
Business License
(916) 445-4038
(916) 445-4033
Web site: http://www.cdpr.ca.gov/
PR-PML-143 (REV. 9/07)
SUPPLEMENTAL APPLICATION INFORMATION FOR MAINTENANCE GARDENER
PEST CONTROL BUSINESS LICENSE
Section 11704(b) of the Food and Agricultural Code states: The maintenance gardener shall be limited to
pest control in ornamental and turf plantings indoors, surrounding structures and commercial parks. (A
"commercial park" is a tract of land where several commercial establishments [e.g., stores, offices,
restaurants, warehouses, factories] are located. Business "parks", industrial "parks", office "parks", and
shopping centers or malls would be commercial parks.) A contract or verification that the pest control
operation is incidental and that maintenance gardening is the primary purpose shall be immediately
submitted to the commissioner or director upon request.
I, , the undersigned, verify under penalty of perjury, that the pest control
(Print Name)
operation is incidental and that maintenance gardening is the primary purpose of my business. The business
name is
Executed on
(Month and Day)
, 20
at
(City)
, California.
SIGNED
(Address)
(City) (State)
APPLICANT - PLEASE SEND THIS COMPLETED FORM ALONG WITH YOUR MAINTENANCE
GARDENER PEST CONTROL BUSINESS LICENSE APPLICATION TO THE LICENSING AND
CERTIFICATION PROGRAM AT THE ADDRESS LISTED ABOVE IN THE UPPER RIGHT CORNER.
This page intentionally left blank for double‐sided printing.
Type of
Pest
Control
Business
Option 1:
Liability Insurance
Option 2:
Certificate
of Deposit
Option 3:
Surety Bond
Option 4:
Self-
insurance
Pest Control
Business
(Ground/
Fumigations)
Submit one of the following:
• Acord Certificate of Liability Insurance
(must include required statement; see
sample); or
• Certificate of Insurance (PR-PML-052)
Proof from
bank issuer
Pest Control
Business
Licensees Bond
(PR-PML-053)
N/A
Pest Control
Business
(Aerial)
Submit the following:
• Certificate of Insurance (PR-PML-052)
Proof from
bank issuer
Pest Control
Business
Licensees Bond
(PR-PML-053)
N/A
Maintenance
Submit one of the following:
Proof from
Pest Control Liability
Gardener
• Acord Certificate of Liability Insurance
(must include required statement; see
sample); or
bank issuer
Business Certification
Pest Control
Licensees Bond Statement
Business
• Certificate of Insurance (PR-PML-052)
(PR-PML-053) (PR-PML-170)
STATE OF CALIFORNIA PEST MANAGEMENT AND LICENSING BRANCH
DEPARTMENT OF PESTICIDE REGULATION 1001 I STREET
P.O. BOX 4015
SACRAMENTO, CA 95812-4015
(916) 445-40
38
FAX (916) 445-4033
Web site: http://www.cdpr.ca.gov
FINANCIAL RESPONSIBILITY OPTIONS
FOR PEST CONTROL BUSINESS
(REV. 5/07)
If you are applying for a pest control business license, then you must demonstrate financial responsibility by choosing
one
of the options listed in the tables below.
Required
forms
The following table lists the forms required for each option. You can obtain all department PR-PML
forms from our Web site at
<http://www.cdpr.ca.gov/docs/license/lcforms.htm>. If you choose to
submit the Acord Certificate of Liability Insurance form provided by your insurance company, then it
must state that your policy meets and complies with Title 3 of the California Code of
Regulations, Code section 6524, including chemical bodily injury and chemical property
damage coverage. See our Acord sample for more details.
Required
amounts
The following table lists the dollar amounts required for each option.
Type of Pest Control
Business
Option 1: Liability Insurance
Option 2:
Certificate
of Deposit
Option 3:
Surety
Bond
Option 4:
Self-
insurance
Bodily
Injury Per
Person
Bodily
Injury Per
Occurrence
Property
Damage
Pest Control Business
(Ground/Fumigations)
$100,000 $300,000 $50,000 $75,000 $75,000 N/A
Pest Control Business
(Aerial)
$100,000 $300,000
$100,000
per aircraft
(a)
$50,000
per aircraft
(b)
$50,000
per aircraft
(b)
N/A
Maintenance Gardener
Pest Control Business
$5,000 $10,000 $5,000 $5,000 $5,000
Pay for
damages
using
personal
assets
(a) When more than one aircraft is insured, the property damage aggregate is one-half the property
damage limit times the number of aircraft insured.
(b) A certificate of deposit or surety bond need not exceed $300,000 per license.
STATE OF CALIFORNIA
PEST MANAGEMENT AND LICENSING BRANCH
DEPARTMENT OF PESTICIDE REGULATION
1001 I STREET
SACRAMENTO, CA 95814-2828
P.O. BOX 4015
SACRAMENTO, CA 95812-4015
(916) 445-4038
FAX (916) 445-4033
Web site: http://www.cdpr.ca.gov
CERTIFICATE OF INSURANCE
DPR-PML-052 (REV.
08/11)
This is to certify to the Director of the Department of Pesticide Regulation, whose address is 1001 I Street, Sacramento, California
95814-2828 that (name of business), an applicant for a
pest control business license, is at this date insured with
(Insurance Company) for the Limits of Coverage stated below.
Coverage Descriptive Schedule
Insurance Coverage
Policy
Number(s)
Expiration
Date(s)
Limit of Liability
Per Person
Limit of Liability
Per Occurrence
Limit of Liability
Annual Aggregate
1. Bodily injury including Chemical
Liability
$
$ $
2. Property Damage including
Chemical Liability
$ $ $
3. Combined Single Limit for Bodily
Injury and Property Damage
including
Chemical Liability
$
$
List of Covered Aircraft (Attach additional sheet if necessary)
Aircraft "N" Number Aircraft Usages (Chemical Use/Nonchemical Use) Remarks
1) N
2) N
3) N
Insured Information
INSURED BUSINESS NAME
PEST CONTROL BUSINESS LICENSE NUMBER (Optional)
BUSINESS LOCATION ADDRESS
CITY
STATE
ZIP CODE
Insurance Company and Insurance Agent/Broker Information
1. INSURANCE COMPANY NAME
FAX NUMBER (Optional)
EMAIL ADDRESS
(Optional)
PHONE NUMBER (Optional)
MAILING ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON NAME (Optional)
2. INSURANCE AGENT/BROKER NAME (Optional)
FAX NUMBER (Optional)
EMAIL ADDRESS
(Optional)
PHONE NUMBER (Optional)
MAILING ADDRESS (Optional)
CITY
(Optional)
STATE
(Optional) ZIP CODE (Optional)
CONTACT PERSON NAME (Optional)
The undersigned hereby certifies that liability insurance issued to the aforementioned insured, fulfills the requirements stated
above and the requirements pursuant to Section 6524, of Title 3, of the California Code of Regulations.
The issuing company agrees that in the event of non-renewal or material change, including cancellation or reduction of coverage
of the policy(ies), the issuing company will endeavor to give the party to whom the Certification is issued 30 days advance notice
of such non-renewal or change, but the issuing company shall not be liable in any way for failure to give such notice.
DATE
INSURANCE REPRESENTATIVE SIGNATURE
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STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
PEST MANAGEMENT AND LICENSING BRANCH
LICENSING AND CERTIFICATION PROGRAM
1001 I STREET
SACRA
MENTO, CALIFORNIA 95814-2828
(916) 445-4038
FAX - (916) 445-4033
Web site: http://www.cdpr.ca.gov/
PEST CONTROL BUSINESS LICENSEES BOND
DPR-PML-053 (REV. 08
/11)
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
Pest Control Business Licensees Bond
Food and Agricultural Code Section 11702(c)(2)
Premium Amount:
KNOW ALL PERSONS BY THESE PRESENTS:
That
having an address for service at
,
California, as PRINCIPAL, and
,
a corporation duly authorized as an admitted surety insurer in the State of California, as SURETY, are held and firmly
bound to the State of California, and in favor of every person or entity obtaining judgment against the
PRINCIPAL,
in the sum of
DOLLARS ($
), for the payment of
which we bind ourselves, or heirs, executors, successors, and assigns, jointly and severally, firmly by these presents.
WHEREAS, the above-named PRINCIPAL holds or has applied to the Director of Pesticide Regulation of
the State of California for license entitling said PRINCIPAL to conduct the business of Pest Control, in accordance
with the provisions of Division 6, Chapter 4 of the Food and Agricultural Code of the State of California; and
WHEREAS, the provisions of the Food and Agricultural Code Section 11702(c)(2), require that the
PRINCIPAL satisfy the Director of PRINCIPAL's financial ability to respond in damages from any illness, injury,
or damage resulting from the work authorized by the license, and this bond is executed and tendered in accordance
therewith.
.
NOW, THEREFORE, if said PRINCIPAL shall respond in damages for any illness, injury, or damage
resulting from the work, then this obligation is void, otherwise to remain in full force and effect.
The aggregate liability of the Surety on all claims whatsoever shall not exceed the penal sum of this bond.
This bond shall be deemed continuous in form and shall remain in full force and effect, and run concurrently
with the license period and any and all renewals, or until cancellation or withdrawal of the Surety from the bond.
Surety may cancel or withdraw from this bond pursuant to the provisions of the Code of Civil Procedure Sections
996.310 et seq.
This bond is executed to comply with provisions of Chapter 4 of Division 6 of the Food and Agricultural Code
and of Chapter 2, Title 14, Part 2 of the Code of Civil Procedure, and said bond shall be subject to all of the terms
and provisions thereof.
NAME OF SURETY
ADDRESS FOR SERVICE
I certify (or declare) under penalty of perjury, under the laws of the State of California, that I have executed
the foregoing bond under an unrevoked power of attorney.
Executed in
,
(City and State)
.
on
.
(Date)
Signature of Attorney-in-fact
of Surety
Printed or typed name of
Attorney-in-fact for Surety
STATE OF CALIFORNIA PEST MANAGEMENT AND LICENSING BRANCH
DEPARTMENT OF PESTICIDE REGULATION 1001 I STREET
LIABILITY CERTIFICATION STATEMENT
MAINTENANCE GARDENER PEST CONTROL
BUSINESS LICENSE
PR-PML-170 (REV. 7/03)
SACRAMENTO, CA 95814-2828
P.O. BOX 4015
SACRAMENTO, CA 95812-4015
(916) 445-4038
FAX (916) 445-4033
Web site: http://www.cdpr.ca.gov
I, certify that I engage in pest control for hire as
an incidental part of my regular Maintenance Gardening business.
I will respond to any damages I may cause while performing activities through the use of my own personal
assets.
I certify that there are no unpaid judgments against my company resulting from lawsuits filed against the
business.
I certify that there are no current lawsuits filed against my company relating to pest control activities.
I certify that there are no liens on my personal or real property due to unpaid taxes.
THE BUSINESS NAME IS
I DECLARE UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE STATE OF CALIFORNIA,
THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE DATE
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-- -- --
◻
◻
/
State of California
Department of Pesticide Regulation
Sacramento, CA
Web site: http://www.cdpr.ca.gov
Email: [email protected]
DPR-105-A (Rev. 7/20)
Page 1 of 1
Licensing Visa / Mastercard Transaction Form
Complete this payment form and mail with completed application form(s) to:
ATTN: Cashier
Department of P
esticide R
egulation
PO Box 4015
Sacramento, CA
95812-4015
All sections must be completed. Do not e-mail or fax this form. Electronically received forms will not be
accepted.
Failure to complete all sections of this form will result in your application and payment being delayed or rejected.
Cardholder Information.
Name (as it appears on the card) Telephone Number
Card Information. (Visa and Mastercard only. No other cards are accepted)
Card Type (check one):
Visa Mastercard
Card Number (16 digits):
Expiration Date: Billing ZIP Code:
Total Amount of Payment: $
Signature of Cardholder
Billing Address (Street or PO Box Number)
If the cardholder is not the licensee, or if the cardholder is paying for multiple licensees, indicate who the
payment is for below. Please attach an additional sheet if needed.
1) Licensee Name
4) Licensee Name
License Number
(if applicable):
License Number
(if applicable):
2) Licensee Name 5) Licensee Name
License Number
(if applicable): License Number (if applicable):
City State
ZIP Code
3) Licensee Name 6) Licensee Name
License Number
(if applicable): License Number (if applicable):
(Department Use Only) – Entered on POS by: Date Entered: Date Mailed: Mailed By:
Notes:
( )
