The URL can be used to link to this page

MATT STEWART - EXP 12/2014 rpm, 1o1► AFC JAN G 2 Lu111 i OFFICIAL USE ONLY • FORWARD TO P.D. BY' APPLICATION FOR TAXI OR LIMOSINE FOR HIRE OR RENEWAL Please complete application to register with the City of Yelm.A renews/application shall be made in the same manner upon submittal of the fee and other information and items required for the initial application,including photographs.(5.02.030 B) Application fee:$35.00 PAID PROOF REC'D-Waived if applicant has established an approved license from another Thurston County city. Proof of the paid for-hire license for the same time period and background check must be shown and verified.(5.02.070 C.) Fingerprinting Fee$5.00 (5.02.030 Al) Submit photographs with application- Three recent photos must be submitted with application. (lx application,lx police dept,lx attach to license when issued) Driver's Name it1-.44 he W 07 S' e Li I ( ! Phone number 36:0 -3.5'f "3 76—s Driver's Address '3/ ' jrttc,(ij.;/ (4 City,State and Zipcode Y{f!'^^, E_.if A. Mailing Address PC? 13 on I ( City Stale and Zipcode `i1/� u Lj f5 S' 7 Valid Washington State Drivers License Number 5'f 2 i/V 21-r_TY?O(')' (5.02.030) Vehicle License Tag/Plate Number Proof of Ownership Birthdate 0-C? Must be at least 18 years old. Proof of Insurance Business Name and Address k ell y /(4.3 City,State and Zipcode Mailing Address To I 1 7 ( City,State and Zipcode /r(ws 'i 5 5 7 Washington State 11131ft 1)Have you been convicted of a felony,or of operating a motor vehicle while under the influence of intoxicating liquor or drugs or of being in actual physical control of a motor vehicle while under the influence of intoxicating liquor or drugs,or of reckless driving or negligent driving,or of vehicular homicide or vehicular assault,with five years preceding the date of application for a license? N(y 2)Have you been convicted of three or more moving violation during any one-year period within the five years preceding the date of the application fora license? 1\l6 3)Are you at least 18 years with no physical or mental infirmity,which jeopardizes the ability to operate a for-hire vehicle.No person shall drive a for-hire vehicle,including limousines,within the City without first obtaining a license therefore from the City. A- 1,11 I certify my statements are true and accurate.My signature authorizes the City of Yelm to verify any information including a driver's abstract. :di ��.-- Signature , �� \_.__> `-� Date c� _ o� I-G' WATCH Search Results-No Match- Washington State Patrol Page 1 of 1 • Thursday, January 02, 2014 ISLONSTIITE PATROL fin` WASHINOTON ACCESS TO CRIMINAL HISTORY Web Search No Record Found Report Washington State Patrol Identification and Criminal History Section P.O. Box 42633 Olympia, Washington 98504-2633 Telephone (360) 534-2000 THE FOLLOWING WEB SEARCH NO MATCH FOUND REPORT IS FURNISHED FOR OFFICIAL USE ONLY This report was generated from a transaction run on 01/02/2014 at 14:41 Conviction Criminal History RCW 10.97.050(1) Pursuant to the purpose of inquiry, NO Record was found in the Washington State Criminal History Repository based on the descriptors provided: STEWART,MATTHEW 3 DOB 10/17/1963 SEX M RAC U This may mean that the person you searched for has no criminal conviction record OR that your search criteria did not match the spelling of the person's name or date of birth. Positive identification or non-identification in the Washington State Patrol's database, can only be determined by fingerprint comparison. https://fortress.wa.gov/wsp/watch/Inbox?rsPage=detail&LocalIndex=0 01/02/2014 dtWASHINGTON STATE DEPARTMENT OF LICENSING Vehicle Registration Certificate 956YFO 04/23/2013 License plate Plate Issue date Tab no Reg expiration Value code Year Mo reg Mo gwt Pwr Use Mod yr Make „ Body 956YFO 01/2009 G123960 04/19/2014 21585 ' 2001 12 G CAB 2001 MERC SAB4D Vehicle ident(VIN)/Serial no Res co Scale wt, Seats Model BT Gwt Gwt st Gwt exp Fleet Equip 1MEHM55S61G601581 27 3232 SL 4D Prey plate Filing TBD RTA Tax Subagent GwtNeh wt Other Total fees Gwt cr <32899 $3.00 $5.00 $10.00 $30.75 $48.75 KELLY FOSTER DBA KELLY KAB PO BOX 1761 YELM WA 98597 IP Ikliiippipr Signature of regisi'lirr.wner(s) Signature of registered owner(s) Comments: USE TAX WAIVED: GIFT-COLOR-GRAY- DISPLAY TAB ON BACK LICENSE PLATE ONLY- FRONT PLATE IS STILL REQUIRED. f I , • V, 5 Validation code 03342203131130423130001038147 t t t t t r r t t r t r r t r t r r r t r t t r r r r r t r t r RPT ID: AREGPR-1 This certificate is not proof of ownership. i • •t+ VehicleRegistration(R/10/12)E TD-420-802(R11112)Page 1 of 2 r ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MOD NYYY) 12131!2013 PRODUCER Phone:(206)420-4270 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Key Insurance,LLC HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 5200 Southcenter Blvd Suite 110 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tukwila,WA 98188 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Gateway Insurance Compannnnnnn _,_„�,. Kelly Ray Foster - -- - m DBA Kelly Kab INSURER B: P.O.Box 1761 INSURER C Yelm,WA 98597 INSURER D. I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DISK AOD'L POLICY EFFECTIVE POLICY NUMBER DATE IlT*DDIYYI PDATE MYTMTIDIYYIOUCY II LIMITSLTR u15RQ TYPE OF UISURANt'E GENERAL LIABILITY EACH OCCURRENCE $ LIABILITY DAMAGERENTED COMMERCIAL GENERAL $ PREMISES E M ISE S S LE.a.occurence)............. ._.____............................._............. CLAIMS MADE f I OCCUR MED EXP(Anyone person) f PERSONAL 8ADV INJURY $ GENERAL AGGREGATE $ GENt AGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ - -I POLICY 1 jE " J LOC , A N AUTOMOBILE LIABILITY CAP625481301 07/16/2013 0711612014 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY f 100,000 X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ 300,000 NON-OWNED AUTOS (Per ecddent) PROPERTYDAMAGE $ 25,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EAACC f AUTO ONLY: AGG $ EXCESSAIMBRELLA�LIABILITY ( EACH OCCURRENCE $ �, OCCUR 1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ I $ WC STATU- OTH- WORKERSCOMPENSATIOIIAND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERAAEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 8 If yes,describe under SPECIAL PROVISIONS below ' E.L.DISEASE-POLICY LIMIT $ OTHER A UIM CAP625481301 07/1612013 07/16/2014 25/50/10 DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLE S tE XCLUSIOIIS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS 2001 MERCURY SABLE IMEHM55S61G601581 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Department of Licensing NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL P.O.Box 9034 IMPOSE 110 OBUGATIOII OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Olympia,WA 98507 REPRESENTATIVES. AUTHO',?'',, ESENTATIVE �.. ( Y) ACORD 25(2001108) ©ACORD CORPORATION 1988 Printed by KKY on December 31,2013 at 09:04AM IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACO RD 25(2001108) Printed by KKY on December 31,2013 at 09:04AM IIIIIIIIIIIIIII D r b -� m 0 w, ti n x ~' cc ; � o 1 ft) ti o N o lv v, lit rb ---1 AIQ o a 7:) 7J it)) 3OIa