City%20of%20Seattle%20Taxicab%20Association%20Application

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City%20of%20Seattle%20Taxicab%20Association%20Application Powered By Docstoc
					                                                                                                                 CITY OF SEATTLE
                                                                                                                Consumer Affairs Unit
                                                                                                                805 S. Dearborn Street
                                                                                                                  Seattle, WA 98134

                                                                                   TAXICAB ASSOCIATION LICENSE APPLICATION
Directions: Please complete all parts of this application. Incomplete applications and applications with material misstatements of omissions will be denied [SMC 6.310.210B].          To advance within excel spreadsheet use
the Tab key and/or the mouse. The last page (pg 61 )must be printed, signed by association representatives and submitted with licensing CD and fees by December 31st. NOTE: Once information is entered into a field, it
is ok if entire data does not show. It is still in the field once it is entered. Just advance to next field and continue.

               TAXICAB ASSOCIATION OWNERSHIP INFORMATION [SMC 6.310.200A(2)]
Legal Name of Taxicab Association
Form of Business Entity (ex;corporation)
Trade Name                               Additional Trade Name                                                                            Customer Number                                                   UBI

               TAXICAB ASSOCIATION OWNER/OFFICERS/AGENTS
           Full Name                                 Title                                 Home Address                               City, State Zip                               Phone                     DOB              Fingerprint
                                                                                                                                                                                                             mm/dd/yy            Yes/No




                                                                          Attach a photocopy of the incorporation Papers Diled with the Secretary of State

Attach additional sheets if necessary, List any alias. Indicate "Yes" if fingerprints have been provided to the Consumer Affairs Unit previously. A criminal records check Is required annually: 1st year - fingerprint check, 2nd/3rd
year - name/date-of-birth check. Cycle repeats.

               CRIMINAL RECORDS - TAXICAB ASSOCIATION OWNER/OFFICERS/AGENTS
Please list all bail forfeitures, convictions or other final adverse findings during the five uears previous to the date of this application against any of the owners, officers or agents of the taxicab association [SMC 6.310.210]:


Name                                                   Findings                                                                                                                                                                    Date
              TAXICAB ASSOCIATION REPRESENTATIVES/ALTERNATES [SMC 6.310.200A(5)]

           Full Name                               Title                                Home Address                                  City, State Zip                               Phone                     DOB              Fingerprint
                                                                                                                                                                                                             mm/dd/yy            Yes/No




              CRIMINAL RECORDS - TAXICAB ASSOCIATION REPRESENTATIVES/ALTERNATES.

Please list all bail forfeitures, convictions or other final adverse findings during the five uears previous to the date of this application against any of the owners, officers or agents of the taxicab association [SMC 6.310.210]:


Name                                                 Findings                                                                                                                                                                      Date




              BUSINESS OFFICE INFORMATION

Business Address                                                                                                           City, State ZIP
Mailing Address                                                                                                            City, State ZIP
Open at:      0:00 am                    pm          Close at:                 0:00     am             pm                  Days open
Business Office Phone                                                                 Business Dispatch Phone
Business Office Fax                                                                   Business Dispatch Fax #
Email Address                                                                                                                             Web Site Address
        TAXICAB INSURANCE INFORMATION [SMC 6.310.230A(2)]
                             Only use as many rows as needed then advance to next section of application

Cab #   Policy Number   Exp Date   Insurer Name                   Address                           City, State ZIP   Phone   Liability   Underinsured
                        mm/dd/yy                                                                                              Coverage    Coverage
                                                                                                                              Amount      Amount
           TAXICAB ASSOCIATION RATES [SMC 6.310.200A(7)]

Fixed Rates
Drop:       $2.50 Per 1/10 Mile:                  $0.20 Per Min. Wait:                    $0.50 Extra Passenger:           $0.50

Special Rates
Senoir Citizens:           % discount off meter         Handicapped                 % discount off meter

A Certificate of Compliance is on file for every new taximeter installed since the National Type Evaluation Program (NTEP) of the National Conference on Weights and Measures became
effective in Washington.

           CONTRACT RATES

Comments

Name                        Address                               City, State Zip               Rep Name           Phone           Fax     Rate              Conditions Eff Date
                                                                                                                                                                        mm/dd/yy




           ACCEPTABLE METHODS OF PAYMENTS (Yes/No & Comments)

VISA       MC       AMEX       DISC      Traveler's     Personal Money      Metro Scrip         Canadian   Other Comments
                                         Checks         Checks Orders
            TWO - WAY COMMUNICATION [SMC 6.310.220A(1)]

FCC - Licensed Radio Frequencies:

Frequency                  Use                      Location of Base Station   Shared With




            MOBILE RADIOTELEPHONE SERVICE

Cab #       Telephone Number        Use
            AFFILIATED FOR-HIRE DRIVERS
For-Hire drivers must have a valid license and may only drive for a mazimum of three (3) taxicab associations. [SMC 6.310.150C]
                                           Only use as many rows as needed then advance to next section of application
Name                         Address                                 City, State ZIP                          Phone             Customer   DOB        F-H #   WA State DL
Last, First MI                                                                                                                  Number     mm/dd/yy           Dual, City or
                                                                                                                                                              County
            AFFILIATED TAXICABS
This license application will be denied if there are not as least 15 currently licensed taxicabs [SMC 6.310.210B(1)]
                                             Only use as many rows as needed then advance to next section of application
Cab #       Licensee Name                    Address                    City, State Zip              Customer WA State Plate   VIN   Year   Make   Licenses Held
            Last, First MI                                                                           Number                                        Dual, City or
           TAXICAB ASSOCIATION VEHICLE COLOR SCHEME [smc 6.310.200A(3)]
Please provide two 2-inch x 2-inc sample color chips and diagram or color photographs (front view, rear view and side view) of taxicab painted with the color scheme.

Vehcicle Color Scheme Comments

Base Color          Parts of Vehicle                            Second Color         Parts of Vehicle                       Stripe Color Logo


            TAXICAB ASSOCIATION DRIVER UNIFORM(S) [SMC 6.310.200A(4)]
Please fully indicate all uniform color. Only indicate one color for pants and jacket
Pants       Shirt Sweater                   Jacket         Shorts (Summer)       Other                                 Comments


             TAXICAB ASSOCIATION YEARLY LICENSE FEES [SMC 6.310.150A]

Fee Type            Fee Amount                                  Explanation
Annual              $ 1000.00                                   Association Regulatory License
Business License    $ 90.00                                     Association Business License
Fingerprint         $ 26.00                                     All owners/officers/agents/representative/alternates

             CERTIFICATION OF TAXICAB ASSOCIATION REPRESENTATIVES [SMC 6.310.200A]
I certify that the information provided on this application is tru and complete. I understand that incomplete applicaions and application with material missstatements or
omissions will be denied. [SMC 6.310.210B]




                   Signature of Taxicab Association Representative                                                                   Date


                                              Subscribed and sworn to me this                           day of              200

                                                                                                         Residing in                                        Notary Seal
                                                                     Notary                                                 County
Last Page # 61

                        TAXICAB ASSOCIATION REPRESENTATIVE AND ALTERNATE SHEET


    Please complete and submit with application diskette.


                      PRINT NAME                            SIGNATURE            EMAIL ADDRESS

				
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