Required Documents:

• License Application Form (PI-079)
• Proof of Insurance
• Incorporation, partnership, or assumed name documents (where applicable).
• Notarized Statement of Experience (PI-217) if adding a new category.

1. LICENSE APPLICATION
   
   
1. Is the current and full legal name of the business on the application?
   
   
2. Have you filled in the emergency phone number and the fax number? Note: E-mail address requested for 2007!
   
   
3. Are all the applicators full names and certification/registration numbers listed? Attach an additional sheet if necessary. It is the responsibility of the license applicant to provide updates to MDA regarding any changes in status of any of the firm’s applicators. Certified applicator's must be certified in categories they're applying for before submitting business license application.
   
   
   • If you or your employees have recently taken certification exams, please attach copies of your receipt(s) that show the exam scores and dates.
     
     
4. Have you selected all the license categories that your firm intends to provide application services for?
   Does your listing of certified applicators cover all those categories?
   
   
5. IS THE APPLICATION SIGNED? We cannot process an application that is not signed.
   
   
6. Have you enclosed a check or money order for $100.00, payable to STATE OF MICHIGAN?
   
   
   Please allow 4 to 6 weeks to process your business license.
   
   
2. CORPORATION/PARTNERSHIP/ASSUMED NAME DOCUMENTS
   
   
1. Have you enclosed necessary business name documents?
   
   • Incorporation or Partnership verification
   • Assumed Name Certificate
     
     
2. Are the certificates current and active (i.e. have not expired)?
   
   
3. PROOF OF INSURANCE
   
   
1. Does the insurance certificate form include:
   
   • Exact same legal name of the business as provided on the application?
     
     
   • Exact same street address for the business as provided on the application?
     
     
   • Correct effective and expiration dates that coincide with the license year? It is the responsibility of the license applicant to provide a current certificate of insurance to MDA, not the insurance agent’s duty. You must mail or fax (517-335-4540) any updated insurance information to our Lansing office Pesticide Application Business Desk, MDA Pesticide Section.
     
     
2. Are the amounts of coverage correct? See PI-168 for amounts.
   
   
3. Does the insurance coverage include bodily injury and property damages that arise from pesticide applications?
   
   
4. NOTARIZED STATEMENT OF EXPERIENCE
   
   
1. Have you enclosed the notarized statement of experience (form PI-217).
   
   
2. Does the experience statement include the required timeframe and the contact persons along with their phone numbers?